HomeMy WebLinkAboutT15N R1W SEC 19 LT 22
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
M^,L,NCAD.RESS po, ~o~ ~ 3l
LE ^LDESCLT' N ;, t,
Manufacturer · , ' Materia~ No. of compartments
L~q' .~a ' ' MEBDE.' Inside length Width Liquid depth
~ ....... ~ Liquid capacity in gallons
DISTANCE TO: [~ ~ /~ ~ ~ ~ Distance be~epn lines
No. of lines ~ Length of e~n~ Total length of lines ~ width (
Top of tile to finish grade // Material beneath tile / , ~ r
Length Width Depth PERMIT NO.
Type o~ Crib diameter Crib dept~ Total effective absorption area
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
72~013 (Rev, 3/78)
PERMI'f NO. ( )
LOCATION
T~'F'E OF SOZL RBSORBTZON _,~_,TEM
MAXIMUM NUMBER OF BEDROOMS =
THE REQUIRED SIZE OF THE SOIL MB_~ORPTIuN =.~_]EM IS:
LOT _I=E /~)~9¢(¢-.QURRE FEET
SOIL RATING (SO. FT, BR..-
D. EPTH= ~¢r /¢':-7-
THE LENGTH DIMENSION IS THE LENGTH (.(N FEE]-) OF.Tt4E TRENCH OR DRAINFIELD.
THE DEP.TH OF R TRENCH OR PIT IS THE DISTFINCE BETWEEN THE SURFACE OF THE
GROUND BN[:, THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEE]').
REL--4.1J I RED, S;EP'-F I C:
PERMIT RPPLICFINT HAS THE RESPONSIBILITY TO INFLRM THIS DEPFIRTMENT DURIN.~ THE
INSTRLL, RTION INSPECTIONS OF RN~r' WELLS FIDJRC:ENT TO THIS PROPERTY FIND THE
NUMBER OF REz, I[.E~uE_ ]'HAT THE WELL WILL _ERbE.
TI-,-I C~ ( 2 ) I i'-4 SF' E C:- ]- I I]~l'-I'_~ ARE RELqLI I RE [.'-,
8FIC:KFILLING OF RNM SMSTEM WITHOUT FINAL INSPECTION AND FIPPR. OYFIL 8~r' THIS
DEPFIRTMENT WILL BE SUBJECT TO PROSEC:UTION.
MINIMUM DISTANCE BETWEEN Ft WELL AND FiNer' ON-SITE SEWFiGE DISPOSFiL S~?STEM IS
100 FEET FOR FI PRIVATE WELL; OR
150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS FiRE REQUIRED FiND MUST BE RETURNED TO THE DEPARTMENT WITHIN gO DRYS
OF THE WELL. COMPLETION,
OTHER REQUIREMENTS MFi'¢ FipPLY. SPECIFICATIONS AND CONSTRUCTION DIFtGRRMS ARE
FiVFiILFiBLE TO INSURE PROPER INSTALLR'rION.
PERI'I I T E)~-:F· I RE.=. [:,EL~--EMBER _~--1..
I CERTIFY THAT
1: I RM FBMILIFiR WITH THE REQUIREMENTS FOR ON-SITE SEHERS FtND WELLS RS SET
FORTH 8~' THE MUNICIPFiL. IT¥ OF RNCI4ORFIGE.
2: I WILL INSTFiL_L THE SYSTEM IN RCCORDFINCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM f'lR~' REQUIRE ENLRRGEHENT IF THE
RESIDENCE IS REMODELED TO I~CLLIDE MORE THAN ~ BEDROOMS. ~ , -
......
0 & E ENG,NEERING & DEVEL ,JIENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Performed for:
SOIL LOG
Name: ~v/~ /~' ~Z.~
Mailing Address: ,'~ 7;;~./, ~4~'/-'~ //~/~'~-/~,
LegalDescription: ZoT" ,~, c~. J~'., ~'jb~/./ ~ ~::>/Vd',~
Earl Ellis
688-2280
Tel. No. '~ - 2~.~
Depth (feet)
0
Soil Characteristics
4__
5__
6__
7__
8__
9__
10__
11__
PLOT PLAN
12__
13__
14__
15__
16__
PERC. TEST
//~ ' Z4~T ~a
Ground Water Encountered: Yes /'"/" No If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments: ...~//~ L ~
Performed by: ~ .... ~ ~_
GAAB-HD-I
GI~r-~TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT ~
327 EAGLE ST. ANCHgRAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING j'~)~ '7 '~/ ~', /~, PHONE.
ADDRESS --
LEGAL DESCRIPTION ~"~ r ~,- ....
DISTANCE FROM WELL '~ 7 ! J
MATERIAL (~'j/1-~'j~', b /'~-~.. NUMBER OF
COMPARTMENTS
LIQUID CAPACITY /J '7 '~'~-,~ GALLONS. INSIDE LENGTH JJ' ! INSIDE WIDTH 7 ! DEPTHLIQUID
SEEPAGE SYSTEM: SEEPAGE PiT:
NUMBER OF PITS ~/
LINING MATERIAL ~ .~"~,C-~",
NEAREST LOT LINE
OUTSIDE DIAMETER OR WIDTH
J""l~/'~'I 5' DISTANCE FROM WELL_ I '~ '7
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH f~ ! , DEPTH ~ /
BUILDING FOUNDATION ~'~ /,
e~ '~:'-~ SQ. ET.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
, FOUNDATION ~,/,- NEAREST LOT LINE
DISTANCE.~J~:,.T. tArE-'~ LINES TRENCH WIDTH
SQ. FT. _~LENGTH OF EACH LINE
!
DEPTH OF FILTER MATER AL BENEATH TiLE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
DISTANCE FROM ,~¢~ j WATER
!
. .. BU LDING FOUNDATION SAMPLE
WELL: TYPE~ J~ ;- ~.NEAREST DEPTH. SEPTIC ~¢7 j SEEPAGE
LOT LINE · SEWER LINE ~-~ r~ TANK SYSTEM /~'7 . CESSPOOL
DISTANCES:
':7~J ~/"7/
~-7~ =,5
DATE
, NEAREST
OTHER
, SOURCES
DIAGRAM OF SYSTEM
6
APPROVED ','~.4~ ~).
HEALTH AUTHORI[¥ ~
GAAB-H D-~
GREATE ANCHORAGE AREA DROUGH
. . , HEALTH DEPARTMENT
: ' 327Eagle St. A~chorage~Alaska 99501 279.2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION
NAME.OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
~ ('~'~) &( /~- ~ MAILING ADBRESS
LOCATION OF INSTALLATION
,SEEPAGE PIT v . ~/,;~RA,~N~iELD
T0 BE INSTALLED BY .~,
~ ANTICIPATED DATE 0F COMP~ETION
BELOW T0 BE FILLED OUT BY HEALTH DEPARTMENT~'~
& PERMIT
,OTHER.
, PERMIT TO INSTALL A
AS DESCRIBEB BELOW. S ZE OF UNIT TO BE J{E,RVEB ' ';~ ~'~ ~ ~ [~fi/( /"
.SEPTICTANKSlZE /~)~ T~PE'(/'~' ~?~S~EEP,AGE"A~REA .-~9c~ TYPE
DISTANCES:
Health Authority
DIAG RAM' OF SYSTEM
/~ certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE ~/ ~:/~: APPLICANTS SIGNATURE W - ' '