HomeMy WebLinkAboutPARADISE VALLEY BLK 9 LT 8
/t '\__ ,* MUNICIPALITY OF ANCHORAGE ,, /
i 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 ~--' . ~ . · PHON~
MAILINGADDRESSw D ~ ~ 7F7°~? ~UPGRADE
DISTANCE TO: I A~'°~Pt'°'"r"°x '
~ Manufacturer ~'~ Materi No. compartmo~/~
~ . ~,~ of · -
Liq. CT~allons IF HOME,DE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~_hO Z < Manufacturer Material Liquid capacity in gallons
~ .~,, ~o..,~d', ~.r.~,,?~o/ + ~o.7~D~/~
No. of lines Length~°~e~F~ line Total lengt~ o~lines~ Trench ~dth Distance between line~--~ ,
-
~ Topoftilet/finishgrade4 , Material~eneathtile
Length Width Depth
area
~ PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
a 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
~ ~ ~/x ~ ..~'
SOIL TEST RATING
REMARKS '
, .
I
P O E ' /~4 DATE LEGAL
3 (Rev. 3/78)
t:- ,~.~f~ I. J. T NO.
RF'F'LZC:F:tNT ..:rn':r=F,.."E:F.::r_GZTTE k!EBER F'E BO',:~:
,_ OCR'F I '.' I'.t R = i"tFIN _T Ft
LE 3F:~L L.E,' E 'iq. f:'FIF.:FID I '.E;E: ',,,'IgL. LE'~r
T?F'E F~F J~F'rl I=IE:'=;"'R:.'[=.,'T'[qI'.,~ = .:.---.,.
............... .':, FEI I ~'~:: TF.]ENCH
~'d - '..'
..H,,II'-.ri NLIHBER OF E:E.:DF:OOHD =
THE: !~E~L IF'EE:, t.:.;ZZE: OF THE SOIL FIBSC~'F'TTFH'.,~ '-'
£...- ~_:.. ~- T F-Il ..... ::L ~7.~ E_ ~E' ~-,~ ~,E~i T
LOT
THE LE:NGTH [:,!MENSION I:E; '['HE LENGTH ,'IN FE:E:T::, OF THE 'FF.':ENEH OF: DI':.:I::I!NF']E]...D.
THE DEF'TH CF' ~ TFtE]'.4CH O.R PiT ].':5 TFIE: [:,ISTFtNCE E:ETHFJEN THE SLE'FFtC:F.!: OF TF.E
Gg.'C HI', RND THE E:ETTOH OF THE: E:'-','CF¢,/RTZON ,'IN FEET>.
'T'HEF.:E I'::T, NO ?:,ET I.,-!![:,TH F'OF.: TF. iENCHEF;.,.
THE GRFI'v'EEL. DEPTH T':; THE MINIMUI"I E EF FH OF F ...... F'
..... ' -'" . .~r'..r~,.:... BETHEEN THE' FJLF]"F'FI[.[.. F:'T~"F'
Ri",ID THE E;OTTOH 'iF THE E::'::CFI'v'F:t'T '[ :~ i",l ':.' Z N FEET >. '"
I EKt i ~. ! FIF'F'L I C:RNT FIFE:; THE RE.E;F'ON5 1 E; ! L. I '1"'¢ TO I NFORh't TH I S DEF:'FtF:Ti'.'IEi,.,rF ,.r.:,t IF' 'r H 2 THE:
~ NSTFILLFIT i E N I NSF'ECT ~ ON~.:.; OF FI!".I'T' NELL~ R[:'JFICENT TO 'FH:[ :5 F'ROPEF:T'?' FINE:, ' ~ ~ '"
FmE
NiJI'"iE:E:F.: OF F..E:,I[..EN..ES 'THFI'T' THE I.,.IELL HILl_
............ T' ~L..[I C~ .: ...... "":,
E:!::ICf::F!LLINI3 OF FIN'T' b;?~;"FEfl I.,.IITHCILIT FIf-,IF!L IN'qF'E'-T'FqN
.... ~ I1-, D j, rd... 'I"H .I :~;
E:,EF'RRTMENT HZLL BE SL E:.ZEC T T 3 F'ROSECLITZ :N.
HINIMUM E:'ZST~NC:E BETklEEN FI HELL ~f',lD FIN"r'
· 13E~ F'EE:T FCR R F'RI' ,FITE NELL.; OR -
:!..SEI TO 2E3 FEET FROM R FtE_~7 NELL E:,EF'END~NG LIF'ON THE Th-'F'E OF F' ~ ]': tEE ..........
HELL LOGS ~RE REglLIIF:ED FIND MLIST BE RETURNED TC THE: DE~F:'FIRTMENI" I.dITHZN }~:E~ DF'~.'";
OF THE NELL C:OHF'LE:TION. '"
0'!-HEI~'. REg~U ~ REMENI"S MR'.? RF'F'L¥. SPEC :[ F ~ CFIT ~ ONE FIND CONS'TI;:LIC:"I" ~ ON D I F,3tq'R.'I:~ F:i~'F'
FIVF~ILF~EL.E TC ~NELRE PROPER ~NSTFILLFITION. ' ....
.T. CEF::TZF'T' THRT'
:I..: I Fli'"l FF~MIL..IFIF.: Ii,.IITI--I THE F~:EL=4U]~REH[ENTS F=F.' ON-SITE 5E.k.!Eiq::5 FIN[:, t.,.IEELL.:g I::]S SET
FORTH E,r THE I'"11 N:[CIF'FIL. IT'¢ OF FINCHOF.:RGE.
2: I H.Z[L It",!STFtLL THE
...... T_,rLrl IN FICCOF.:DFiNCE I.,.I]:TH THEE COE:,E:~-:;.
3:: Z LIN[:,EF.:STFff.41:.':, TFIFiT THE ON-'Z;ITE .=':EHEF. t ~;'¢E;'f'E!I i',ff%.' F F£(;g. ~F:E Er.,ILFID:GEHE:NT :I:F' THE:
RES I E, EN '2 E: I:5 F. tEMODEL. E:E:, TO
_ _ _ R'T' ....... C
DEP~RTI;,'iE~'~-~~ OF HEFiLTH ~ND ENVIROt.~MEN"i~RL i PROTECTiON ,
825' 'L~ STREET, 8NCHORAGE, Fit(. 9950i ,
, ' : 264-472E~
NELL Rf-dB ON--$ITE
PERMIT NO. (
TYPE OF SOIL RBSORBTION SYSTEM I:S:~E~C ~
THE REQUIRED SIZE OF THE, SOIL RBsoRPTION SYSTEM IS:
DoEF'TI !-- / LEr4I]TH= ~ f ' '
']~:R%.'EL [,EpTH
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIEED.
THE DEPTH OF 8 TRENCH, OR PIT IS THE DISTRNC:E BETWEEN THE SURFR~:E OF THE
GROUND RND THE BOTTOM¢OF THE E,,.CH~RTIJN <IN FEET>.
THERE IS NO SET WIDTH, FOR 'TRENCHES.
THE 6RRVEL ~EPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE~EXCRVRTION <IN FEET).
'--;EPJER~ PEF-:P1 I T
LOT jSIZE~..~5, O~) S.;'LIRF...'E FEE
PERMIT RF'PLICRNT Hi=tS THE RESPONSIBILITY TO INFCRf,1 THIS DEF, RRTMENT DLIRING THE
INSTF~LLFITION INSPEC:TIONSi OF FIN~¢ WELLS FIDJFICENT TO THIS PROPERTY, FiND THE
NUMBER OF RESIDENCES THFIT THE WELL WILL SERVE.
TbJI3 < 2 )' '~ I~J~"PECT I El l'-,i'---; RF:E REC--!LI I F:EB¢
BRCKFILLING OF RNY SYSTE~i WITHOUT FINFIL INSPECTION RND RPPROMRL BY THIS
DEPRRTIdENT WILE BE SUBJECT TO PROSECUTION.
HINIMUM DISTFtNCE BETWEEN 'FI WELL FIND FINY ON-SItE SEWFIGE DISPOSFIL SYSTEbl IS
400 FEET FOR FI PRIVt~TE WELL; OR
:L50 TO 200 FEET FROM FI PUBLIC WELL DEPENDING UF'ON THE TYPE OF pUE:LIL': WELL
NELL LOGS FIRE REQUIRED FIND MUST 8:E RETURNED TO THE [:,EF'FIRTMENT WITHIN _~R DFIYS
OF THE WELL COMPLETION. -
OTHER REQUIREMENTS MFIY RF'F'LY. SPECIFICFITIONS RND C:ONSTRUF:TION DIFIGRFIHS FIRE
FI;?RILFIBLE TO INSURE PROPER INSTRLLFITION.
F'ERf-1 I T E,XP I F-'E$ D-'ECEf. IE:EF.: _---,: :.i__ .. -1 -_~. 75.
I CERTIFY THFIT
i: I 8M FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS FI$ SET
FORTH BY THE MUNICIPFILITY OF RNCHORRGE.
2: ! WILL INSTFILL THE SYSTEM IN RCCORDRNCE WITH THE COl'ES.
2<: I LINDERSTFIND THFIT THE ON-~ITE SEP~ER S~STEM MR~ REbqUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELEB TO INCI~JBE MORE THRN :B BEDROOMS.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-222'J
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
I
2~
3
4
5,
7
8
9
_~-~10
11
12
13
14
15
16
17
18
19
20
COMME"'~TTS
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND -- FT
72-008 (7/76}