HomeMy WebLinkAboutLUND LT 1
, 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 PHONE
lx~ 'T) ~UPGRADE
LEGAL DESCRIPTION
DISTANCE TO:
~ Manufacturer X*%O~ Material No. of compartments
Liq. capacity in gallons IF HOME,DE: Inside length Width Liquid depth
, ~' , DISTANCE TO: ~~ DweHing PERMIT NO.
O Z ~ Manufacturer Material Liquid capacity in gallons
Q Well Foundation Nearest lot line PERMIT NO.
t
[ines~ ~
Nc. of I,nes ~ Length of oath I,~ Total lenflth of line~ Trench ~,d~ 0 inches Di,tance between
Length ~dt~ Depth PERMIT NO.
~ ~ Type of crib ~ dia~e~ Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
m DISTANCE TO:
~ ~l~s ~ Depth Driller Distance to lot line PERMIT NO.
m - Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTAELER ~
R EMAR KS
--'
72-013 (Rev. 3/
PERMIT NO.
APPLICANT
LOCATION
LEGAL
DEPARTMENTOF HEALTH AND ENVIRONMENTAL PROTECTION 8;25 'L/ STREET, ANCHORAGE,
oN--~:: I TE SE[aER UPGRADE P~~~
( 78~918 >
JOHN LUND
112TH AVE & MEAL ST
Li LUND
BOX 27 SAR 344 5008
LOT SIZE 100908 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= 8 LENGTH= 45 GRAVEL
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF R 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 OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
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.
T~O (2> I t~SP.F, CT IOr-~-~ ~:R~ RE(~.LIIRED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT ~0 PROSECUTION
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL~ OR
iSeTO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
RES DECEI~IBER '~-:. :L.. -'1 ~<~78
I CERTIFY THAT
i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS 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 SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
V3. ;2
[] SOILS LOG
PERFORMED FOR:
LEGAL DESCRIPTION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-2224
SOILS LOG - PERCOLATION TEST
1
3
.4
,,,-' 5
6
7
PERCOLATION
TEST
LOPE
DATE PERFORMED:
SITE PLAN
I0
11
-,~-12 --
13-
14-
15-
16
17
18
19
20
WAS.ROU"OWATE"
IF YES, AT WHAT
DEPTH?
Gross Net / . \ Depth to Net
Reading Date Time Time [~} Water Drop
,:z ,, 5~ ~ /5- I ~ ,, 3"
3 ,, ~ :033o l&" ~
~ ~ :~ 4~ /s~l~'' I%"
~- ~: 3 ~ ~ 0 /~ 7/r' 1i4"
PERCOLATION RATE / ~ (minutes/inch)
TEST RUN .ETWEEN .~-- PT AND ~ , FT
COMMENTS
PERFORMEDg :
DATE:C~./2~,/"'~ y
72-008 (7/76)
GAAB-HD-]
G,,~""~ER ANCHORAGE AREA BOROL~H
HEALTH DEPARTNIENT
327 EA~LE ST. ANCHORAGE, ALASKA 99501 279-2511
- INSPECTION REPORT ON-SiTE SEWAGE DISPOSAL SYSTEM
MAILING ' '
LOCATION~ ~:~4~ [~ ~'~[ LEGAL DESCRIPT~O
SEPTIC TANK:
D STANCE FROM WEL
LIQUID CAPACITY /
MATERIAL
GALLONS. INSIDE LENGTH
NUMBER OF
COMPARTMENTS
INSIDE WIDTH. DEPTH __
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAL
NEAREST LOT LINEage'C/d'~/' ~'~J TOTAL EFFECTIVE ABSORPTION AREA WALL AREA)
~'~ OR WIDTH /,~ ,LENGTH /~-'~ ,DEPTH G ,
DISTANCE FROM WELL /~/'~ ' BUILDING FOUNDATION ~'~ "'i~i~ir:,
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM '~EL_ FOUNDATI~4N'"""'"'~ , NEAREST LOT LINE _,,'""'"~ , OF _INES .,
DEPTH: TOP OF TILE TO :INISH GRADE DEPTH OF F LTER MATERIAL BENEATH TILE IN. ABOVE TILE
~( ~ DISTANCE FROM '? WATER
WELL: TYPE DEPTH ° , BUILDING FOUNDATION. '~ SAMPLE '"'-~"~'~/"~"-~ NEAREST
'~ NEAREST SEPTIC ~' 7' SEEPAGE /~?~ ;r OTHER
LOT LINE , SEWER LINE . TANK SYSTEM , CESSPOOl '~ , SOURCES --
DISTANCES:
DIAGRAM OF SYSTEM
HEALTH ~-U] H O PITY
.' GREATEI~',~NCHORAGE AREA
' '~ * HEALTH DEPARTMENT
~27 Eagle St. AnchOrage, Alaska 99501
No. ~';~ o
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
-..~ ~-
NAME OF APPLiCANTT~;/'_/// ./~.,b'J'l/,~,
RESIDENCE ADDRESS
LEGAL DESCRIPTION
MAILING ADDRESS..................~? f/J~ PHONE NO, '5/-g/~2---.
LOCATION OF INSTALLATION.~/~ c~ ~~ ~
APPLICATION TO INSTALL: SEPTIC TANK ~>""~,SEEPAGE PIT. /~DRAIN FIELD, ~- OTHER
-,-o
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION.,-~://'' ,/~/"~ --,-"~-~'"-~,'-7
DISTANCES:
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
DESCRibED ~ELDW. S~ZE OF UNiT TO BE SERVED
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.~..~..~ ...7~;..~. ,/./_,~,~¢.~ .~,~~~~ ~
..... :'
327 ~.,A~I.,E .....
ANC~iORAGE, "'. ...... '
Locar io~ Sketch
I
"P'":'"'-'"'
Was Ground Water Encountered?~,,
Date
Deo'th To d2[~
Net Drop