HomeMy WebLinkAboutMCMAHON #2 BLK 8 LT 9
t~ 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 PHQNE I I~NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
~ Well Absorption area Dwelling PERMIT NO.
DISTANCE
TO:
~ ~ Manufacturer Material No. of compartments
Liq. capacity in gallons IF HOME,DE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well DweUing PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
Q Well Foundation Nearest lot line PERMIT NO.
Length of each line Total length of lines Trench width Distance between lines~/~
~ Top of tile to finish grade Material beneath tile Total effective absorption area
~ inches
Length Width Depth PERMIT NO.
( ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to Jot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
8OIL TEST RATIN6
INSTALLER _
REMARKS
I
~PPROVED . reCUr No 1783-E
(Rev. 3/78)
!:::,EPF¢;.:]"MEF4T OF- ,EF!I....'I"H FINg, EN'v'Ii:~Oi'.,IMENTF!L F" 'r'ECTION ~/~ S]- 1~ IIt¢'t-
:::;]-;:'!=i '" L '" %"[' f;.:I.'.~] E T., I:::i ?',!C I'"! 0 I:R I::!. (.:i.E., F:IK. ~;~L:;15 (-]t:J.,
'2: E 4-4' 7 ::2El
IL-..[ lEE IL.... L ..... F:I] ~",[ El:" CD lf'",~ ........ :Ei~;; % 'T' EE: ~i!:~;; EE: [..".] E.%" I~:~: IF:::* E: IF;':':: Ii'"tl % "]1
I'tF-,- L I ..Il ,1t
L. 0 C i:::t ]" I 0 N
L.. E G I:i ! ....
~! t",t E.N]".::X.:~:F'R I '.E
!...Ff'r'E:'E N
L. 9 B8 Mr2MFIH. ON :-E;,.."[,
T'T'F'E OF SO I L. FIEd~;ORIL:',T Z DN -":;' 'STEM t :5: TRENC:tq
HF:IXIMUH H.t"IEEF.' OF FE[':,r.:h']C[M'5 .... ~.
THE t::i:Et]:¢j Z[ I:;.:ED :5 1 ;;:::E OF' THE ':':!; ][ T L. I:::l[': '.L:;ORPT Z ON z, '~ .:, r:.. [ I E; '
!fZ::, !E IF:::" -F IH! == :IL. I~E, L. E':,,J::E I1'.. ,IJ C]:J -!F H1 :: ;;?. :;:;~ ~:3 b;: [~ %" F.2: L. IE:, E: F:" ""IF" tF,...i! .... ~E;
THE LENGTH D I MEN"-'] I OF,! I S ]"HE LE]'4L'~i]]"i ,:: I i",l FEET ::, OF THE "I"RENCH OR DRR I NF' I ELI:'.
THE [:,EI::'TH OF Ft TRENCH C~F.: F'tT IS THE [:,I:::!;TFII',ICE BET!-,tEE".N THE 51...IRFFICE (iF THE
GROUN[:, FINE:, THE BOTTOM OF THE E',='=;CFI',,,'F:ITION ,::IN F:'EET).
"FHEF4:E I:5 NO ~':ET I.,.IID'FH FOF.: 'I"F<ENCHES.
THE CiRFI'v'E'L [:,EPTI'4 I::5 THE H INZhlUH [:,EF']"H OF GRIg,,,'Et_ BETI,.IEEN THE OUTFI::IL..L F:'IF'E
F:!ND THE BOT'I"OM OF THE Ei."-'iCF:i',/FI'T i ON ,.': f N FEET).
F'ERM ]: T RF'PL Z Ct::~NT HF!:5 T'I.-IIiE RESF'ONS_T B 1: I.... ! T"r' TO INFORM TH ! ::.i; [:,EF:'['~I:;i:TMENT [)I JR [ [',IG THE
I NS'T'FILLFITZ ON Z N2;F'ECT I ONe5 L')F: FIN"r' 1.4ELL.~.T, FIDJF:ICENT TO TH I ::5 F'F' '.'. PEI:~:T'"r' FIND THE
NUMBER OF RESI£:'ENCE:i:."; THFIT THE 1.4EL. L HILL. :E;ER",,'E.
E:F:tCK!::' I L.L I i},l(:~i OF F:II',I'T' E;'T':!.-]TEhl !.,t I ]'HIDUT F I t',IF-IL I N:E F'E ::' T I '.'[l'.,t 1::It'-4[::, Rt::'PRO',,,'FIL B"r' "['FI I E;
[:'E:PFIRT'MEt",IT I.,.IIL. L. E;E SUBJIECT TO PRO%ECU'TION.
M I N I h'lLIf'l~ ~i:r ::..:';T'RI'.,IIi:E IL:~E"FI4E:EN FI kIEL. L FiND FtN"r' ON-S l TE :iii;EI.,.IRGE [:' ): :L:;,POSRL fS"/::.x;"FEM i [.:.';
:t. lZI8 FEET FOR Ft F'F.:I'v'FFFE k!EL..L.~ OR
:1_50 ]"O ;.:;:_'C'~E.I FEET F'REIH R F'UBLIC:: I.,.IF. LL [:,EPEND!NG UF:'EtN "I'HE T'T'PE (::iF' F'IJBI....IC 1.4ELI._
14E:LL LOG'S F:IF.:E RIEQLItF;.:ED FIN[:, MUST
CIF' THE: I.,.IELL COPIPLETION.
OTHER REC:!Lt I I:;.'.E]'"IENT% MF!"r' FIF'F:'L'T'. 'f.:;PEE: I F' 1' CF!T
FI',/RILF:IE:I._E T'O INSURE F'ROF'ER IN:i.T, TRLLF:tT'ION.
I CERTIF'T' 'T'HFIT
J_: t F:IM F:'RMIL. IIaR I.,Ii'T'H THE REiQUtREHENTS FOF.: ON-SITE
F'ORTH E',"r' THE ML.INICIPF]LIT'.F OF:' ¢II'.,ICIqORF~GE.
2: i I.,.IlLL. IN:E, TFII._L. T'HIE '.:ii;'¢::JTEM I.l'.,l FICCORDF:INCt!:.:: NITH ]"HE CODE:L=,.
]:::: I I_INE:,ER'_:!;TF:IN[:, T!'-IFIT THE ON-:.T.,.T_'T'E SEI.,.!ER F.:;'T'S"FEM MI:::I'T' RIEL::!LtIRE ENLF:IR0~EMENT IF' "I"HF.':
FqE':S l [:,ENC~J :.1.' IqCt,,, ,t'[:,E ['"tOI:;:E THt::!I'-4 4 E:EE:,ROOHE;.
X iii ............
CON'.SUI_TIi"iG GEOI_OG S"
SOILS LOG
16
]_8
20
Total Depth of Excavation~ &
Groundx. Tat or
Reached
Depth, if Reached
Soil Type Water Level Remarks
Material at Total Depth
Bedrock
~ot Reached
Depth, if Reached
Classificat:[on Method
~isual
( ) Sieve Analysis
()
Gary Fi Player, Consulting Geologist
WATER WELL LOG
WELL
LOCATION
FOSS DRILLING
1336 Ingra Street
Anchorage, A/aska 99501
t )~,~.~.~DP9 USE OF WELL
SIZE OF CA~ING/t3"DEPTH OF HOLE/%Y4'~. CASED TO / 9/ FT.
FEET OF DRAWDOWN.
aEMAP~S
DATE COMPLETED q--~~ 7d puMP~T0 BE S~T AT
_.._g 0
~0
to
~0
__to
to
r
Time
Time
Date Date Date
Inspector Inspector Inspector
Comments Conditional Approval
.~.~_) (~Q Aeprowd ~adrooms
( ) ....... ,.:, .......
Date Sewer Installed Permit No. Septic Tank Size
~ ~ ~/ Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY .
Address -- ,~ . , ~ ~~ ~ .
nding Institution ~ ~ ~ ~' ~ ~ Phone
Realty Co. & Agent Phone
Address
Street Location ~Z~ ' '" ~ ~' '
Typ~ 9f Residence
~ Single Family
~ Multiple Family No. of Bedrooms
Q Other
WatD~upply
~ Individual A~ACH WELL LOG. A well Icg is required for all wells drilled since June
~ Community ~ 1975. For wells drilled prior to that date, give well depth (attach log if
~ Public Utilit~ . available.)
Sew~e Disposal ~'
'~ Individual Year Individual Installed:
~ Public Utility When Oonnected to Public Utility:
~ Holdin~ Tank
NOTE: THE INSPECTION FEE Must ACooMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
Richard E. Crow, Jr.
SRA Box 1561-H
Anchorage, AK 99507
~nr3dzvlslon Add ~2
Subject~ Lot 9 ~loc]. 8 .~.~cMahon .... ' ' ''
Approval for the indivi<~ual sewer and water facilities cannot
be granted until the following items have been co~npleted:
° 1~e water analysis report, needs ho be submitted to this
o£fice from the Chera Lab, 5633 B .~t_e~.t, ~_or our review.
septic tank pumped with a receipt submitted to this
e~artment.
Please notify this Department for a reinspeetion ,Jhen the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264~4720.
Sincerely,
\. ''~:j
Robert ~ ~ ~ t
.Associate Environmental Specialist
MUNICIPALITY OF ANCHORAGE ~J'.;';i,;.;,i~:, ;d',L ; ;.,, !?;~ I:)N
~% DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
) 825 L Street-Anchorage, Alaska 99501 , ~ ~ ~. .¢.
I ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER 1 [ PHONE
MAILING ADDRESS
PROPERTY R ESI DENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION I PHONE
I
MAILING ADDRESS
4. REALTOR/.AGENT I PHONE
I
MAILING ADDRESS
5. LEGAL DESCRIPTION
7
STREET LOCATI ON
6. TYPE OP RESIDENCE . NUMBER OF BEDROOMS
[] One ~ Four
{~ SINGLE FAMILY [] 'Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
~ INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975, For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** **1 f individual/on-site, give installation date ¢--7~'~
If system is over two (2) years old an adequacy test is required
[] PUBLIC UTI LITY by this Department.
NOTE: THE INSPECTION FEE MUST ACCONIPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONL~
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR I N-SP ECTOR I NSP ECTOR
DIRECTIONS:
=
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE ' [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Con.~ection Verified INSTALLER
[~eptic Tank or [] Holding Tank
Size:~.q~lfTank ishomemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Hol orption Area Sewer Line I Nearest Lot Line
WELL TO:
I
Absorption Area to nearest Lot Line
5. COMMENTS ,
[~,.~ APPROV ED FOR ~-~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)