HomeMy WebLinkAboutHOMESTEAD HILLS #1 BLK 3 LT 12
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 B/ELl. INSPECTION REPORT
NAME ~ I [~-EW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION .~ / ~ - NO. OFBEDROOMS
-- Well Absorption area Dwelling PERMIT NO~_
I DISTANCE TO: I /J~ /
> Z Manufacturer ~ Materia~ .~ ~ No, of compartments
Liq. c~ciXx gallons IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
0 ~ < Manufacturer Material Liquid capacity in gallons
~ DISTANCE TO: Well / 301 FounOatio~o /+ Noarestlotlin~ ,+ PERMITNO.
Lengt~o~each line Trench Distance between
~ ~ g No. of lines i J ~ ~ ~ Total 1ongtl~}nes w~th6 inchof effective t~area
~ Top of tile to finish grade ~ , ~ Material beneath tile 8/ inches Total
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller ~ Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
SOIL TEST RATING ~ ~O
REMARKS
PERMIT NO.
RPF L I ..HNT
Lu_,RT I ON
LE.~RL
DON,."DRVE CONST
TRRPL I NE
DEF'RRTMENT C?-xHERLTH RND ENVIRONMENTRL ~JIEbTIUN
,:,~..., .:,TREET., RNCHCF.'RGE RI'<. 99. J.
264-4720
t-..~ E t,, L,'--' !'4[:,, I'-I l"~~-- 5 I TE .'_--~ E IL-.~ E R PERP11 T
,.: )
PO 80X t0-548 995il 274-90e~
LOT >I~E 5~[~0¢~ SQLIRRE FEET
b: i2 B:~:HOMSTERD HILLS
TYPE OF '-SI-IlL PtB_,URPTION SYSTEM IS: TRENCFI
MH,":;IMLM NUMBER OF BEDROOMS
SOIL RRTINb (SQ FT/BR)= ~00
THE REQUIRED SIZE OF THE SOIL RB'~ORPTInN__ _ ~TEM~'"= ' IS:
E:,EF'TH= 12 LE[~t t'~ ]-H = ~-_q:~ ~ R R"...'E L [)EF"TH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE E~CRYRTION (IN FEET).
~:E~2L~ I F'~.ED ~EPT I L--: TR~( '=; I ZE= i0~}0 ~, ,LLCi~--
' '~ '1'1 'q ' "
PERMIT RPPLICRNT HRS THE RE_~_N_I6ILIT~ TO INFORM THIS DEPRRTMENT DURINA THE
INSTRLLRTION IN~FEL. TIUN5 OF RNY WELL_-, 8D..3~L. ENT TO THIS PROPERTY RND THE
NIJI'tE:ER OF RE_,IDENCE~ THRT THE WELL [,JILL SERVE. "
T[.~C, <2> I ~]F'EC:TI Cl[~ I:tRE RE'~LIIRED
BRk. KFILLIN~ OF RNY =~TEM WITHOUT FINRL INz, PEE. TION RND RPPROVRL BY THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
t00 FEET FOR R PRIVRTE WELL OR ~50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVBTE WELL 'TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RYRILRBLE TO INSURE PROPER INSTRLLRTION.
PERf'I ][ T E:>=:P I RE~_] E)EIZ:Ef'IBER _'~-dL..
I CERTIFY THRT
1: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNIC!PRLITY OF RNCHORRGE
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
3: I UNDERSTRND YHRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RE=IBENE. E IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. t ~ ~/~/~
ISSUED BY
RPPLICRNT DON,..'DR'v'E CONST.
..................... DRTE_~.--_~-~'-~2-~- .... & ¢~. V4. 0
· DEPFIRT~?~T ~.">"% HEALTH Ftt'iIP ENVI RONMENT.L Ir'~OTECT I ON
'. ' 82.~, "L STREET., 8NCHORRGE., "K. 99;..1
% ' 11.4ELL RI-ID ,~-,!"-.!.¢~:~I TE SEI.4ER('~PE~-:~.I I T
E>EP~-H= J_2 LE~4GTH= 6;8 GB t~/EL [:.EPT~ E:
THE D, EPTH OF R TRENCH OR F'ZT ZS TI ~S~RNC BETWEEN T~ECLI~F¢,~E OF THE
GROLIND ~ND T~E BOTTOM OF THE EXCR' ~If, FEET). n kX kl /~
THERE IS NO SET WIDT FOR TRI ~ ~ ~ ~ ,
THE 6RRVEL DEPTH IS Mir'Ill YOF 6~ BETW~ ~HE OUTFRLL PIFE
RND THE BOTTOM OF TH FEET). ~ ~
/
~i,>l_l I RE[~ S I leE4E~ GRLLC~[-IS'--
PERMIT RPPLICRNT HRS TH! ISIBILITY TO THIS DEP~RTMENT DURING THE
INSTRLLRTION INSPECTIDNS ' WELLS R ..T8 '0 THIS PRO~'ERTY .ND THE
BRCKFILLIN,~ OF RNY SYSTEM WITH,~ F~I[~k INSPECTION RNa, p~FJRO',/RL BY THIS
[:,EF'RRTMENT .ILL BE SUBJECT TO ~~ON. n' ~ ~ '
.oo FEET FOR PRZV TE.WE TO 2C, e FEET(kF ¢ PUebZ¢ L DE EN NG
UPON THE TYPE OF PUBLIL. WELL . t ~ ~ ~ .,- .-.~ ~.
MZNZMUM D~STRNCE FRON R PRZVR~E W~LL~TO R ~:ZV~SEWER ~.~E ZS 25 FEET .ND
P,IELL LOGS .RE RE~UZRE[:, .ND MUST BE ~:~T~:[~ TC~~R~IENT WZTH~N 3e DRYS
OF THE WELL COMPLETION. ~1~ ~ ~ ~ ............ ~,-.~,¢ , ,
OTHER REQUIREMENTS MRY RPPLY. S~~TIONS RN[~~,IRGRRblS RRE
R',/RILRBLE TO INSIIRE PROPER IN%TRLL~N. ~
I CERTIFY THRT
l: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS .ND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
~: I UNDERST.ND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS.
RPPLICRNT DON&DRVE .CON~T
I :.~LIE[. E:Y- --DRTE---,~-~//
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6.650. Anchorage, Alaska 99502 276.222!
SOILS LOG - PERCOLATION TEST
SOl LS' LOG
y PERCOLATION
TEST
1
2
3
§
7
8
PERFORMED FOR: ' ["'~
LEGAL DESCRIPTION: L.
0 -/
10
11
12
13
~4
20
I
COMMENTS
~o~
SLOPE
WAS GROUND WATER ~l 0 S
ENCOUNTERED? L
0
P
E
r IF YES, AT WHAT
DEPTH?
,..,-7 O0 .5.-h"{/
SITE PLAN
I I I I
Reading Date Gross Net Depth to Net
Time Ti,~e . Wdier Drop
I
.ER.OR.ED..': CERT,P,ED.'.:, ' /O'/
7
$
^.'~BUJLT 3L~V~.Y