HomeMy WebLinkAboutBIRCH HILLS TERRACE #1 BLK 2 LT 4
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES O.S ~ _/z//.
Address TANK FIELD WELL
Township, Range, Section
AS-B~ILT DIAGRAM (Show location of well s~t~c system, ~operty hn~s
._. ~ drive, way. water bedim5, etc.)
TANKS
~SEPTIC ~ HOLDING FtI __
'Material ' / ~o. of Compadments
TYPE OF SYSTEM ~ ~ i '/~ i
~ENCH : BED ~ W. DRAIN : OTHER X '~'' '-~- ~' ~-~'
Depth to pmpe bottom from I Total depth from original grade % % ~ ~
Gravel length Gravel width ~. ~ ~ ~, ~ I
~ FT Z OFT '' '~
q eta, absorption aiea Distance between ,mes ~/~ X
Nun,be, el hnes lS°'l rat,rig P,%:mXterial %
Installer ' Date Installe~ / ~ --- %~
WELLS ' . X
: PRIVATE : OTHER (Identify) ~
Classification (A,B,C, ] oral Depth I Cased to '
InstaileJ Date }nslalled:
RE~ARKS: '
~ ¢~¢ Scale:
Inspections Performed bY: "; '; ~3~¢
Date~
Health Depadment Approval: ~'~'~ Date: , ¢b ~ht3/~:U[':ES~'Xt"~;'~',~2(~%,., ,.,,.
72-013 (3/85)
,g£
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I='a r c e 1 ',Il !::t: 050- 14 it.-'-.2. 1
I....ot I....e!.:.:!a ii.: Sub d :i. v i s i on: B ill RCH H I LL..S "I'ERR. ~l; 1 Lat.
S =:,r..~ i on :: :1.' ..... I"c:~wr'~ sh :i. p ;~ 141',I Ran,:~e ~ ',~;~l,~J
L. crl:.. Size 5A (sq,, ~'L,, or' ac:r'es)
Max )~(Dl::Jr'.l::)c)rii~.J~ 'T'l"~is Per'm:i.'L: 4 "l"otal Capac:i.t.y~ 4
:I: Cli'::.F;i' T' :Il F::'Y 'T'I'-I(.'¥'[ ;:
:1.,, iti am ~'am:i,I:i. ar'. ~.~i'Lh the p(,:,;?qu.:Lr'emer~ts ['of c~n--.,~ :L t, e sewer'~ and ~e].].s as
l:or.'Lh by tl'"~e Mur'~:i,C:Ll::)alit¥ c:)l (-:u'"~chor'age (l"lil)(~'~) and the Stat. e o~' A',Lasl.;:a,,
',;:'., I w:i. i :L 'li.l'-J~'~.~':l~.I. :1. 'Lh(':") ~'y ~; ~lll Ill~l:~ f~J :il J'' J accc:~r'dar"~c.~,~::, w:i.'Ll"~ a'.l. ]. I"lC)l<.'~ cc)c:le~?~ and
and :i.n comp ]. ianc,:...:, ~,,.~:i. tl"~ the des:i, gn c:r.:i, ter'ia ,:::)$' th:is per'mi'L,,
:];,, :t: ~:i.:l.]. adher'e 'l:.c~ aJ.l ["IC)A .;;';~l']d ~]~'~:.a't..(.z~ c:~f P, lasl.::a I"(.;.:,~CIL.~:LI"ef~(,E,t"~'~:.~ ~',:,:)1'" 'Lhe se't:. I::)ack
CJ :i.~ii~tai']C:G~:,ii!; {' t'"C)O] af'i'?" (D)< :i, !~ ['., :i.r"~(;] w~.::.:,]. I ~ wastew,}~'c~:,mr' ~::1 J. sj:)cME, a.[ ~Ei, yfi~.'~,G)¢Ti C)I" pu.J::):[ :i.c::
sev,~(~r'a(;.:.l(.'.~.) t~;'::,..'~;'l:.(,:.:.:,~'~ ol"~ this (::)P afl7 ac:Jja(:::,:~.:.~r'i'L, c:)r' t"'JE, ar. by
~t].~C:) ~.ll'"~(::J(.:,:,:,t"~i~-'J:,,~l"l~::J '[',,h~,'[:, [',,I"~(.):~ cal::)ac::i, ty (::)~ the Lc)La]. ~i!Yy'~i!~'t:~..~Q'i :i. fi~i /,J, l::)edr,(::x:)m~
ar'~'./ er'~].ar'(~]emerit t,.,~:i. ]. 1 J"equj. r'e a~ ~dc:l:i.t:i. DrJal
(Own e r' ) F::'EAC~Tt .IEF:~AI'q (:~~SJ:]I'qAGIS.
' ' / -~' '~'/' '~ )..)A IL.
/ -
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
0 77'0t
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2O
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
H~/~o~E~ 7 z~,4y'<~
Depth to Water After
Monitoring? ~ Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE W//~ (minutes/inch) PERC HOLE DIAMETER
/
TEST RUN BETWEEN __ FT AND __ FT
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
,/
VEl
Archliectuml, Engineering and Suweylng Consu/tants
FRACTURE J
WOrK FROM RIGHT TO LEF'T SA~E ON
TOTAL 'A ADD TO
FRACI"~RE ~EC~
Et}UHCI
OVERSIZE
I
~RADING AT RIGHT
INDIV.
WEIGHT
TOTAL
WEIGHT
GRADATION
WEIGHT I~ETAINED
GROUP
WEIGHT
tr. PASS
TOTAL SPEC~,
7 q-~
COARSE WASH
SIEVE ~ ~UM.
l
· 10
·:)0
FINE
RETAI~NED
PASS
· Ami
SPECIFIC GRAVITY
WT. ~SD AGG
FINE WASH
SIEVE I CUM.
SIZE I WEIGHT
DRY
WT. DRT ~-'~_ · --C
IULK .... ~ · - C
P APP.
SSt)
COARSE
FM -- F~E C. BEFORE
MIX ~ ~ ~. ~ R
Ami
~ ~ I'AS~ PLUS
RETAINED 1' X m Y X · Y
Al iERBURG UMIT$
MOISTURE
DRY ~, 4 ~A~E
TARE
DRY C. ~L ·
PI LL PL
wi.
z
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I-I.UdON
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Za-t ~,~ZK, Z; dl/e, rH HIL.~ 7'ER,~,qc_G' ~U~/D ~.1~t
V E I Consultants
P. O. Box 774649
Eagle River, AK 99577
(907) 694.3574
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 IPHONE
~ UPGRADE
MAI L.~G ADDR ESS
LEGAL DESCRIPTION
LOCATION
IJ Well ,__ ,L..~ _.,-, I Absorption area
~v-- J DISTANCE TO'. ,I ~' ~ 1 ~¢~'- ~'I ~'~', ,~ · ~J ~¢
~ Z J Manufacturer ..... /~F~
[Liq.~y~n gallons ........... ~~length
m ~ JWell, . ~ ~--~a F~ndatio~ __
~ ~ ~ J No. of lines ~ I Length of each line~FlJ~otal length of lines
-- ~ ~ I / ~ ~ .... ' .~ '
~ ~ ~ J Top of ti~ t~ish grade ~ Materi~enea~h til~
~ Length 'Width Depth
~ DISTANCE TO: Well Building foundation
~ I~ss Depth Driller
Dwelling~;~ ~__~
W dth
NO. OF BEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
Nearest tot line
Tre.~chgidt h inches
inches
PERMIT NO.
Distance between lines
Total effective absorption area
PERMIT NO,
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO.
Septic tank Absorption area(s)
OTHER
PiPE MATERIALS
SOIL TEST RATING
INS~rALLER
REMARKS
DATE LEGAL
72-013 (Rev. 3/78)
Dli.ZI:'FIR:THENT ElF' I..t[--RL.I'I...I R[.,ID ENVIF.:ONHENTFIL PF:OTECTION
':"='=; '" I.. '" :...3TF.:EET., FIN - H -i~'1:::1
264.-..4720 : F:~NC:HORF:IGE 6 S,~ ..-. 2 :L 3: :L : ERGLE I~: l ',,,'ER
,:, ~".-,~ ....... .".E; X l'" EE E"; E ~-,-~ EE Fa: F' EE F;-"": lh"t Z -'F
PERH I T [.40. 8.".:~:±O1'"2:
' F - ' ~ .... 6 9 4 - 3:,4 5 6
I, "I',-, -. "ll"l F' F'E]=ICE E",,' LIJTH[',t CHt=::CH F'HI"~NE '
RE:'DF.'E:E;,%: F'O E:O',:':; 'F"7~:~'""Z.':E~7
EFIGI._E iq: I',,,'El:Z,:.. FII<
,- · n. ~ B L O C K '-' · 4
L..EGFIL,"' ~rr'='_, '--m_.,,. 'r~ F'T I ON ..... .... '=,11E:[: I' ' I x, ~. _ ,'~ ' E: t 'F.:CH H I LL.S TERF.: ' ...'. LOT
LOT S;IZE 0 '...-'.g!. lifT. TOI.,JN23HIF': ..... 'F.:I::INGE: .... SECTIL-iN: -
I"IFi',:':iIf'IlJH NUI"IEJI~ER OF E:EE:,ROOHLE; = 5 21OIL 'iq:I::ITII"4G
L_I:'E;,'FED EJEL. Ot.4 t'-'IB:FZ THE OF'TIONZ R',,,'I=IILF:IE:LE TO "~"OU :[['4 DESIGNING 'T'OUF.'. :5EF'TtC
.'E;,'¢~TIEH. CHOOSE THIE OF'TIL-fl",I THI=IT BE"2";T F'ITG k"OUFi:
1 ~.".~C:: H IE: E: =::, ]t: ~ .
HIE:,TH = ~ . . ~ 5 FT.
~ ~["'~.t. O FT. ! ['40'l"E J .... ::' '~'
L.
E
N
t'
TO'I'FIt~FH ==".,-'"'""'--~~ F'"L E~ FT.
G F.:FI',,, ~=_' ~ '"~ FT.
GF.'.R',,,'~:. ~"r'E:'S.
~~.3FII...-E ON:5 ,' TI.40 COHF'I=IF.':THENT TFINI<: ::,
l.q i DTH = '~ . ~¢~.-'."T.
L.E[.4GTH :=~ ~.E~ FT. ~ '
T O T FtL D E [~ :~;. (:".~ F T.
GF..:FI'v'EL E:,I~~; FT.
G R FI',,,'E;L ',,,' ~~: U. '-r' E:':5.
"I"FINI'::; :5I~'"t O G'RLL. ONS ,'THO COHF'FIF;:THENT TRNK
I.,.IIDTH ~ ...¢5¢~-~ FT.
'1'C,', I::: ~""' 0 F T.
,:.=~ R,* ,., ~~. ,F].,'T;.
Iii F.-~ Ft'v' ~~.~: C U. "r' [:,
!7 :,!"L.= .............. .2" !:! ':' ..... '= t:..'. '"" !;: ':' [.'"!
i CERT II:"r' THFtT:
t. I Rhl FRI'IILIFff;: I...ilTH THE F.:E6!UIREHENT'.5 FOF.: ON-E;ITE '=-',ENEF.:E; FIND I.,.IELL:5 R'.=:, '2;ET
FOR'TH E:"r' THE I"ILINICIF'F:ILIT"," O1=' FINCFIORIqGU R~4E:, THE '=;TFITE OF: RLRE;KI:J.
2. I P.IIL. L I NSTFIL. L. THE S"r'GTEH It',1 F'ICCORDRNCE H ITH THE CODES RNE:' I'"IFI'v'E RECEI'¢ED
R C. OF"¢ OF THE; CODE :-SLIHHFtF='."," F:IND D IFiGF;:FtH F:tTTFtCHHENT2; NFl ICH i% F'RF~:T OF THIS
F" E 'R I"'11 T.
.7..':. I UNDEF.'.STFIND THRT THE OI',I'-".5ITE '.:=;ENER S"r'STEI"I' I"1R'¢ REQUIRE: ENLRF.".GEHENT IF' THE
I:;;:E:~; I E:,ENCE l S REI"IODELED TO I NCLUE:,E HOF'.E THRN 5 BEDF.':OOH'Z';.
PERI'"IIT FIF'F'LICFtNT t...IF.r.Z, THE REE;I='ONSIBIL. IT'¢ TO INFORi'I F'EF.:SONNEL DURING
THE IF,I%TFIL. LFITION IN:SF'ECTIEd',I% OF RN'.¢ I.,.tELL:5 RE:,JRCENT TO THIS F'ROF'ERT'¢ RND
THE: NUI,'IE:EF.: OF .F..:EE;It.".:,ENCE:i5 THFIT "FttE HELL t.4ILL
l F Ft L.I. FT , '.E;TI:::IT I ON 1:5 l N:STFILLED., FIN ELECTF..: I CFtL F'EF..'.H I T RND l NSF'EC'T'I ON t"IUSTI"
BE OBTR iNEED. RS;-...BU IL'T'S E:RNNOT BE RF'F'RO'v'EE:, 1.,41THOUT FIN ELECTRICRL. INSPEC:TI ON
REPORT. THE ELECTRiCRL 14OF.:K 1,1U2;T BE: DONE E:'¢ FI LICEN2;ED ELECTRI('.':IRN.
F:'EI=ICE E',,,' LUTHN CHF.':CH
DFITE: t2/12/S~:
Department
MUNICIPALITY OF ANCHORAGE
Health and Environmental
rotection
825 Street, Anchorage, AK .... 501
' 264-4720
i'!C. ' ,~ HANDWRITTEN PERMIT * * *
Permit ~ ~-'~ ''~ w~ 0N_SiTE
SEWER
PERMIT
Applicant:~.[~,,~,.~. ~'~-~.~-~¢~.f.~. ~~' C~_._~ling Address: ~,~,
Location: Phone Nu~er: ~9~-- ,~ ~<%
Type of Soil ~sorption System Is:
Trench: ~/ Drainfield: Seepage Bed: Eolding Tank:
Maxim~ N~ber of Bedrooms:~~~ ~ SQil Rating(sq.ft/br) /~~
The Required Size of ~he So~l ~sorp System Is:
DEPTH ~ ~ i i LENGTH <7C>/ 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 gro~Bd a~d
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minim~ depth of gravel between the outf~ll Pipe and
the bottom of the excavation(in feet).
· * REQUIRED SEPTIC(~TANK SIZE = /~> GALLONS
permi% applicant has the responsibility to inform this dep~rtm~nt 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 ~ny system without final inspection a~d approval by this department
will be subject to prosecution.
Minim~ 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. Minim~ distance from a private well to a private sewer line
is 25 lest and to a co~unity sewer line is 75 feet. Well logs ~re required
and m~st 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 1 9 8 B * * *
I certify that:
(1) I ~ f~iliar with the requirements for on-site sewers ~nd wells as
set forth by the Municipality of ~chorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
th residence~s remodeled
SigneR: . _ ~ -
SWP/024 (1/81)
to
include more~C~3 bedrooms.
Issued by: ~_.~,~--~'~"
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[~ SOl LS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
' LEGAL DESCRIPTION:
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SLOPE
SITE PLAN
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2O
COMMENTS
PERFORMED
72-008 (6/79)
/)~/: WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
s
L
O
P
E
Gross Net Depth to Net
Reading Date Time Time Water Drop
I
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch)
FT AND FT
DATE:
,~....---