HomeMy WebLinkAboutVALHALLA #1 BLK 4 LT 80 1 5
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MUNICIPALITY OF ANCI4ORAGE
DEPARTMENT OF NEALTH& ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NO, OF
BE.D OOMS
IF HOMEMADE: inside length
DISTANCE TO:
t Manufacturer
Iwen
NO. of lines .~'~ ~ Leads;ii
Top of tile to finish grade ~
~GRADE
P E R ~4~T NO4
? (, %
Liquid depth
Well Dwelling PERMIT NO.
Material Liquid capacity in gallons
LU
Length Width
Foundation
%
Total len~gth o.o.~:~ines
OYx ,--.A_ ,
Material beneath tile
· ~;~ inches
Total effective ab.~_9~ption area
¢_.
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: 8ulding o nda ion Sewer line Septic tank [Absorptionarea(s)
OTHER
PIPE MATE~ I,~ LS
INSTALLER
REMARKS
IAEPF~QyED /"~ ~} _ , DATE
LEGAL
/
' !(; .',F' ::,'," ~: ': ~L::".' - : :;~ ',",_~ .", ...". ,: '", .. ,"~ ~:' Z,':" ,, i:; :'
J
,~' ..~. ,,-' ~... .... ~ , ....
DEPAI:~I'T4ENI' /:' HEAL. TH AND ENVIf~ONI~iENTAL
BFOg-; ' L.. ' STREET, ANCH[]IR~('.~E, ~1< ,, 99B0 :L
lvl I¥1ELLOT']'
iAI I i ..OERNEf:~S LANE
L(]'l" E( Ii:J[( 4. VALJ-tALL.A
~1::~P b I C AN T'
L. OC A T' I ON
,SRA F]OX 449M
T'yl)e o+: sci1 absorption sysl:em is: fRENCH
~E) X:i,'FIIL~IIi TIUTrlbei" O'l'; bedroo~ls = }]
S~il rating
t"he r'equ:),red size o~ the soil ~)bsorp't:i, on syst:ern~.'~"_,
'l"he .Lengt:h d~.mens:i, on :i.s 'the length (in ,Feet) o¢. the trench or dpa:i.n.FJ, eld.
The depl:h o.¢ a t:nei')ch on p:Lt: &5 the dial:alice between the sur'~:ace o4: 1:he
ground and the bo'ttom e~ ~he excavation (in {.ee't),
/'he gr'ave:L depth is 'the m~n&mum depth o~ gpave:l bet:~een the ol.ttF, all pipe
and ~he bot:~og~
.:h:~ pm :i 't appl.tcan~ has the PeSl:)OnsLbili~¥ 1:o in¢.or'm ~h:Ls department: dur:i, ng the
:J.T~S'~E:I.LI~'[iOT~ :Lr)speEf:iOJlS o+: any ~ells adjacen't to this ppopept:y ,?~f)d 1:he
nLJlnbep o'1: r'es:i, denl::es that the well w:Lll serve,
.ih.."i~cl.(,F.l,,Ll£ng o~:' al'iy syst:el~ wJ.-I:hol,tt: +'.ir)al J,~l)ectJ. of) ¢~rr~:l 8pppoval b)/ t:h:[s
depart:rnen~ w:Lt;L be subject ±o prosecut,ton.
100 .F. ee't Eel' a pP:i. vat:e ~elt on 1BO to ~;~00 ~eet .~r'¢fr~ a pub].~c ~e].~ depend:lng
upon the t~pe 0¢. public
fhi. n~mLml d:Lstanc~ 'From a pp:Lvat:e ~ell tea private ~ewep lime J.~ CZE, .Feel: and
1:o a COrIfml,m:i.t:~ sewer l~ne ~.s '~
]tl"[e[' requ:i, pemen'ts may apply. Speci.PicatJons and construct:i, on diagrams
,ava~.l. able to ~l]sl,ipe proper' installation,
I cert::i..Fy 1:hat:
].~, i[ all) .li¢.Jfn.tl:Lar wi'th the requ:krements ~or on-sit:e sewers and wells as set
Top'th by the Mun:~.c&palit:y o.F Ai'~chorage.
¢~ i ~:i. 1]. ins'tall 1;he system &n accordance with the codes,
r'es:Lder)ce :).s pemode].ed 1:o ir)elude mDpe 1:hah B bedroofns .... ~ ~ ;}
,J.[ b Iq ::1.).
APF:~L I CAN]'' M MEI.~L.OT"I'
I ,:LI _U I:: ¢ ........................................................................ DA I E_.._£ ..........................
Contra dngEngineers&Associates
212 East International Airport Rd,
Suite 204
ANCHORAGE, ALASKA 99502
(907) 278,3773
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
DATE PERFORMED', ?-' /¢-'
LEGAL DESCRIPTION:
1
10-
SLOPE
11
WAS GROUND WATER
ENCOUNTERED?
13
IF YES, AT WHAT
DEPTH?
SITE PLAN
14
15-
16
17
18
19
20
COMMENTS
,¢AMP '.,'/ 5'/,
Gross Net Depth to Net
Reading Date Time Time Water Drop
I 7./o~¢/ ?:~t7
) 7-/0 t/;I~ ~q d /~. 2.
:~ ?.,/o //:' 99 /~ 7 / 1"
PERCOLATION RATE / ~ h] l ~, /I ~/ (minute~/inch)
TEST RUN eETWEEN L~ , FTAND ~ ,. FT
/'
:-
GRr~,?ER ANCHORAGE AREA BOROI H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
M^ UNGADDRESS /P7 7/ &?--PHONE
SEPTIC TANK:
!
D STANCE WELt
LIQUID CAPACIIY r/~) ~' ','J' ____GALLONS.
.4~ NUMBER OF
MATERIAL 8(~/A. C P'~.- COMPARTMENTS /
INSIDE LENGTH_ 7 ! LiQUiD ~'
INSIDE WIDTH ZTZ ! DEPTH '~'-
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAL ~T ~lA. (E -~ (~,/~ .
NEAREST LOT LINE
OR WIDTH. / l~ , LENGTH / ~ , DEPTH
· DISTANCE FROM WELL
BUILDING FOUNDATION~£) /,
Z-'7 /
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
FOUNDATION .~_. ,'IqEAREST LOT LINE
DISTANCE BETWE~N-EINES TRENCH WIDTH
LENGTH OF EACH LINE
TOTAL LENGTH
, OF LINES
iN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. AgOVE TILE
WELL: /(/~ Z' .,'mr' ,¥"'~ 2--
TYPE DEPTH
'l NEAREST ~
LOT LINE , SEWER LINE
DISTANCE FROM WATER
,BUILDING FOUNDATION / Z~- ! SAMPLE /N/e , NEAREST
SEPTIC ~, ~ / SEEPAGE ! OTHER
TANK , SYSTEM /,// , CESSPOOL "-- , SOURCES__
DIAGRAM OF SYSTEM
DISTANCES:
¢-2~ ~ '771
4 ~
DATE APPROVED
GAAB-H D-2
GREATEk ANCHORAGE AREA ,)ROUGH Case No.-~--~:
327 Eagle St. Anchorage, Alaska 99501 :(~,;.~/~ 'it,' 279-2511 , i4,~ / .
SEWAGE DISPOSAL SYSTEM - APPLICA?ION g PERMIY
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED TH,ROUGH ~-~
,-Paq~Ol. ai-iOl~ TEST RESULTS
SEEPAGE PIT
MAILING ADDRESS ,~/~7 -~'//~'~W PHONE
LDOAT,ON OE ,NSTALLAT,ON. -
~ ,DRAIN FIELD ,OTHER
TO BE INSTALLED BY ~-~. /
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO B~E)ERVED
· SEPTIC TANK SIZE. ,//~/~?z~.) TYPE c/~¢//¢~[~/~-~PAGE AREA
DIAGRAM OF SYSTEM
DISTANCES: ~
TYPE
Health Authority
i'tify that I am familiar with the requirements of Greater Anchorage A ~o, rough Ordjmance No.,2.~8-68~and t~t th9
above described system is in accordance with said code ~r2P-¢ .... ' ~ ~. ~ ~//~t ~ ~/ Jd~.~¢ ~
DATE / / / A,PLICANTSSl6NATURE G~¢-, 9 ~'~'~
.ATE? A!iC~!(?A'v: ;-.i:]],".. BOROIJGU
III.;ALTH DEPAI.:TF. EUT
327 EAGLE STREET
ANCHORAGE~ ALASKA 99501
Performed For' Gary Mellott Date Performed October 2, 1969
Legal De s cript~ol~4
This Form Reports a; S~Log~~olatzon Test .... __
Depth
Feet Soll Characteristics
Was Ground Water Encountered?__ No~
If Yes, At What Depth .....
Reading
Date
Net Time
Location Sketch
Fropose~ Instal~"~f'~'n~Seepage Pit Drain Field --~
Devth Of lnlet I)ept--~----T~~~'it Or Trench
~' ' ~ Cess oo~'~]~d With coarse rock
CO~.:4EN ,~ ~ ..... ..................
Test Performed ,By: Nati?al T~h2g Seyyics_s2~nc ~
Dat~ ~ober 3, 196~__. :
Time ¥ima
Date "Date Date
Inspector Inspector Inspector r
~ornments ~endlt~enal App~oYe~
Date Sewer Insta,~:~.~ Permit No. Septic Tank,lze -
,~ - ~ { ~ Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
~Property Owner ~//- ~ ~ L~ LO ~;. = ...... Phone
Buyer
Address
'~endlnglnstitution M 6 0 F¢ Phone
Address
Realty Co, & Agent ):1 U~I~L(- "~ (,pl(,~(~L O t..(~ Phone
Address ~q I(.r d ~{ ,
Legal Description L~> ,1' ~')/ / ~¢C-'~'-~ ...... ~ ~..~ ,v, % ''-.- ,/
Street Location ~.' ~ L ~) ~ tee(: Y~ "~ 0 0,~ f~ · '~ F~',.~'rlt:*~'A~ / : ~D (~o~ tT r.,~n I~f6P!
Type¢ Residence
~Single Family
~ Multlplo Family ~o. of Bodrooms
Wat~¢Supplg
~] Individual A~ACH WELL LOG, A well Icg is required for all wells drilled since June
d Community 1975. For wells drilled prior to that date, give well depth (attach Icg If
~ ~ub~ic Utility available.) __~
Sew~e Disposal ~/~[,/;J :
R Public Utility : When Connected to Public Utility: ,; .;',
[ 1 14oldin~ Tank
NOTE: THE IHS~ ECTION FEE ~UST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
March 9, 1982
~lr. ~l. ~ellott
SRA ~]ox 44.9
99507
Lot ~. tllock 4 Valhalla ~,ubdiv~slon
Approval. for the ln~.vidual sew.~.r and water facl].lties cannot
be granted ~lntil the following items ]]ave been completed:
water analysis report needs to be submitted to t'his
o.rflee from the Che~ Lab, 5633 B .~treet for our review.
t xpose the well for our inspection to determine proper
construction, also to insure minimum distance requirements
are met between the well an¢] sewer syst¢;m.
Please notify thJ. s department for a reinspectJ, on when the
noted discrepancies have been corrected. If there are any
fllrther questions, please call this office at 264'-~720.
Sincerely,
ROl4ert c. Pratt
Associate Environmental Specialist