HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 12 LT 8
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iUNICIPALITY 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 ~
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATIO~ ~0. OF BfiD~OOMS
Well ~~'~ AbsorPtion area Dwelling ~ PERMIT NO.
DISTANCE TO: ~¢~ ~¢ I ~' ~ ~ ~~
~ ~ Manufacturer ~ ~ Material%~ ~ No. of compartments~ ,,.
Liq. capacity in gallons Inside length ~ Width Liquid depth .
~O ~ tF HOMEMADE: ~ ~
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O z ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot line PERM IT NO.
~ ,- DISTANCE TO: ~ ¢ ~ ~
~_,~(~~*-- ~ No. of lines Length of each line Total lengthpf~lines Trench ~idth ~/ ~ Distance~between lines
~ -- Top of tile to finish grade / Material tile Total effective absorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth To~al effective absorption area
~ 'Well Building foundation Nearest lot line
e DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER / ~
PIPE MATERIALS Z ~
DATE LEGAL 0 ~
APPR
72-013 (Rev. 3¢
Permit ~
Applicant:
Location:
MUNICIPALITY OF ANCHORAGE~
Department,/~-hHealth and Environmenta/ ' Xotection
825 _ Street, Anchorage, AK. ~9501
264-4720
S? * * * HANDWRITTEN PERMIT * * *
' W~N-SITE SEWER PERMIT
~~, ~ Mailing Address:
Phon?
Legal Description: Z o ~' ~ ~ /~~~/~Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: ,y Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq. ft/br) / ~
The Required Size of the Soil Absorption System Is:
DEPTH L LENGTH ,_~"~ ! GRAVEL DEPTH ~,~2'&6~~.~DTH ~" ~
The length dimension is the length(in feet) of the trench or drainfield. 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).
* * REQUIRED SEPTIC(H~TANK SIZE = '~-.,9~:;~d~ GALLONS * *
ermit applicant has the responsibility to inform this department during the
nstallation inspections of any wells adjacent to this property and the number
f residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
ackfilling of any system without final inspection,and approval by this department
'ill be subject to prosecution.
iinimum distance between a well and any on-site sewage disposal system is 100 feet
or a private well or 150 to 200 feet from a public well depending upon the type
f public well. Minimum distance from a private well to a private sewer line
s 25 feet and to a community sewer line is 75 feet. Well logs are required
nd must be returned to this department within 30 days of the well completion.
ther requirements may apply. Specifications and construction diagrams are
vailable to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * *
Z certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will instail the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that~3~
A~p, licant % ~./v ~
Date: ~--/~--~-
swP/024
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
SLOPE
4
5-
6
7
8
SITE PLAN
10
11
12
13
14
15
16
17
18-
19-
20-
COMMENTS
PERFORMED BY:
72-008 (6/79)
WAS GROUND WATER ~) ~
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION BATE ~ · ;,~'~'*,,,,,,; 'i '" *',? · ¢(n3i~ufe~/~,nch )
~'~iEST RUN BETWEEN ~;~a' AND - ,
.. · APPLI,E~'~.~T FILLS OUT UPPER HA~' ONLY
Property Owner ~(~ ~:~
Phone
P~one
Address
I~ending Instituti°n .,~ ~/~ ~'~
Address A
Realty Co.&
Address
LegalDescription ~q ~ 1~,~/(~_~--~ /~L.~
Street Location
Type of Residence
.%Single Family
Multiple Family
[] Other
No, of Bedrooms
Water Supply
[] Individual ~.._~.. ~>~_.~-
L~community -
[] Public Utility
ZiP Code
Zip Code
7ip Code
Phone
~~~-TACH 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).
Sewer Disposal
~x:~,_.~ndivid ual
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time,.~/
Date Date Date Date
Inspector Inspector ~ j.~ [. Inspector Inspector
( ~ APPROVED BEDROOMS ~
OF
APPROVAL
( ) ~ISAPPROVED
( ) OO~DITIOaAL APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area ~ ~ Well Log ~ceived
