The URL can be used to link to this page

Home My WebLink AboutTIMBERLUX #2 BLK I LT 5Lc>r' ~,~.~ 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 DISTANCE TO: Manufacturer ;ide length I Width IF HOMEMAD DISTANCE TO: Manufacturer Well DISTANCE TO: No, of lines Length of eac lin ~ ]Topoft~letofinishgrade ~__~ I Length Width Type of crib / //~ Cribdia~ we,, DiSTA~'C/L~fO: Class ( Depth DISTANCE TO: Building foundation Dwelling Foundation Total length of Material beneath tile Depth Material Nearestlotline~'r~ Trench widt ~h~.nches OTHER [] UPGRADE NO. OF BEDROOMS No, of c~artments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO...~ ~O53 ~ PERMIT NO, Crib depth Total effective absorption area Building foundation SepticNeareSttankl°t line Driller Distance to lot line PIPE MATERIALS SOIL TEST RATING F'ERMIT NO. DEPRRTMENT OF HERLTH RND EN',/IRONMENTRL PRZTE]TI]N ,_,~._~ '"L'" STREET.. RNCHO~RGE., RK. ~'~0~ 264-4720 , 8~1o_.4 ..' FPLI_.RNF ROEHNER R. ,,NI'v'ER, _.i~~. W. -',-'..RE R"/E LOCRTI ON LONGBOH RVE LEGRL L5 E:LK I TIMBERL-I~ S/[:, LOT _,I~-E ,':!-55:04 SQIJARE FEEl' TYPE 0F _,LIL RBSORBTION _,T_TEM IS: TREN~.H E, EDRuOM_, = blR,~IM~M NI~t,IBER OF SOIL RRTING ':'q~' FTr"E:R;,= :t,~,._ .-..I¢..E OF THE SOIL RBSORPTION =,¢_,TEM I.=.. THE REQLIIRED '- ~' E:,EF'TH= ::t_2 L_Ei'--IL~Tt4= 24 -~i ..PI '. El._ DEP-FH= --. 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 SURFRCE OF THE GROUND RND THE BOTTOM OF THE E~CFIVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVR'TION (IN FEET). RED- SEF'T I C PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF BNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. BRCKFILLING OF RNY SYSTEM WITHOUT FINRI_ INSPECTION RND RPPROYRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS 200 FEET FOR R PRIVRTE WELL; OR $58 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE : RVRILRBLE TO INSURE PROPER INSTRLLRTION. PE~:~-I I T E:qP I ~:ES ['>EC:Ef-IE:E~-': Z=:$.. - " I CERTIFY I'HRT l: I RM FRMILIRR WITH THE REL-]UIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. Z~': I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS RE~0~D TO INCLUDE MORE THRN ~ 8E[:,ROOMS. SmN : L C NT RO HN R ............. .... I _,~I_IED B~ ............ [)RTE PLAYER VENTURES CONSULTING GEOLOGIST SOILS LOG Performed for ]~o?~ ~ Iii ~4/' Date Location IS-O' ~ c4/v~ 72_o' tlJ ~ S ~ ~ to~ ~ 2 Soil Type Water Level .Remarks 'c~ 14' 16 18 20 Total Depth of Excavation /,5~ Material at Total Depth Groundwater Bedrock Not Reached (X) Not Reached Depth, if Reached Classification Method Depth, if Reached (V) VisuM ( ) Sieve Analysis () Gary F. Player, Consulting Geologist Is :: ~ ~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE ~UNICJPALI~ OF ANCHORAGE ~UNICIPALITY OF ANONORAG~ DEPT, OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~T~JRONMENTAL P~OTECTION ) ENVIRONMENTAL SANITATIO~ DIVISION MAR ~ 5 lg81 , Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incemplete requests will not be processed. Please aUow ten (~0) days for processing. 1. PROPER~YOWNER PHONE PROPERTYR~SIDENT(Ifdifferenznoma ove~ PHONE 2, BUYER PHONE MAILING ADDRESS 4. R~A~TOR/AG ENT~ MAILING ADD~ESS~ * I ~ ' 5. LEGAL DESCRIPTION ~ -'~ /g ~ 6. TYPE OF RESIDENCE NUMBER OFtBEDROOMS ~ SINGLE FAMILY ~r~ ~¢ . ~ One ~ Four ~ Other ~1 ~(~'. ~0~ ~ Two ~ · Five : MULTIPLE FAMILY ~':~ U~r~ 'Z~: Three : Six 7. WATER SUPPLY ~ INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available,) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY /??? YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 {Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [~3 F~VE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMSER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -BITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size:~) ~)OO If Tank is homemade SOILS RATING give dimensions: 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~-~'APP Rev ED FOR ~}'~- BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) EZ] DISAPPROVED DATE BY 72-010 (Rev, 6/79) NJUNICIPALITY OF ANCHORAOE MUNICIPALITY OF ANCHORAGE DEPT. OF (~-~ALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~V|RONMENT/~L 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION FEB 51979, Telephone 264-4720 ER~ F~A~C j~ ~j~ ~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW I DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PROPERTY, R ~ , MAI LING ADDRESS PROPERTY RESIDENT (If different from above) PHONE~ ZTZ PHONE 2, BUYER PHONE MAI LING A DDR ESS 3. LENDING INSTITUTION I PHONE I MAILING ADDRESS 4. REALTOR/AGENT MAI LING ADDR ESS JPHONE i5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE [~SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY [~ iNDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LoG. A well log is required for all wells drilled since June 1975. For wells drilled prior tO that date, give well depth (attach log if available.) ~c~nl -' 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date ~- ~- ~" ~ If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE Must ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~10(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ SINGLE FAMILY [] ONE ~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FQUR [] SIX PERMIT NUMBER 2. WATER SUPPLY _~ ~.~.~v, -~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY I ('~ ~-- -- DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED PERMIT NUMBER 3. SEWAGE DISPOSAL SYSTEM "~-3L''' :'' I -~INDIVIDUAL/ON -SITE DATE INSTALLED E~]PU BLIC UTILITY ~ _~C.,~,~ Connection Verified INSTALLER 'E]~Septic Tank or [] Holding Tank ~L"~ ~ ~ C' ~, Size: \C"~'~C') If Tank is homemade SOILS RATING -- give dimensions; ~ ~ ~ TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESWELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS /~ APPROVED FOR ,'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)