HomeMy WebLinkAboutW G PIPPEL BLK 3 LT 114
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t._...~ 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
8 []"PGRADE
MAILING ADDRESS
EGALDESCRI~TIOi ~,~' ¢1' ~)~L~s
DISTANCE TO:]W ¢~.D ~,,,~ 0 S ¢~,~' I Absorptio~rea
Manufacturer
Liq. gallons [F HOMEMADE:
Dwelling
DISTANCE TO: Foundation/O ~ N~arest lot li~ O
No. of lines Length of! Total length~ I~e~ Trench wide(. 1~
,~ 0 riches
Top of t e to finish grade ~ Material beneath tile ~ches
Length Width
Type of crib diameter
Well
DISTANCE TO:
Depth
Building foundation
Building foundation
"O'OF'BE¢OOMS
Liquid depth
Liquid capacity in gallons
Distance between lines
PERMIT NO.
DISTANCE TO:
Total effective absorption area
Driller Distance to lot line
Septic tank
'PERI'IT NO.
Absorption area(s)
OTHER
APPROVE DATE LEGAL
72-013 (Rev. 3/78)
T 1:;;: E ['.~ C: H
t'"IF~XIf"!UH NLIME:ER Cfi:' [.,E.E.[ ....... I'1..
THE [;~':::':~_ IRE[) ::,I,¢..[:. OF THE '_'5OII_. I.-I[,:,LF.,F] ] ..14::, z, _ .... :
THE L. ENGTH DIMENSION ES THE LEN(3TFI ,::ff.,! F:EE-I') OF' THE TRENE:H OR [)RFiZNEIE[D.
']"III:E DEF'TH OF FI TRENCH OF'. PIT IS THE D IS-I"F/I",!E:E E:I:?I"klEEN THE SI...IRF'FIE:E OF H"'IE
GROUND RND THE E:OTTOP1 OF THE EY, E:FIVFITION (IN FEE:T>.
THEI:;?.E I:~i; NO SET 14I[:,TH FOR TREI",ICHES.
THE GRR',/EL DEPTH I':'.; THE MINtHLIH DEF'-f'H OF' GI:;:FIVEL E:ETHEEH THE: OIJTF'FIL. I.. F'IF'E
RI'qD 'TFIE E:EITTE$1 OF THE E',:<CR',/FITtOi'.,I (I1'.,I F'EET).
F:'ERHIT 1.4f Ft.] .~ N[ Hl::r_:_: THE RE;SF'OI'.4'_:;!BILITV TO II",IFORM I~1~:, [:,EF'FiRTFIEr.4T r:, RING 'fl..If:'
]. 1,1:, r - L.L.HT I L 1'4 I r !.... [ [... -. f I _ iq-, O1:: FIN"? !.,.IEI_L.:'5 R[).:rl:ll2Ei'.4'l" '1"O TH :r_ S F'RCIF'ER.-I'V FIN[:, "t"I-.IE:
[' ~ L.I[' I [. E-_-. I: .. O F f;: E S I C, E N C E S T H FI T T H E I.,.I E L.I.... 141 L I ....... E [., [:.
F: I::'ICKF I I..L I NG OF FIl",lt? _, ? .., EJ'I 141 "['t'4OU'I" F' I i",!RL .L I L ~ E ._. I' i .. I I FIIql) I:::I,r':'F'[(:L':I~v'¢:IL E!',"i" TI-! ):
[:,EF'I:~R'T'MEtqT t.'JIL..L E',E .:',lJb,..l::._.'l TEn PR. CISEE:I...ITION.
M _l: N I P1LII"! I)): S"l'l::lh!OE E:ETI.4EEN R I.,IEI..L Rh!D RN~'r' Of'4' "'-'?.; I TE SEFIRL:iE [).1' SF'OSRL S"r'STEH I S
:t6iEi FL:.:ET FC[R I::'I F'RtVFITE 14ELL.; OR
:L~SE~ TO 2'EIC.'~ FEET FF4:Ot'q R F'UE~I_!C: 1.4E[...L [:,E::F'EI',I[):[i",ICi UF'ON -I-t'l[i~
14ELL LOQS RRE RE~:IUIR. ED FIND MUST BE: R. ETLJR. NED TO THE D[.i:PFIFU]"['"IEI',Fr I.,.IITFIIN
CIF' TI-IE IqELL. C:OP1PL. ETIE~N.
O-['HE:R REL::!LI]:F:E]',I[':Zi'.,r]'s t'dFl'~' I::iF'F'L'¢. ::_.:F'ECIFICFITIO[q~: RN[:, C:OIqL:.;TRLIC:T!C$!
Ft;,,'FIILFIE~LE: TO Ii'.,ISI.JRE: PROPER. IN:E;TFILL. FITZON.
I CERTIF"¢ THRT
i.: I RM F'RMIL. tFIR FI:['I'H THE RIEQUIR:EHEN-F'_:_:; EOR ON...SITE SEklEF'.S FIND !4Et..L.S RS SET
FOF.:TH [.-::'T~ THE HUNICIPFII_.!T'¥' OF FINCHOF;'.FIGE.
2: I I.,.IILL INSTFILL THE S'-?:E;TEM :I:N I.--ICC:E~R[:,FINCE FiI-['H THE CODES.
_7:: I UNDERS-f'FIN[:, THF:IT THE: OF,I-'.':_:;IT[~: '.'EiE[qER'. S'-P}i;TEffl HF:l"r' I:;:EG!UIFdE ENL. FI~'.EiE:HE:NT IF THE
F;;'.ES I [)ENCE l :E; R:Ei'flO[)IEL[£[:, 'Fo I i'.4CLUDE I',IOF:::E!: 'f'FIFIN 4
PERFORMED FOR:
~:.,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-222f
SOILS LOG -- PERCOLATION TEST
1
2
3
4
5
6
7-
8-
g-
10-
11
13
14'
15
16
17
18
19
20-
?
72-008 (7/76)
SOILS LOG
[] PERCOLATION
TEST
DATE.ERFORMED: /0 77
SITE PLAN
WAS
GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
GrossNet Dept[~ to Net
Reading Date Time Time Water Drop
/1~///'~
PERCOLATION RATE ~'~/~ (minutes/inch)
TEST RUN BETWEEN , FTAND FT
MUNICIPALITY O~.~,NCHORAGE ,~...~ ~?~.., .
POUCH 6-650 ANCHORAGE, ALASKA 99502 ~.,~ , /
REP,Y DATE FROM
FORM 91-008(3/7§)
ENVIRONMENTAL PROTECTION
DOC Co. dba
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
LEGAL DESCRI~ION
DATE - Sta~ed
PE~IT NUMBER
MAR 1 7 1981
RECEIVED
DEPTH OF WELL <,~ c~,
STATI~ LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From
From
From
From Ft. to
From ,-)
From Ft. to
From.'! ~'~ Ft. to a~' ~']~
From.__Ft. to Ft.
From ':~?. Ft. to '~"~:~ Ft.~
From Ft. to Ft.
From Fi. to__.Ft
From Ft. to__.Ft.
From Ft. to __ Ft
From Ft. to Ft.
From Ft. to___Ft.
From___Ft. to Ft.
From Ft. to Ft.
Ft. to ''"~ Ft.
From
From
From
From--
From
From__
F~om
From.__
From
From
From
From
From
From
From
From
iFt. to Ft.
Ft. to Ft.
Ft. to.__ Ft.
Ft. to Ft.
.Ft. to Ft.
Ft. to___Ft.
Ft. to __Ft.
Ft. to __Ft.
Ft. to___Ft.
Ft. to Ft
Ft. to Ft
'~t. to F~
~t.~o 'Ft.
bt. to Ft
Ft. to___.Ft.
. to Ft.
Ft. to Ft
MISCL. iNFORMATION:
DRILLER'S NAME
[:,EPRRTMENT ~ HERLTH RN[:' EN',/IRONMENTRL ~',J¢'.OTECTIGN
""'-' ~" "L ........ .YL"¢._ (~::L
c,~._, STREET., HNL. HORAGE., AK. '-'"'.~-'
264-4.728
P~ELL PEF~'4 I T'
PERMIT NO. ( 8:~r304.6 )
WILLIFiM J. HILL
CENTER _TEEET
LOT i 8LK ) W. G.
RPPL I CRNT
LOCRT I ON
LEGRL
BO,S::_-.,~'~'~=. I=INCH.
_-,I ~.E
PtPPLE SUB LOT" ~'
3:48E'i0 S~;;!I_IRRE FEET
MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIYRTE WELL TO R PRIYRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 PEET.
WELL LOGS PRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS AND CONSTRUCTION DIRGRRMS PRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
. c C. E L--: E ~-'1B E F-': ---~: ::[ --
PER f4 I T E::-(F' I F-.E__.
I CERTIFY THRT
- '"' _ _EWEF.._ RN[:, WELL:, RS :,ET
±: I RM FRMILIRR WITH THE REt4UIF. EMENT= Fear 0N-SITE c;
FORTH B~' THE MLINICIPRLITY OF HNC. HU~H=E.
2: I WILL INs, TRLL THE =,~_TEM IN RCCORDRNCE WITH THE CODES.
RPI~'L'"" ---- I CRN"r W ~I~LL~%
V4. 0
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received ,],Jly 16~ lq7~
Time of Inspection 3:00 p.m. .
Date of Inspectton_~
R~QUEST FOR APPROVAL OF
INDIVIDUAL S~WER & WATER FACILITIES
FOR
FHA
1. Approval Requested By: Thomas Keene
Address: P. O. Box 9]5;. ~.~ Eagle River, 99§77
2.. Prooertv O~ner: Thomas Keene
3. Legal Description: Lot ], Block 3, W. G. Pipp]e Subdivision
Location: Corner of Lazy St. and Easy St.
5. Type of Facility to be Inspected: .~ .Single Fa,mily dwellin9
Number of Bedrooms: 3
6. Well Data:
A. Type Drilled
C. Construotion .Standard
7. Sewage Dts~osal System:
A. Installed Approx. 1967
Septic Tank: 1.
D. Seepage Pit: 1.
Disposal Field:
Distances:
B. Depth ~0' +
D. Bacterial Analysis
B. Installer
Size 2.
Size 2.
Total Length of Lines
A. Wel[ To: Septic Tank
· Nearest Lot Line
Foundation to Septic Tank
Phone: 694-2633
Phone~
~anufacturer
~aterlal
Satisfactory
50' + , Absorption Area 95' , Sewer Lines
~6' , Other Contamination
5' "~ Absorption Area 20'
Absorotion Ares to Nearest Lot Line
12'
Request for Approval of~/<dividua]
Page Two
g. Comments:
Sewer & Water Faeilit~ '
~/ ptsspproved ..... i ~ate .],,ly ?a'. lq7~
' /7~ ' 'XApprova] Valid for One Year From Date. Slgned
/~,reater Anchorage Area Borough, Department of Environmental
DIAGRAM OF SYSTEM
I certify that the information contained in this request for apprmval to be a true
and accurate representation of the subiec~ sewer and water facilities located at:
Sign ~d~
Date