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HomeMy WebLinkAboutKNIK HEIGHTS BLK G LT 4~~ / . o/7 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTti & 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 ADDRESS IPHONE ~NEW [~]UPGRADE LEGAL DESCRIPTION LOCATION ] Well DISTANCE TO: ] /~J ~ ~L LL~, Manufacturer ~Liq. capacity in gallons I .......... Iw''' _,/ ~~ Length of each line ~op ~f'tile ,o finis~ grJde : ~--'O Length Width Type of mib ~,~ Crib diameter' Absorption area [ Dwellin9.,l I /Mate iai Dwelling Material Foundation Nearest lot line z¢~ / Tre'~thgdth Total length of lines Material beneath tile Depth NO. OF BEDROOMS PERMIT NO, Li~pth PERMIT NO, Liquid capacity in gallons PERMIT NO. D i st a rge/,~t we e n lines Total effective absorption area PERMIT NO. Crib depth Building foundation Total effective absorption area Nearest lot Ihle Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE LEGAL October 12, 1981 S & S Engineers 5610 Silverado - Suite A7 Anchorage, Alaska 99502 Subject: On-site Sewer Inspections This department requests a more detailed report on the inspection reports. See example below. If there are a~ office at 264-. Sincerely, Les N. Buchhol Senior Environ LNB/ljw / .,i,,,i'~, ,th . ...,/. h,-,-,~'', · ,Z.I ,,,,i f,, I,>,,.~1,, 2:,: .... / . ~ MUNICIPALITY OF ANCHORAGE / DEPARTMENT OF HEAl_TH & ENVIRONIVIENI'AL PROT['_-CTION I.!k.~l~'.-~))ENVIRON~ENI'AL ENGINEERING DIVISION 825 LStreet-Anchorage, Alaska 99501 Telephol]e 264-4720 ON-S~T~ S.WAQ~ ~SPOSAL SYST~ ANU/O. W.LU ~NSP~C'nON .~PORT ..M. ~ ~- ,' 1P"°"~ MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~ |~ DISTANCE TO: I . i: ~. I Manufacturer ~ ' ~ Liq. capacity in gallons ~ ~,,~ ~ L ~SZANC~ZO: ~' ~ ~ ~ Top of die to finish grade _ ~ "DISTANCE TO: ~ Well Depth Absorption area Inside length Dwelling Foundation 'Total length~:~f Iines --L6', ~"~ Material beneath Depth Crib depth Building foundation Driller Sewer line NO, OF BEDROOMS Dvvellin9 PERMIT NO. [Width Liquid depth PERMIT NO. J Trunch width ~ Distaoct~ between lines ~ b~ incl?~. _L Total effeclive ab$orl)uOl] 81011 OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE LEGAL 'T'H[:.:: I_[EI'.,![~'TH fi:, I I'"IE:Iq'.E; ]: O1'-,I :[ :~:'~; "['HIE I....E:I'.,IQTH ,:: I i'.,I f:'EET ::, OF' 'TFI[~: TR:E:I'.,IC:H O1:~: r~,l:;?.f:.l ;[ I'.,IF' ]: EL.I:::,. 'T'FIrE: [::,E:I:::'TH 01:::' f::l 'T'F.':E:I'.,tC:H 01~: F:':[T :1::~!: THE: [::, ]: '."~:TP'II'.,IC:E!: E:E:'T'FI[~:E:I'.,I THE: ':'!:';L.I[r:iI::'FIC:Ei: Cfi::' TH.E!: I:~il:r~'.OI...ll'.,ll:::, l::ll'.,l[::, TH[i: E?,CITTOI'"I OF' TH[:.:: "['HE:F;i:E: :!::ii~; i'.,!O :~:~;[~:'T' I.,.I:[[::,TH F:'OF;i: THE: C:ffi¥:l'v'EI.... I:::,E:I:::"T'H :[ !~: THE: RI'.,I[:.', THE: E[CF'I"TOP1 OF' 'T'HE: E:?::C:FI',/FIT :[ CE:!:;i:T ]: I::".," 'T'f.'lf:lT ::l..: :1:I::11'"1 I:::'t:::ll'"l:[lr..:[l::lf;~: F.t]:TH THE: I:r:iE:~:~:!I...I]:'::::E:P'IFZt'"IT'.E; f:'Of;i: OI'"I'":!.~;:[TE: %E:l".l!:~i:F~::i'~; F:II'"I[::' I."lE:l...t....:~i; I::'OI:;i:TH E""r' THE: I"!I..If"I:[C:]:I::'FII...:[T"r' O1::: ~:~: : :1: I"rl :[ I...L-- :1: !'.,IE~',"r'I::IL.I... THE: :.::!;'-.,.':E;T,E:I"I :1: I'.,I F:IC:CCff~:[::,f:Ii'.,IC:E: !.,.I :1: TH "Ir'HE: :!i:: :1: Uf'.,I[::,EF.".~'::TFII'.,![::, 'r'HI:::I'T' THE Ol'.4--.'.:.:;:['T'[i: :E;[!:I.,.IE:I'~: ?.r".i];"r'l:::.'l'"l .h'lt:::l'~.' ~:E:~;!l...l:[f;~:li~: [~::I'.,IL..I:::IF;iiGE:P'!Ei:I'.,I'T' ]:F' 'T'HE!: I:;':'.[~:!~;ZI:::,E:t'-,ICE: :[:!!i; Fi:[i:r,'lOl:::,[i.:L.!El:::, '['0 :[t'.,IE:L.I...I[::,Ii~: I','lOf;iE: THI::IF,I ::~: Applicant: Location: Department ,UNICIPALITY OF ANCHORAGE Health and Environmenta ?rotection 825 ~ Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT C~.~C~O~ Mailing Address: Legal Description: ~ ~ ~&)©~ Type of Soil Absorption System Is: Trench: ~. Drainfield: Maximum Number of Bedrooms: _ ~ Phone Number: ~V ~--S _~-~ y ~//71/¥ ~L~ .Lot Size: ~ ~L<"i"~-~ Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) Ck~ The Required Size of the Soil Absorption System Is: DEPTH /~]L _ 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 TM /~O 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 $ 1 * * * 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 the residence is remodeled to include more that 3 bedrooms. Signe~: ~'~.~./~ :~ ]~'-~ Issued by Applicant / Date: SWP/024(1/81) .tUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-S50, Anc~orr. ga, Alaska 9~502 SOILS LOG -- PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: 2 3 5 6 7 8 9 10 11 ~`. '~"".' VC~ f,..] ~,/~ I~ DATE PERFORMED: SLOPE SITE PLAN --/- '13 '14 - 15- 16- 17- 18- 19 2O COMMENTS PERFORMED ENCOUNTERED? IF YES, AT WHAT DEPTH7 Gross Reading Date Time ~,, ..~ ~t Depth to Net ne W~ter Drop Net Time PERCOLATION RATE (minutes/inch) TEAT. RUN D/~ TWE E~/ , ~ff//~FT A~D~.~ FT . , Static Water Level _ ~ Draw Down .... feet WELL LOG feet Gallons Per Minute ' ~/~ Total Feet of Casing_ Type Material Drilled: 0 feet to to ~'3 DA'['E RECEIVED INSPECTION APPOINTMENTS TItlE TIME TIME DATE~ DATE INSPECTOR INSPECTO~ INSPECTOR~ J ~UN~c~LI~ O~ ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~d~.. ' OF HEALFH & 825 L Street - Anchorage, Alaska 99501 ~NMENTAL PROTECTION (~) ENVIRONMENTAL SANITATION DIVISION 0~'~ 6 Telephone 264-4720 DIRECTION8~ Complete all parts on page 1, Incomplet~ requests will not be processed, Please allow ten (10) days for processing, 1, PROPERTY O~R PHONE MAILING ADDRES~ ' PROPERT~ RESIDENT (If different~m above) PHONE MAILING ADD ~ ' ~ ' - ' 3, LBNDIN6 INSTITUTION ' - PHONE MAILING ADDRE88 4, REALTOR/AGENT [ PHONE I MAILING ADDRE88 5. LEGAL DESCRIPTION Lc T I 6. TYPE OF R~:SI~)~N'CE ' '1~i~-~ SINGLE FAMILY [] MULTIPLI: FAMILY NUMBER OF~B EDROOMS- [] One [] Four [] Two [] Five ~__~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL~ 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.) 8. SEWAGE DISPOSAL SYSTEM % INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. L- ,'f'" /I - ', THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified iNSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS []~APPROVED FOR ~BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED