HomeMy WebLinkAboutPETERS GATE BLK 1 LT 5
;¢ MUNICIPALITY OF ANCHORAGE
i DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
· ENVIRONMENTAL ENGINEERING DIVISION
825 L ~6't- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE 155SPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPHONE q2i~O [~NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION N~ OF BEDROOMS
~Well [ Absorption area Dwelling I PERMIT NO.
~ ~ Manufacturer Material No. of compartments
Liq. capacity in gallons inside length Width Liquid depth
/ ~ IF HOMEMADE:
~ DISTANCE TO: Well Dwelling PERMIT NO.
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation / Nearest lot ti~ i PERMIT NO.
~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines
~_~ / ~ ~' ~' ~ inches
~ ~ Top of tile to finish grade Material beneath tile Total effec~ve ~bsorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation 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
INSTALLER
REMARKS {/ ~ , J /
,*,"*'.,,.~,o J~ V ~ .-
,,
72-013 (Rev. 3/78)
PERMIT NO.
I'tl_ll'-,I I ,.T: I F AL. I T't' C"F I'~'II'--II-~.:HI] ?.IZ'IISE
DEPARTMENT OF HEALTH FIND ENVIRONMENTFIL PROTECTION
825 "L"' STREET, ANCHORAGE, AK. L~L~501
264-472F1
~Z'~I'-.II---'._~. 1] TE '_--7..EL-JE~: PE~..'t'I I T'
( ?90408 )
APPLICANT
LOCATION
LEGAL
HOWARD ERIC:KSON/
SULLINS DR.
L5 B1 PETERS~
SR BOX ~0~0
LOT SIZE
688-9280
44000 SQU~RE FEE7'
TYPE OF SOIL. ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING (SQ FT?BR)= t25
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[:.' E F"F H = :1. ~-_---_'~ L EI'-I~JiTH = _3--: .'~-' GF: R',,,' E L_ [:.E F' T t-t =~ ~:?.
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIEL..D.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURF~CE OF THE
GROUND AND THE 80TTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL.. DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALI_ PIPE
AND THE 80TTOM OF THE EXC~VATION (IN FEET).
'ERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
'NSTALLATION INSPECTIONS OF 8NY WELLS ~DJBCENT TO THIS PROPERTY AND THE
!UMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TI4,] (2) I t-IS;F'EC:T'I C,t-I:3 RE:E ~:ECO~.IJ I F:E~;[])
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND 8NY ON-SITE SEWAGE DISPOSAl.. SYSTEM IS
100 FEET FOR A PRIVATE WELL; OR
t50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PL:BL..IC WELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F' E F-' r-1 I -F E .'.=-=: F' I F-: E S E:, E I]: E M E: E ~: ~ :~L., :~ S~ ? :~
I CERTIFY THAT
t: I AM FAMII. IRR WITH THE REC.!UIREMENTS FOR ON-SITE SEWERS AND NELL..S AS SET
FORTH 8Y THE MUNICIPALITY OF ANCHORAGE.
2: I HILL.. INSTALL THE SYSSEM IN ACCORDBNC:E WITH THE CODES.
]~: I IJNDERSTAND THAT THE/ON-SIT~" SEWER SYSTEM MAY RE~!UIR. E
R. ES IDENCE IS REMODELED/C, INC:L/~R~_~HAN .7':-- '' BE[:,RC, OMS.
L":. I UI'.,IE[:,: ............... ~~ .....
APPL I CRNT H~.[:, ER I L.~<SON
I =.=,LIED B'
ENLARGEMENT IF THE
O & E ENG.,,,IEERING & DEVELO, .vlENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Performed for: Name:
Mailing Address: ~---'~,
Legal Description:
Depth (feet)
Soil Characteristics
m
8__
9__
10__
11
12__
13__
14
15__
16__
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
Comments:
No.m
~' If yes, what depth
Drain Field__
PLOT PLAN
PERC. TEST
Performed by:
Date:
V Iii' I I ' 4 4 eb Nn -W -ng lat"'PALITY OF ANCHORAGE
DEPT, OF I _ALTH &
by RONMENTAL �,,vTECTION
DOC Co. dba
g�jU1LnVkp\j TjkTT JIBU2123 FEB 5 iq8o
P. O. BOX 272, CHUGIAK, ALASKA 99567 o TELEPHONE 688-2759 c (i 1/
J� .I' h f� a
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE. - Started Ended
PERMIT NUMBER Q 1
KIND OF FORMATION:
DEPTH OF WELL
STATIC LEVEL OF WATER FT
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
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MISCL. INFORMATION:
DRILLER'S NAME
F'ERH I T
D[':T'.F'FtF. tTHENT uF HE:FILTH FIN[:' EN',,,' i F;:ONHEN"t"I:::IL..';:"Fi~O"f'l!~;(/:l" :1: ON
t'.:1:;75 '" L. "' STF.:I:::':ET., FII"~CHORF~G[C., FIK.
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L. 5 8:1. PET[:.:.F:S GF-tTE :~:,.."[:,
.i!:505 I..I..Jl'.~ f:lF.':
L 07' :::.-: :[ 21E
f't I t'.~ i MI..IH [:) I .':5,'TI::INC:E: BE THEEN 8 HEL. I .... 8ND Ft!",t"r' ON""'S 1[ TE :~;E:I.,IFIGE: E:'
:[.00 F'E:ET FOI:;.' FI PF. t IVFITE I.,.!ELL..~
:!. '.:j:', ~!~ TO ;~:00 FEET FF.:OM Ft PLIE~L. IC WFJ[..[.. DEPEN[:,ING UPOI",! THE
WELl... LOG:E; FIRE RE(..i!UIR[:J[:' FIN[:, MU'F;T DE F.:E]"LIF?.NE[:, 1"O THE [:,EF'F:L~:THEI",IT
OF' THE WELL COHF'LETI'ON.
OTHEF?. F..'EQU:[F.:EMENTS MFI"? F!PF'L'Y. .SF'ECIFICFITIONS FIN[> COI"4STF'.UCTIOI",!
FF,,' Ft ]: I... FI E: L_ F{ TO INSIJF.:E PROPER INSTF][..L_FITIOI",I.
I C[.:.:F..'T~ F"T' THRT
:1..' ]: FIH F'FIHILIFff';.: I.,.tlTH THE F:'.EQUIF.':EHENT:.:-:; F'OR ON-SI"f'E :.:.;EI,]E;F::Z FIN[:' t.,!F~L.!....:!!!; F:!:!!i; SET
FORTH B"r' THE HLII';I I C I F'FIL ]: T"r' OF'
2: .T..W~LL. I.WSTF!L..L. 'TH[E S'YSTE!"I IN FIC:COF. tlii:,RI",ICE F.IZ'.]r'H THE
~.:, I GNEi'.[:,:
FIF'F'L I C:RNT .;[faCl-::: TFIORIqTON