HomeMy WebLinkAboutHAMANN LT 4B
NAME
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
I.PHONE
hEW
E]UPGRADE
LEGAL DESCRIPTION
/_o T 14
Absorp~e~
Inside length
· Dwelling
DISTANCE TO: Well /~:)(~
I Manufacture~A
[Liq. capac ty b~gallons [
Manufacturer
[Well
DISTANCE TO: [
~::::t'let°f'n'shgr~:idthg
Type of crib Crib diameter
Well
DISTANCE TO:
Foundational, ~ /
Total len gt~li~es
Material beneath tile
Depth
Crib depth
Building foundation
Class Depth Driller
DISTANCE TO: Building foundation Sewer line
OTHER
PIPE MAT,¢ R IA LS
SO'LTESTT Z
XISTALLi~R
REMARKS
Dwelling ¢~., 7 /
Mat er.~_~___.~ ~
W dth
NO. OF BEDROOMS
PERM,T
No. of compart~ts
Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
Nearest Iotli7~ / PERMIT
T r e n c h~iC,t4n~ Distance b et~ve,~l~ es
~--'~ inches
~ ,d Total eff,c,~ive/absorption area
1- ~
PERMIT NO.
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO.
Sept c tank Absorption area(s)
APPR 0~__~,~ DATE LEGAL
F'EF'.H ~ T NO.
F-iPPL :[ CFINT
.L. OC:~T I OF!
LEGRL.
HRHRNN E:,R.
L 4B HFIHRNi',! S,-"E:'
i"tFIXIH!JH NIjP'!BEF: OF E,~5'.:!"?::h'S = -'4
-a...,D,.=h.=.~ SQUF:iF?..E F EkT
SOIL F;::i::!T Z big
THE LE.NGTH F. ]'HEN'E,.T3N i'E, THE _.ENGTH ,':IH FEET':, OF THE TREH:H
...... ~,,E
THE F:,EPTH OF= Et TRENC:H -b? PIT :iS "FHa:' D]:STF:!:.,,C'E E',ETHEEN THE SU[~:Fi~CE OF ....
3PC. UhJ'2 FIND THE BEFFTOH '5 F' THE E::.::CR'v'RT Z EfN ( Z N F'EET ::,.
'"HE~'E ~S iqO 5ET H:[DTH F'OR TF:ENC:HES.
THE 3~'F.',.,'EL DEF'TH Z:5 THE FIINZHUPI DEF'TH OF GRFt'v'EL F3E'TI...EEf-! THE OUTF'F!LL. F'ZF'E
..... 'T'~ '-' E qT T 3H OF: THE F',:.:: '3¢i',,,'FIT T -qq ,:' Z N FEET ).
F'EF~ff"i Z T RF'F'L :[ E:Fii'-,IT i-I!:t:E: THE F:ESF'ONS Z E; :[ L :[ Th.' 'TO ;[ NFOF:P1 TH Z S,.. .... ~:r'"' .F .,,- .... ..r -1c,,:.,,~,~" DL!F.': Z ?.JG THE
]: NL~;]'FILLRT I Olq ....... T NSPEC:"F .'[ ONS; EiF ¢t~'~"r' !,IF:'[ [ '::; R[:,...TRCE?',Ff TO TH l S ,r:'F-"-,~,.,~:'~:'~. ,-.:'TU, Fq",,_r" 'THE:
NUHBER OF F:E':7, IDENCE:E'; THFIT THE i.,~Ei.!, b. ilM... SEF;:VE.
i'"iZNZHL!H DZSTRb!E:E E:ETI.,~EEb! f~. HEL.L. FINE FIN'r' ELf,I-SITE SEIqF!GE: [:,i'SPOSI=IL. Sb%'TEH IS
:'LOE~, FEET FOR !::1 F'F.':!'v'FiTE F.!EL.L OR !50 'T'O 2E'¢0 FEET FROH .Fi PUE~L. ZE; HELL DEPENDING
UPON THE T":'F'E OF PUE',i...ZC HELL
i"!TI"4iHUH DZSTRNC:E FF'.OH R P.,':?.IVFfTE HELL 'TO i::I F'R:['v'RTE SE!.qE%: LThiE IS ;25 FEE"r RND
TO Fi COHHI. JNZT'¢ SEHE:R L.. i[ !'.,!E ~i:S 75 FEE:T.
.klELL L06S RF.:E REQU:I:RED Rh,![;, HUST BE F.'ETijRF,IED TO TF!E DEPF:iF;:THEIqT t4iTHIi'-¢; :]:0
OF THF: !4ELL COi'"IF'LETIOI'.L
OTHER RE6¢U'.r. REHE.'NTS f"!F!'.d FIF'F'L"r'. SF'EC:[FZCFITION:.:'~; RND CONSTF'.UCTiON [:,ZRGRF!H$ RRE
R'v'F:I l L.f:IBLE "f'O l F,,IS(.JRE F'F?.OPER Z NSTRLLI=I'T'Z 0!'4.
I CEF:TIF:'¢ THFIT
±: :[ aH F'FIH:[t._:[RF: b.tlTH TH.E REQLiIF.:ENEihlTS FOF..' ON---SITE SEHEF'.S RND HELLS RS SET
F'O:F::TH B'./ THE FILtNICIF'FtL. ITh,' OF RI',K::HOF,::FIGE.
2: i HILL INS'f'FILL. TF1E SVS.:;,'TEH !N RC:CORDRIqCE b.~:[TH 'TIDE COl)ES.
3':: i UN[:,ERSTRND THf:IT THE ON~.S!TE SE!.,.!ER S'?'STEH r,ie,'?' f.~:E('='.it.jZ.g;:[~ ENL. RRGEHENT IF: TFiE
RESIE:,ENE:E IS REi'qO[.',EL. ED TO ~NC. LUDE HOF:E THRN 4 E~EDROOifiS'.
F. 'i G;NE:D: ....................
F!PF'L :[ E:Ftkt't' /E:F~?.~T/] v
"O&E
EN( NEERING & DEVELC~.MENT CO.
k~Box-- 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell O~'sler
694-2774
Performed for: Name: ~' ~ ~/~
Mailing Address:
Legal Description:
Earl Ellis
SOIL LOG 688-2280
Depth (feet)
$oll Characteristics
11 -'- ~ -
Ground Water Encountered: Yes No, If yes, what depth__
Proposed Installation: Seepage Pit~ Drain Field
Comments: ~O¢~ ~¢~ld/~0~
PLOT PLAN
PERC. TEST
DOC Co. dba
SULLIVAN WATER WELLS
P.O, BOX272, CHUGIAK. ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE - Started
PERMIT NUMBER
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OFCASING
KIND OF FORMATION:
From
From
From
From
From
From
Ft. to ,~ ~, Ft.
Ft. to Ft.
Ft. to / ~-'''' Ft.
Ft. to //< Ft
Ft. to f i',:~ Ft.
Ft. to , Ft.
From "' Ft. to
From Ft. to
From ,/ ~'' Ft. to
From : ': ;Ft. to
From Ft. to
From__Ft. to.-
From, : > Ft. to
From _Ft. to
From Ft. to
From Ft. to
Ft. to f ;'!. 5' Ft.
; 4::~ ~ Ft.
Ft.
/i":t Ft.
? '?' :/Ft.
Ft.
.Ft.
,:' '" ~ Ft.
Ft.
Ft.
Ft.
From __Ft. to Ft.
From Ft. to_ Ft.
From Ft. to_~ Ft,
'-/"~ ~'F~om Ft. to_~ Ft
From Ft. to~Ft
~-~ '.."Ac ,: ? ,:.'. ~?', %, :.g From Ft. to__Ft.
· , -, :::.~: ,?' From Ft. to__Ft.
l 4..':'}4" ,:? '~ '~ ' ':' __
) .,..,.'~ ,<- ~, ~f,-- From Ft. to__Ft.
/~ ', :::'4 'c, '~,. Fromm. Ft. to~Ft
~, : c' ~.,,/: ~ ,'< From~Ft. to~Ft
,1 ~ ~ .~ .... ~ ?tL', ( ~:"'.
/ '~ ' ,' ,'-~ From_~Ft. to__Ft.
<~ <? '~'P~,: '<]' <-~ ~" '<"~ From Ft. to Ft
From Ft. to__Ft
From __Ft. to__Ft.
From Ft. to Ft
MISCL. INFORMATION:
DRILLER'S NAME
Prope~rtyO~ner APPLI( iNT FILLS OUT UPPER HA[_/ONLY
..... Vooi' Phone
Buyer
Address ~ Zip Code
Lendin~ Institution ~ ~ ~ ~ ~ ' ~' ~'~ ~?~ . Phone
Address ~0. ~-~" ~"~ ~ ~ ZipCode
Realty Co. & A~nt Phone
Address /,~ ~ Zip
Code
Street Locati~
TyPe of Resi~nce
~ingle Family ~
~ Multiple Family No. of Bedrooms
~ Other
Water
Supply
~ O~ ~ ~ A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
ndividual Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility ~_OO i
Sewer Disposal
Year Individual Installed: / ~ ~;' ~,.
ndividual ublic Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED,
Time Time Time Time
~ / ~)~"""~/2~ Date Date Date
Inspector Inspector Inspector Inspector
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
Soils Rating Date ~wer Installed Well To Absorption Ares Well Log Received
J ~ / 7-- ~ X~ ~ WelltoTank Septic T~k Size
72~23 (3/62)