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Home My WebLink AboutT15N R1W SEC 4 LT 23 /~ 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 NAME MAILING ADDR LEGAL DESCRIPTION LOCATION PHONE [] NEW Well DISTANCE TO[ No. of lines Length Top of tile to finish grade Foundation DISTANCE TO: ] /O'7I~t~ I b/~' '70~'~ Manufacturer DISTANCE TO: Well ~/,~ Dwelling Nearest lot line lines Trench width inches Length ,.,~,/ / Width NO. OF BEDROOMS Type,,of crib Crib diameter No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines Material beneath tile Total effective absorption area inches ~ , OV j PERMIT NO. Crib depth To{al effective ~bsorption Building fo~d~_~io~.~ Nearest lot line ,~ Driller. I Distance to lot line [ PERMIT NO. Sewer line I Septic tank I Absorption area(s) Well DISTANCE TO: DISTANCE TO: OTHER PIPE MATERIALS foundation INSTALLER MUNICIPALITY OF ANCHORAGE Department oh Health and Environmental~rotection ~_~ ~ 825 i ,~Street, Anchorage, AK. i '* * * HANDWRITTEN PERMIT * * * ,,-4~ELL AND/OR ON-SITE SEWER PERMIT .-~ Location, Phone Nu er: Legal Description: Z ~3 ~ T/I~B/~~t Size: Type of Soil Absorption System I~: Trench: Drainfield: ~._ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating (sq. ft/br) ~ ,~,~.~ The Required Size of the Soil Absorption System Is: ,~- / DEPTH 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(HOA4~rt'NG) TANK SIZE =/~/C/L3 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 onisite 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 3L 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set fore_th by the Municipality of Anchorage. (2) I wi~ ~nstall t~e system in accordance with codes. ' (3) I ~de~d ~t the on-site sewer system may require enlargement if ~~y/y re modeled to include more that 3. bedrooms~ ! SWP/024 (1/81) O & E ENC',~NEERING & DEVELC. MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 894-2774 SOIL LOG 688-2280 Performed for: Name: ~---A,4.1 ~ ~ P, i~,q U ,~/'2. Tel. No. ~'~'- UailingAddress: ~,~)' ~ I ~-~/ CL-(¢(~[/~(~, ./ /~,~- LegalDescription: L~'T' 23/ ~>,~..,Z~ "'T-I~-I~ f ~'~IW/ Depth (feet) 0 2__ 3__ 4 5 6__ 7 8 9 10__ 11 Soil Characteristics ~P PLOT PLAN 12__ 13__ 14__ 15__ 16__ Ground Water Encountered: Proposed Installation: Comments: PERC. TEST Yes 1// No___ If yes, what depth Seepage Pit Drain Field Performed by: Date' .2-/.~/~ ~, Property Owner Maignrg Address APPLIC' IT FILLS OUT UPPER HAI. "ONLY Zip Code Buyer Address~ Lending Institution Address ~..~ / ./.~ , . Zip Code Realty Co. & Agent Address Zip Code Street Looatio~ Ty o~_~i Residonce Single Family ultiple Family No. of Bedroorr~ [] Other Zip Code Phone Phone Phone ater Supply Community Public Utility ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). Sew r Disposal (~ Public Utility [] Holding Tank Year Individual Installed: When Connected to Public Utilily: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ( ~OVED BEDROOMS ~ 'CONDITIONS OF APPROVAL ( ) DISAPPROVED CONDITION APP OVAL* . DATE 72-023 (3182) APPLIC "~T FILLS OUT UPPER HAL~- ~ONLY '" Phone Property Ow~ner ~),q ~'l ~ ~' ~' L~/~' ~ ~ ~< Buyer ~j~O ~ ~ ~}G,~[~>~o~ Zip Code Address Zip Code Realty Co. & Agent F) o ~ ~ z,p Cod~ Address Type of Residence L~ Single Family [] Multiple Family [] Other Water Supply ~ Community [] Public Utility ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available). Sewer Disposal ~ ~n~c~lViicd ~l~'il i, y [~ I:lolding Tank Year Individual Installed: ~ ,~ ~j t_'~ When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY~ E'ACH REQUEST BEF~ORE PROCESSING CAN BE INITIATED. Time Time Tilne Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ~" ( ) APPROVED BEDROOMS~. ~~ *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE~ Al?~--~ u ~'~*r~ Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72.023(3/~2} CHEMICAL & GEoAjOGICAL LABORATORIES OF ALASKA, INC. /'~-- / TELEPHOI~ (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER %\5\~'JP,~ t ~_~/~ /~Z~'_~ ~., ~ 5~33 s st,~ ~, -~ ~ TO BE COMPLIED ~Y~WATER SUPPLIER TO BE COMPLIED BY ~BO~TORY WATER SYSTEM: )I.D. NO. (') see h o~ back Analysis shows this Water sAMPLE to be: ~ati~factory Water System Name ! Phone No. Day Year SAMPLE TYPE: ' Routne el' [] Check Sample (for routine sampl with lab ref. no. [] Special Purpose Zip Code [] Treated Water [] Untreated Water SAMPLE NO. LOCATION Time Collected , t , I Collected READ INSTRUCTIONS BEFORE COLLECTING SAM PLE [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. ate R,c,,ved Time Received Analytical Method: [] Fermentation Tube ~/'Membrane Filter Lab Ref. No. I I I Result* Analyst 06-1220 (t~) BACTERIOLOGICAL WATER ANALYSIS RECORD EXCAVATION ROBERT A. SHAFER WORK August 11, 1983 CIVIL ENGINEER 694-2979 The Municipality of Anchorage Department of Health and Environmental 825 L Street Anchorage, Alaska 99501 Protection Reference: Lot 23: Section 4: T15N~ R1W: Seward Meridian At the request of A1 Larson, Rustic Homes Construction, we examined the well located on the referenced property. We found that the well was adequately sealed and that all wires had been placed in,conduit as required. The ground around the well casing sloped away from the well. At the same time we took a water sample and submitted it to Chemical and Geological Laboratories of Alaska. It is our understanding the results of this test which have been furnished to your office were satisfactory. If we m.a..y be of further service, contact ~s. , Sincer e~.~t/? / please do not hesitate to SRS 196X EAGLE RIVE~, ALASKA