HomeMy WebLinkAboutPETERS CREEK BLK 3 LT 16 (2)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIVIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME [] NEW~
MAILING ADDRESS
,,~ ~ ~ ~~ ~o.o~ ~oo~s
~ ~,,, ~~ ~ ~so~t,o, ~ ~ ~e,,in~
DISTANCE TO:
I~V~~ I
-- ~ Mate , compartments
~ Manufacturer ,,~ ,,," ~ ~~ No. of
~ Liq. capacity in~allons ~ Inside length Width -' Liquid depth
/ OO~ ~F HOMeMAdE:
~ ~ ~ DISTANCE TO: Welt Dwelling PERMIT NO.
~ Z
O Z ~ Manufacturer Material Liquid capacity in gallons
Q Well Foundation Nearest lot line PERMIT NO.
~ = DISTANCE TO:
~ ~ Distance between lines
~ No. of lines Length of each tine Total length of lines Trench width
inches
- ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area
~ inches
~ Length t~/ Width /~ Z Depth /O~/~l PERMITNO~
~~ Typ~ Crib diameter ~ ~ Cribdepth ~ ~ Total effective absorption area
~ Well Building fo~dation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING /
REMARKS ~
72-013
PERMIT NO.
APPLICANT
LOCATION
LEGAL
GLENN BREWSTER BOX K CHUGIAK
PETERS CREEK
L15&l~ B~ PETERS CREEK S/D/
LOT SIZE
21000 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: PIT
M~IM.IM NUMBER OF BEDROOMS = SOIL RATING (SO FT/BR>= t. 75
THE REQUIRE[:, SIZE OF THE SOIL ABSORPTION SVSTEM IS:
[:,EPTH= ::L2 LEN/_.~TH= 22. G RA'-.-'EL [-', E F" T H=
THE LENGTH DIMEN.,IONC- IS THE LENGTH (IN FEET)'OF EACH SIDE FOR 8 SEEPAGE PIT,
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET.',,.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
F~:EI--~I_I I RE[) SEPT I L~-- TRNF.: S I ZE"'= 1000
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TWO (2) I NSF'EmZ:TIO~4_c,. ARE REm2LIIRED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR A PRIVATE WELL~ OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'ERI"I I T E:~'4P I RES C:'EL-:ENBER Z-::~L.. :~.-979
I CERTIFY THAT
i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
<' I UNDERSTAND THAT THE ON-SITE SEWER =,~:,TEM MAY REQUIRE ENLARGEMENT IF'
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS,
RPPLICRNT OLENN BREWSTER : / .>
~,": ~, ~k....~-c'-~ ' ~ '
O Er E GEO 'CHNICAL Er DEVEL, 2MENT CO.
Russell Oyster.
694-2774 =
Soils Et Foundations
Performed for: Name:
Legal
Box g0, Davis St., Eagle River, Alaska 99577
694-2774 or688-2280
Earl Ellis
$OZL LOG sea-22ao
Land Development
Depth (feet)
Sotl Characteristics
0
1
2
4
m
10
13
15,
16
Ground Water Encountered:
Proposed Installation:
Yes
Seepage Pit
No ~
~Orain Field
If yes, what depth...__._
Co~ents:
Performed by: ~~
Date:-~,~,~ ~ /¢7?'
Certified Well
Datecom-iet'ed ' Ck...,_.~
~, ........... y~--~;-:, ..... .,. ............ ,.. ........... . .................. ,.; ..... ,. ........
Depth of well ................... ~.~. ...............
Size of casing ............................ ~...~. ~..L~ ............................................................
to
Distance water ..................................... '.L..: ...... L:. ...... ~ ..........................................
Distance to water while pumping ..... :....L:.~.~. ............... ' ....................... ~at rate
of ~0 0 al
............................................ ~ lon~ pet,ho~r.
I '~ertlf¥-ih~ abov~ tr'ue and correct.
DOTTEN DRILLING"'CO.
":/John's Road
SPENARD, ALASKA
We advise you to attach this certificate to your deed.
PERMIT NO.
~.ILIN I C I_, AL I T'~r' I_-IF ANCO', RRGE
DEPARTMENT OH HEALTH AND ENVIRONMENTAL PROTECTION
825 '"L'" STREET., ANCHORAGE., AK. 9950i
264-4720
I~IELL PERt"I I T
( 8~e~8I )
APPLICANT
LOCATION
LEGAL
GLENN 8REWSTER BOX K CHUGIRK
LOT SIZE
~88-2~74
21000 SQUARE FEET
MINIMUM DISTANCE BETWEEN A HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR R PRIVATE WELL OR t50 TO 200 FEET FROM A PUBLIC HELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE HELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 20 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY RPPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
F'ERM I T EXP I RES DECEMBER _~i..
I CERTIFY THAT
l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF RNCHORRGE.
2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
SIGNED'
APPLICANT GLENN 8REWST~R
I ~'",L ED B~
V4. 0
c-~
"~{'i~ / ~ / REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate
' "%, Name .of person, requesting
2. Name of p~operty, owner ~;"'
3. Legal description
4. Nu~er '.of ~edrooms in house
5. Wate~ Analysis:
7. Sewage disposal system.
a. AEe of sys~m .
b. Septic tank capacity in gallon8
c. Name of septic tank manufactu~0~r
a. Bacterial
b. Detergent "' ' :- \
T
C.
Casin~
d. Distance fmom well to closest exzsting or proposed:
~. O~hem soumces of possible contaminetion, i.e.~ c~eeks, lakes,
houses, baPn, d~alna~e d~teh, etc.. ....... .
1. If "home made" show diasram on reverse side of this form.
d,' Disposal field or seepage pit size and type .......
1. bl~ance to property line to house ~,mdation
e
e, Percolation Test results
f. Percolation Test performed by
Use the reverse side of this form to show diagram.
,~he foilowing information: ~operty lines;.well location, house location,
~ptic tank location, disposal area location, location of percolation test,
and direction of ground slope.
Diag'ram should include
The tv~forwation on this form is true an(] correct to the best of my knowledge.
Signature of Applicant
TO BE FILLED OUT BY HEALTH DEPART~ENT PERSONNEL
Te above describe~! sanitary facilities are hereby approved, subject to the
........... ~ltowing cgn~ion~_.. ~ ~
Conditions:
The above described sanitary facilities are disapproved for the following
reasons:
Approval is valid for one year following the date of approval.
CPJ:cw
