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Home My WebLink AboutFLAT TOP VIEW #1 BLK 1 LT 5I'~ 000 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ I MUNICIPALITY OF ANCHORAGE ~ ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 MAI LINGOS /0 LEGAL DESCRIPTION LOCATION DISTANCE TO: IWell [~(~)/' Manufacturer ~ Liq. capacity in gallons I I ~3~ .~O IF HOMEMADE: DISTANCE TO: I Well Manufacturer DISTANCE TO: Well ~00~' Ne. of lines / Length o[~h~ ne Top of tile to finish grade /~;~. / Length Width J Abso~n area Inside length Dwelling ~ Foundatio~ Total I e n~.~h~fgt i n e s I- ~ ~ Material beneath tile C3 Depth uJ ~: I- Type of crib Crib diameter Crib depth I~ Well Building foundation u3 DISTANCE TO: .t Class~ ~ , ,'~. Depth Driller m Building foundation Sewer line ~: DISTANCE TO: IPHONE [--]UPGRADE Maten~j_~ Width NO. OF~.~DROOMS PERMIT NO. No. o fo~...mpar tments Liquid depth PERMIT NO. Material Liquid capacity in gallons Neares~.~' Trenc~l~tf~! inches .~' inches Distance between lines Total~f~t~ absorption area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS c..'c. + -5o3d, SOl L TEST RATING INSTALLER REMARKS APPROVED 72-013 (Rev. 3/78) DATE LEGAL PERHIT NO. ( 780503 ) APPLICANT LOCATION LEGAL DAVID L t,IILtIRRTH. FLAIIUH VILW S/D L5 Bi FLATTOP VIEW SUB DEPRRTrIENT OF HEALTH AND ENVIRONHENTRL PROTECTION 825 'L' STREET, RNCHORAGE, AK. 99501 264-4728 Ot~--S I TE SEb~ER PER~ I T LOT SIZE 15000 SQUARE FEET TYPE OF SOIL RBSORBTION SYSTEH IS: TRENCH HRXIHUM NUHBER OF BEDROOHS = 4 SOIL RRTIHG (SC.! FT?BR)= ~ THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEH IS: DEPTH= -i~,~* LEt-~GTH= ~ GRR~EL E, EPT: T~E LEHGTH DIHEHSION IS THE LENGTH (IN FEET) OF THE TREHCH OR DRRINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND RHD THE BOTTOH OF THE EXCAVATION <IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL ~EPTH IS THE MINIHUH DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOtl OF THE EXCRVRTION (IN FEET). E:EI_~IJ I RED SEPT I C TRr4K S I ZE: '1 250 GALl ON$ PERHIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPRRTHEHT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUHBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO ( 2 ) I t~$PECT I ON5 RRF R~r--m. Lm I RED BACKFILLING OF ANY SYSTEH WITHOUT FIHRL INSPECTION AND APPROVAL BY THIS DEPRRTHENT WILL BE SUBJECT TO PROSECUTION. HINIHUH DISTRHCE BETWEEN R WELL RI'il) ANY ON-SITE SEWAGE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVATE WELL; OR t50 TO 200 ~EET FROH A PUBLIC WELL DEPENDIHG UPON THE TYPE OF PUBLIC WELL OTHER REQUIREHENTS MAY APPLY. SPECIFICATIONS AHD CONSTRUCTION DIAGRRHS ARE AVAILABLE TO IHSURE PROPER INSTALLATION. PER~ I T E×P I RES DECEt~BER ~., d 97S I CERTIFY THAT l: I AH FAMILIAR WITH THE REQUIREHEHTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE HUNICIPALITY OF ANCH. ORRGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEH MAY REQUIRE ENLRRGEHENT IF THE RESIDENCE I5 REHODELED TO INCLUDE HORE THAN 4 BEDROOHS. ~ I GH~: _ ~CONT DAVID L. I,IILI'IRRTH ..... ~_-- V~. 2 PERFORMED FOR: LEGAL DESCRIPTION: DEPTH (FEE'rl :2- 4- 5- 7- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Ancho~,ag~, Alaska 99502 276-222~ SOILS LOG- PERCOLATION TEST SLOPE [~OI LS LOG n *PI~RCOLATION TEST 10- 11- 1'2- 13- 14- 15% 16- 17- 18- 19- WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Reading Date Time 'H Net Depth to Net Time Water Drop 20 .- COMMENTS PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) FT CERTIFIED RY: ~ DATE:,~', ~'&/~, 7~ 72.00C 17/76) MUNICIPALITY OF ANCHORAGE DEPT. OF I~.EALTH & ENVIRONMENTAL ENGINEERING DIVISION JAN § 197 Telephone 2B4,4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplm ~uaa will not b~ proc~sad, Rem Mlow t~n (10) dayl for pn~lling. 1. PROP~Y QWNER MAILING A D.~IR ESS Pd /O-- PROPERTY ~ESlDENT (If different fr~ a~) MAILING ADDRESS PHONE PHONE ~- LENDING INSTITUTION MAI LING ADDRESS JPHONE 4. REALTOR/AGENT MAILING ADDRESS PHONE 6. LEGAL DESCRIPTION STREET LOCA.rioN//~¢ ~ 6. TYPE OF R ~ SINGLE FAMILY [~] MULTIPLE FAMILY * 7. WATE.~PLY INDIVIDUAL° [] COMMUNITY I--I PUBLIC UTI LITY BEWAGE DISPOSAL SYSTEM .,~, INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One ~-~ Four [] Two /~'~[] Five [] Three [] Six [] Other * ATTACH 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.) **If individual/on*site, give ir~tallation date /-jJ~.~'~' '~.~ If system is over two (2) years old an adequacy testqs required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/78) TIME DATE INSPECTOR DIRECTIONS: THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME DATE DATE INSPECTOR INSPECTOR 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL · [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE [--IpUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: ~o~'-.~'-O If Tank is homemede give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~l ONE C] TWO PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MAN U FACTUR~_~.~ MATERIAL Septic/Holding Tank NUMBER OF BEDROOMS [] THREE [] FIVE [] FOUR [] SIX JSewer Line [] OTHER JNearest Lot Line DATE ~/E~CRIPTION ~L~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED I BY (Title)~( ~~ 72-010 (Rev. 3/78)