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HomeMy WebLinkAboutUS SURVEY 3201 LT 25 PTN T10N R1W SEC 9 ' ' 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 NAM E ~/,~ MAi Li NG A D DR [[~SS~'~ ~'~---'/ {,~$ PHONE [~] NEW LEGAL DESCRIPTION LOCATI~ON ~ I Well DISTANCE TO: F- ~ Manufacturer ~ Lq. capacty nga OhS IF HOMEMADE: AbsorPtion area Inside length [Dwelling 7/~ ! Material Width ~'~('~ NO. OFBEDROOMS PERMIT NO. No. of compartments Liquid depth Well DISTANCE TO: No. of lines Length o%e.~h tine'--' Total length of lines47! PERMIT NO. Nearest lot line ~.~ ~ Trench wid h 40 !~.~h inches Liquid capacity in gallons PERMIT NO. Distance between lines Top of tile to finish grade Length Width Type of crib Crib diameter Well DISTANCE TO: DISTANCE TO: Class Depth Building foundation Material beneath tile Depth Driller Sewer line Total effecti e absor tion area inches Z I ~---~ ~ PERMIT NO. area Distance to lot line ~ptic tank OTHER PIPE MATERIALS 72-01'3 (Rev. 3/78) DATE LEGAL PERMIT NO. RPPLICRNT ~ ~.~ ~/,~"~'~"~'~ ~:. ~c~ LOCRTION ~t~ ~v~ TYPE OF SOIL RB~ORBTION SYSTEM IS:%~G~c¢ DEPFIRT~dENT r"~HEBLTH FIND EN'.,,'IRONMENTBL ~OTECTION 825 "L STREET, RNCHC~R~GE., FIK. 26.q._.~ 720 P~l F--- L L_ R ~'-~ [::, C~ t'-~ -- '-~; I T E ( ) LOT SIZEY¢'9/¢¢~ SQURRE FEET MRXIMUM NLIMSER OF BEDROOMS ='~ ~_~,~¢/~ SOIl.. RRTING (SLq FT/BR)= THE REQUIRED SIZE OF FHE SOIL RDSORPTION SYSTEM THE LENGTH DIMENSION IS THE LENGTH (iN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF ~ TRENCH OR PIT I~ THE OI~T~NCE BETWEEN THE SURFBCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GR~VEL DEPTH IS THE MINIMUM DEPTH OF GRB',,,'EL 8ETI.4EEN THE OUTFFILL PIPE RND THE BOTTOM ElF TFIE EXCRVRTION (IN FEET). F4EL-]U I RES, 2;EF'T I C: TRI'-tI-{ _~S ]1] ZE= ]¢)~)I~) t3 F:I L_ L C~ r-4_c· PERMIT RPPLICFINT HRS THE RESPONSIBILITY TO INFORH THIS DEPRRTHENT DURING THE INSTRLLFITION INSPECTIONS OF RNY WELLS RDJFICENT TO THIS PROPERTY bINS, THE NUMBER OF RESIDENCES THP]T THE WELL WILL SERVE. TI~4C~ ,.' .?:- ) I I'-.ISF'EE:T I C~ i'--I ~:- i-fiRE R E L-'t'! LI I: RE[':-, BRCKFILLING OF RNY S~?STEM WITHOUT FINFIL INSPECTION FIND FiF'PROVFIL BY' THIS DEPFIRTMENT 14ILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN Fi WELL FIND RNY ON-SITE SEWRGE DISPOSFIL SYSTEM IS :L00 PEET FOR FI PRIVFITE NELL) OR ±50 TO 200 FEET FROM Fi PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS FIRE REQUIRED FIND MUST BE RETURNED TO THE DEPF4RTMENI- WITHIN ~0 DFIYS OF THE WELl_. COMPLETION. OTHER REQUIREMENTS MFIY FIPPLY. SPECIFICFITIONS FIND CONSTRUCTION DIFiGRFIMS FiRE h]VFIILFIBLE TO INSURE PROPER INSTFILLRTION. PERr-1 I T EXF' ]: RES [:,ECE~,IBEER I FORTH BY I'HE MUNICIPFILITY OF FINCHORFIGE. 2: I 'WILL'INSTRLL THE SYSTEM IN BCCORDFINCE WITH THE CODES. · ~: I UNDERSTRND THRT Tt4E ON-SITE SEWER SYSTEM f'lR9 REQUIRE ENLRRGEMENT RESIDENCE'-IS REMODELED TO INCLUDE MORE THRN } BEDROOMS. CERTIFY TFIFIT I .BM FFIMILIFIR [4ITi~ THE RE6'~uIREMENTS FOR ON-SITE SEWERS FiND WELLS FIS SET . IF THE F'EF~:i',I]; 'r' NO. FtI'::'F'L. ;11 C!::I!',IT I"iRF-'."r' E;EL. LE; C:,.'"O [. QC:I':'I"[' ); CIN E: ]; t?.f) F:l',,,'l::i: LEGF:It I....;.?.~:~ USS 320:1_ 'i"B:i::II',I':S F'! 1.,:; L. OT Fi; ]: ZE 272 8829 THE LENGTH [::, Z I'I[ENE; Z ON :[ E; 'THE LE:[qGTI-~ ':: ]: N FE:E:T ::, OF 'I'H[~ -FRE:i'-,!CI'-I OR DI:~".F::I :[ I~;ff::' :( E:I_.D. "I'HIE E:,Ii.".:F"I"I'-I OF FI TR~NCFI OF~: P):T Z:5 'f'l~lE; D]_'£¢TFINCE E~E:TI-,]EZEI",I THE '_'~I..II:;~:F:'RC:E OF 'Ff"l["_" G[;?.OUt",ID Rt",ID TI-IE: BEI-f-TOI"t ElF THE E'/~',CR'v'I::IT 'I"FIEI:;:E ):S NO SET 1.4]:C, TH t:::'OF;: TF.:ENC:HE:B. THE GF;~FI',,,'E:L. [)I:::F:'TH :[~; THE I'"IZN]'I"'IUI'"i F:INB, 'FHE E',OI'TCdvl OF' THE IE',~'~',C?I',,,'FIT F'F:;I'Rf'IIT I:::IF:'F'L.):CF:INT l'"ll':l';'i:; THE: REE;F'ON%IE:):L. IT~¢ TO :[NF'OR["I THZ::ii; D[::PI::tI:;'.TI"IE:NT [::,L.II';;:]:i'.,ll:~i "f'FIE ;[N:E;TFILLFI'f'ZOI",! tN%PECTICd'-,I::S OF FIN"r' [4[.::'1.&..2; F:II]:,.J'IhCEd",!T TO T["tZE; I::'I:?.OF'EF?.T~¢ F:li'-,l[::, TFIE NLIbiE:EF~'. OF FRE2~:]:[DE{NC[~:r_:; TI'-IFIT THE I.,.IE':LL. BRCKF:' :1; LL :[ NI3 OF:' FIN"r' S~¢:E;TEI'"I 1.4 :!: THOUT F [)[:::F'Fff,~:Ti'"IENT [,lii._.[._ E~E :E;I..IELJ'E:OT 'Ti]) I'"1 ]: N ): r,lUb'l [::, ]; E;TI::tNCE: E=E:'TI.,EE[Ebl l::l I.,IEL.L. FiND I:-II'.,!U Of.I-E; :r. TE E;EI.,.!FtGE D ::t.~:!18 F'EET FOlqr la I::'F?.Z',,,'FITE.' I.,.!EL.L.~ J/.Si/j TO 2~)~::J F'E_'[ET F'F?.OP1 F! F'UBL]:C kiEL_l_ D[:JF'[EI'.,!C,:(Ni3 UF'OBI 'T'H[E T"r'F:'E OF PLIErL;[C: I.,.IE:L.I .... I::l'l'l-.l[El:.~: F;:I_"~:I;:!UZI:;~:E:FtEJNTLE; I"11::1¥ RF'F'L"?. :SPEC:]:F':[CF:FI']:ON~:i FIND C:Ob,I:E;TI'~:UCT):Eff',! FI'CFI Z LRE'~I..E TO :[ N:SURE F'F,:OF'EF?. .[ NSTFIL. L.FIT :[ ]: C:ERT :[ F'? &: ]: RP'I FrI::Ii'"I]:L.):FIF;: !.4I'Tl'-I -['I"'1[~ R[E6]IJZ!:?.EFtENT::~; FOR ON'"'E;)ZTI; F:'Cd:;:'I'FI [3¥ THE: I'"IUNZCZF'F'iL:t:T¥ OF RNCFI()B:FIEiE:. 2: Z t.4~L.t. ZNE;TFILL. THE{ E;'¢E;TE:P1 ZN I::~CCOF%aF!B~C:E I.,.I ]: TI -I TFIE 5~:: Z LINDE:F;;:E;'I¥~t..!E) 'T'HFIT THE: ON--'-SZ'T'E E;E:b~ER S'-r".E;TEF! I'"IFI'¢ [RE:6:iUIRE: EP',IL.F:I~'.C~Eh'IE~:NT :(F:' THE F;?.[EE;I[)E'NCE: I E; F?.E:IdODE:LED -1'0 t I',IC:L.U[)E: FIOI:RE ]"HFIN SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRC, TF. CTION Pouch 6-650, Anchorage, Alaska 99502 276-222~ SOILS LOG -- PERCOLATION TEST PERCOLATION TEST 6 7- 8- 10- 11 13- 14- 15 16 18 19 20 OATEPERFORMED: SLOPE SITE PLAN Gross Net ,/" Depth to Net Reading Date Time Time ~' ~Water ~ Drop l~,,o~ ~;~ ~4~ ~G'~ PERCOLATION RATE ~ 0 (minutes/inch) TESTl RUN BETWEEN ~ FT AND ~FT COMMENTS ~:':':':':':':':':~..'~_'r-~g;~_ ~-'~,'q~ ~-~,~P~_M, ~/~[-~ ~t~[,~'~ ~ ~'~ ~E~O~O(~O~-  ENVIRONMENTAL ENGINEERING DIVISION 2 AUG 9 /979 Telephone 264-4720 DE£E H/Er~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~Ft~A{31IL~/r~E~J MUN C PAL TY OF ANCHORAGE DEPT. OF Hr''',kTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTLIj(~R©NMENTAL i ROTECTION 825 L Street - Anchorage, Alaska 99501 )IRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE t. E"OPE"TYO"NE .AnN PROPERTY RESIDENT (If different from above) ~AILING ADDRESS MAILING ADDRES~ J 5, LEGAL DESCRIPTION STREET LOCATION R~ 6. TYPE OF RESIDENCE / N~ER OF BEDROOMS One ~ Four ~ Other ~ ~ Two ~ Five SINGLE FAMILY ~ MULTIPLE FAMILY ~ Three ~ Six 7. WATER SUPPLY '~ INDIVIDUAL~ COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM  i NDiViDUAL/ON.SiTE.~ D PUBLIC UTILITY * ATTACH WELL LOG. A wail Icg is requ'ired for all wells drilled 'since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ~) ~ ,~r **If individual/on-site, give installation date/~Ktl0 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. 72-010(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 [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Varified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFAGTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS · ---'- '- ---~~ROOMS [] CONDITIONAL APPROVAL (letter must a,,~peny certificate) [] DISAPPRO~LE~_ vO DATE ~ BY (Title) ( LEGAL DESCRIPTION '~ ..... 72-010 (Rev, 3/78)