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Home My WebLink AboutEAGLE CREST #1 TR B LT 4 NAME ( MUNICIPALITY OF ANCHORAGE f ) *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 I'--~ UPGRADE MAILING ADDRE~ ~ LEGAL,I~ E~'CRIPTION i DISTANCE TO: Well~.~ I ~C Dwe.i.g IF HOMEMADE: In$idelength NO. OF ~.~ROOMS Wetl PERMIT NO. DISTANCE TO: Manufacturer Material Liquid capacity in gallons D,STANCBTO: ~'~"='" .-,..t,o,,ll , PERMiTNOT?'oq ~,~/ No. of lin. lines Distance between lines inches Top of tile to finish grade C~ ~ ~ tile Total effective area inche~ Type of crib WKtth Depth PERMIT NO. Crib diameter Crib depth Well Building foundation Depth Driller Building foundation Sewer line DISTANCE TO: DISTANCE TO: Nearest lot line Septic tank OTHER PIP ALS EO''TE'T"AT'NG/R 5 REMARKS APPROVED DATE LEGAL / - . DEPflRTI~ENT OF HEALTH fiND ENVIRONMENTAL F~J~-L;IIOi'I . "'~, [~JgJ~k, ~./ ~ 825 'L' STREET, ANCHORAGE, AK. ~9501 '~ ~ ~/ ~G4-472~ ~ / ~ APPLICANT STEVE ~CHUHANH ~47 ORESTYiEW LH (EAGLE RVR) ~94 ~7 LOCATION 4TH & CRESTVIEW ~ LEGAL L4 TRACT B EAGLE CREST LOT SIZE 178~ SQUARE FEET TYPE OF SOIL ABSORBTIOH SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT/BR)= 195 THE REQUIRED SIZE OF THE SOIL ABSORPTIOrl SYSTEM IS: DEPTH= 15 LEr~GTH= 4::~ GRAVEL DEPTH= ? THE LENGTH DIMENSION IS THE LENOTH (IN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND 8ND THE BOTTOM OF THE EXCAVATIOH (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 EXCAVATIOH (IN FEET). REIC~U I RED SEPt I C TRr-,IK $ I ZE= ::L000 IC~ii::ILLON--~L:~ PERMIT RPPLICAHT HAS THE RESPONSIBILIT~ TO INFORH THIS DEPRRTMEHT DURING THE. INSTALLATION INSPECTIONS Of ANY WELLS ADJACENT TO THIS PROPERT~ RrlD THE NUMBER OF RESIDENCES THAT THE WELL WILL ~ERVE. BRCKFILLIHG Of ANY SYSTEM WITHOUT FINAL INSPECTIOH AN~ APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTIOH. MINIMUM DISTANCE BETWEEN A WELL AND RHY ON-SITE SEWRGE DISPOSRL SYSTEM IS i00 PEET FOR R PRI¥~TE WELU OR 150 TO ~00 FEET FROM R PUBLIC WELL DEPENDING UPOH THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTIOH DIRGRRMS ARE RVRILRBLE TO INSURE PROPER INSTALLATION. PERt1 I T EXP I RES DEC:EMBER ~:1-' 1~c~?:~:~ I CERTIFY THRT 1: I AM FRHILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. ~: I WILL INSTALL THE SYSTEM IN ACCORDANCE.WITH THE CODES. ~: I UNDERSTAND ~4AT THE O~N~SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS ~E~~I C~THRH ~ BEDROOMS. RPPLICRNT STEVE SCHUMRNN M.D.G. I':NGINEERINC~ , SOU-SLOG - PERC. TEST J~pS oils 'log ercolation test performed for: leaal desc. 9 I0 II 12 13- 14.. 15 I 17- I ~,,~-~/' 19- ground water depth ~_d.ate g.hme n.time d.fowater net drnn PERMIT NO. I'.ILII'-,I I (;: I F~F-tL I T"r' OF F'II'-I CHiT~ I~:F'I GE DEPARTi"IENT t"--'~HEALTH AND EN'/IRONMENTAL /"~TECTION 825 'L- 'STREET, ANCHORAGE, 264-4728 14ibb PER£'I I T ?80726 > APPLICArlT LOCATION LEGRL STEVE SCHUf. IRNH 147 CREST VIEN LRNE CITATION L4 TRACT B ~A~L~i} ~D LOT SIZE 694 9227 22800 SQUARE FEET MIHIMUM DISTANCE BETWEEH A WELL AND ANY ON-SITE SENAGE DISPOSAL SYSTEM IS 20£~ FEET FOR A PRIVATE WELL~ OR 150 TO 200 FEET FROM A PUBLIC WELL DEF'ENDIHG UPON THE TYPE OF PUBLIC NELL NELL LOGS ARE REQUIRED AND r'IUST BE RETURNED TO THE DEPRRTHEHT WITHIN 3.0 DRYS OF THE WELL COMPLETION. OTHER REQUIREr'lENTS HAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO IHSURE PROPER INSTALLATION. PEAr-! I T E~--~P I RES DECEI'-IBEI~: _--~---~1_. CERTIFY THAT I R~'l FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE,.,MUHICIPRL~Y OF ANCHORAGE. 2: I WILL IN~TALL THE._ ~/YSTEM/ IN ACCORDANCE NITH THE CODES. S I GNED ~--2__2~_~_~ APF'LICANT STEVE SCHUr. IANfl ISSUED BY__~__~ ..... V2. 2 A & L DRILLING COMPANY BOX97, EAGLE RIVER, ALASKA99577 · TELEPHONE694-2588 OWNER OF LAND ~'~'~o'~ 3C/(6~-~',O,,~,] DEPTH OF WELL ~ ADDRESS /~ ~ ~ ~ ~ ~ ~ ~ STATIC LEVEL OF WATER LEGALDESCRI~ION ~ ~ ~ '~ ~/~RAW~WN~. /~ PERMIT NUMBER ~:~ 0 77C KIND OF CASING 7 KIND OF FORMATION: From ~)' FI. to c,~ Ft. From ~'~ Ft. lo ] c~ FI. From ! ~ FI. to ~ ct' FI. From ~' Ft. to From /'?-~"' Ft. to /~'/' Ft. From/~f'/ FI. to /~ Ft. From.[~' FI. to ]~7'Ft. From /~c:7 FI. to c~/O Ft. From ;~1_.__~_0 Ft. to From ~ ~" Ft. to . From Ft. to From Ft. to From ~ Ft. Io~ From ~ Fl. to~ From Ft. Id From ~ Ft. to~ From ~ Ft. to F~m ~ Ft. to From ~ FI. to From Ft. to Ft. From FI. to From Ft. to Ft. From FI. to From Ft. to Ft. From FI. to From Ft. to Ft. From FI. to From FI. to Ft. From__Ft.(o__ From FI. to Ft. From__FI. to From__FI. to Ft. From FI. to Ft Ft. .Ft. .FI, Ft .Ft. Ft. .Ft. Ft. Ft. Ft. Ft. Ft Ft. .Ft. Ft. Ft MISCL. INFORMATION: DRILLER'S NAME " MUNICIPALITY OF ANCHORAGE /dUNICIPALITY OF ANCHORAGE ~__~__ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTiOND£PT.i~RO;' JJ~ALTH & 825 L Street - Anchora.]e, Alaska 99501 ONMENTAL I'~,OTECTIOIq ~'~'! ENVIRONMENTALENG'UEEmNG DiVISiONtDEC 4 1978 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processad. Please allow te,~ (t 0) days for processing. 1. PROFERTYOWNER _._/_(4 ? 2. t;UYER PHONE PHONE PHONE 3, LENDING INSTITUTION PHONE PHONE .5. LEGAL DE:$CRIPTION STHE[T LOCATION 6. T~PE OF RESIDENCE I~ SINGLE FAMILY [] MULTIPLE FAMILY [] One i--1 Four f--I Two I-'l Five [~ Three I--1 Six r-i Other 7. WATER SUPPLY INDIVIDUAL· [] COMMUNITY [] PUBLIC UTILITY SEWAGE DISPOSAL SYSTEM ~)Q INDIVIDUAL/ON-SITE*'4VE ~'' [] PUBLIC UTILITY · ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wails drilled prior to that date, give well depth (attach log if available.) · 'l f indivldual/on-slte, give installation date.J~r ~' . If system is over two (2) years old an adequacy test is required by this Department. NOTE: TIlE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, · ' /"-"~ ' THIS SIDE FOR OFFICIAL USE ONLY ' DAlE H ECEI v,c.D INSPECTION APPOINTMENTS TIME TIME TIME t)IHECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ;~ SINGLE FAMILY ~ ONE ~ THREE D FIVE ~ OTHER ~ MULTIPLE FAMILY ~ TWO ~ FOUR ~ SIX PERMIT NUMDER 2. wATER SUPPLY [~ INDIVIDUAL . DEPTH OF WELL ,~' ~ COMMUNITY DATE DRILLED ;~ PUBLIC UTILITY Connect[on Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMDER [~ INDIVIDUAL/ON -SITE DATE INSTALLED '-' ,.~ PUBLIC UTILITY Connection Verified {~Septic Tank or ~Holdlng Tank S[ze:~.~__ f Tank s homemade SO~LS RATING ~ve dimensions: T¥?~ O~ TA~K MA~UFACTURE~... ~ TOTAL A~SORPTION AREA MATERIAL WELL TO: ~ ' ILO' I I 5. COMr,~ENTS I ~ CONDITIONAL APPROVAL (~etter must accompany certificate) ' ~ '~ DISAPPROVED '' "':' ~ ~ ' ~ ,,, . ..,~ _. 720:0(Rev. 3/7~) /k '-~"-': ' ~ P.O. BOX 4-1276 ANCHORAGE, AL~KA ~ ~g BglNE~ PARK BLVD. D~n~i~ Water A~ Repod for Total Col~orm o- TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM: I.D. NO. Public WatM SyStem N~me Mo. Day Year SAMPLE TYPE: I-I Routine [] Check Sample (for routine sample with lab ref. no. ) [] Special Purpose ZIp Code [] Treated water r-i Untreated Water SAMPLE NO. LOCATION ~[ I ~I I ~I I ~I I Time Collected CollectedSy \O°° "~r~O~< TELEPHONE (g07) 279-4014 TO BE COMPLETED BY LABORATORY LABORATORY: NAME -- - ADDRESS CiTY Date Received Time Received Analytical Method: [] Fermentation Tube [~embrane Filter Lab Ref. No. Result' , Analyst/-~ READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) 0&,1220 (bi Rev.]9?8 BACTERIOLOGICALWATER ANALYSIS RECORD