HomeMy WebLinkAboutVALLEY VIEW ESTATES #1 BLK 1 LT 7 -FA'r 5
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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'b~ . UPGRADE
DESCRIPTION
Liq. caEacit in gallons Inside length Width Liquid depth
, ~ Well Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
~ DISTANCE TO: Wellr~o ,+ F°unOati~ ~ Nearest I~n~ ~
No. of lines/ Lengt~ ~e Total 12~es Tre~dtb Distance e, Ii,es
Total ef ctive sorption area
~ ~ Top of tile to finish grade ~ Material beneath tile ~c~
Length Width Depth PERM
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Wei] Building foundation Nearest lot line
~ DISTANCE TO:
~ SJass Depth Driller Distance to lot line PERMIT NO.
m Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
REMARKS
Rev. 3/78)
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694-25SB
OWNER OF LAND /~D
ADDRESS --~' ~'
LEGAL DESCRIPTION
DATE-Started --~ 7,~ ~'
PE~IT NUMBER
DEPTH OF WELL ] do
STATIC LEVEL OF WATER FT.
~ DRAW' DOWN ~. ~'o
K1ND OF CASING ~o~
KIND OF FORMATION:
From ~'~'
From / 0
From ~[~'~ Ft. tol/°
From Ft. to-
From / iv Ft. to /~)O
From Ft. to
From__Ft. to
From .Ft. to
From Ft. to
From Ft. to
From __.Ft. to
From__Ft. to
From Ft. to
From Ft. to.
From Ft. to
From Et. to
Fr. to -~'~ Ft. o
Ft. to /O Ft.
Ft. to qS- Ft.
Ft. (~ ,~W,(O
Et,
Ft.
Ft.
Et.
Et,.
Ft.
Et.¸
Ft.
Ft.
Ft.
Ft.
From Ft. to Ft,
From _Ft. to Ft,
From Ft. to Ft.
From Ft. to Ft,
From__Ft. to. Fr
From__Ft. to Ft.
From Ft. to Ft.
From .Ft. to Ft.
From Et. to Ft.
From__.Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Et. to Ft..
From Et. to Ft.
From__.Ft. to Ft.
From__.Ft, to Ft.
From Ft. to Ft.
MISCL. INFORMATION:
c.? ~ ~ //
DRILLER'S NAME ,4. · ,~::-'
F'ERb~IT NC
BPPL. ! CfiNT
t "F' F~T '£ - H
LEGRI.._
DONfiLD
EiF']N LRNE
I7 -'" ',"- "'¢'[c'I4 EST
._, 61 fiLLET .~
LOT .:,I ~.m
:1.,~ ;~E Es3 SI;!IjFIF.:E FEET
! ~F,_ ~F:' _,_ I1_ R :~'=;F'~PpT]'FN SYSTEM .[_.. TRENOH
· .c'.,Yl,*,, ,. . ,,** NUI"IE:EF: 0F' E:EDR00MS = ]: SOIL RFITING (SQ F-'"I,-' "Ell:";' ........" --
THE REQUIRED ST..iF OF TH~:
iSEI
THE LENGTH DIMENSION lC; THE LENGTH <iN FEE]') OF TF!E TRENCH OR DRF!INFIELD.
THE DEPTN OF R TRENCH OR PIT IS THE DISTRNCE E:ET!.,.IEEN TNE SURFF!CE OF ]"NE
GROUND FIND TNE BOTTOM OF 'T'I-IE EXCR'¢BTION (IN FEET).
TNERE IS NO SE"!" 14IDTN FOR TRENCHES.
THE GRFIVEL [:'E:PTN tE; TNE MINIMUM DEPTN 0F' GRR',,,'EL E~E"FI4EEN THE OUTFFILL. PIPE
FEND TNE BOTTOH OF ]"HE E::':;C:RVRTION KIN FEET).
F:'EF. ff,IIT hFFL.EL. Ph't~ HR~-_'; 'FFIE ,...E_,F u,4_,IE, I,_If, TO INFuF..h -I"HIS DEPRRTMENT DURING THE
ZNSTRLLRTION ]'N'-~F'E-T T - '.iq CF FIN'¢ .~[.L_--, RDJRCENT TFt THiS F'RC~PERT',:' RND THE
NUI'IE~EF: OF RESIDENCES "FHFFF ]H_ HELL HILl .... Eh.,E.
HINIMUM DtSTRNCE BETP.IEEN FI HELL RND RN'T' ON-SITE SEI4RGE DISPOSFIL SYSTEM !S
i.C~8 FEET FOR R PRIVRTE HELL OR :t58 TO 2(3C~ FEET FROM R PUBLIC HELL DEF'ENDZNG
UPON THE 'TYPE OF PUBL. IC HELL
!'dINIMUM D!S]"RNCE FROH R PRIVI::I'TE !4ELL. T0 R PRI',,,'WT'E SE!qER LINE IS 25 FEET RND
"Fo Fff CC~MMUNI'f"T' SEHER LINE IS 75 FEE'T'.
OTHER REQUIREMENTS MFI'./ F4F'F'L~'. SPECIF'ICFITiONS FIND CONSTRUC:TION DIRGRRh1S !3RE
RVRILRBLE TO ~NSURE PROPER ZNSTF!LLF~TtON.
! CERTIFY TFIFIT
i: I RM FI~MtL. iF!R HITH THE REQLIIREMENTS F'OR ON-SITE SEHERS FIND HEL. LS RS SET
F'OR]"H E:'¢ THE MUN!CiPRLITY OF" F-INCHORRGE.
2: I WILL. INS'FRLL TI-IE S'¢S'TEH IN F!CCOF4'.DRNCE !4ITFI THE CODES.
]:: Z UN[:,ERSTRND THRT THE ON--S~TE SEHER S'.?STEI'I I'11a¥ REgRJZRE EI',ILRRGEMEN-F ZF THE
F;'.ESZDENCE IS ~HOE:,ELEE:, TO INCLUDE MORE THFIN 3: BEDROOMS.
S I GhlED:
RPPL I 2 F. NT HEk~'
PERi~II T NO, ( 7'803.-~0
APPLICANT DONFILD AERY
LOCBT I ON
LEGAL
I'IUN I Fj I PI:IL I TV JiF RI'-,ICHCIRRGE
DEPARTMENT ?~,, HERLTH AND ENvIRONMENTAL/'~OTECTION /~ ~ ~
~'-~ 825 ' STREET, ANCHORAGE, AK. 9.~i /
WELL A~D O~W--S I TE SEWER PERr~ I T
LOT ? BLi VALLEY VIEW EST #1
BOX 211 E.R. 995?? G94-~154
L~T SIZE 1~000 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: .TRENCH.
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING (=,Q FT?BR)= 150
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH=- :LO LENEITI~= ----?3: I~iRR%~EL DEPTH= ?
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFBLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
RE['-!LI I RED SEPT I C: TAf-IK S I ZE= :1. OE'10 GALLCIhlS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPRRTI~IENT DURING THE
INSTALLATION INSPECTIONS OF ANY t,.IELLS ADJFICENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES TI-IRT THE WELL WILL SERVE.
TWO ( ~ > INSPECT I OF, IS I:II:;:E RECqU I RE[:,
DI~CKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO' PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND RNY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELb OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL. LOGS ARE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRRMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'ERi'"I I T E~'~F' I RES DECEMBER ..7_.-1.. -1~7L3
I CERTIFY THAT
l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS 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 ~ BEDROOMS.
ISSUED ....... D8TE ........ Vi2
SOILS LOG - PERCOLATION TEST
SLOPE
SITE PLAN
10-
11
12
13
14
15-
17-
18-
19-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
.I