HomeMy WebLinkAboutT15N R1W SEC 30 LT 40
~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEAL'rH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRI~ION
Well Absorpti n ar
L%~Oall°ns IF HOME.DE: Inside length Wid,h Liquid depth
, ~ Well' Dwelling PERMI~ NO.
0 ~ ~ Manufacturer ~ Matorial kiquid capacit~ in ~allons
:~ No. of lines / Length ~h li¢~ Tota~f ~ne~ Distance be.¢n~
~ ~ ~ To~f.~e ~ni, g~ ~ ~ Trenc~d~ inches Total %~¢on ~ea
0 ~gt i I ~ ¢~ inches
Length Width 'Depth / PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ ~ DISTANCE TO: Well :. Building foundation Nearest lot line
~¢ IClass~ ~ ~' ~De th Driller Distance to lot line PERMIT NO.
~ Buildin8 foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOILTESTRATING~X C .~ ~ --
REMARKS
//~ZU-~ ? ' PH, 694-2979
72-01/~ (Rev. 3/78)
825 "L. STREET.,
~ RF'F'.... ~ 'SF!H-F R Z E:HFff~:D,
LOCFiT ;[ ON
L.ECiFIL TiSNR:AH :E;38 L. 4.9
,r)EF'FIF:TFCENT ~"'"]HEFILTH FIND, EN',/;[ROF.!HENTFIL. ~-"kDTEC"F:[CIN
FIN, CHOF:RGE¢ RF':. 2~D...
THEE F:E]!_]Zf--::EE, ::=:];ZE EiF' THE 'j;O_TL
"f'HE LENGTH ,.5',it"]ENS);ON :.rS THE LENGTH ,::]:N FEET) OF THE TRENCN OR [:,RRZNFIELD.
THE DEPTH OF ~ TRENCH OR P~T Z9 THEE C, ZSTRNCE E:ETHEEN THE 'SURFRCE OF i-HE
Gr(:OUN[::' FIND, THE DOTT,r)P1 OF THE E',:':',CR',/RTZON ,::]N FEET).
THEF:E IS N() SET I.,.f}?'TH FOR TRENCHE~].
-i-HE 6RR'¢EL E)EPTH .IS 'T'NE hIiNII"IUH D, EF'TH OF (]~RRVE,r.. E:ETHEEN THE OUTFRL. L I='IF'E
FIND THE 80-f'TC6'I OF TNE Ei:.::CRVR"!");CIN (ZN FEET).
F'ERHI T RPF'L'I CRNT HRS THE RE:E;F'Oi",tS I D i L i'r? 'FEI ZNFOF:f'I TN'i E; D, EPRFCFHENT E:,LIR I NG THE:
.... ""- · ........... FINE:, THE
IN~;TF!LJ._,~"¥'r'IIZIt'.:I II!_rE_.T±J?L.,, OF RN'¢ HELLE, FIE:,,:rRCENT
['.,!I,.I[',iE~E[4: OF ~,F%:[I',f=i'.-E': -] ..... -
.................. ~.H THE HEL.L H:[,r..L '=~'E"'~=
,.:,r ...... F.. LL. Lr. N a QF:' FI?.,!? '5'-/::.;TEH ~.,l'r THOUT F' ]: NFtL ]: NE;F'EC-f' ] ON FINE:' FIPPI:~'.O',,,'HL B'¢ 'FH :[ b,
DEF'RR"I'HENT hq' ~ F:F - c '- --m .
......... ::,,_t,:,..., El... , T,r) F'i~:O:E;ECUT ..T. L-IN.
H!NIHUH D!:E;"f'RNCE BETHEEN F! HELL RND
±EiEi F'EE",r' FOR Fi F'R:_r',/RTE H[=LL OF'.': ::L58 TO 20E"l FEE]" FROf"! R F'UE',L:[C HELL. DEPENDING
LIPON THE T"r'F'E OF F'UE:LZC: HE:LL..
t','tiNZHUH DIE;'fRt'.,!CE FD. OH Ft PF.'::[VFFt-E HE:LL TO R PRI'v'RTE SE[dEFt LINE Z:S 25 FEE:']' RND
"FO FI COf,'.I!','.tUN):T'?' :E;EHER L:(NE ZS Z5 FEET.
OTHE:F: RE~T~(_!_TF..'Ef,'iEN"!"'..-T, HFf¢ FIPPL"r'. L:;PEC_TF:[CFI-F.T. ONS RND E:ONSTF'.LICTZON DZRGRFIH2: ~RE
R',/F!_TLFIEfi...E TO :[NSUF.:'.'[:/. F'F:E}PEF..' )~N:gTFILLWF:[ON.
:L:
FOF..'TH B'¢ THE P'!UNZC]:PFI,r_tT'.¢ OF Ri'4C:HORF!GE.
2: :[ I.,.!.~LL Zt".,]?rF!L.L THE S'¢'.2;'TEH Zf.,! F!E:COF'.DF!NCE H:[T.H THE E:ODE::5.
3: Z UN£:,EI;?E;TFINE:, THFIT TH!E OI'.,!-:5]:TE SE:HE?. fE:'~-'~::TEFI HFI? RE6:!LI.T_[E:E ENERF~:GEI"IE;F~]" ]:F' THE
RE'JSZDEi',!CE Z£':; F:EHODE:LED, TO :[NE:LUDE f,'I(_'~F~:I:E: THRN 2:
F!PPL. ]: E:FII'.-FI'~R Z C:H,r::IF.'~ C~F:E!Ei',I[E
'[ ~':;I IF'F:, r-::¢ '._E:,,q. TE ............ E ''~ ',/,::.".. Ei
CE!:;:TiF? THRT
H:. SET
]: FIH F,¢:IHIL~RF: HZTH THE F?FEdI'!'~'F'FI[:NT'~ ................. t-_r,F~' ..,!'' --':'_.lT._L" :SEHE[4::=E; FIN[) F.E.....:-: .... ;
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Ataska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
7
CJ
SLOPE
SITE PLAN
10
11
12
13
14-
15-
16-
17
18
20-
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time ~ime Water Drop
/
/
PERCOLATION RATE
TEST RUN BETWEEN
AND
(minutes/inch)
-- FT
COMMENTS
CERTIFIED BY:
DATE:
F'ERM I T NO.
DEPFIRTMENT ~ IJEFILTH FIND ENVIRONMENTRL" ~%nTECTION
825 "L~' STREET, 8NCHOROGE, BK. 99d0i
264-4~0
~ELL PER~'~ I ]~
( ~8045~ )
APF'L I C:FINT
~ F
LOL:RT I
LEGRL
RICHRRD P. GREEKE
OLD GLENN HWY
L 40 SEC -~:~ TiSN R±W
SRR BOX ._,DE, CHUGIRK L4-:.~.-,6,
LOT SIZE lkm:,~0~-~ q~]I~RF'E FEET
MINIMUM DISTFINCE BETWEEN R WELL 8ND RNY ON-SITE SEHRGE DISPOSRL SYSTEM IS
100 FEET FOR 8 PRI9FITE WELL; OR
150 TO 200 FEET FROM 8 PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL.
WELL LOGS 8RE REQUIRED FIND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF ]'HE WELL COMPLETION.
OTHER REQUIREMENTS MFIY FIPPLY. SPECIFICRTIONS 8ND CONSTRUCTION DI8GR8MS 8RE
FIVFIILBBLE TO INSURE PROPER INSTRLLBTION.
F'ERrl I T E?;F' I RES DECED18ER _~-~-.i1_.. ~[:E-]?.~--:
I CERTIFY THRT
t: I FIM FBMILIFIR WITH THE REQIJIREMENTS FOR ON-SITE SEWER'_-] RND WELLS RS 'SET
FORTH 8Y THE MUNICIPRLITY OF RNCHORFIGE.
2: I WILL INSTFILL THE SYSTEM IN HL:CORDFIN~E WITH THE CODES.
V -:,'.. 2
r~-w DRILLING, Inc.
P.O. Box4-1224 · 1310C International Airport Road
(907] 274-461]
ANCHORAGE, ALASKA 99509
DRILLING LOG
MUN~iPALITY OF ANCHORAGE
DEPT. OF H~ALTH ~'~
ENVIRONMENTAL PROTECTION
MAY 2 0
RECEIVED
Well Owner
Use of Well
Location (address of: Township, Range, Section, if known; or distance mare road
Size of casing :, feet Cased to ']c) feet
Static water level "~ ft. (aboi~) (below) land surface. Finish of well (check one) open end (
.Depth of Hole
Screen ( ); Perforated ( ).
Describe screen or per£o:ation
Well pumping test at ~ gallons per (hour)
of drawdown from static level.
Date of completion .~ :~ ~,~: '7~
(minute) for
WELL LOG
Depth in feet from
ground surface
hours with
Give details of formations penetrated, size of material, color and hardness
);
ft.
_TO.
_TO
TO
_TO.
.TO.
TO.
TO
_TO
_TO
_TO
_TO
_TO
TO.
_TO
Ger~icate No's. 814 & 973
2 -- STATE
DEPT O~ i~[ALB~ ?.
M -W' DRIU. IN~, I~¢.
P. O. Box 4-1224 ; 1310C nternational Airpor[ Road
(907) 274-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
Wel] Owner
Use of Well
Location (address of: ,Township, Range, Section, if known; or distance main road
Size of casing_ ,;' Depth of Hole ,,.' feet Cased to o(- feet
Static water level ~-~ ft. (above) (below) land surface. Finish of well (check one) open end
Screen ( ); Perforated ( ).
Describe screen or perforation
Well pumping test at ~.' gallons per
of drawdown from static level.
Date of completion ~ ~ ,~i>~ ~.9~.,
(minute) for
hours with
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
TO
_TO
_,TO.
_TO
_TO.
_,TO.
_TO
.TO.
.TO.
.TO
.TO
.TO_
);
ft.
NXVWA CertSfled Conic'actor
Cci'u£icate No%. 814 & 973
2 -- STATE
GREI?''~ ANCHORAGE AREA BOR,
Department ~3~n;irs~er~;ntal Quality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL
MAILING ADDRESS Ps/- ,~ ~'~Z~ ~/Z]F~ PHONE
LEGAL DESCRIPTION
ff/t~eg~.-' MATERIAL 5/~/~' NUMBER OF
COMPARTMENTS ~
LIQUID DEPTH LIQUID CAPACITY /~)~ GALLONS.
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
SEEPAGE PIT:
NUMBER OF PITS /'
LINING MATERIAL ~?
BUILDING FOUNDATION
ADDITIONAL ABSORPTION
D,AMETER ¥~' OR W,DT, /Z,' LENGTH I~i DEPTH &'
$ --
CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL
NEAREST LOT LINE /~'! TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~:~
SQ. FT.
WELL: ~/~
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
DEPTH
NEAREST SEPTIC
SEWER LINE TANK
. REMARKS
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No, LQ-0:31
DIAGRAM OF SYSTEM
C
DATE ~/~/~./~'7.~ APPROVED/
// ! ~__///G.A.A.B.
GREATER ANChOrAGE ArEA Borough
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
PERMIT NO.
DRAIN FIELD , OTHER,
NAME OF APPLICANT
INST~LLATION OF: SEPTIC TANK
TYPE AND SIZE OF ]FACILITY TO BE SERVED
Sc/
TO BE INSTALLED BY
FINAL INSPECTION: 24 HOUR NOTiCE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL SESUBJECT TO PROSECUTION.
TYPE SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK ..
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL--//5-/
SEPTIC TANK -, SEEPAGE PIT DRAIN FIELD
TO NEAREST LOT LINE.
DIAGRAM OF SYSTEM
WATER MAIN TO SEPTIC TANK -, SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4~ INCH DIAM E~ST IRON SIPHON PIPES O~N SEPTIC TANK AND SEEPAGE PIT
FITTED WiTH A[RT[GHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCR S TEM IS IN ACCORDANCE WITH SAID CODE.~
GRI :ER ANCHORAGE AREA BOROU' 't
DEP~RTMENT OF ENVIRONMENTAL OUALIq,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
/ / MAILING
NAME ~'/~-- ?~ ~-~ ~z-~)~c~-~J~/-/~ ADDRESS ~/~-~-
LOCATION ~//~/~/~../~' ~)~ LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELL ~f~/
LIQUID CAPACITY_ //~ ~20 GALLONS.
NUMBER OF
MATERIAL ,~" /~"-~=~.~.. COMPARTMENTS
INSIDE LENGTH ~ INSIDE WIDTH. ~
/
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS /~ OUTSIDE DIAMETER
LINING MATERIAL~
NEAREST LOT LINE_~:'~
~ OR WIDTH ~/~ . LENGTH ,/~ , DEPTH
DISTANCE FROM WELl //~ , BUILDING FOUNDATION
TOTAL EFPECTIVE ABSORPTION AREA (WALL AREA) ~ ~ SQ. FT.
TILE DRAIN FIELD:
ABSORPTION ARE.~/'~ SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
, NEAR E
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
· OF LINES.
IN. TOTAL EFFECTIVE
IN. ABOVE TILE.__
WELL:
LOT LINE
?
TYPE ~J~ , DEPTH
/~ ~j~ NEAREST SEPTIC
· SEWER LiNE "~/ <~=- . TANK
DISTANCE FROM WATER
· BUILDING FOUNDATION.
SEEPAGE
~a(-~/ , SYSTEM
NEAREST
OTHER
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
APPROVED ~
G.A,A.B.
DATE
GrEaT'~R ANCHORAGE ARea BORuUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
SEWAGE DISPOSAL SYSTEM -- APPLICATIO~N AND PERMIT
2227
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT ~ , DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY tO BE SERVED ~~)~ '~/~/~ /~//~--~/~
SOIL TEST RESULTS /~6~i~;'~ ~:~:S~ NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TESZ
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORIYY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE /"~'g:'/ ,~'~/" TYPE c~'~ ~:'~'
MINIMUM DISTANCES, REOUIREMENT5
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL /- )-
WATEa m^}N tO S~PTIC TANK :A' SEEPAGE Pit /~:
DRAIN FIELD
DIAGRAM OF SYSTEM
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
] CERTIFY THAT [ AM FAMILiar WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE