HomeMy WebLinkAboutTIMBERLANE PARK #1 BLK 4 LT 4 (~-'\ 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
MAILING ADDRESS
LEGAL DESCRIPTION ~ tJ
DISTANCE TO:
are8
PHONE '.~NEW
L OF BEDROOMS
{MIT NO.
Inside length Width Liquid depth
IF HOMEMADE:
Well Dwelllng PERMIT NO.
DISTANCE TO:
Manufacturer Liquid capacity in gallons
We
*STANCE TO:
No. of lines / L~ngth
Foundat~l /
Total leng~)l~es
Material beneath tile
Depth
Top of tiJe. to ~jsh grad~ /
':/,5 .--6
Width
Length
Material
Tr;.ch i.ches
7/2 inches
Distance .~n lines
Total effective ab p ' n area
PERMIT NO, ~
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot ilne
DISTANCE TO:
Class Depth Driller Distance to lot Jine
Building foundation Sewer line Septic tank
DISTANCE TO:
OTHER
PIPE MATERIALS
SO, L TE g%,N%,I
'NSTAEL cO n
REMARKS
I
J
,
/ ~ DATE
72-013 (~ev. 3/78)
LEGAL
PERMIT NO.
[:'EPRRTi"IE~T_. .,~3E., HERLTH RND ENY I RONMENTRL ,~'L~:OTEF':T I FtN
~:z._, "' STREET., FINF:HORR6E, RI-:.'.. 9'-: )t
264-4728
OF,~--S Z TE SE~-..~EE: F'EE.I"I .[ T
( E:'tO_~94 )
FFLI _.Hi',IT
LOuRT I ON
LEGRL
DEFIN TUEL ::L .... DEFIN PLRCE 9'9504
L4B4 TIi',iE:ER LRNE'.~'_,.-r.~O¢.~ ~D
?;,RD
LOT '.-";IZE ':399999 SDURRE FEET
TYPE 0F ~FCL HE,_,ORFTIuN _,T_,TEN I=,. [:,RRINFIELD
MFIXIHLII,'i NUMBER 0F BEDF'2]',IS =
SOIL I~.HTIN= '::SD FT/BR;'= i5E~
THE REQUIRE[:, _,I~.E OF THE .=,LIL HE_uE. FTIL, N _"r_TEi't I_:
g. EF"]-H-- ? LEF.I,3TH= ~'~2: GRR'¢EL E:.EF"TH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFFICE OF THE
GROUND FIND THE BOTTOM OF THE EXCRV8TION (IN FEET).
THE TFtEF~C:H 14 Z [:.TH Z'--~ 5. E~OE~ FEET.
THE GRRVEL DEPTH IS THE MINIMUI4 DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET),
F-:ECHJ Z F-:E[:, SEF"T T C: TRF&k: _ Z: ~-E-- ±000 ~3RLLCuF~S
PERMIT RFFLI_.MI',tT HRS THE RE_,FuN_,IE, ILITY TO INFORM THIL=; DEPFIRTMENT [,IIRING THE
INSTFtLLFtTION Ii',LFEL. TIuit_, OF FINY WELLS FtD,'rFICENT TO THIS FR_FEF4TY FIND THE
i'-.IUMBER OF RESIDENCES TI-iRT THE WELL WILL
T [.-~C,,.. .... ,=.:' .':, ][ f &_..F EC:T -ii- L,~q_. RF:E F:E g!lJ Z RE[:.
BFIE:KFILLING 0F RNY ~Y_,TEM WITHOUT FINRL IN:-,FEL. TILN RND RFFFL,HL B'T' THIS
DEF'FIRTMENT NILL BE =,IjE,.JEut T0 FI~.u_EL. UTIuit.
MINIMUM DISTFINCE BETWEEN R WELL FIND BNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
±E~O FEET FOR FI PRI',/FITE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON'THE TYPE OF PUBLIC WELL.
MINIMUM DISTFINCE FROM FI PRIY8TE WELL TO FI PRIYRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MFIY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRI"E FIRE
FIYAILFIBLE TO INSURE PROPER INSTBLLRTION.
PEF-:P1 T T E.--.F I F-:E'__g [:.EC:EFIBER Z--:±.. 1 ..... ---
t CERTIFY THRT
±: I RM FRMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS RS SET
FORTH 8Y THE MUNICIPRLITY OF RNCHORFIGE.
2: I WILL INSTFILL THE SYSTEM IN RCCORDFINCE WITH THE CODES.
3: i UNDERSTFIND THRT THE ON-SITE ~EWER SYSTEM MRY REQUIRE ENLFIRGEMENT IF THE
RESIDENCE IS REt"IODELED TO INCLUDE MORE THRN 3: BEDROOMS.
....................
RPPLI CRNT DERN TLIEL
ISSUE[: BY___ ',,,'4. C1
- ~,,,,/ / , <, (, ,~ ~', ~' >.~ ?-
PERFORMED FOR:
SOILS LOG
MUNICIPALITY OF ANCHORAGE
[] PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
Mi_
2
3
5-
/
9-
11
12
-~mn~oe~ L~n e_.
SLOPE
Sub~ivi~o~
SITE PLAN
13
14
15
16
17
18
19-
20-
WAS GROUND WATER H0 SL
ENCOUNTERED? pO
E
IF YES, AT WHAT ,~
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
COMMENTS
PERFO.M~D~Y: /'Z~ ~/hCERT,F,~DS~:
UF?Z,-O2 L/
72-008 (6/79)
(minutes/inch)
, FT AND -- FT
APPU-~.NT FILLS OUT UPPER Hi ;- ONLY
Prop~ty Owne~ ~) ~,/~/d -~/.~ ~_ Phone
Address / ~ [ ~0 /-t//~,~ Zip Code
Address /
Phone
Realty Co. & Agent
,~//~
Zip Code
Address ~,~ ~ ,
Street Locati~ /7 ~ .~'./~ ~
Type of Residence
Single Family
~Multiple Famgy No. of Bedroo~
~ Other
Water Supply
~dividual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
Community For wells drilled prior to that date, give well depth (attach log if available}.
Sewer Disposal
Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Datel ~-~
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
DEPT. OF HS?,LTH
ENVIRONM2NYAL PROTECTION
RECEI EB
~) APPROVED B~DROOM8 'OONDITION8 OF APPROVAL
(
( ) DISAPPROVED
( > OO~D,~,O~*L*~OV*~'
DATE ? ~-~ 4
Soils Rating Date ~wer InstaJled Well TO Absorption Area Well Log Received
~{ -~ / ~/' 3 Well to Tank Septic T~k Size /
72.023 (31821