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Home My WebLink AboutMCCABE LT 1EoT' I 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 PHONE J~NEW ~ ~ Manufacturer Liq. capacity in gallons Inside length Width Liquid depth ~ ~O IF HOMEMADE: ~ ~ ~ ~ Well Dwelling DISTANCE TO: ~ PERMIT NO. ~ - ~ ~. ~- ~ ~ateria'k, '. Liq~ity in ga~ ~ Foundatio~ ~ Nearest lot line ~ PERMIT NO. Total length ~f line Trench width Distanc'e b~t~e~n lines Length °f each~nel ,~ t 3 ¢ inches e~e~tivo abs ~ Top of tHe to finish grade ¢, Material beneath tile ~ i&T Total o~narea Length Width Depth PERMIT ~ ~ Type Crib diameter Crib de ~ ~otai effective absorption area ~ ~STANCE TO:~ ~Well ~ ~g foundation N,a~tqot line ~ ~ .,.~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOl L TE~T RATING INSTALLER REMARKS APPROVED ~ . DATE LEGAL ,3/78) PERMIT NO. 8PPLICRNT LOCRTION LEGRL FRBNK BETHRRD I r"'~k~'~-~ I [: I PAL I T"~r' OF- A~.~CHFZgRAw]E CEPMRTMENT ~,HEBLTH MND ENVIRONMENTBL [~TECTION ,_,~., 5TREET~ ANCHORAGE., AK. 264-4720~'' 'I,...IEL. L R[-~[:, 6,[-~--S I Ti SE~4ER PERf"I SR* 16Ye K .NOHORRGE LOT SIZE 42560 SQURRE FEET TYPE OF SOIL RESORPTION SYSTEM IS: TRENCH MRXIMUM NUMBER OF BEDROOMS = 4 SOIL RRTING (SQ FT?BR)= 85 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: C, EF'TH= ::L~li LEr4gSTH= 2L~ 6RA~"EL DEPTIH= ~ 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 E×CBVBTION (IN FEET), THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRBVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVATION (IN FEET)~ E:Ei;~L~IREC, SEPTIC TAr4F(: SIZE= dL25~D GALLC,~-~S PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS 8DJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TI-JO (2) I ~4SF'E£:TIO[4S PRE REQt] I RE[:, BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION 8ND 8PPROVRL 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 i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRI9RTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET TO R COMMUNITY SEWER LINE IS 75 FEET. WELL. LOGS PRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS 8ND CONSTRUCTION DIRGRRMS PRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. I CERTIFY THRT i: I RM FRMILIBR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORBGE. 2: I WILL INST8LL THE SYSTEM IN RCCORDBNCE WITH THE CODES. ~: I UNDERSTRND THBT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUC, E MORE THRN 4 BEDROOMS. SIGNE~~~~~ --~. ................ % ~'PLICRNT FRRNK 8EF~D PERFORMED FOR: LEGAL DE~SCRIPTIOI MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND EN VI RONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2224 SOILS LOG -- PERCOLATION TEST {~ SOILS LOG [] PERCOLATION TEST 1 2 3 4 5- 6~ 7- 8- 9- 10. 11 12 13- 15- 16- 17 18 19- 20- COMMENTS SLOPE SITE PLAN WAS GROUND WATER ,,~,~'~.~,'-~"' ENCOUNTERED? IF YES. AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT 72-008 [7/76) WATER WELL LOG FOSS DRILLING 909 CHUGACH DR. ~CHORAGE, ALASKA 99503 WELL OWNER Frank Ow Bethard USE OF WELL Domestic WELL LOCATION Lot 17 Blk,~ McCabe.Subdivision f SIZE OF CASING6" STATIC WATER LEVEL REMARKS DEPTH OF HOLE 102 FT. CASED TO 89 FT. G. P. M. 8 WITH 102 FT. I_~FTo OF DRAWDOWNe ~A?E COMPLETEO PUMP TO BE SET AT 100' o to 4 4 to 15 15to 2o _3.q. to 85, ,8~ to lOO 100 to102 tO tO to to to to to to to to to Organic: brown color and soft Alluvium: grey c01or; medium hardness Till: ~rey and hard Till: grey and very hard; with large boulders Alluvium: ~rey color~, medium hardness Sand and Gravel: ~rey; with water to --' , APpLI FILLS OUT UPPER ONLY · Phone ' Zip Cods ~.~" L~. ~ ~ - . ~ ~ ~/ ZiP Code ' - Phone RealtyCo.&A~nt ~'~ T ~ ~ ' ~ ~ ~ & ~ ~:' Address C ) 5 1 ~ ',_.. Zip Code Legal Description ~OT I ~ ~R 1~ ~0~ · ~ ~ ~ ~ (~ ~ ~1~ ~ ~ ~5~ Street Locati~M J ~xt ~V M ~T, Type of Resi~nce / Single Family Mult~plo Family ~o. 6f,Bedrooms ~ Other - ~' - Water Supply lndividual ~,:-?~ //~:[ A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. Community~ For wells drilled prior to that date, give well depth (attach log if available), ~ Public Utility Sewer Disposal ~nOividual Year Individual Installed: / :~t ] ~ Public Utility When Conne~ed to Public Utility: ~ Holding Tank NOTE: THE~INSPE~TION FEE MUST ACCOMPANY EACH RE. EST,., BEFORE~ ~OCESS ;NG'CAN, BE',~ INI~IATED,,~, ;., : .~: '¥. ~' Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector~ ~' '"r~'O(-~-~'/ MUNICIP/LITY U~ AN~MUKA~E FieJd Notes: ~{ ___ DEPT. OF H~ALTH & RECEIVED ( ~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAP~OVED DATE Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~ J~ ~ Well to Tank Septic T~k Size J~ 72.023 (3182) ~ "- "' DATE'REcEIVED INSPECTION APPOINTMENTS ¢ TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR_ ~UNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT, OF ~*~A~H~& DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~N~,m~, ~v~N~,~ FI~CTI~N/J 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~~" DIRECTIONS: Complete all parts oa page 1. Incomplete requests will not be proc~sed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ , PHONE MAI ~ING ADDRESS PROPERTY R ESl DENT (If different from above) PHONE 2, BUYER PHONE MAILING ADDRESS '- MAILING ADDRESS I 5. LEGAL DESCRIPTION , YPE NUMBER OF~BEDROOMS [] One ~ Four · ~ [] Two [] Five SINGLE FAMILY [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for a 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 UT UTY YEAR ON-SITE SYSTEM WAS NSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 IRev. 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 [] INDIVIDUAL/ON -SITE DATE INSTALLED [] PUBLIC UTI LITY Connection Verified iNSTALLER I--]Septic Tank or I--IHolding Tank Size: \~-'o If Tank is homemade SOILS RATING give dimensions: ~'" TYPE OF TANK MANUFACTURER TOTAL ASSOR PTION AR EA MAT ER IAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: I Absorption Area to nearest Lot Line 5. COMMENTS I~;~APPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)