HomeMy WebLinkAboutHILLSIDE PARK PUD LT 12
D~TE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
dATE DATI~ ~.~'"" ~ DATE
INSPECTOR I NSP INSPECTOR
MUNICIPALITY OF ANCHORAGE DEPT. OF H~,'~,L'iil &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECI~IRONMENTAL ;:;: 'ISCTION
825 L Street- Anchorage, Alaska 09501 '-! ~, ~1 'J. 2 !9 8'1
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 R E C E J V E D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
!1. PROPERTY OWNER I PHONE
;MAILING ADDRESS
PROPERTY RESIDENT {If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3'. 'LENDING INSTITUTION I PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT I PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATI O1~1
TYPE OF RESIDENCE
S
INGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One ~] Four
[] Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY [] INDIVIDUAL*
COMMUNITY
[] PUBLIC UTI LITY
*ATTACH WELL LOG. Awell 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
I
NDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
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
I-]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 [ Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~-APP ROY E O FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~
DATE BY
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIVIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE
I
[~NEW
[] UPGRADE
NAME
MAIUNGADDRE~}0 {~ ~){~ {0--'¢;~3 /
LEGAL DESCRIPTION
rptlon area , Dwelling 'O ~ . :
~ ] Ma ufacturer 0~ ' I Material J - ~ [ No. of
c~rtments
~, ~,~.~,,o.~ ~HOM~MA~: '""~"'~""~'~ Iw'~t'-
Q'. ~ DISTANCE TO: Well Dwelling [ PERMIT NO.
~ I I~eH ' ~ Foundation I Nearest lot line I PERMIT NO.
~= I DISTANCE TO: ['~ ~O I ~ zO I
~ · ~ ~ No of lines I~;~ of each line ~ , Total ength of lin~s..1 I Trench widt~ . r I Distance between lines
==~ Top of tile to finish grade e'"' Material beneath tile ~' ' inches II '°'al effect' e ab~oTa
Length Width Depth ~ PERMIT NO.
~ ~ I Type of crib / ~rib diameter ~epth / I Total ere ti abs~ ea
~' DIST CE:O: ~e,I ' Buildingfoun tion Nearestlo ' e':
~ : ~ ~g foun/ti ~ .
~ ic~ Dept/ Driller{ ~ance to ct line
~ ~ DISTANCE TO: ~dingfoundation Sewer line ~ I~ptictank Absorption area(s)
OTHER
PIPE MATER IA~LS
so,, C
REMARKS
APPROVED
:
DATE LEGAL
PERMIT NO.
APPLICANT
LOCATION
LEGAL
I'~II_llt...I ! C I F'AL I T'~r" ~DF
DEPARTMENT G~HEALTH AND ENVIRONMENTAL P~TECTION
P'-'= STREET .... ~'~
.,,=:..:, "L ., ANE. HORAIJE., AK .......
264-4728
Clll"-,l--S I Ti SEI4ER PERf'~ I T
CUSTOM STRUCTURE P.O. BOX
TREE TOP LANE
EOT I~,:HILLSIBE PARK
LOT SIZE
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
227:30 SQUARE FEET
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL RATING (SD FT?BR)= 100
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
B. EPTH= lk-~ LE~-~QTH= ~4 ~ R }=~{'..." E I DEPTH= 6
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
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).
REG!LIIRED SEF'Tlii: tRr-~:~ SIZE= t 258
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT dURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT 'fO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERME.
TI40 <~.:) I NSPEn]TIIiI~S RR~E REQLIlRED
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
188 FEET FOR A PRIMATE WELL OR t58 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIMATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PEF:r4 I T E)<P I RES DE~3Er.18ER
I CERTIFY THAT
I: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MR~ REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED:
APPLICANT CI ISTOM STRUCTURE
V4. 0
!HE e .-"
M~.~;E.E 10 INE,L~¢E PROPER
( ...,(2 '.. .. , .¢-, -
V4. 8
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650. Anchorage, Alaska, 99502? 216~222~
SOILS LOG -- PERCOLA:FION ~TEST
r~ SOILS LOG
PERCOLATION
TEST
ASI NO 01880
PERFORMED FOR: Floyd Bridges, Custom Structures
Lot 12, HilJside Park
LEGAL DESCRIPTION:
DATE PERFORMED:
9/23/80
1
2
3
4
5
6
7-
8
9
10-
11
12
13-
15
16
17
18
19
2o
Organic Overburden
Silty Sand
Clean CSC
Sandy
Gravel
1 .0t
SLOPE
SITE PLAN
4~en D. 5!wc~der
~. 4143-E
WAS GROUND:WATER
ENCOUNTERED?'</
O
.p
IF YES, ATtWHAT ? ', ' N/A
DEPTH?
Gross *' ' Nat Depth to Net
- < 5 min/inch
PERCOLATION RATE :. (minutes/inch)
6.5' 7.5'
TEST.RUN BETWEEN F~ AND FT
The testhole would not hold water.
COMMENTS ,
PERFORMED BY:
Harry Bakes
CERT, F,ED ~¥: Stephen D. Shrader,P.EmATE:
Alaska Soils tnvestzgations'
624 W. Int'l Airport Rd
Anehoraee, AK 99582