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Home My WebLink AboutT15N R1W SEC 9 LT 50Lo't- 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 LEGAL DESCRIPTION LOCATION DISTANCE TO: I //Vol ~-/V V~f ~Absorption~ ~ gallons We:lF HOMEMADE: Inside length.~ DISTANCE TO: Manufacturer Well Foundation DISTANCE TO: ~//,~r ,/~/~..r' /~z/~r ~7-/v No. of lines / , - . ~ Top of the to finish grade ~ ~ J Material beneath tile Width Depth Length Type of crib Crib diameter ~//~ Crib depth Well Building foundation DISTANCE TO: V~/-. Depth Driller Building foundation Sewer line PHONE [=~ NEW &9'/-2qlZ E~ UPGRADE Dwelling I/Y~F W dth ~ Material Nearest lot line Trench i th NO. OFBEDROOMS~ PERMIT ~'~ I ill No, of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERM'T O I IqS' Dist a n c ~.~ee n lines Total ef fec~ti'~a/_b~?t~1 area PERMIT NO, Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. DISTANCE TO: Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE PERMIT NO. I'-ILIN I C I AL_ I T%-' OF RI'-~£~I-, JRRCiE-; DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 ~'L' STREET., ANCHORAGE., RK. 99501 264-4?20 OI'~.I--S I TE SEI~ER PER~q I T 82~145 ) APPLICANT SO. FORK CONST. LOCATION ER LEGAL Ti5NR1WS9 LT. 50 PO BX 56? ER LOT SIZE 99999 SQUARE PEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EPTH= :1.8 LEI'-IGTH= 4-.?~ GRR'-~'EL [:.EPTH== ? 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 FEETX THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). RE~]IJ I AEC) SEPT I C: TR~-IK S I ZE= 1758 GF~LL_O~,tS 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) I ~ISPECTIO~-~S 8RE REC4UIRE[] 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 t00 FEET FOR A PRIVATE WELL OR ±50 TO 208 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 COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PER,'11 T E:-(P I RES ~ECE~4E:ER ~:Z..., ::L_~:;:32 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 6 BEDROOMS. ~~~IST. [,ATE SIGNED:_ =_~., .... : ................... I ~_,UED B V4. 0 SOILS LOG PERFORMED FOR: LEGAL DESCRIPTION: 1 4- 5- 6- 8 ~2 18- 20- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99B01 264-4720 SOILS LOG - PERCOLATION TEST SLOPE [] PERCOLATION TEST SITE PLAN ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop // / PERCOLATION RATE minutes/inch) COMMENTS TEST RUN BETWEEN 72-008 (6/79) CERTIFIED _/ i//, /// I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6.650, Anchorage, Alaska 99502 276-222~ SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST DATEPE"FO"MED;Z~ ~: ?? SiTE PLAN ;LOPE !, 13 14 15 16- 17 18 19 20 WAS GROUND WATER ,/~///~ ENCOUN~:ERED? IF YES, AT WHAT DEPTH? Reading Date Time Net Time Depth to Water Net PERCOLATION RATE_ ~~ (minutes/inch) TEST RUN BETWEEN . ._ FT AND , FT COMMENTS __ PERFORMED BY: by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK ALASKA 99567 · TELEPHONE688-9759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE-Started ' '. Ended PERMIT NUMBER DEPTH OF WELL STATIC LEVEL OF WATER FI. DRAW DOWN FT. GALS. PER HR ' KIND OF CASING ~ ' ',' KIND OF FORMATION: 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. Fromm__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__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: DRILLER'S NAME APPLI¢ NT FILLS OUT UPPER HAl ONLY P;operty Owner ~.CL' (/~3 ~J ~ T (~ ~3~--~ J L~ t'J Phone Type of Resl~nce Single Family Multiple Family No. of Bedroo~ ~ Other Water Supply ~ Individual ATTACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach Icg If available). Sewer Disposal ~ Individual Year individual Installed: ~ Public Utility W~en Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Date Date Date Date MUNICIPALITY OF ANCHORAG~ RECEIVED ( ~ APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVALS' ~/~ 2~ Soils Rating Date Sewer Installed Well To Absorption Area /'6 ,3 / '/ Well Log Received ,J~ 'S51 MUNICIPALITY OF ANCHORAGE EPARTME.TOr HEALTH, ENV,RONMENTA'PROTECTION ~ ENVIRONMENTAL HEALTH CASE REVIEW WORK SHEET [~ PLATTING BOARD [-j PLANNING & ZONING CASE NUMBER NAME S-5512 ~ Section 9~o~ November 17, 1980 COMMENTTO PLANNING BY Dece~er 5, 1980 FOR MEETING OF CASE OF I~ PUBLIC WATER NOT AVAILABLE TO PETITION AREA [~ PUBLIC SEWER.~OT AVAILABLE TO PETITION AREA REVIEWER'SCOMMENTS: 71-014 (Rev. 2/78) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222I SOILS LOG - PERCOLATION TEST SLOPE pERFORMED FOR: 5 6 7 8 9 10 11 WAS GROUND WATER ENCOUNTERED? 12 13 14 15 16 17 18 19- 20 IF YES, AT WHAT DEPTH? Reading Date [] PERCOLATION TEST DATE PEREO.MEO= ~'J~ ?? /~/.~J SITE PLAN L Time PERCOLATION RATE~ Net Time ,_ FT AND -- TEST RUN BETWEEN -- Depth to Net Water Drop (minutes/inch) · FT COMMENTS 72 008 (7~76) ~ 55 12 [~EC 81980