HomeMy WebLinkAboutHAMANN LT 12 ~.~, 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
MAI LI N'G AD D R ESS,,'~ ~ ~ ~ ~ ~"~- t ./'~)
/aD '5c5 ¥03 .
LEGAL DESCRIPTrqN __ .~ / ....
LOCATI~ · ~ -- .~ ~ } NO. OF BEDROOMS
} Well ~-- / ~ I Absorptiop area ~ Dwelling ~ ~ PE~9. ~
~,~NC.~; I ~/~' I ~ IM , ~ ~~~
Manufacturer ~I~ ~ ~/~ '~ ~ ~ ate ~~~ z No, of c~mpar~ents~
Liq, IF HOMEMADE: Inside length I Width
DISTANCE TO: Well Dwelling
Wa,,
I Length ors? in,¢
Material
DISTANCE TO:
No. of lines /
1
Top of tile to finish grade
Nearest ] ot~l.l~ ~
Trench wi~,.d~¢,.~ inches
inches
Liquid depth
Liquid capacity in gallons
Total effectiv~can area
PERMIT NO.~
Length
Width
Depth
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO,
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MA~ER. IALS
TEST RATING
so,,
INSTAEL~
REMARKS ' --
LEGAL
Lo't
T'¢PE IF ':~E~!L. FIE ':;h"; F?EEr'I" I ON S'r.E;'T'Ei'" I:~'i;'
THE RE(:]iI...I :[ RE[) ::, .1: ,,:.,.':: OF -r'HE-: ...... i!'%) ]: [... FIE:iF;';OI::;:F:'T :[ (]lq ':::"~"::'T~::'M,: ..... I '.:..'; '
'T'HE: I....E;"qdiTH E:,.'l: MEN:E; ! EtI'.,I ! ~!;:; 'ThlE LENG'T'H ,:.' ]:t'.,! FEET) O!'~ THE "i'RE;i'.,ICH Cfi;;: DRF! ): ?.,ff:r :[ EL.I}.
TFIF.--.' [:,EF'TH OF I:::1 TRENCH (:;ti:;'. F'!'T Z:E; THE D:[STFII'.,II]:[E E',ETHEE?',I THE f:~;L.t.RF'FICE OF THE
GROLti'.,!I} FIN[:, THE:: [.:]CrT'TEff'I OF' 'T'I...tlZ EXCI:::I'v'f::I'f').'EI!'.4 ,:: t t'.,t F:'EET).
THERE
TH_E C:iF;;:F:?,,,'EL. [)EF'TH I ri:!; THE: Id I F,t :[ FfLliVl [.':,EPTH O!;:' GI'~:I:::i',,,'E!.L. EdE"I"I.,.!EEiq THE-: OUTF:'F:IL..L F:' ]: PE
F:II",!,D '1"HE IE:OTTOM OF THE E::.:',C'I:ZI',,II::ITZ Ell'.4 ,:: I N I::'E..r<T .':,.
PEt:~'i',t :[ ]' t::tPF'L, l CF:II'.,IT PIF:t:!~; TI..IIE REE;PCIN:E; .T. E: ! I... t T"r' TO I J"!FC RM TH ]: :E; [)EPF:IRTMENT [:,LIE'. :1; [",!(3 "~ -
! I",t';:~:TFILI_FY[' :[ O1",1 I N'.~i;F'ECT ]: 01",!!~; OF F:II"~"¢ FIELI...:~; FI[)JFICENT TO q"H Z ri!; .::'l'4' ;: I:::'E:F:T"r' l::l~',l[::'
J"l.."IE E'R OF:' RE':'~; ! [)E[",tCE:!g; ]'1"11::1'1" THE: I.,.IEL. L 1.4 1 LI.. E;ER'v'E.
i-'i :[ J",t ! MLlhi I}
~!..00 FEET F'OR !:~
:[.5¢~1 '1"O ;?~:.lEI I:::'[EET Ft:;;'.OM I:'1 I::'IJ[]:L I C l.,.l[ii]....L, t}EF'ENE:, I i",IG !JPOF,I 'TPIE 'T"?'F'I:~: OF' F'U[i?,I... :[ C [.,.!E:L.i.
O]"HER [;?. E (;:!U
FI',/f::I ! I....FtE;LE': TO :!: I",I:~!;IJF'::E!: PROP[:']:;;: I Iq:::-.';TF:ILI...FtT:[ ON.
:[ CERT :[ F:'"r' T["IFtT
:L: ! laM FI::IP1]:L.!F:IR I.,.!l"T'l~l THE REI]:!LI:i:.REMENT'.E; FCLr¢.: ON..--i~;ITE :E;EI.,.IER':'!!;
FO[:;:TH E?'r' THE FIUt",!]:C];PF:IL. IT"¢ CIF' FINCHORFIGE.
2: ! !.4]LL :[N:~;'f'I:aL..L THE :E;"r'::?.;TEM Il",! F:ICC:ORDFINCE I,.IITH THE
]:: ! IJlq[:,liEl:;i::?,]"FtN[)'T'HRT THE ()N'"":!~;tTE': :"!!;EI.,.IE!:;;: SV:~71'EM !"IF:IV F?.E~:!IJ :[ R[':': E!'-,IL.F:IF::(:~E]"!E]"4T ]:F' TI'"!E
RE~] I [:'ENCE I '.:~; REMO[:,ELEt} TO INCL. IJ[)E MC)RE 'T'HF'IN 4
Russell Oyster
894-2774
O & E ENG.NEERING & DEVELO')r-,AENT CO.
Box 90, Davie St., Eagle River, Alaska 99577
894-2774 or 688-2280
SOIL LOG
Earl Ellis
688-2280
Performedfor. Name: %t" A/ t —Tel. No
'S e=,Q/ /.• /iii ✓ea />. /!re• �% 1...%l
Mailing Add: -
Legal Description: /^7' /X7lV/'// I4 A" Ili 5eje'o.
Depth (feat) Soil Characteristics
1 5 /�-'idl e /<7 r C r1i/dEc cy F
3 — --
4
5
6
7-
8 Gta./se c'Lr.'Nn/
9
10
uu,,culy.//ev.7o„� sc. /xi
SgRiw, /r/6`A. SCF/S/))�-EiOT/"u�l 'f-6cI�
13_
14 _
15
16_
Ground Water Encountered: Yea No—,—/” If yes, what depth_
Proposed Installation: Seepage Pit_ . Drain Field
Comments:
Performed by
PLOT PLAN
//0 5cgcr-
PERC.TEST
Date,
O & E EN6~-~NEERING & DEVELO;-MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Performed for:
SOIL LOG
Name: .~ ~:~ ¢,/l';:
Mailing Address: /':';'-
Legal Description: Z,<~ 7" ,!,~ , ./--/ /-t,,¢/ i-~'
Earl Ellis
688-2280
Depth (feet)
0
1__
2__
3
4__
5__
6__
7__
8
9__
10__
11
Soil Characteristics
.....
13__
14__
15__
16__
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
No )×/ If yes, what depth.
Drain Field
PLOT PLAN
PERC. TEST
Comments:
.,~t ~., ~.
Date: '/ '" '
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE- Started
PERMIT NUMBER
co. OC'J" 5 9.79
SULLIVAN WATER WELL .(
P. OoBOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759
Ended
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAw DOWN FT.
GALS. PER HR " : ':
KIND OF CASING '
KIND OF FORMATION:
From Ft. to_ Ft.
From Ft. to Ft.
From Ft. to_ Ft.
From__Ft. to Fl
From Ft. to Ft._
From Ft. to .Ft.
From Ft. to Ft.
From Ft. to_ Ft.
From. _Ft. to Ft.
From Ft. to. Ft.
From_- Ft. to.__.Ft.
From_- Ft. to. Ft.
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft.
From_ Ft. to Ft.
From ' Ft. to Ft
From Ft. to Ft.
From__Ft. to Ft.
From Ft. to ' Ft.
From__Ft. to_.' Ft.
From--Ft. to--FL
From Ft. to__Ft.
From Ft. to__Ft.
From Ft. to_ Ft.
From Ft. to_ Ft.
From Ft. to Ft.
From Ft. to__Ft
From Ft. to Ft.
From Ft. to Ft._
From Ft. to__.Ft,
From Ft. to. Ft.
From Ft. to Ft.
From Ft. to .Ft.
MISCL. INFORMATION:
DRILLER'S NAME
PERH I '!" i't 'L'
DEF'FIRTMIEi",IT OF HEFtL. TH l::ll'.,ll:::, EM',,,' 1: F? 2 HI"IE,N'I'IaL. I::'ROTEE:T I 01'.,I
.- ~.z .... L." '::!:TI';.':EET., I::lf'l '" HORFIGE:., Fll::::.
:F' E 4- d. 7 2 E~
t} FI',,,'E [:, E !::1 N '.:.:.;
MI 5 EFIGLE F..:I',,,'ER
L:l.;;:2 HFIMMflNN :E;,.."[:,
[:'.~ Ei~']X '3~F3.7:.-': EI"]G!...E R:[',,,'ER
I C T S:[ ZE
Ft I N ]: MUH [:' 1:5'I:'f:Ii',IC:E BETHEEN I::1 HELL FIN[:' F:IN'T' ON-S I TE '.:~;f. ii:HFIGE [:' I ~,PCESFII.~.
1EtEI FEET FOR F't PRZ',,,'FITE HELL..; OR
:t~.SEl TO 2C~C:l FEET FROM Fl F:'LI[:]LIC I.,.IEI...L. [:,EI::'EI",tD:[NG UF'ON THF T'T'PE Ol::' F:'U[i!:L]:C HELL..
WELL I...OG'.5 FtF.".E RELZ.!LI!F.'%[:' FIN[:, MIJ:'ST 8E I:~'.ETUI:;?.NE[) TO THE DEI:::'RRTHENT 14ITI'"IZI",I
OF THE !.4ELI.... COP1PL. ETION.
O]"HER REL::.!LI l' REMEI",FI:".'5 Mla'.r' I:tF't:::'L'.r'. ~I::'EC: I F I CFIT IONS FIND C:ON~.:;TF4:LICT.T. ON [:, Z FIGF:F!MS FIRE
F:I',,,'R Z L. FIBLE ]"0 :[ f'.,I::_.:IJF:tE PROF'ER Z N:~.Tf'FIL. LFIT !' ON.
F" tEE ~:41:E,11
I CERT:[F"r' THFtT
:I.: Z FIH I::'FIM]:LIFIR ,WITH THE REQUIREHENTF-5 FOR
l::'Ol"::'.]"H BY' THE: MUN :[ C::[ F'FIL I '1"'¢ (:il::' FINCHORF:IGE.
~: I k!ZLL Iiq:"~]"FILL 'THE :!:?¢STIF:.H II",l F:ICC:ORI}FINCE HI'TH 'T'I:"IE:: CODES;.
' DATE RECEIVED
TIME TiME TIME
DATE DATE DATE
,NSPECT?,,R ,NSPECTOR ,NSPECTOR
DEPT. OF IL-ALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENT,~L
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ' '
825 LStreet-Anchorage, Alaska99B01 F~8 4 1980
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RECEIVED
REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
PI RE~TION~: Complete all parts on page 1. Incomplete requests will not be pro~essed. Please allow ten (10) days for pro~essing.
1. pROPE~OWNER
MAI LING A~RESS
PROPERTY R~SlOENT (If different fromabo I PHON~
2, BUYER PHONE
MAIhlNG ADDRESS
3. LENDI~INS~ITUTION ] PHONE
MAIUING ADDRESS
4. REALTOR/AGENT ) [ PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
(~]-"'~-I-NG L E FAMILY
[] MULTIPLE FAMILY
NUMBER OF,B EDRO~OM~,~
[] One ~ Four
[] Two [] .Five
[] Three [] Six
[] Other
7. WATER SUPPLY
[~'i'N DI VI DUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
*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.)
8. SEWAGE DISPOSAL SYSTEM
~NDIVIDUAL/ON-SITE~
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) ,,~ '~
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
E~ SINGLE FAMILY [~] ONE [~ THREE [~ FIVE E~] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
E~ PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
Size: I~.,%-D If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER~
TOTAL ABSORPTIQN AREA MATERIAL
4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line [ Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
E];~APPROV E D FOR ,'~ BEDROOMS
[~ CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)