HomeMy WebLinkAboutT15N R1W SEC 18 LT 214
, ~ 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
~ UPGRADE
MAILING ADDRESS
LOCATION NO. OF BEDROOMS
Well
~ L~q. c~acity in g
, ~ Welt Dwelling PERMIT NO,
~ Class ~¢~ // Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATE I LS
SOILTESTRATING/~ ,,}t ~
INSTALLER [ ~ ~'
REMARKS ' ~ ~ ~
ED ~ ' DATE LEGAL
3178)
Permit ~
Applicant:
~ MUNICIPALITY OF ANCHORAGE.
~ Department Health and Environments ~o~~~
~/~ 825 ~ Street, Anchorage, AK. ~5~_~~)
%+ 264-4720 i /I,~%~ -
~g~.~ * * * HANDWRITTEN~R~IT * * *~--~,~
/ WELL AND/OR ON~I~ER PERMIT
Location:
Legal Description: ~,~/ ~/~;3/~
Type of Soil Absorption System Is:
Trench: Drainfield:
Phone Number:
Seepage Bed:
,,ct si=e: /-
Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH ,~,~('-I LENGTH 12b-~ 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 SEPTIC(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. Min~-~---~is~an6e 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 8 3 * * *
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 r~quire enlargement if
the~sidence~~is remodeled to include more t~~
S iqne~: '7~/~~-~-~--~-'~-'- Issued by:
SWP/024 (1/8I)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
4
5
6
7
9
SLOPE
SITE PLAN-/~
IAI I,I I
IIIII I',~Jl IIII
10
12
13
14
15
16
17
18
19
20
WASGROUNDWATER S
ENCOUNTERED? A/r~ L
0
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND FT
COMMENTS-~/-o/~'~ /~- /O/~' '~--' ~--~ ~'~ ~ ~ ~o ~/~c~
72~OO8 (6/79)
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of Lc-J-'
by ..... '~ <~0
~:~ approved.
public water system located
, Alaska, submitted in accordance with 18 AAC 80.100
have been reviewed and are
E] conditionaJly approved (see attached conditions).
If construction hal~ not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVEDCHANGEORDERS
Change (contract order no. Approved by Date
or descriptive reference)
The "APPROVAL TO OPERATE" section must be completed before any water is made available to.
the public.
APPROVAL TO OPERATE
The construction of the public
water system was completed on (date). The system is hereby
granted interim approval to operate for 90 days following the cpmptetion date.
As-built plans submitted during the interim approval period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
final approval to operate.
BY TITLE
APPLIC' -IT FILLS OUT UPPER HAL '3NLY
Property Owner ~/?/4~'/~ ~'/ /~'/~' ~ ~ ~'I Phone
Buyer /'-~ ~ ~,~ ~,/-,,~'' / ~¢- ~
Address ,/.' ~ ~,~ ~/, ~ ~ Zip Code
Address /~ ~ ~.. Zip Code
~ltiple Family No. of Bedrooms ~
~[~dlvldual Year Individual Installed: / ~ ~" ~
Time
Time Time
Date Date Date
Inspector Inspector Inspector
Field Notes:
(Z.~) APPROVED BEDROOMS
( ) DISAPPROVED
N~UNJCIPALITY OF ANCHORAGE
DEPT. OF t~,SALTH ~'
ENVIRONM,SNTAL pp, oE EcTION
RECEIVED
*CONDITIONS OF APPROVAL
CO DITIONAL APPROVAL*
DATE
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank OC~?
Well Log Received
Septic Tank Size <~ 0 (D(~) '
EXCAVATION ROBERT A. SHAFER
WORK CIVIL ENGINEER
694-2979
September 14, 1983
Municipality of Anchorage
Department of Health and Environmental Protection
825 L Street
Anchorage, Alaska 99501
Reference: Lot 214: Section 18: T15N~ R1W
The well located on the referenced property was inspected. A
sanitary seal has been placed on the top of the well casing
and the wiring is in conduit. The well casing extends above
the ground and the ground around the casing slopes away from
the well. A water sample was taken and submitted to Chemical
and Geological Laboratories of Alaska for Coliform bacteria
analysis. The results of this test were satisfactory.
If we may be of further service,
to call.
please do not hesitate
SRB 196X EAGLE RIVER, ALASKA