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Home My WebLink AboutT15N R1W SEC 8 LT 111 MUNICIPALITY OF ANCHORAGE OEPAFITM£NT OF HEALTH AND HUMAN SERVICE5 Envlronmenlal Heallh Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N~m~ DISTANCES ~.r.~ ~ FRO~ TANK FELO WELL Phone{s) Permit NO Bedrooms L°~ FOUNDATION TANKS A [~ U Manulaclurer Cap,city In gallons ~ ~ ~ [~' ~RENCH ~ BED ~ W. DRAIN ~ OTHER l~I / Depth to pipe bottom Irom Total depth from original grade Gravel length Gravel widlh Total absorption area ~O S~ FT Distance between lines ~/~ FT ~ ~ '~ ~ ~' [ =~F~ ~ ¢ ~ ~-- Number of lines Soil rating Pipe material Installer Dale Installed ~l ~ C~' Inspections Pedormed by: I 1~n~4 E~aje River L~P R°ad N°' ~ cedily ~t Ihl~inspe¢ion was pedormed according lo ~11 72-013 (3/85) I=' 1!i F;'. t"! ]11 '1' Ck,,!nc*r I',laml~,!~: 'I(3NY Ii:H:'CiCIIqI"'IEffRE: 'Day ~ d~ 6 f'c)l"'Lli t::)y 'LI'lo IflU. FIJ. C: J. I:i ;A ]. J. 'tw Of' (.~l"l(::hl:H'i~tgi~e (I"I[:)FI) ~}u'id t.l"tc~ l~!l'La'l',e:, I:if :1 w~.].l :irHst. a].l the') !Ei'y!Bt.F.)ll/ :il"t ac:c:(;~Pl:laf'lc:~:':') I4:['LI'I a].]. Idl:)P, I:::cl(::h:e![i ar'icl Etl"ld ;[f'l comp ]. i.F. ll'l l:: (..2 t,,li ~'.h 'LI'I('~ dE.)~ii:J.(jJlg ~::1" :i.'Le?P J~:t. c;if' ~:.h :i.~r;i ]: ~,,,~i.l.:l adl't~.)ro I'o all. I~11::l~t ar'icl ~31',ai'.e Eli (.~].i',/~Bl.::,':~ re,H::lU:iric,~mient'.~ icH" (:t:i.~F,'LalW::t~zqF, From F}l'ly e:,x:i.~t.J, ng W~;~:l.].~, iNi;i~iit, iel,,~a:cL(<~)r' cl:i.~i!;l::lCl~ia]. ~y~'L0?l/l c)r any tX~l"l],Cil".~j(,~,lil0.~Fi'~'.. ~:i.]]. PMqL/:i,I'(.~ ~'iFI ,zldcIJ,'~.~.CIl'l~'~[ I::H:H" m :i, i: ,, SCALE Muntclpality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 2 4 5 6 7- 8- 9- 11 -- DATE PERFORMI Township, Range, Section:-'~ i~ t ~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? 13- 14- 15 16 17 18 19 20 II= YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Tirade Time Water Drop PERCOLATION RATE ''~' . (minutes/inch) PERC HOLE DIAMETER TI=ST RUN BETWEEN _.~¢~" AND FT ACCORDANCEWIT~¢~~'~GUIDE[~¢E~FECT ON THIS DATE. DA'rE: _ -- MUNICIPALITY OF ANCHORAGE MUNICIPALITY CF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~VIRONMENL'"L ENVIRONMENTAL ENGINEERING DIVISION 825 I. Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Material ¢,~,¢. ~o. of compart ~ Manufacturer Well . ~. t ~ Foundation~_ /..~ Nearest lot Hne~ f~ ~~esPERMIT N~ ~ ~ DISTANCE TO: /5 Z '-- -- ~ ~ ~ Top of tile to fh~ish grade / ,~. Ma~l l~9%eathlt~e ~, ~ / Total effecti~ absorption ar~o ~ ~/¢ Total effuctive~bsorption ,rea PIPE MATERIALS 72-0~ Rev. 3/78) ~r '~ - I",~ % C: ::£ F" Fll L.- .'il-IF %"" [:,EPRF:Tr,IENT r' HEFtLTH FINE:, ENVIRONMEN'f'I::~L ¢ "OTEC:TION .,.=._ "L .....TREE I'., HN...Ht. RHt.~E., RI<. ~'~: .. _,:1.. 264-.-472EI s,l..l-... :: % T'['~ .:.E_I. IER LN F" ¢3 F-: FN I=.'" E: F" .EF:~[;.".~"I ][ "r FIPF'LICF~I",IT ERF,'L NORTHRUP F'O BOX 422 LOCRTION ..Ti"t"r' HFIt.4,k; DR E. R. LEGRL ..T-I~N P..iN S. 8 GOVT :LOT :~.:L:L T'-/F'E OF SOIL RBSORPTZON S'¢STEH IS: PIT LOT :SIZE ..1. k~,=,..0¢ ',Sg!.RRE FEET MFI>::Ii',t.H NUMBER OF BE[.,F, OuM-, = "~. THE REQUIRED _Z,.E OF' THE :,_ILL HE:LRFT.[O[4 =,r=FEM .... : :::' ' ........ .~F.,B · EL, THE LP"NG'f't4 DIMENSION IS "['FIE LENGTH <IN FEET.':'. OF EFICtl SIDE FOR FI SEEF'RGE PIT. THE DFF'TH OF R TRENCH OR PIT IS THE r:,ISTFINCE BETHEEN THE SURFRCE OF' THE GROUND RND THE BOT'rOH OF THE E~-:',CFIVRTION (IN FEET). THE GRRVEL DEPTH IS THE HINIMUM DEPTH OF' GF,'RVEL BETHES"N THE OUTFRLt_ F'IF'E Rl'.,lf:, THE BOTTOM OF' THE EXCRVRTION (IN FEE]'.'.',. PERMIT RF'PLICRNT HRS; THE RESPONSIBILIT'¢ TO INFORM THI'S DEPRRTNENT E'.,LIRIN6 THE INSTFII_LRTZON INSPECTIONS OF RN"r' NELLS RD.]RCENT TO THIS F'ROPERTV RND THE NUHBER OF RESIDENCES 'T'HRT THE 1.4ELL HILL SERVE. P.',FI:KF"ILI..IN6 OF FINV =,'r.=,TEfl NITHOUT FINRL INSPECTION RND RPPROVFIL BV THILS I)EF'FIF?.TMENT [,.IILL BE _,UB...fE...T TO PF 3=EL. L TION. MINIMUH [:,I'STRNCE BETHEEN FI NELL RND RNV ON-:SITE SEWROE DISPOSRL SYSTEM :I..E~.'3 FEET FOR FI PRI'v'RTE NELL OR t50 TO 288 FEET FROM R PUBLIC NELl_ [~EPIENDING UF'ON THE T'¢PE OF PUBLIC NELL. I"IlNIMUH I)ISTFINCE FROM FI PRI',,,'RTE HELL TO R PRIVRTE SEHEF..' LINE I2!; 25 FEET FIN[:, Ti:) R COMMUNITV 2;EI4ER LINE I':.; 7,5 FEET. OTHER REg!UIREMENTS fiR"," FIF:'PL'¢, SPECIFICRTtON~; FIND C:ONSTRUCTION DIFIGRFIMS RF.:E FF,,'R~LIqBLI"-" TO INSURE PRCiF'ER ~NS'f'RLLFIT~0N. I CERTIF'¢ THRT :1.: I t':lM FRM:[LIFIR 14ITH THE REQUIREMENTS FOR ON-SITE SEI.4ER'.-:; RND NELLS RS SET FORTH BV THE HUN~C~F'RL]:T~¢ OF' RNC:HORflGE. 2: I 1.4ZLL ZNSTFILL THE 5VSTEM ZN RCCORB,13NC:E 1.4~TH THE CODES. S~: Z UNDERSTRND THRT THE ON..,..SZTE SEI4ER SVSTEH MRV REQUIRE ENI_RRGEHENT ~F THE RESZE:,ENC:E ZS ~:EHCIDELED TO INCLUDE MORE THRN 3: BEDROOMS. MUNICIPALITY OF ANCHORAGE ~j DEPAR'rMENT OF HEAl_TH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST Pouch 6-650, Anchorage, Alaska 99602 276-2225 SOILS LOG - PERCOLATION TFST 10 11 12 13 14- 15- 16 17 18 19 20 WAS GRO,NDWA*ER ENCOUNTERED? IF YES, AT WFIAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RU BETWEEN ____~.~ FTAND .~--%1-~. FT (minutes/inch) 72 008 (7/76) PERMIT NO. ~-IUI',t I C: ][ PAL. I '1-¥ [;~F FiI~C:HOI;~RGE~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 E. TUDOR RD., RNCHORRGE~ AK. 99507 27'G-2221 APPLICRNT ~I:'JO_R!=~,_~.I:!![_L~O_I~Io P 0 BOX 4i522 LOCATION JRYHRI.,JK DR OFF E:IRCHNOOD LOOP LEGAL Llii ..~EC S TiSN RiW LOT SIZE IO0000 SCIURRE FEET MINIMUM DISTANCE BETHEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEFI IS i~ FEET FOR R PRIVATE WELL OR ~ FEET FOR R PUBLIC WELL. HELL LOGS ARE REI~UIRED AND ~UST BE RETURNED TO THE DEPRRTHENT WITHIN S~e DRYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER I NSTRLLRT I ON. PE;Rt"I I 'T ~,~RL I D FO~ OhlE '~EF~R F'ROH ]E I CERTIFY THRI' ±: I AM FAMILIAR WITH THE RE:g!IJIREMENTS FOR ON--SITE SEI,JERS AND WELLS RS SET FORTH BY THE: HUNICIPRLITY OF ANCHORAGE, 2: I WILL. INSTALL THE SYSTEM IN ~ORI)ANCE WITH THE CODES. SIGNED: ...... :- '-- APPOinT CHARLES S HILSON ...... OWNER OF LAND erIifieh lrilltng by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 95577 · TELEPHONE 594-2588 ADDRESS LEGAL, DESCRIPTION d /// .I~- C ~ DATE- Started Ended DEPTH OF WELL f) ~_~ STATIC LEVEL OF WATER FT, DRAW DOWN FT. GALS. PER ttR cfc) KIND OF CASING KIND OF FORMATION: From_ d-) _Ft. to~/ Frorn~_Ft. to_dJ'{-- From > Ft. _ From. / ~ ' * /}~U ~ Cd ffJ' Fiom From ,/q'~UFt. to_/(' ¢~Ft. From_/~ ~" Ft. to '~ O O Ft,__,Y~*~ 5' Fo~/r~ From FromzJ'/,5'D Ft. to ';?~c) Ft. ,/Z~-~ 3D),-,E .j/¢7o4,7/~ 0 From Erom ~)(~>-~Ft. to_ )~J'_FI.__, From_ V V,LFt. to~! · 1- Ft._ From Ft. to____Ft._ From.____Ft. to__--Ft. From Ft. to____Ft From Ft. to Ft. From Ft. to___Ft. From_ Ft. to Ft. From FI. to_ Ft. From Ft. to Ft From Ft. to _ __Ft.__ From Ft. to __ Irt.__ From FI, to__ __Ftc_ From Ft. to_ __Et __ _ Vt. to .... Ft. FI. to_ _ Ft. ___.FI, to _Ft. From_ Ft. to____Ft.___ From___ FI. to__ Ft. From Ft. to____Ft. From FI. to Ft. From.___Ft. to Ft. From FI. to Ft From Ft. to Ft. Erom Ft. to ____Ft. From_ __Ft. to.__ Ft. MISCL. INFORMATION: '~ 7' / 7'77"7" DRILLER'S NAME OWNER OF LAND C ///ld/- (.gertffieh lrilltng by A & L DRILLING COMPANY BOXg7, EAGLE RIVER, ALASKA 99577 · 'TELEPHONE694-2588 ~ ~.x., M ~,o .... DEPTtt OF ~yELL ADDRESS LEGAL DESCRIPTION ~ /// DATE ~ Started PERMIT NUMBER _ STATIC LEVEL OF WATER FT. Eoded ~ GALS, PER HR 5' )/5 /~.~ KIND OF CASING ~-¢,Od¢ __ KIND::,0F FORMATION: FronC ,D __Ft. to From'!_ J :__Ft. to__,~ ,, e, ~--, to_:F/ From ! -Ao Ft. From ~ I Ft. to~O0 Frmn /°~Ft. to~'~A Ft. Frmn. / /,~? Ft. to /?'o Ft.. From /~Y' Ft. to~ o~ Ft._ From.~Ft. to From ~Ft. to _Ft. From~Ft, to _Ft. From~Ft. to_ ~ Ft. From~Ft. to_ _Ft._ Fmm ~.Ft. to ~ Ft. Fr0m~ Ft. to _Ft._ From Ft. to Ft. From Ft~ to. Ft. From ~Ft. to_ _Ft Ft. //4" Ft,_ J From Ft. to Ft. From. Ft. to_ __Ft,. From ___ Ft. to__ Ft From Ft. to __ _Ft From __. Ft. to Ft. From .Ft. to_ __Ft. From ~Ft. to_ __Ft. From __Ft, to_ Ft, From__ __Fti:lo__ Ft. From ___l~t. to____Ft. From____Ft. to__ Ft From __ Ft. to__ Ft. Frmn __Ft. to_ __Ft._ From __Ft. to _Ft, From .... Ft. to Ft. From Ft. to.__ Ft.__ From Ft. to___ Ft MISC L INFORMATION /)/ DRILLER'S NAME " ~"~TE- i~ E C El V E D , INSPECTION APPOINTMENTS R TI~E TIME 'rIME ~A._ MUNICIPALITY OF ANCHORAGE M~N~CIp~ OF ANCHORAGE 82~ ~ St~t - Anchorage, Alaska 99501 ENVIRONMENTAL PEO~EC~IO~ ENVIRON~ENTALSANITAT~ON DIVISIONJUL :2 4 1980 Telephone 264-~720 DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days For processing. PROPE TYOWNER MAILING ADDRESS I ~O~RTY R E~NT (If different fr6m above} -~ PNONE -51' L~EGAL DESCRIPTION "~. ~PE 0¢: RESIDENCE ' ~,,,, SING LE FAMILY [] MULTIPI.E FAMILY '~, WATER SUPPLY [] One [] Four [] Other ~ Two [~ Five [] Three [~ Six INDIVIDUAL* [] COMMUNITY [] PUBLIC lJTI LITY 8, SEWAGE DISPOSAL SYSTEM * ATTACH WELL LOG; A wi;Il log is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available,) '~0' INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTFM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST r3EFORE PROCESSIN6 CAN BE INITIATED, 72-010 (Rev. 6/79) /'Ii ]/~r-- // THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL }EPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED PERMIT NUMBER 3. SEWAGE DISPOSAL SYSTEM E31NDIVIDUAL/ON -SITE DATE INSTALLED E3PUBLIC UTILITY Connection Verified INSTALLER ~]Septic Tank or E~] Holding Tank S ze:. If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Ei~e 5, COMMENTS I~,=. APPROVED FOR ") .... BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [~DISAPPROVED CATE / I,- 4 72-010 (Rev, 6/79)