HomeMy WebLinkAboutGREAT LAND ESTATES #2 BLK 3 LT 4
~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
~ ENVIRONIVIENTAL ENGINEERING
DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE ]~NEW
LEGAL DESCRIPTION
Well Absorption area Dwelling PERMIT NO.
DISTANCE TO: ~ ~0 X
~ ~ ~anufactuFeF Matedal No, of compa[tments
Liq'c~a~xgaH°ns~ IF HOME.DE: 'nsidelength~[a Width m la Liquid depth ~ i
' ~ DISTANCE TO: W~ Lh Dwelling PERMITNO.
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ ~ell Foundation ~earest lot line ~BMIT ~O.
~ ~ ~ NO, of lines Length of each line Total length of lines Trench~t~._~" Distance between lines
~ To. of tile to fini,h ~rad. ~[ O ~} Material bono.th tile ~, O't inche, Tot. l.ffectiveabsor.tion.rea~
Length Width Depth PERMIT NO.
~ ~ Tgpe of crib ~ eter Crib depth Total effectiuo absorotion area
m Building foundation Nearest lot line
~ DISTANCE TO:
~ :~a~s ~ Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
SOIL TEST RATING
INSTALLER
R EMAR KS ~
DATE LEGAL
!::'El'.';-.:!"!:[ '1"
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TH.r.EI:RE: Z rii; I'.,!O ':'SE:T !-,.IIDTH I:::OI:R
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FIND '!"H.E E',CITTEfi',I OF' THE: FZXCFt',,,'I:::iT I EIN ,:: ! N I::'EET ::,.
~-.~.. ,.,., F:iPt:::'L. IE:FIF(!' -If,..:, THE I::::E'.:!!;F'Cd'-,!'J:J;Tj:::t:LIT'.r' ]"0 .'I:I"F'FZF'h'. 'T'HI::":; I)EI:::'F:iI:,~:-!"I',IELN'T DUI:;'::Z,iqG THE
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]: C:ERT]:F'¢ THRT
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""HE _EI'.,IGTH D]:I"'IEN::~;]:EIN ]:S THIE LENGTH ,::'t:1'.,1 !I~::'%.~.HE TF:ENE:H OF:: DF:Ft:f. NF':[E:I._[::,.
THE: DEF'TH ElF: Ft 'TRENC:F-I CIF.': F'.'[T ]:E'; I~'I.,.I~:E:I'..I THIE ~:;LI[;'.F:'F:IE:E OF' THE:
GF.".OUNE:, FIND THE BOTTOH OF THE E',:-::~ )i'.,IFEET::,.
I"HE:I:L'E :IS NO E;ET 14:lEi, TH FOR
'T'HE EiRFI'v'EL DIEI::'TH :['..'i..1 THE H ]: N :[ HUH
FII'-,II3, THE E~E)'f'TOH OF THE E:-'.::CFt'v'RT .1: O1'. (: 1't'.,I
E~FIC:I-:::F.~LJ_ZNEi O1::' FIN'?' ::,'r.:, I E.i'i t...I]:THOIJT
E:,EF:'FII:;.'."I'HENT !.,.I]:LL. E~EE E;I.JE',._TEt;Y1" TO F'F.'.ITISE
H:Ei',I:[HUH E:, ]: :E:TFII",ICE E~E"I(i.,.IE'EI",I F:I b-!EL.I... RI",tE:'
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LE;F'LEE: ]: F ]: C:I::IT ]: Ol",lE¢ RNE:' CIX,N:':'.:TRUC:T"'''~: :lZ Cfi,!
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GRRV:L~'"_ BETktEE:N TFIE: OL.ITF'ALI._ F']:F'E:
).
O1'.,1 FIND FIF'I::'iE:O'v'FIL B'?' TH:i:.'.:::;
Illt'.,I..-:5 :[ TE E;EI.,.IRGE E:, i SF'OSFtL .:::, ~ ._, ] b.I 1 I:E;
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:[ ClEF. iT ]: F'"r' 't'HFIT
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FOF.:TH E?'," "['HE: PIUI".I :[ E: ]; PFIL. ]: "l""r'
2: 3: M]:LL. Zi",I:.E;TFIL.I... THf.E
"~:: :[ LINDER~::;"r'FIN[::, THFIT THE
:E; ]: DENCE: :[ '1.4; F:EHOI)E':L.E[::, '1"O
RE6iU I F.:Ei'"IENT:E;
)F' FINCH OF.'.FIGE
I t'-,I FICCOR
ITE
I.,.I ]: TH 'I"I--IE C:O£:,E:E';.
:5'-r"..=.;'fEi"1 HFI"r' F.:E(;iI_I :[ F::E E:NL. FIF.':GEHEi',IT :[ F 'THE:.
THRN .T.'!:
-' ~. O *MENT CO.
GEO~";CHNICAL Er DEVEL
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Soils ~ Foundations
Performed for:
Mailing Address:
Legal Description: ~JJ~ -~
Depth (feet)
Earl Ellis
688-2280
SOIL LOG Land Development
Soll Characteristics
5~
7
10
11~
15
16 '
Ground ~ter ~ncountered: Y~s No~,~
Proposed Installation: Seepage Pit~ Drain Field
Comments :__ ~ ~ ,~ _ ~.'~:~:~'~
If yes, what depth~_.
October 25~ 1977
~76883
Peter Halverson
Star Route Box 1124
Chug~ak, Alaska 99567
Subject: Permit Exptraulon
Dear Mr. t{alverson =
A permit issued by this depart~aent for well and/or on-site
sewer installation on Lot 4 Block 3 Great Land-Estates
Subdivision has expired since the issue date exceeds one
(1) year.
In the event you still plan to install the well and/or
on-site sewer system, a ne.w permit is required. The original
soil test may be used to obtain a curr~nt permit.
If the well has been drilied~ a well log shoul~ be sent to
this department to document the installation date.
If you have a/%y .questions r~gamu~ng the above matter, please
do not hesitate to contact this office immediately at 264-
4720.
Sincerely,
Les N. Buchho!z, R.S.
Sanitarian
November 7, 1977
~76891
Peter Halverson
Star Route Box 1124
Chugiak, Alaska 99567
Subject: Permit Expiration
Dear ~r. Halverson:
A pe.rn%tt issued by ~l~is department for well and/or on-site
s~er installation on Lot 4 Block 3 Great Land Estates
Subdivision has expired since the issue date exceeds one (1)
year.
In the event you still plan %o install th~ well and/or on-site
se~er system~ a new permit is required. The original soil
test ~%y be used to obtain a current permit.
Zf th~ well has b~en drilled~ a well log shoul~ be sent to
this department to document the installation date.
If you P~%ve any q~estions regarding the above matter, please
do not hesitate to contac'b this office ~ediately at 264-
4720.
l~s No Buct~holz~ R.S~
Sanitarian
F'ERHtT NO.
DEPFIRTHEN'E OF HERLTH FIN['.', EN',,,'IROI'.,IMEI",ITRL PROTECTION
2.5±6~ E. TIJ[:,OR RD.., FtI'.~CHCIF.~Rt3E, BK.
B-.~E L.L F' i F-:: ~"-1i % -E-
,:.' '768',E:~: ;:'
F:tF:'I::'L I CFINI"
L O C IR 1' I Lq N
LEGRL
F'E T F~Ia R I ',.,' E !R S 01'.4
L.d. E:"-::: GF.:ERT Lf:IN[:, EE;'I"
SF.! E;EI::.:: ~L:1.;2,~ I7.:HIJ(~
t'"tlN~I"'IUH DISSTRNIZ:E BETI4EEI'.4 fl I.,.IEL. L fiND PIN'¢ O1'.,I-:5]:'
:tOO FEET FEd:;.: I:l F'RI'v'RTE [,JELL. FiR 200 FEET FEIR FI
WELL LOGS FIRE REQUIRED FINB, HUST E:E RETL.I. RNED TO
E"lF.' THE 14ELI_ CF3HF'LETI ON.
SF'EE: I F' I CRT :[ ONS RN[:, C '3NE;TF.:UCT ]: ON [:, I R 3F:FII~E
I NE;TRLLFIT I ON.
C, ~-~ E. ".
'.1.0000E1 ~;QURRE FIEE"F
~iF'OSRL E;'¢E;TEH IS
fqRTHENT WITHIN 30 E:,R"r'S
.RE:LE TEl Ii'-,I'$LIF.::E PRCIF'ER
i:'IZIRTH E:'T' THE HIJNIE:IPF
;2: I HIL. L INS'ERLL 'THE
'/'"' "/; ".~._ _.z.
b I .~t'-4bl... ~ _
'" F4 P F'L I IZ:FHq"F F'F~
I E?_'; IJ E: [:, E:"r'_ ....
F" liE:: F-: t'-"lt 1; -F "..." i!:~ L.. ][ IE::, F- IL.":, F-': E FII F.~: F' F: C, Iblt ~: _-:_. _-:.. lt..... E£
i CERT I F'Y 'I"HFtT ~'. ~F~.~' ..~.
t.: I RH F'F:~HTLIRF.: W:I:TH fH~ F.:E[:.!U ENT'_=; FOF.'. ON--SITE SEI4EF.:'::; FIND HEI._L.S R:5 SET
I T 'r OF RNCHI~.IF.:RI~iE.
S'T'STEH IN F:II:EERE,RNIE:E HITH THE CIZI[:,ES.
1305 W. 45TH STREET
ANCHORAGE, ALASKA 99503
PHONE 2'7;>-g343
DRILLING LOG
Location (address of: Township, Range, Section, ff known; or distance main road
· ~.z~.'u~ (,~ ,. (_M,.:/~C dC
Size of casing (r __Depth of Hole_ I~ feet Casedto l~O feet
Static water level~' ft. (above) ~) land surface. ~inish of well (check one) open end (
Screen ( ); Perforated ( t/).
Describe screen or perforation_~.x-[t~-cA~
Well p~mpin~ test at J> ~allons ~er <hour) ~m~nu~
for.
of drawdown from static level.
Date of completion
.h~4~-with (~9 z~ (o
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
ft.
(
TO
TO
TO_
TO.
.TO
TO
~O'
TO_
~.TO.
.TO.
TO
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION NOV 2 0 1978
Telephone 264-4720
DIreCTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing.
1. PROP~RTYOWNE~ ~ I ~HONE
PROPERTY RESIDENT Jif different from above) - ~ PHONE
2. ~UY~R ~ ' PHONE
MAILING ADDRESS
3. LENDING INSTITUTION PHONE
M~I-LI~G ADDRESS
4. R~KLTOR/AGEN~ .... ~ ~ PHONE
MAILING ADDRESS
,/
5. LEGAL DESCRIPTION
STREET LOCATION
[] SINGLE FAMILY
[] ' MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One ~' Four
[] Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
J;~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach tog if available.)
8. SEWAGE DIS,,~-~3SAL SYSTEM
~ iNDiViDUAL/ON.SiTE.* **If individual/on-site, give installation date~'- v
If system is over two (2) years old an adequacy test is required
[] PUBLIC UTILITY by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72~010(3/78) ~)~t."~'~ I~)~ ~'~-~" 1~.~- '~I~IZ~--~(~ ~OO ~ Ol~,.J
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME 'rIME
DATE DATE DATE
INSPECI'OR INSPECTOR INSPECTOR
D'~-C-~O N S:
1. TYPE OF RESIDENCE '. . ,.NUMBER OE BEDROOMS '
[] SINGLE FAMILY '' ~' :'
E~] MULTIPLE FAMILY
E] ONE
[] TWO
[] THREE' [] FIVE
E3 FOUR , [] SIX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
E~INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Set)risc T~.~k or [~Holding Tank
Size: ~--,.) L)~ If Tank is homemade
give dimensions:
TYPE OF TANK
~T~-L ABSORPTION AREA
4. DISTANCES
WELL TO:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERM]TNUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
MATERIAL
-
Sepdc/RoldingTank Absorption Area
_ ~ewer Line
· Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~--~APPROVED FOR ~_ .... BEDROOMS
[] CONDITIONAl_ APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Tide)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)