HomeMy WebLinkAboutNETTLETON ACRES #3 BLK 1 LT 1AN- 4tlc
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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 ~
LEGAL DESCRIPTION
LOCATION
Absorption area
Manufacturer
Well
Liq. capacity in gallons
DISTANCE TO:
Inside length
Dwelling
Material~ .j¢(~. (
Width
~NEW
NO. OF BEDRO4.~L_MS
PERMIT NO.
No, of compartments
Liqaid depth
IF HOMEMADE:
Well Dwelling PERMIT N~.Q._
Manufacturer Material Liquid capacity in gallons
Well
DISTANCE TO:
No. of lines
to finish grade
¢ Fonndation ~ Nearest lot line
/-~rme (, , Total length of linesL~ l ' Trench width~, fi~hes
~ , Maters beneat,t e ~ ,~s
Width
"~'~) diam et er
Depth
C~dib.dept
Building foundation
Driller
absorption
Length
Nearest lot line
Distance to lot line
Type of crib
DISTANCE TO:
Depth
DISTANCE TO: Building foundation Sewer line Septic tank
PERMIT NO,...~ ¢~ 0 '...~/~ (~
Distance between),) lin~sL~
Total effective absorption area
PERMIT NO.
PERMIT NO,
Absorpt on area(s)
OTHER
PiPE MATERIALS
SOIL TEST RATING
1 5)0
INSTALLER
DATE
LEGAL
72-013 (R~v. 3~78)
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i'!.lli:!:;i:lE :[:i:i; H(:I :!i;l~ !' l,!:[D'i'!l I::;'CfI';iI
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Fi:[i:::ii;]:l)F:]",IC:l!: :!::!i; l::;:!i:l"i()f::,t!i:l.[!:!:::' '!'O :!:t'.,!C:!..I..!!::,E: t'IC~[:i:!!: THI:'I[",I ,:'I
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6.650, Anchorage, Alaska 99502 276-2221'
SOILS LOG- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: ,/-~, //
1
2
3
4
5
6
7
8
[] PERCOLATION
TEST
DATE PERFORMED:
SLOPE
SiTE PLAN
q' - t --' -
~,---i--~~ 4
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER
~F 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
COMMENTS
PERFORMED BY: ~/~',/L,Y ,~ /~'i ~.¢.,(,.
CERTIFIED
72-008 (7/76)
MUN!C',i~A!.!TY C F
IV'i '-~"'~,!V DRILl, lNG, Mc,
P.O. [3OX 4 1224 ¢ 1210C Ihte n,diona[ Anpo~t Road
(907) 274-4(;t ]
AN(iIIORAGE, A ASKA 99b09
DiIiLLINO) LOG
Robert- Hi]by
Use of Well Domes tic:
l,ocation (address of: Townshi)), llan¢;e Section, if hnown; or distance mare roacl .....
Blk 1 Lot lA Net:tier'on Anchorape
Size of casing _ 6" Depth of Itole 86 . feet Casedto $~ ._ feet
Static water leveL_50 __ ft. (fi4aWCL'¢) (below) land surface. Finish of well (check ar, e) open end ( xx );
Screen ( ); Perforated ( ).
Describe screen or perforation_ _N/A .............................
Well pumping test. at 2 gallons per ~N_~Xt:¢) (minute) for ..... 1.. hours with ~Z)O?Z~ elk.
of drawdo~vn from static level.
Date of completion l~O/~2~2~/~ 9 ..........
WEI. L LOG
Depth in feet from
gl'Otllld surface Gi{,e details of formntions penetrated, s/×e ol lll~q[ei'Ja], co]oF [lrid hardness
0 TO _._ 2. _
2 TO 3
3 _TO 9
...... 9 TO ......
... 29 TO 33
33 .TO ....
7~_ TO
_ TO
. '['O
.... TO
TO
T
TO
..... q'O.
(os_trig ~J:ickup
Or_garlics
S i~l_t.y__ sravel
__Sandy g~r a~eJ ............................
. _Sandy gra~.el: dam8 __ .
~iA~y kard pan .................................
_ Wale]:: gravel ..
.........................
1 -CUSTOMER
LOT SIZE x ........ ', - SQL.IRRE FEET
SO:II_ RRTINO <SA FT,.-'E:R>=
THE REL;!UIRE[.'., SIZE OI= ]'FIE SOIL FtBSORF"f'IC~I'4 5YSTEP1 IS:
U F-: H \¢ [£ t .... [) E-,: t- T i,--!
'THE LEN(ITH DIMENSION I% THE LENG1-H (j. fq FEET) OF THE TRENCH OR DS:F~INFtELD.
THE DE.P']'H OF R TRENCH OR Pi~[ IS ','H.E '.'b;STRNCE rdET~4EEN THE SURF,~,CE OF T?iE
GROUND RND THE BO]'TO¥~ OF THE EXC~'iVRTION (IN FEET)_
THERE IS NO SET bI:[DTH FOR TRENCHES.
THE GRF~VEL DEPTH IS 'THE MINIhlLIhl DEF"FH OF- GRFtVEL BETPlEEN THE OUTFF1LL PIPE
RND THE BOTTOM OF THE E>,'CR'¢RT~ON (ZN FEET).
PERMi'F'FIF'PLIC:RNT HFI5 ]'HIE RESPONSiE:ILITY 'FO INFORH THIS ['.,EPRRTMENT DURING THE
INSTRLLRTIOH INSF'ECTICNS OF RHt¢ NELI_5 FI[>JRCENT TO THIS F'ROF'ERT~¢ FINe, TH[;
NUMF3ER OF RESIE)FN';E:5 'fliRT THE HELL IqlL. L .SERVE.
-- , ~. ,,., ,-
~,,I=ICKFTLLTNCt OF' FIN'¢ E,,"r".STI~,M !.4.'[-i"HOLIT F']:Nt=tL INSPECTION F~i".!D HFPi.O',RL ~&r' TF'IIq
DEF'FtRTMENT N ILL_ BE' SUBJECT I'O PROS.;ECUTICff4.
MIHIMLIM DISTRNCE BETWEEH £~ HELL RND RN¥ ON--SITE SENRGE DISPOSRL S¥~;TEP1 IS
:LOO FEET FOR R PR IVRTE HELL; OR
±50 TO 200 FEET FROM R PUL::LIC P~ELL. DEPENDING UPON THE: TYPE OF PUBLIC P.IEL. L
HELL LOGS RRE REQUIRED FIND MU:-."ST E:E RETURNED TO THE DEPIRRTHENT NITI4IN ~0 DRYS
OF THE PlELL COMPLETION.
.OTHER REf;!IJ~[REMENTS P1FIt¢ RPPL'¥'. SPECIFICRTIONS RN[) CON!.;TRUCT[ON DIlaGRRI,1S RRE
RVRILRBLE 'TO INSURE PROPER INSTRLLRTI
P E] F:~ hl Z T F] ."~.* F" ]: IF~ E: 2; [.", E": L'Z: fEZ !'-'i 8 E R .--,=: =1_ .. '.cL.. 9 '7"" .~.
I CERTIF'¢ 'FHRT
±: I FIM FFIMILIRR [4i'~FI 'ride F~:EL:~IJ:[REMENTS FOR ON-SITE 5ENER5 RND 14E~L5 las SET
FORTH B'¢ THE HLINICIF'RLIT'¢ OF RNCHORFIGE. ~
2: I '[4II..L INSTRL. L THE S'¢STEH IN RE:CORI}RNCE WITH THE CODES.
~: I UNDERSTRND THRT TtaE ON-SITE SEP]ER Sb'STEM HRY RE64UIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE ]HRN 3 E:EDROOHS.
-- '- -' D~,TE RECEIVED
INSPECTION APPOINTMENTS "
TIME TIME TIME
DATF ~- [DATE DATE
I NSP EC'~R INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF I'. 'AI_TII &
) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~I~ONMENT,:,L ,,. ~'1ECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION FEB 2., 5 19 30
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on pago 1, Incomplete requests will not be processed, Please allow ten (10) days for processing.
1. PROPERTY OWNER )-~ ! PHONE
~R Dp E R Ty R ES I D~NENT/(~diff~erent f ro~v~K ~(~) ~ PHONE
2, BUYER R E,~S S~/~ Y ~ ~~) ~,~ (:2 / --~? ,~ PHONE
3, LENDING INSTITUT/T~3)N PHONE
MAILING ADDRESS
4. REALTOR/AGENT ,~--) PHONE
MAILING ADDRESS
6, TYPE OF RESIDENDE NUMBER OF~BEDROOMS
-"~ F-lOne /~1'~ Four []
SINGLE FAMILY [] Two Five
[] MULTIPLE FAMILY [] 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
~ I N DIVI D UAL/ON-SI'YE** /~/~
[] UT UTY
YEAR ON-SITE SYSTEM WAS INSTALLED,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
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
[~lSeptic Tank or [] Holding Tank
Size: ) ~i~,?'-L~ If Tank is homemade SOILS RATING
give dimensions:
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
Absorption Area to nearest Lot Line
5. COMMENTS
[~--APPR OV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVFD
DATE BY
72-010 (Rev, 6/79)