HomeMy WebLinkAboutBROADWATER HEIGHTS TR H LT 8A
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 ' I
/ ~ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
NO. OF BEDROOM8
LOCATION
I Well / I Absorption area
O !4DISTANCE TO:
~z m Manufacturer
~ [Liq. capacity in gallonsm ...........m Inside length
/~ ~ ,~ ~,v,~.v~=:
6_~ m ~mSTANCETO. mw~u I
~E~ M...f..t.r~
O m m Well ~ Foundatio~
~ I DmSTANC~TO: m
~ ~ ~ m No of lines ) Length of each I~e Total length of lin~s
~ ~ [ Top of tile to finish grade / Material beneath tile
g ~ Width Depth
~ ~ I Type of crib --
~ DISTANCE TO Well Building foundation
~Cl~s Depth Driller
I
Width
PERMIT NO.
No. of compart~.~nts
Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
Nearest lot line
/~ /
Trench width
~ inches
~) inches
PERMIT NO. _
Distance bet~/[n~nes%
Total effective ~bsorption 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
INSTALLER
REMARKS
I
APPROVED DATE
72-01:~ (Rev. 3/78)
LEGAL
DEF'ARTME[~T 0~ ,EALTH AND ENVIRONMENTAL P, rECTION t /~/Lg.~-,.J:)
L::25 "L ' STREET., ANCHORAGE., AK. 995C~t . ~
;.?.64.-472o
F:'ER. MI'T NO. ( 79F~424 ) . r~i'j '~'--
RFFLICRNT ..... E,F..ICK H. JLILSEN SF..-2 E,O,.':," 2"_:.':t-B' - / 694
LOCA"r I ON I NE DR I VE f --
LEGAl~. L. 9 TRAC:T FI BROA[:,WATER HTS LnT SIZE _3:AF::3:8~SQI...IFIRE F"EET
MF~::,'; ~ MUM NUME ER OF BE[:,ROOMS = .4 SO I L RAT I NG ,:: SQ FT,.' BF.. ) = '14E~
(
'I"HE REEqlIRED _-,I,:.E OF THE c-/ --,,-- ,-, -
.... '-' -"" ..,L IL RE,_-,UF..FTIUN SYSTEM I'_=,'
[:,' E F' T k.! = ,.?~: L. E t-~ ~3 T H = 5 7 ~3 Es_' Ft ',,,' E L. E.', E F' T F"'~ --~"- 5
THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD~
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND 8ND THE BOTTOM OF THE E>:;CAVATION < IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM [:,EPTH OF' GRAVEL BETWEEN THE OL~TFFIL. L PIPE
8ND THE BOTTOM OF THE E;:-~;CAVATION <IN FEET).
F-':E£,~-~L.! I ~."EE:, .'F..EF"T ! C TRNIK S I ZE= :1..;~;~' 5 ~
F:'EF.'.MIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING "FHE
INSTRL. LRI"ION INSPECTIONS OF ANY WELLS AD..TRCENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE NELL. N ILL SERVE.
BACKFILLING OF ANY S?STEM WITHOUT FINAL INSPECTION AND APPROVAL BY TI-tlS
DEPARTMENT WILL BE SUBJECT TO PROSECIJTION.
MINIMUM DISTANCE BETWEEN A NELL AND FtNY ON-SITE SEWAGE DISPOSAL. SYSTEM IS;
t~1~,~ FEET FOR A PRIVATE WELL; OR
tSF'l TO 200 FEET FROM R PUBLIC WELL [:'EPEN[:,ING I..IPON THE TYPE OF PUBL. IC HELl-.
NELL. LOGS ARE REQUIRE[:, AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 3:8 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SF'ECIFICRTIONS AND CONSTRUCTION DIAGRAMS ARE
R',,,'RILRBLE TO INSURE PROPER INSTALLATION.
I C:ERTIFY THAT
t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WEI_LS AS SET
FORTH BY THE MUNICIF'FII_ITY OF ANCHORAGE.
2: I 14ILL INSTALL THE S;YSTEM IN RCC:IDRDANCE WITH THE CODES;.
~i:: I UN[)ERS"FFIND THAT THE ON-SITE SEWER SY'-qTEM MAY REQ. LIIRE ENL. ARGEMENT IF TFtE
RESIE:,ENCE IS REMODEL. ED TO INCLUDE MORE THFtN 4 BEDROOMS.
::, I GNE[:' ' _ .................................
FIF'F"'L I F:FINT EF..,¢I C:K FI. ..TULSEN
:::,::.I..IED E: ...... [)ATE ',,"Z. ~"'
O & E ENG,,qEERING & DEVELOF,vlENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Performed for: Name:
Mailing Address:
Legal Description: ZoT- P,. '7"-,~,,~7" ,/-/_,,
SOIL LOG
Depth (feet)
Earl Ellis
688-2280
Soil Characteristics
0
1 ,
3~
4__
5__
6
7__
8__
9
10__
11__
12__
13__
14__
15__
16__
,Zoo
PLOT PLAN
PERC. TEST
Ground Water Encountered: Yes ~'/No.~
If yes, what depth /.~ /
Proposed Installation: Seepage Pit
Comments: ~--~"~/~-/-. C
Performed by:
Drain Field
Date:
SlX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED AT THE RATE OF _~~_ PEr FOOT.
LOCATION OF WELL TE
W'~L.,L LOG:
~ -, - ' '.
E~521,00
WRITE CH~CK PAYABLE TO RAMPART DRILLING WOR~S ~OR TH~ SLIM ~'
SIX INCo .WATER,WELL DRILLED AND. CASED .OU~:TO THE DEPTH OF'.~~l,/.: . :'~ .
~g2500,, O0 ....
~' i,''' ' ~ .';. ' ,! · , ~
': :' :';'?:';,'~:";H ' "'; .
"'"' ~:' ' "' '"~:~::~":'::q: '.P7~,g~'~ '~
;,, ..:'~;. f : -,
cos~, ~NCLU~aS ALL L~Oa-- ' -- "'-- ~N~:'~A?~R~U ~Oa~CO~PL~O~ OF SA~V
~'~'~',~.:. }~.,:,, ~,~.,,, :.., ;
.... . : ,;,, .,f;;.(' ..
CHECK PAYABLE TO RAMPART. DRILLING WORKS FOR THE SLIM
'WRITE .
THANK YOU VERY. MUCH, -;' ~
- "; ' BERNI~LAUS OF RAMpA~'~D ~I~LIN~:WORKS
:::~,. ,,.,, '.;~,,;,~ .. :..,;.... ~ . ,,,.. . , .
gERVlGE C}.tARG~:"~?;'qV,,~' PER MONTI-I.X~IUI?B~'Ag..,ES~ED:'O 4, PA,3T..DLI~'A~SGOUNT:5 ·
'- ' ',' ' . ..... '_. :'.
,'' ~' DATE RE~3EIVED
' ' , INSPECTION APPOINTMENTS ~ /'
TIME
TIME
DATE ~
DAT ~
~S~ECTO~ ~s~c~ _tt
825 L Street - Anchorage, Alaska 99501~" ~ ;
ENVIRONM~N~,'~.L .....
ENVIRONMENTAL SANITATION DIVISION ~ 9 ~'~
Telephone 264-4720 [~ ~ ~
DI R ECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proce~ed. Please allow ten (10) days for processing.
1. PROPERTY OWNER ~ PHONE
MAI LING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
MAI LING ADDRESS '
3. LENDING INSTITUTION
PHONE
MAI LING ADDRESS
4. REALTOR/AGENT I PHONE
MAILING ADDR~~
5. LEGAL DESCRIPTI~)N
i ~T. EET LOCATI ON ' ' '
.~,,~'Yz /x/~-'- .~RI//~- - / /~/,~ ~"
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
1~ SINGLE FAMILY [] One ~ Four
[] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~'1 N DIVI DUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) ~ ~L_.__~ ~
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL sYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic. Tank or [] Holding Tank
Size: I~.~/D If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4, DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
NUMBER OF BEDROOMS
[] ONE
[] TWO
PERMIT NUMBER
[] THREE [] FIVE
[] FOUR [] SiX
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
iNSTALLER
SOILS RATING
MANUFACTURER ~
MATERIAL
Septic/Holding Tank IAbsorption Area
[] OTHER
Sewer Line ] Nearest Lot Line
5. COMMENTS
DATE
' [~A~PPRoVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED .._~~
72-010 (Rev. 6/79)
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