HomeMy WebLinkAboutT12N R4W SEC 10 LT 42AOnsite File
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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
'/ .. -- PHONE ,~NEW
LEGAL DESCRIPTION
NO. OF BEDROOMS
]Well f I Absorption area Dwelling ' PERMIT NO.
~ ~ Manufacturer ~ ~<~ Material ~ ~¢~ N°' of compartments
Liq. capacity in gallons Inside length Width Liquid depth
~ ~¢ (~ IF HOME.DE:
, Z Well Dwelling PERMIT NO.
O Z ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation ~ * Nearestlotline ~.~ PERBITNO.
~ No. oflines ~
Length of oac¢]~ Total ,e.gth ~ I~s Trench w~h¢ Distance be~elXnes
Q~ ~ Top of tile to finish grade--~- ¢ Material beneath tile ~O inches Total effective~ ab~orptiOn¢O ~ ~area
Length ~ Width Depth PERMIT NO,
~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS ~ ¢~
SOIL TEST RATING
iNSTAELER
72-013 (Rev, 3/78)
PERMIT NO.
DEPRRTMENT ~ HEBLTH BND ENVIRONMENTBL' !OTECTION
825 ~L~ STREET~ RNCHORBGE, BK. 99501
264-4720
WELL R~-~[:. E,~-~---SITE 5E~4E~ F"E~:~d IT
( 8~0i~ )
RPPLICRNT
LOCATION
LEGRL
LUCHSINGER INC
W±?2 BLM L42 T22NR4W
PO BOX i0-~74 ~5ii
LOT SIZE
~44-50~6
DDD~DD SQURRE FEET
T9PE OF SOIL RBSORPTION SgSTEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS = 4 SOIL RRTING (SQ FT/BR)= 85
THE' RE~.I_II~.ED' r ' ' :,I~E'- --'- OF THE _,uIL'=- HE,=,E~FTILN- '"" '' '- '='"'"'_,~TEM' IS:
[:'EF'TH= ~]]: L E ~'~ ~-~ T H = 4--< 6F~R%""EL [;~EF'TH= 4
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 EXCRVBTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRBVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVBTION (IN FEET).
~:E,]:-~Li Z ~:E[:. SEF"T I C: TRI-~:: '_:. '¢ ZE= -'~ 250
PERMIT RPPLICRNT HRS THE RESPONSIBILIT9 TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RN9 WELLS RDJRCENT TO THIS PROPERT~ RND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
Tl4C, (2) I ~4SF'ECTI £,t4S ARE REIZ~UI ~:E[)
BRCKFILLING OF RN9 SgSTEM WITHOUT FINRL INSPECTION RND RPPROVRL B~ THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RNa' ON-SITE SEWRGE DISPOSRL SYSTEM IS
±00 FEET FOR 8 PRIVRTE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNC:E FROM ~ PRIVRTE WELL TO R PRIVBTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO TH~ DEPRRTMENT WITHIN ~0 DR~S
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MR9 RPPL~. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVBILRBLE TO INSURE PROPER INSTRLLRTION.
I
i:
FORTH B'¢ THE MUNICIPRLIT'¢ OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
]:: I UNDERSTRND THRT THE ON-SITE SEWER S'¢STEM MR'¢ REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS.
.__ . .. '_
_, I GNE[:, ...................
RPPL I CRNT LUCHSINGER INC
ISSUED B~ ....................... [.NTE ...... .~_ ¥4. 0
CERTIFY THRT
IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR: ~/~-~rt~L [Ub' C ,H- ~ I~'~/~- ~'~L- DATE PERFORMED:
LEGALDESCRIPTION: 4xx~. ~ ~' [~1~?~7 ~'~. :~10 TJ'~,~'
1
2
3-
4-
5-
6-
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
COMMENTS
SLOPE
SITE PLAN
WAS GROUND WATER S
ENCOUNTERED? ~0 L
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
,[minutes/inch)
-- FT
PERFORMED BY:
CERTIFIED BY: ~"~ ¢) V {/" ..( ~',.~"/~- ~ DATE:
72-008 (6/79)
DOUG .S A. STAKK and ASSOCIATES, CON~ ~TANTS
957 P~estbury Drive · Anchorage, Alaska 99503 * Phone: 277-4.;00
Soi~ Tesg'
D&~e oC'Tes~.~
Te~,l'ocat£on:
·es¢ m~hod:'
March ~, ~983
~/es:~: hal~~ of BLM Lo* 42, Sec. 10:~ ~12N~ R4W
100'' sou~, 2~' east og north~est'~orner
Bac'khoe ho~e, dug-~ 12' -- no, groun~watero
S'amp~e ~aken a~ 6;t. Soil quali~y suc:h thai;
n~ per¢oIa~ion ies~ne~essaryo
~W
Organiz. ation · Management · Engineering · Surveying · Planning ° Human Resource Development
v ,. WEI.L DRII.¥.ING lOG
Size of cssin~,..' ~
Location (address of, Township, Range,. & section, If known,
_~:._Z..~V /~.~ ,~'/'vi D~ te oom~].eted _
Depth of hole ~(~ feet. C, sed to.2~ 6eel;.
Sta. tta water ].eve1
feet (above) (be]ow) lsnd surface. F}n~sh of
well (check one) ODen end (~), Screen ( ), Perforated ( ).
Oescribe screen or perfor~tlous
Well pumoin~ test at 2o
with
R ems rks.
per (hour) (minute)For //~ ~ hours
Depth in feet From
ground surface
._.~._.__eo __F
..i~ _to
G · - - go ..... ~. ·
feet of drawdowu'from static level.
..............
Gave dete%ls of form~t, lons penetrated.,
s~ze of materlml, color,nd h~'rdenss.
~./t
/
APPLIC~'NT FILLS OUT UPPER HA[~-'~'ONLY
Property Owner __
Buyer .:~' ~/
Zip Code
Address
Lending Institution /L~' ~/~ .~[// ~, ~.~ .~ ./ ~.~¢~" .~//~ Phone
Realty CO. & Agent Phone
Add~ess /~'~:/C Z~ Co~e
Legal Description (..?..~..p
'-
Time Time Time Time
Date Date Date DAte
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OP ANCHORAGE
DEPT. OF HEALTH &
I~NVIRONMENTAL PROTECTION
AUG 5
RECEIVED
7/~ PPROVED BEDROOMS 'CONDITIONS OF APPROVAL
(
(J) DISAPPROVED
( ) CO~IT~/~AL APPROVAL'
Soils Rating Date Sewer installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size