HomeMy WebLinkAboutLot 009A
LOCATION
/ '" MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NO. OT OOMS
PERM O.
No. of compartments
Inside length Liquid depth
IF HOMEMADE:
Well Dwelling PERMIT NO.
Well Foundation
DISTANCE TO:
No. of lines Length of each
Top of tile to finish grade
Width
Depth
W dth
Material
Nearestlotline
oflines Trench width inches
Material beneath tile
Depth
Liquid capacity in'gall, ohs
Crib depth ~ t
Driller
SewerJine
DISTANCE TO:
Suilding foundation
PER,NO,
/~ance between lines
Total effective absorption area
inches
Total effective absorption area
Nearest lot lin~ /' ~
Distance to lot line
Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATIN~,
72-0 I~y~/Rev. 3~78)
~MUNICIPALIT~ OF ANCHORAG~-$
Department f Health ano Environment~ )Protection
825 L Street, Anchorage, AK. 99501
Permit
Applicant:
Location:
264-4720
* * * HANDWRITTEN PERMIT * * *
~L~5~---AND/OR ON-SITE SEWER PERMIT
~O~~ Mailing Address:
Phone Number:
Legal Description: ~'-~-/~ 5.1 S
Type of Soil Absorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms: ~
~t~A~ /~C/~ot Size:
Seepage Bed: __
Soil Rating (sq. ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH~'y LENGTH /$~ GRAVEL DEPTH ~ '&~ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE : /C~OO GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disPosal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
t~sidence is remodeled to include more that 3 b~drooms.
Applicant Date: ~"~'~f'~'~3 ~"
SWP/024(1/81)
v MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
82~, ,%~reet, Archorage, Alaska 99501 264-4720
SOILS LOG ~ PERCOLA] ION TEST
PER FO~h',~ E D FOR:
5
6
7
8
9-
10-
11-
12-
13-
15-
17-
18-
19-
20-
COMMENTS
SOILS LOG
SLOPE
WAS GROUND WATER WO ~_
ENCOUNTERED? 0
P
E
IF YES, AT WHAT
DEPTR7
[] PERCOLATION
TEST
SITE PLAN
PERFORMED BY:
Time Time Water Drop
PERCOLATION RATE (minutes/inch)
BETWEEN FT AND FT
DATE PERFO",,"ED:_'Z'
APPLIC' ,NT FILLS OUT UPPER HA ONLY
Buyer
Address ~ ~/~' Zip Code
Phone
Lending institution
Phone
Realty Co. & Agent
Address Zip Code
Legal Description
Type of Res~nce
~ Single Family
~ M~tiple F~mily No. of Bedrooms
~ Other
Water Supply
~ Individual A~ACH W~LL LOG. A w~l log is required for all wegs drilled ~ince June ~975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tenk
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector ~nspector
~ ~ t - ~LIm~ MUNiCiFALiTf -~F ANCHOF, AGE
Field Notes: ir) /~ ~ \L....V~' ~/ (1 l~ , ~ DEPT. OF H~/',LTH ~..
( ~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
co. mo.
ADEQUACY TEST
WATER AND SEWER INSPECTION
WELL INSPECTIONS ANO
FLOWTEST
S~TE PLANS
ROAD DESIGN
SOIL TEST
ON SITE WASTE WATER
DISPOSAL SYSTEM DESIGN
EXCAVATION WORK
Abernathy Construction
SR 1 Box 1015
Chugiak, Alaska 99567
ROBERTA, SHAFER
November 18, 1983
CIVIL ENGINEER
694-2979
RECEIVED
Dear Mr. Abernathy,
Reference: Lot 9A~ Section 25~ T15N: R2W
A well inspection was performed on the well located on the
referenced property as you requested. It is noted that the
well casing was equipped with an adequate sanitary seal~' and
that the wires needed to be placed in conduit. On re-inspection
the following day it was noted that the wires had been placed in
conduit. .It was also noted that the ground around the well
casing adequately sloped away from the well. At the same time
c~hat this inspection was performed a water sample was taken
and submitted to Chemical and Geological Laboratories of
Alaska for coliform bacteria analysis. The results of this
test were satisfactory.
If we may be of further service, please do hesitate to contact
Sin~e~7 ,~/~ ~ /
/ 7 /' P.E.
cc: First National Bank of Anchorage
Eagle River Branch
SRB 196X EAGLE RIVER, ALASKA 99577
CHEMIC.4L & GEoLOGIC/iL LABORATORIES OF'~i, ASK.4, INC.
TELEPHOh ~NCHORAGE INDUSTRIAL (
Drinkin ysi for Tota
'Bacteria
TO BE
WATER SYSTEM:
suPP~IER~
COMPLETED BY LABORATORY
shows this Water SAMPLE to be:
Water
Zip Code
Year
SAMPLE
NO.
I
I
3 I
I
chy
SAMPLE DATE: ~ ~
Mo. Day
[] Check Sample (for routine sampl~
/with lab ref. no. ,~! E] Treated Water.
~[-Speclal Purpose [ ,, ~ntreated Water
' I
isfactory
le too long in transit; sample should
.~ over 48 hours old at examination to
reliable results. Please send new
)le via special delivery mail.
//-I~-~.?
:'-!~'"~'
Tim .~eoelved
' A~al!~ical Method:
[3 Fermentation Tube
~JM embrane Filter
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
oL122o lb) BACTERIOLOGICAL WATER ANALYSIS RECORD