HomeMy WebLinkAboutGREEN FOREST BLK 2 LT 5
MUNICIPALITY OF ANCHORAGE
DFPARTMENT OF HEALTH & ENVIRONMENTAl.. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Tel0phone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAM E ~"'~ ~ · - PFION E
NEW
DISTANCE
Manufacturer
'Absorption area Dwelling
Inside length JW dt)
NO. OF BEDROOMS
PERMI ~/
No. of compartments
Well
DISTANCE TO:
No. of lines ~'~ Length ofe~ctlli~
/
of tiJe to'finish grade ,~'~ / '~ ~
Top
Length
IF HOMEMADE: Liquid depth
Well Dwelling PERMIT NO,
Liquid capacity in gallons
Foundation
Total ~g~t~ f ~nes
Material beneath tile
Depth
WidYh
Type of crib Crib diameter Crib depth
Well Building foundation
DISTANCE TO:
Class Depth Driller
DISTANCE TO: ' Building foundation Sewer line
OTHER
SOIL '1' EST R AT, N~ ~:;~ ~.,~..
INSTALLER i/~~t~,% Q~j ~ ~ ,
REMARKS
] Material
Nearest lot li~) !
/ Trenc'~w¢dth
__ inches
inches
APPROV E~~. DATE
D is t a n c e ~i~Jvy,~l ' n e s
Total ef~sorption area
PERMIT NO,
Total ef e_c_tiv: absorption area
Nearest lot tine
'D-'~ ~ot ~ne PERMIT NO.
Sei~tic tank [Absorption area(s)
LEGAL
SOILS LOG
MUNICIPALITY OF ANCHOFIAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-2221' (-'
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LFGAL DESCRIPTION:
1
2
3
4
5
7
8
9
I0
11
13
14
15
16
17
18
19
2O
COMMENTS
Leroy C. R~ld, Jr.
No. 2251.E
PERFORMED BY:
DATE PERFORMED:
WAS GROUND WATER
ENCOUNTERED?
SLOPE SITE PLAN
___.L. i 'i ~ ......
S
L/x~5 L
O
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
7 //.. /p /? p,..: 7
~COLATION RATE
ST RUN BETWEEN /// FT AND
/", w",-/ p.-,*-' ~','-'.~ ¢-4
CERTIFIED BY:
DATE:
72-008 (7/76)
CONS'-FRUC'-i-ION
TEST I.AB
. ,L/d~-ORMED FOR:
':{GAL DESCRIPTION:
:'HIS FORM REPORTS:
Mr. Richard Derrick
Lo~ 5 Block 2
O Visual Soils Exomination
1800 .,,-'. 48TH A',,'ESrE 'C'
~,oi.<'
248--1333
DATE PERFORMED'9/I- 0_Z.9/J 3/--8-0-0 ......
Subdivision Green Fo__r_e_s__t_
~ Percololion Tee ACTL-80-1453
SOIL NOTES
DESCRIPTION
ORV-SI-SA
-- Lt. Bm. w/ Organics
2.5'
SA-SI ML
480 rain/
5'
7'~
SA-SI
w/ Clay ML-CI{
-- DOES NOT PERC
].2, --------------~
DOES NOT PERC
- ]5, CL-SI TO SI-CL CH_'~'~_TM
............................. =_~,.~-~r~
BOTTOM OF' HOLE
GROUND WATER ENCOUNTERED NO
'YE%, '¢,'HAI DEPTH
R '.',D'NG DATE GROSS TIME
No. g,£. 4623
NET TIM1
9/12 11:00 0 }irs.
2: 00 3 Hrs ,
2:30 3.5 Hrs.
3: O0 4 Hr8 .
.... :El 't{E s'r
'~ GENERAL SITE SLOPE
DEPTH TO H20
NET
DRAINAGE
:! F,tCOLATION RA~E: 960 Min/inch DRAINAGE REOUREMENTS: .................................
;u:~OPOSED INSTALLATION: O SEEPAGE PIT )D(DRAIN FIELD G OTHER
....... ENTS: ............................................
-
GRr"',TER ANCHORAGE AREA BOROI,'"-H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ~,. ,. x ~ ,..,.,
NAME ..~7-'~.,~:X".-;.~' .~"e,~Xz~AZ ADDRES"S;~9/J'"~*~"~"~'~ '"~,/~:'~:~'~: PHON~_
LOCATION ~/Z~.
SEPTIC TANK:
DISTANCE FROM WELL ~-'"~ /
LIQUID CAPACITY /~') ¢"?-) ~:" GALLONS.
¢_~ V .~c :'/,~:- /';"~r:'/'" ~,C'~Z-~- ~'~''- NUMBER OF
MATERIAL
~ COMPARTMENTS
INSIDE LENGTH U' INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER GE PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGF PIT:
OUIStDE DIAMETER OR WIDTH ,'"~ /_, LENGTH /~., x, DEPTH ~ '""
~:"/)1~";~"~'~""¢:~ "'J DISTANCE FROM WELL _/~ '*
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
_, BUILDING FOUNDATION '~'~'~" x
TILE DRAIN FIELD:
NUMBER WIDTH
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
IN. TOT~,'~ EFFECTIVE
IN. ABOVE TILE__
WELL: Typ E.,~/.4~/z,~.. ~,~.-~ DEPTH ~S~ ~' DISTANCE FROM WATER
, BUILDING FOUNDATION. ,..~ /' SAMPLE
LOT LINE .~6~ x NEAREST .*-~"'"~ SEPTIC ,~ ~' SEEPAGE /
, SEWER LINE , TANK , SYSTEM /'/-~)~;~ , CESSPOOL
NEAREST
OTHER
SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE
HEALTH AUTHORI]Y
GAAB-HD-2
GREATE:
327 Eagle St.
SEWAGE
~,NCHORAGE AREA )ROUGH CaseS0 ~'
HEALTlt DEPARTMENT //
Anchorage, alaska 99501 279-251~,~f~~.'.~].
DISPOSAL SYSTEM - APPLICATION & PERM6
NAME OF APPLICANT__L~~t~../'c~a- MAILING ADDRESS,('~ /_('7'_.,'¢,.+'/ . PHONE NO.
RESIDENCE ADDRESS .... '_, LO. CATION OF
APPLICATION TO INSTALL: SEPTIC TANK ,SEEPAGE PIT. ,DRAIN FIELD__ ,OTHER
TO SERVE THE FOLLOWING FACILITY . _~ -~- d~2.~.-' -'/4~/> 4.
F,NANCED T.,DDG. -'~ O,"~.,.,.~.--,,:r'~ ,E ,,',,STALLED ,~','. ~w-i-'"---~ ~-.~ ~---
PERCOLATION TEST RESULTS :),.~5 b 0~/YI ANTICIPATED DATE OF COMPLETION ~ELOW TO BE FILLED OUT BY HEM.TH DEPARTMENT
THIS IS TO SERVE AS J'~r"l/~"~, ~"'~''L''~'~LC~'k'", PERMIT, TO INSTALL A
.SEPT,C TANK S,ZE /~:X~ TYPE:~,,~.'~,'~SEEPAGE
DISTANCES:
(_...e.m -~..'.-'"."~-' ' ·
I certify that I am familiar with the requkements of Greater Anchorage Area Borough Ordfl~an~e N.o. 2~-68 aml that th0~
above described/yste~/is in accordance with said code. ,/"7~ ~ d ~,~./~ ::~4 g: ~rt/~ _ &c4~ cY:z"z~//
DATE /'~/-') APPLICANT881DNATURE ~///~y~'
- !" DAT'E RECEIVE~
YIME TIME
DATE DATE DATE
E DEPI', OF
MUNICIPALITY OF ANCHORAG
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~I~VjRON~VtENj/xL t"~ IL.CHON
825 L Street - Anchorage, Alaska 99501
t AUG ~ 2, 1980
ENVIRONMENTAL SANITATION DIVISION
Te,e.ho.e 26,,20 R E C E 1 V [ D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10} days for processing.
1, PROPERTY OWNF-.~/ ~ ,-, ¢ J PHONE
MAI LING A DDR E~S.~- ~ '
PROPERTY RESIDENT (If difterent from above] PHONE
2, B U,~.~E R PHONE
-'~AI LING ADDR E'SS
3. LENOINGINSTITUTION I PHONE
MAILING ADDRESS
MAILING ADDRESS ' /
5. LEGAL DESCRIPTION
1/'
STREET LOCATION
TYPE OF RESIDENCE
~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF ~B EDR~O_LOMS
[] One ]L~J- Four
[] Two [~] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL~
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A welt Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
~ iNDiViDUAL/ON.SiTE~
E~] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO I--I FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified __ LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEIV] PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE iNSTALLED
E~ PUBLIC UTILITY ~<_~. (
Connection Verified iNSTALLER'~
[~]Septic Tank or []Holding Tank
Size:. If Tank is homemade SOILS RATING
TYPE OF TANK MANUFACTURER
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE B~~
72-010 (Rev, 6/79)
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M, SULLIVAN,
MAYOR
DEPARTMENT OF HEALTH AND ENV]RONMENTALPROTECTION
August 26, 1980
Richard D. Derrick
Star Route A Box 1512C
Anchorage, Alaska 99507
Subject: Lot 5 Block 2 Greenforest Subdivision
Approval for your individual sewer and water facilities
can not be granted until the following items have been
completed:
(1)
The top of the well casing sealed with a sanitary
seal so that it is water tight.
(2)
The water analysis report be delivered to this
department from Chem Lab, 5633 B Street, for our
review.
(3)
The depression or pit around the well casing needs
to be filled with impervious type soil so that it
slopes away from the well casingo~
(4)
In order to upgrade the existing sewer system, a
soils test will need to be done. A listing of
private engineering firms performing this test is
enclosed.
(5)
A permit from this department is required prior to
any work being done.
If there are any further questions, please call this
department at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
March 12, 1973
Hr. Robert ?~edelneier
2;316 Jefferson Apt. b
Anchorage, /\l aska 99503
Subject: Appr(Jval o'F i]n--S'ite gewa!'!e 5ysteli,
Lot 5, ~'lock 2, Green Forest [;ubdivision
Uear Sir:
Un ~-~ugust 31, 1970, this office ~ade a finial inspection
of the on-site sewage systeFn, Lot b, iS'lock 2 of Gre(~ll
Forest Subdivision.
The peri',~it was issued to Mr. Jerry ~ru~olt of Reliable
~$uilders after a soils test a. nalysis siiow~.,c: $bO square
feet per bedroom.
'i'h~ system was consid~re,.i satisfactory ~s it conformed to
i;il~ Greater Ancil()rage Area !Joruugil sewer ordil'lances existing
at that time and was subsequ~:n~ly approvc~ci. 'J'i~e system con-
sisted of a 1,O00 gallon septic tank located ~$13 Feet 'From
the well and a 52L~ square foo'~ seepage area with an Gx~x$
lu.~l crib.
Although 'the ordinance require,,ents for on-site sew~r~
i'~inilnum (iistances and square 'Foo~;age of soi|s ~bests~have
changed since the ins'~allation of this system, the l.g70
approval of the system will be upheld by this l'~epartm~nt as
long as 'the system remains in workin~ order.
Sincerely,
Deborah Barr
Environlnental Control Officer