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Home My WebLink AboutLot 06BLo't- ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PI~ , /ECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT VIAl LING ADDRESS LEGAL DESCRIPT]ON I well I Absorption area Dwelling PERMIT NO. DISTANCE TO: ~ Liq. capacity in gallons IF HOME.DE; J~side length width Liquid depth 0 ~ Manufacturer ~ Well Foundation Nearest lot line PERMIT NO. ~ to~ ~ Totallength flines ~~ea No. of lines Length of each lin mg[n~' Trench width Distance between lines ~ Top of tile grade Materia th tile inche/ Total effe absorption area ~ Lengt~ Widtl~ crDepth~pth ~ . .f . . ~ PERilUNe. Type of rib Crib dl eter /ota~ et ectlve adsorption area ~ Well I Building foundation Nearest lot llne ' DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer llne Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING INSTAELER ~(Rev. 3~ 8) Location :'~--- Legal Description: Type of Soil Absorption System Is: Trench: Maximum Number MUNICIPALITY OF ANCHORAGE~-~, Department/'-~ Health and Environmenta2 !rotection 825 ~ Street, Anchorage, AK. -~)501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT '-~: ~ Mailing Address:5~/~ Phone Number: Drainfield: of Bedrooms: Seepage Bed: i Holding Tank:~'~ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH ~ LENGTH ~ GRAVEL DEPTH ~)' WIDTH ~'-' The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED ~(HOLDING) TANK SIZE = ~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 1 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if ~'~4f-~the residence~ ~'~'¢~'~--~is remodeled to include more ~at 3~ed~ocms~~ Signe~: ~/~ Issued by: Ap plic ant Date: ~ · SWP/024(1/81) GRE' '"ER ANCHORAGE AREA BOr'-UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAILING ADDRESS /~'"~ ~ 0~''r//~'~'~g PHONE /~/~l~q/'~/x~Oo/~ LEGAL DESCRIPTION FROM WELL MANUFACTURER ~'~'~'~'~'~:~ MATERIAL ~'~C~I COMPARTMENTsNUMBER OF INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH __ LIQUID CAPACITYt~('~ GALLONS. SEEPAGE PIT: NUMBER OF PITS ,-~-~F~E~R. OR WIDTH , LENGTH , DEPTH LINING MAT ~A~"~L _ CRIB S~~ETER DEPTH DISTANCE FROM: WELL / ~ ~OTAL EFFECTIVE ~ BUILD~NG FOUNDATION , NEAREST LOT LINE A~3S'~RP lO__REA (WALL AREA)// SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE CONST RUCTION DEPTH BUILDING FOUNDATIO/ CESSPOOL NEAREST /LOT NEAREST LINE /7~0 ~ SEWER LINE OTHER SOURCES TANK ~7 SEEPAGE SYSTEM APPROVED DISAPPROVED REMARKS. DISTANCE FROM: DISTANCES: PIPE MATERIAL: Form NO. EQ-031 DIAGRAM OF SYSTEM GrEATEr ANCHOraGE ArEa BOROUGH pERMIT NO. DEPARTMENT OF ENVIRONMENTAL QUALITY 35:~0 "C:"STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274'456! SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT LEGAL DEscrIPTION ~ TYPE AND SIZE of FACILITY TO BE SERVED '~ ~ 0' '~ FINANCED THROUGH OM 'LET'O" OATE ANT,CIPAT ' t SEEPAGE PIT , DRAIN FIELD . , OTHER -, DRAIN FIELD , SEEPAGE PIT ALSO CONSIDER AREA WELLS. · SEEPAGE PIT ., DRAIN FIELD 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PiT FITTED WITH AIRTIGHT REMOVABLE CAPS. TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-G8 AND THAT THE ABOVE DATE / APPLICANT'S SIGNATURE G["~:~.TER ANCHORAGE AREA BORO"~'}H HEALTH DEPARTMENT ' 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N? 434 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ~ , MAILING /~/_~ ~-) ~.~,~ ~.,~.~- ~/ NAME.,~z{~'~-'~'-7'~/'~/ /~/~~ ~ ADDRESS ~ / PHONE L 0 C A T I 0 N, ~~ ~~ L E O A L D E S C RI P TI 0 ~ ~ ~/~//~" ~(~ SEPTIC TANK: NUMBER OF / DISTANCE FROM WEH --s~ ~-~=2~-- ~..~-~~'''~ MATERIAl .~'~'~.7~--~;~/ ' COMPARTMENTS. ~.~ :7~ ~. ~//~-~ ~/~'~"~ .~/~__~ -~.~LI~QQUiD LIQUID CAPACITY ~-~ GALLONS. INSIDE LENGTH ~ INSIDE WIDTH ~ DEPTH __ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PiTy ~AMETER~ OR WIDTH· NEAREST LOT LINE , LENGTH DEPTH. TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ, FT. TILE DRAIN FIELD: DISTANCE FROM WELL ~'~':~--~-~' , FOUNDATION./~' ~' , NEAREST LOT LINE _ce2~:~ NUMBER OF LINES /' DISTANCE BETWEEN LINES / TRENCH WIDTH ABSORPTION AREA *~-~ SQ, FT. LENGTH OF EACH LINE /~----~? ~' ' DEPTH: TOP OF TILE TO FINISH GRADE ~/~'~ / DEPTH OF FILTER MATERIAL BENEATH TILE TOTALLENGTH · OF LINES IN, TOTAL EFFECTIVE IN. ABOVE TILL W E L L: -'~ z '~"~r~z: :~' TYPE .,/~?/~/z~' :.~, DEPTH LOT LINE ~ NEAREST .. SEWER LINE ~ DISTANCE FROM , BUILDING FOUNDATION. /~EPTI C ~ SEEPAGE lANK , SYSTEM , CESSPOOl ~ ~"~, S~OURCES DISTANCES: DIAGRAM OF SYSTEM ~^~-~'~ GREATEI"~'ANCHORAGE AREA '.~OROUGH C~.No. HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT ~ ,.c~, MAILING ADDRESS ~ ~'/~--~¢' PHONE NO. RESIDE"CE ADDRESS LOCATION OF INSTALLATI0" APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT. ~ ,'DRAIN FIELD ,OTHER ,E.C0LAn0~ TEST .ESULTS A~T~C~PAT~ ~ATE BELOW T0 BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS ~'/~'~-~,~ , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED . SEPTIC TANK SIZE ~7~'-/~) TYPE C~"~&~ SEEPAGE AREA /"~¢~- TYPE ~9 ~<'J'~¢~ DIAGRAM OF SYSTEM DISTANCES: I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code.