HomeMy WebLinkAboutHIDDEN HILLS BLK 1 LT 3
e MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street-Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SI:WAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHO-N-~ ~ NEW
MAI LiNG ADDRESS
LEGAL DESCRIPTION
LOCATION g~ 2:' '~i~ NO' OF BEDROOM2~
Well Absorption area Dwellino PERMIT NO.
DISTANCE TO: 1¢&'
Manufacturer Material No. of compartments
Liq. capacity in ~allons IF HO~MADE: Inside length Width Liquid depth
O ~ ~ Manufacturer Material Liquid capacity in gallons
_=~ ~:~ No, of lines I ~ngth of each lin~, Total length ofline~, Trench width0 inches Distanco between lines
~ X~op of time to finish grade ~, Material beneath tile 8~ inches Totameffectiveabsorption~ea
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
m DISTANCE TO:
.j Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS F .....................
SOIL TEST RATING /80¢ I
NSTALLER REMARKS
APPROVED DATE LEGAL
72-013 (Rev. 3~78)
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Applicant:
Location:
Legal Description: ~7- ~ ~ /
Type of Soil Absorption System Is:
MUNICIPALITY OF ANCHORAGE
Department Health and Environmental rotection
825 ~ Street, Anchorage, AK. _,501
264-4720
* * * HANDWRITTEN PERMIT * ~ ~
Permit ~ ~2&dGO
WELL AND/OR ON-SITE SEWER PERMIT
~7 ~ II~' ~-~/~'~ Mailing Address:
Phone Number: .~-e
Trench: ~/ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: -~ Soil Rating(sq.ft/br) /~'d} ~/~n
The Required Size of the Soil.Absorption System Is:
'~"~E~TH //. D / ~ /
LENGTH ~ / GRAVEL DEPTH WIDTH
The length 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 ~ipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = / ~'~ 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
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a co~nunity 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 31, 1 9 * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by t'he Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
~,.re~i~ence× is remodeled to include more that 3 bedrooms.
Signe~: Issued by: ,~<~. ........
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR: ._~-~-- ~1 ~ C-~ -~ '-~ ~: \
DATE PERFORMED:
LEGAL DESCRIPTION:
SLOPE
SITE ELAN
lO
11
12
13
14
15
16
17
18
19-
20
COMMENTS
WAS GROUND WATER ~%l~'~c S
ENCOUNTERED? L
O
P
E
IF YES, AT WHAT
DEPTH?
'1
Gross Net Depth to Net
~l"~q~'~ ~l~,R:ading Date Time Time Water Drop
,ss~~ ~ ~ -~ o ~ ~t, z ~' ,,o
PERCOLATION RATE (minutes/inch}
TEST RUN BETWEEN ,~ ~/'7.- FT AND ---- FT
-~o.~ "z' ~ Il' ,-~ ~,,~-~ 6~ 1,5o~'/b&
PERFORMED BY: ~__~.'I~-CS ) 1~"4("'t<¢
CERTIFIED BY: DATE:
72-008 (6/79)
RETURN TO: Division of Geologlcal and GeD ~cat Surveys (DGGS)
3001 Porcupine Dr~ve [Teleph~ 277~6615)
Anchoraqe, Alaska 99501
~T E~R_ W___E.L L R ~ C 0 R ~
Drlltlng Company Na~
~fLL Please complete either la, lb~ or
1~]~ ~rough Subdivision Lot Block lb, Fract'on
Anch HiJ zML '
Street Address and Area of We!l Locatlon
WELL LOG
~aterlal Type
cemented ~r_a ¥ ~ ~.~ 3L~_tJ~_ _
c o b b 1
---silt~ san~ ana gravel
' avy with
'~-~r av el H20
15. WATER WELL CONTRACTOR'S CERTIFICATION:
Surface
Top Bottom
I_!AO t60_
aao
STATE OF ALASKA
DEPARTHENT OF NATURAL RESOURC~S
This well was drilled under my jur;sdlctloo and this report is true to the best of my knowledge and belief:
~laska Now-Well--Vern' s Drilling & Ent AA
~,e~'[ster~d 8~'~tness' Name Contract ['~cen~umber
Add .....1~2~1 Avlon SRA Box 1560 Anch~~Alaska 99~
Set between
Fittings:
ft. and ft.
9. STATIC WATER LEVEL: ft,
~Above []Below land surface
Type of Measurement;
lO. PUMPING LEVEL. below land surface
ft, after hfs. pumping
ft, after
Il. WELL HEAD C0I~PLETION:
[~Pltless Adapter
13. PU~lP: (if awlilab]e) HP
Length of Drop PIpe~
Type: [~]Submerslble
[~Jet
14, REMARKS:
Water Temperature:
~O_t g.p.m.
hfs, pumping g.p.m.
i] In Approved Pit
~0 inches above grade
]]Other:
ft. capacity g.p,m
[~Reciprocating
-]Other:
U.S,G.S. Local
Drllllng Permit No.
lc. A.D.L. No.
Sect ion No, Township Range Mcr;dEan
k N E/W
3, OWNER OF WELL:
Stephen M, Grevel
Address:
4. WELt. DEPTH: (completed) i Stlrface Elevation Oate of
Comp! et ion
ft. z 784
5. DCable t°°lX[~L~R°tary Il]Driven
6. USE: ~omstlc ~Publlc Supply ~ Industry
~lrrlga[lon ~Recha, rge , ~Con~rclal
~Test Well ~ Other:
7. CASING: ~ lhreaded ~lded