HomeMy WebLinkAboutEAGLE CREST #1 TR B LT 35 ", ~ 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
DESCRIPTI
Manu fac turer~ ~ ~ ~ M=ter~~ No. o~ ~rt~n ts
Liq. c.~gallon. IF HOME,DE: Inside length Width Liquid depth
DISTANCE TO: Well Dwelling PERMIT NO.
Manuf~turer Material Liquid capacity in
Top of tile to finish grade *t Mate h tile ge inch.
Length Width , Depth PERMIT NO.
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller D~stance to lot line PERMIT NO.
DISTANCE TO: Building foundation Se~r line Septic tank Absorption area(s)
OTHER
72-013 (Rev. 3/78)
· ' ' rqL, NTCI( '~LZm"r' OF RNCHmRRGE
· . ~.. DEPRRTHENT ( 'HEALTH AND ENV[RONHENTRL~ OTECT[ON ~,, ~ OI
* '. ~ ." .' 825 'L' STREET~ ANCHORAGE, MK. 9~5~ "~'~'~
264-4720
14ELL Rr~D Or~--5 · TE SEI~ER PERr~ [ T
PERMIT NO. ( 81069i > ~
~PPL/C~NT HAM CONTRRCTOR~ SAR BO~ 3522B 34~,-44~'
r- MflXIMUH NUMBER OF BEDROOMS = 3 SOIL RflTING (5Q FT/BR)= i25
' d './'5"
. _ THEIL[i.I,~TH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRR[NF[ELD.
THE DEPTH OF R TRENCH OR P[T [S THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCflVflTION (IN FEET).
THE TAFt'CH I~IDTH I5 5. ~ FEET.
THE GRAVEL DEPTH I~ THE MINIMUM DEPTH OF GRAVEL BE]WEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET),
/
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.
TI40 (2) I t`ISPECT I Or-IS ARE REQU I RED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION fiND flPPROVRL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINI~IUM DISTANCE BETWEEN fl WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR fl PRIVflTE WELL OR 150 TO 200 FEET FROM fl PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM fl PRIVATE WELL TO fl PRIVATE SELLER LINE IS 25 FEET fiND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS
OF THE HELL COMPLETION.
OTHER REQUIREMENTS HAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERMIT EXPIRES DECErqBER 31~ 19Si
I CERTIFY THAT
"~: I tim FflMILIAR WITH THE REQUIREMENTS FOR ON-SITE SELLERS fiND WELLS RS SET
FORTH BY THE HUNICIPRLITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED: __.
flPPLICRNT MRM CONTRACTORS
V4. 0
LI)~3 r [
~'~,~ co~r~c r~
t. or
,i,.:: '=:-TT~ O~PTH I:~ ~1 YR~-:/):H OR PIT
~ ~ff~ ~rll [~ TIE ~[fl(l'lJ~
i"~l I
CONS I- -,m,,C-FIOIt
lEST LAB
Hark Hachkovlch
D Visuol Sails Exomlnolio~
-- =.-'CRMED FOR;
--_GAL DESCRI.=TION':
.-::$ FORM REPORTS:
E-~TH SOIL
-_- ET Dr SCRI~TION
3' Sandy silt
14' Gravelly sand & some silt
BOTTOM OF HOLE
.E GROUND ~','AIER ENCOUNTERED blo
~ ES, WHAT DEPTH
SEND
-- Pert ZOne
: - So:;,,D~e token
-- Frozen zone
L~ 35 Block Tract ~ Subdivision. En~le C. re~r R.h~l{v(~{nn ~] -
~ Percololion lest
NOTES 1-- I :--+- ~ "-- -
~ ,~~-- ~ ....
............. ~ ·
I ~:.. :z :::~: y_~ ~:~-: ~ ~'
I '- I ..... : .... ~- ' J
I ~ 7_. Z~ ~Z-'7 ~lr~ A~U~-27 i: ....
~ .... . -----q--~ .~; ......
--~-~ F ~ ,~-~~ .... ~'-'.
~ · <~ ~ I :---J---~-.~ .....
~- TN . %~ ~ , . ,
9'""~'t~"~ ................... .6 '~ ........ J--- -; ..... 4 ....
~.~a'a<.~¢.~~ ~-~:z]:'--y]'.':~_L_:-- -
7~James ~insstad~ ~ .... ~ .... ~'-'~ '~:7 [ Ti~' '~
~?~'.. ..';~ .... , --- _ ~ ...............
~1,¢~ ~- .......... t %~ - ......................
'% ~ rrett ~% ~ G=I¢=RAL SITE SLOPE
-- %%'oler loble
-'Z",~G DAlE GROSS TIME NET TIME DEPTH TO H20 NET
Init. 10-20-81 5" t "
I _. f: ...... T :::::-_-'
;~,O~ATIO.~ RATE: 5 min./i~ch DRAIN'AGE REOU;REM[NTS:
L='OSED I~STALLATION: O SEEPAGE PiT ~ DRAIN FIELD O OTHER
· .".tENTS: Perc test was attempted, but due to the mate[iai the water level
disappeared rapidly.
~T PERF ORt.;ED
.................. D~T'- CERTIFIED BY: ..... K_evin.Br.a_un ........
~A~ c:.. jo..-Zo-~J ...... .
' ~SOIL'
DEPTH ; .... ~' .. L , '
FEET ' ,:"~ DESCRIPTION" . · - ;NOTES
"P?' "t ' :BOTTOM
YAS[GROUND WATER .ENCOUNTERED
-" YES, WHAT'.DEPTH
.EGEND " .... -
.. : ,NET-~TIME-':"" Et=TH 0 'H O'/*
EADING' ~.;DATE - ~;ROSS . " ' NET D AGE
i - " ,~" ' '? ~i"':'
ERCOLATION RATE{ R m{n/~n~h "DRAINAGE REQUIREMENTS:' 125 SO/FT.
ROPOSED INSTALLATION:---O SEEPAGE-PIT .,-~.DRAIN';FIELD- O OTHER' - --'
;OMMENTS: pp~ *~t wn~-attempted~'but~d~e'to~the-material'~he'water level--
disappeared rapidly.
EST PERFORMED BY: ~.n.
DATA CERTIFIED BY: Kinney R. Baxter
DATE: 5/14/81
/-
,, W.W.O.
;' : Water Well Drilling"
L~.~ Anchorage, AK.
. . . · ..
we,.ow.erltl'.';'~/')?/"- :--.,
Well Lo c at i o n ,~ ~,, ~.,~, .~,~.,,.~ .~..~ ¢,,~?, ~.- ~_., ~.,~ Date
/,,~-.,' ~ * ~/~f ~/~ ,,
Size Casing ~' Depth of Hole v- ~-- Cased to feet
Static Water Level' ~ ~Z / : ' ' feet -::' -.WellTe~t~ /6-.-~-.'.: 2.. Galpe, Minot¢lor. -~ Hours
,.~' ;, [ ?~ / W~LLOG,~ ~) '
= AUTHORIZATION TO DRILL,
I hereby authorize W.W.D. Drilling to proceed with the above work:Payment shall be ma~e in !he following manner:
, ~1,~,~
Rig Up ~,linim. um (5~'/0 of anticipated depth) feet. @ per foot
Balance due upon completion. / , .
In the event it is necessary to institute legal proceedings to collect any amounts due on this contract, I agree to pay an additional
sum of Ten percent (10%) of the original contract price as attorney's fees, plus costs, for legal proceedings.
Name
Date
Address
)A't ~ RECEIVED
"· ' INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE ~)ATE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~uNtCiPALiTY OF AN~~IORAGE
t ) 825 L Street- Anchorage, Al~a 99501 D[PT. OF HEALTH &
ENVIRONMENTAL FROTECTION
ENVIRONMENTAL SANITATION DIVISION '
Telephone 264~.720 . NOV 2 0
REQUEST FOR APPROVAL OF INDIVIDUAL WATER ANDSEWER ~/~, ~.~L
DIRECTIONS: Complete ail parts oil page 1. Incomplete teque~t~ will not be pro~e~ed. Please allow ten (10) days for processing.
1. PROPERTY OWNER I PHONE
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PRONE
2. BUYER PHONE
MAILING ADDRESS
3, LENDING INSTITUTION J PHONE
MAILING ADDRESS
4. REALTOR/AGENT I PHONE
I
STREET LOCATION
'"'
~ TYPE OF RESIDENCE NUMBER OF~BEDROOMS
' ~ One ~ Four
~ SINGLE FAMILY ~; ~ Two ~ Five
~ MULTIPLE FAMILY ~ Three ~ S[x
[] Other~
7. WATER SUPPLY ~ INDIVIDUAL*
[] COMMUNIT, Y
[] PUBLIC UTILITY
· A'I rACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
ti,
THIS SIDE FOR OFFICIAL USE ONLY ,'
1. TYPE OF RESIDENCE
I~ SINGLE I~AMI LY
NUMBER OF BEDROOMS
i-'l ONE [] THREE r-'l FIVE
I--I TWO I--I FOUR [] SlX
I'-I OTHER
2. WATER SUPPLY
INDIVIDUAL
COMMUNITY
PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
I-'IINDIVIDUAL/ON -SITE
r-IPUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
TOTAL ABSORPTION AREA
4. DISTANCES
WELLTO:
DATE INSTALLED
INSTALLER
I--1Septic Tank or I-'lHolding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
MATERIAL -
SepticJHoid~ng Tank ~Absorption Area
I
Absorption Area to nearest Lot Line
Sewer Line I Nearest Lot Line
5. COMMENTS
DATE
72-010 (Rev. 6/79) ' '