HomeMy WebLinkAboutT15N R1W SEC 9 LT 35
GI~'~,TER ANCHORAGE AREA BOROI~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
COMPARTMENTS
GALLONS. INSIDE LENGTH iNSIDE WIDTH. DEPTH__
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
/ OUTS,DED,AMETER ORW,OTH ,"¥,LE.G,H /f,:PTH
TILE DRAIN FIELD:
DISTANCE FROM WELt
TOTAL LENGTH
, FOUNDATION . NEAREST LOT LINE , OF LINES
NUMBER OF LINES
DISTANCE BEIWEEN LINES
TRENCH WIDTH
IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINF
DEPTH: TOP OF TILE TO FINISH GRADE .DEPTH OF FILTER MATERIAL BENEATH TILT
, DEPTH , BUILDING FOUNDATION.
NEAREST SEPTIC SEEPAGE
LOT LINE , SEWER LINE
DISTANCE~:
IN. ABOVE TILE
WATER
SAMPLE. ., NEAREST
OTHER
, SOURCES__
DATE
APPROVED
GREATEL ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
ROUGH
279-2511
Case No. //'~'7
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ,.~ I ~
PERCOLATION TEST RESULTS
LEGAL DESCRIPTION
LOCATION OF INSTALLATION ~~w~w~r ~/~",;3~,'~¢.&t~)
8EEPA~EPIT. /' , DRAIN FIELD ,OTHER
ANTICIPATED DATE OF COMPLETION ~ ~
THIS IS TO SERVE AS
.. SEPTIC TANK SIZE
ASDESC~I"ED"ELOW. SIZE OF UNITTO BESE.VED
7~ TYPE ~'~L>~ SEEPAGE AREA ~ ~ /TYPE
DIAGRAM OF SYSTEM
Authority
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.
DATE APPLICANTS SIGNATURE
Rick Mystrom.
Mayor
Mtmicipalit). of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
July 11, 1996
Robert G Nisson
PO Box 240672
Anchorage, Alaska
99524 0672
Subject: T15N R1W Section 9 Lot 35
Permit #SW950147, PID ~051-105-06
The subject permit, issued July 11, 1995 by this office for a
single family well and/or on-site wastewater system, has
expired as of July 11, 1996.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for ~a combined on-site wastewater and well permit.
If you have any questions,
SinCerely, ~
~o~rSamCr~nS:J;E'
On-site Services
please call this
office at 343-4744.
enc: Copy of Permit
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW950147
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:NISSON ROBERT G
OWNER ADDRESS:P.O. BOX 240672
ANCHORAGE, ALASKA
99524
DATE ISSUED: 7/11/95
EXPIRATION DATE: 7/11/96
PARCEL ID:05110506
LEGAL DESCRIPTION:
T15N RiW SEC 9 LT 35
LOT SIZE: 108900 (SQ. FTc)
NUMBER OF BEDROOMS: 2 THIS PERMIT: 2
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AMD 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343 4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED
DATE:
DATE:
( erlifie rilli g
ccc to. db, CZ)%\ -I0%~ OL~
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
LEGALDESCRI~ION~/~ ~ .~
DATE - Started Ended
PE~IT NUMBER ~l ~'~ d%f.,~
/
DEl'TH OF WELL 4~ 7"" c'~
STATIC LEVEL OF WATER F'r. /,~
DRAW DOWN FT.
GALS. PER HR /~'~0
OF c^s nG 6'fc ,O
KIND OF FORMATION:
From /') Ft. to
From e~ Ft. to 5"
From.~''~ Ft. tO /
From__Ft. to
From/'~ Ft. to 4',7
From Ft. to
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__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 FL
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 Ft. to Ft
From Ft. to Ft
From__Ft. to Ft.
From__Ft. to .Ft.
From Ft. to Ft
MISCL. INFORMATION:
RECEIVED
AU(; 1 2 1996
Municipality of Anchorage
Dept. Health & Human Services
·
DRILLER S NAME