HomeMy WebLinkAboutGROLL BLK 2 LT 2B
/~ 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
'~AME
6 A D~E~/ ~ -
LEGAL DESCRIPTION
~ ~ ~ Manufacturer /
Lk~ ~acity in gallons
~ ~ DISTANCE TO: ~ell It/ ~Dwelling PERMITNO.
_~ ~ ~ I~ ~,~
O ~ ~ Manufacturer
~ -- p Material Liquid capacity in gallons
~ Well Foundation Nearest lot line PERMIT NO.
=~ ~ DISTANCE TO:
~ No. of lines Length of each lin~ Total length of lines Trench width Distance between lines
~ ~ inches
~ ~ ~ Top of tile to finish g,'ad~ . //[ beneath tile Total effective absorption area
inches
I.~ Tvpo ofcrib~ Crib diameter
' ~ DISTANCE TO: Well
.'" Classy/n/~_ :eptl:_ ~' / S / / ~:'er -- Distance tolot line PERMITNO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE M~TERIA LS
so~ T~ST R*T~NG
INSTALLER
R~ARKS
. _ ,,...,
~" ~ * ~ LEGAL
[Rev. 3/78)
Department
MUNICIPALITY OF ANCHORAGE
f Health and ]Environments Protection
825
264-4720
* * * HANDWRITTEN PERMIT ~ * *
WELL AND/:II~ ON-SITE SEWER PERMIT
~ ~..:~.~. ~:_~ Mailing Address:
/
Phone Number:
L Street, Anchorage, AK. 99501
Permit %~~_~
Applicant:
Location:
Legal Description:
Type of Soil Absorption System Is:
Lot Size:
Trench: Drainfield:
Maximum Number of Bedrooms:
Seepage Bed: Holding Tank:
Soil Rating(sq.ft/br) .~..," d ,.~. :~
The Required Size of the Soil Absorption System Is:
DEPTH ~ _ LENGTH //~ ~. GRAVEL DEPTH .L:~; WIDTH ~L~.
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(H~L-4~NG) TANK SIZE = /C~O 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 departmen'
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee'
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 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
(2)
(3)
Signe~':
SWP/024 (1/81)
set forth by the Municipality of Anchorage.
I will install the system in accordance with codes.
I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
ssued by:
Applicant '-
Date: ~. ,. ·
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, A~chorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG '
PERCOLATION
TEST
PERFORMED
DATE PER FORMED:
LEGAL DESCRIPTION:
1
2
4
5
7
8
9
10
13
14
15
16
17
I8
19
2O
SLOPE
SITE PLAN
COMMENTS
PERFORMED BY:
72-008 (6/79)
Reading Date
!.~-fi~ o ~/~,/~
,i¢~o ~/~,/.~:~
,'fl.~O ,~~/,~/~:~
~ i~ 0
.~~/~/~':.~
WAS GROUND WATERS '~- / I I----J~-"'"~l--- I~~ W~'~
E~CO,NTERED? . r,~____. 0~ -- I I I ~'q----~l
,FYESATWHAT ,~ E .~1-'~?1/Iq
DEPTH? -~ - % ....~--l~hll I
/ / Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ~ 7 (minutes/inch)
TEST RUN BETWEEN -q' FT AND FT
/.-/~
Cory fli ik.I.'i. ~,
APPLI£ 'qT FILLS OUT UPPER HA[ ONLY
Property Owner
Buyer
Address
zip (;ode ~:, 2.?
Zip Code
Phone
Lending Institution Phone
Address Zip Code _.-:.
Realty Co. & Agent Phone
Address "; f / "' J'~-- Zip Code
Legal Description ~__,.; ~' ~), ::< _
Type of Residence
~ Single Family
13 Multiple Family No. of Bedrooms
[] Olher
Water Supply [~' Individual
[] Community
[] Public Utility
Sewer Disposal I~ Individual
[] Public Utility
[] Holding Tank
ATTACH WELL LOG. A well Icg is required fo~ all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach Icg if available).
Year Individual Installed: __!,;: ~;
When Connecled to Public Utility:
NOTE: THE INSPECTION PEE MBST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Date
Inspector
Time
Date
Inspector
Time
Date
Inspector
Time
Date
Inspector
~- )~PA~PROVED BEDROOMS
*CONDITIONS OF APPROVAL
) DISAPPROVED
) CONDITIONAL APPROVA_~*
Soils Rating Date Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received ~,//~:~
Septic T~k Size / ~'~"~ 0
