HomeMy WebLinkAboutPETERS GATE BLK 2 LT 6
(~ 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
I '~¢¢:~ ~ZSc~ [] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
Well [ Absorpt~on area Dwelling PERMIT NO.
DISTANCE TO:
ii Materia~ .~ ~ , No. o, compartmonts
Manufacturer
Liq. capacity in gallons Inside length Width Liquid depth
~'~-- ~ O IF HOMEMADE:
r~ O ~ DISTANCE TO: Well Dwelling ~ PERMIT NO.
· ~ Z
O Z ~: Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot line PERMIT NO.
~ :: DISTANCE TO:
_~ ~: ~ 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 effective absorption area
r~ inches
,,,, Length ,~ '~/- Width
J ~'~ I- Type of crib Crib diameter Crib depth Total effective absorption area
['~r~ DISTANCE TO: Well ~,1~ ~. Buildingi If°undati°n~ Nearest lot line I~ !
. 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
'// x, X _
APPROVED y DATE LEGAL
72-013 (Rev. 3/78)
by
DOC Co, dba
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND .
ADDRESS /f"~] 9 '~
LEGAL DESCRI~ION
DATE-Started
PERMIT NUMBER
DEPTH OF WELL , ~' c ~.-'-
~sTXT~iS:LEVEL OF WATER FT,
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From "-) Ft. to ~ Ft.
From ~.~ Ft. to f:-5~'. Ft.
From ?~-f Ft. to /o?'Ft.
From__.Ft. to Ft.
From- ~27'~ Ft. to/~:~ Ft. ,~)'~z/?,~ c,-,~
From J ~,, ¢: Ft. to / 7 '-5- Ft.O~";"'.~ ~ '~''' '~ ,&
From_ Ft. to Ft. '-- '~'' .o i ,.c,
From ~ 2~,~- Ft. to / ? ~/ Ft. ~ ~'~:;L~ ~ C ,~
From,, t"~ Ft. to ! fi' ~ Ft.
From Ft. to Ft.
From~O Ft. to ,do 0 ,,Ft,
From__Ft. to Ft.
From Ft. to Ft.
From__Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft
From
From
~(~From
From
From_
From
From
From
From
From
From
From
From
From
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
.Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft.
Ft.
Ft.
Ft
Ft.
Ft.
Ft.
Ft.
Ft.
Ft.
Ft.
Ft.
Ft
Ft.
Ft.
Ft,
MISCL. INFORMATION:
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
Department ~ Health and Environmenta3 'rotectlon
825 - Street, Anchorage, AI<. ~950l
264-4?20
* * * HANDWRITTEN PERMIT * * *
Permit
WELL' ~AND~ ON-SITE SEWER PERMIT
Location: ............. Phone Number:
:Legal D~escription: L ~ ~ ~ P~.~ ,~ ....... Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage ~Bed: ~" .Holding Tank:
Maximum .Number of Bedrooms: ~ Soil Rating (sq, ft/br)
,~ The Required Size o'f the Soil Absorption .System Is:
The len"gth 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(HOLDING) TANK.SIZE= /~0 GALLONS * *
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) INSPECTIONS ARE REQUIRED * * *
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 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
0f public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 51, 1 9 $ 2 * * *
I 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 install the system in accordance with codes.
(3) I uEder~sta~",,that the on-site
~e~esi~d~c~ is remodeled to
S igne~: ~. ~CPv~
%pp~ican'~- ' ' ~
sewer system may require enlargement if
include more that 3 bedrooms.
Issued by: ~,~- ~~~ ,
Date: '7'//~"//.0"~-
SWP/024 (1/81)
SOILS LOG
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:
1
2
3
4,
5
6
7
8
9
SLOPE
C/rauel.
(cop)- poor-t,/
10
11
12
13
14
15
16
17
18
19
20
WASENcOUNTERED?GROUND WATER ~,~ I~
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time 'rime Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
PERFORMED BY:
TEST RUN BETWEEN FT AND FT
CERTI FI ED B~~.~~~
72-008 (6/79)
ALASKA ENVIRONMENTAL
CONTROL SERVICE' ~NC.
1220 West 25th Avenue
ANCHORAGE, ALASKA 99503
Phone 276-1361
.................... DATE
CHECKED BY ............................... DATE
SCALE
& ?J-"O /
_ APPLIr - NT FILLS OUT UPPER HA 'ONLY
· Pro~'e',rty Owner ~(~:),c~) ~ t~ ~',-t~(''4 \'~'~ L Phone
Buyer
Address
Code
Realty Co. & Agent Phone
Address Zip Code
Type of Residence
J~Mlngle Family
ultlple Family No. of Bedrooms 2,..--
[] Other
Water Supply DD'3 ~)t~
¢,~ Individual ~0/D~,._,q, I ~ ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Community For wells drilled prior to that date, give well depth (attach log if available).
[] Public Utility
Sewer Disposal
1~ Individual ~/D~c~ 1 Year Individual lnstallod: / ~' ~ ~
Public Utility When Coonectsd to Publtc Utility:
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
~ '~
Time Time Time ~._~ Time
Date Date Date Date
Inspector Insp~tor Insp~tor Insp~tor
Field Notes: j J MUNICIPALI~
DFPT
RECEIVED
( ~PPROVED BEDROOM8 'OONDITION8 OF APPROVAL
( ) DISAP~OVED
( ) OONDITIONAL APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area [ ~ "') Well Log Received
~.~.~ ~ ~-' Well to Tank [ ~.~ '-) Septic T~k Size
72-023 (3182)
