Loading...
HomeMy WebLinkAboutFAIRMOUNT LT 17 Pump ln,staIlation Log Date o~ Zs~ue: __ ~/~/~ ' ides~ ~idap~r Buz~ Dep~: [~ feet  ENVIRONMEN'rAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT IPHONE E~] NEW ' ~ UPGRADE MAILING ADDRESS ZlZZ F LEGAL DESCRIPTION oT' 17 FA/A. z .a/ T _ LOCATION NO. OF BEDROOMS Well Absorpti~ ~rea Dwelling / PERMIT NO. DISTANCE TO: ~ ~ Manufacturer ~ ~ Material~ f ~ ~ ~ No. of compartments2 Liq. capacity in gallons Inside length Width Liquid depth ~ ~. ~ IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO, ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT N~ ~ ~ DISTANCE TO: ~ ~--~ ~ No. of li~s Length~oof each, line Total length pf~ ~ - lines Tren~h~width inches Distance between lines ~ ~ ~op of tile to finish grade Material beneath tile I ~ Total effective absorption area Length Width ~Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line m DISTANCE TO: Dlass Depth Driller Distance to lot lina PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING I~STALLfiB REMARKS APPROVED ~ g. DATE LEGAL'it- ¢'l. '.,"') 1978' DEFEI~/~ 72-013 (Rev. 3/78) PERMIT NO. AF:'F'LICRNT ~ LOC:ATION RABBIT C~:~i RI:, LEGAl_ LOT 17 FAIRMONT S/D TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH DEPARTMENT L ,,.:RLTH RND EN',/~RONMENTRL .. _~. L STREET., R~E:HORRGE,, AK. 99501 264-4720 ( 78048~ ) SAR BOM 472F .S':44- 4643: LOT SIZE 4-_<56E~ SQUFIRE FEE.[' MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING '.'.'SQ FT?BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [::, Er.~ F' T FI = 6. 5 L EI'~.IIST H= 3':.8 I3 F-.' R"-..' E L E:'E F'-r H== ]''HE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR [:,RRINFIE. LD. THE DEPTH OK A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND 8ND THE BOTTOm'1 OF THE EXCAVATION (IN FEET). .['HERE IS NO SET HI[:,TH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETHEEN '['HE OUTFFIL. L PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURINI3 THE INSTALLATION INSPEZTIONS OF ANY HELLS FtDJRCENT TO THIS PROPERTY F~ND THE NUMBER OF RESIDENCES THAT ].'HE WELL WILL SERVE. .......... TI~C~ (:2) I ~SPECTIO~~;-, RF~E REG;!I_II ~E~ BACKFILLING OF 8NY SYSTEM HITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEHAGE DISPOSAL SYSTEM IS ±00 FEET FOR A PRIVATE WELD OR i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC HELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT 1: I AM FAMILIAR HITH THE REQUIREMENTS FOR ON-SITE SEHERS AND HEL. LS RS SE:]" FORTH BY THE r4UNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I L~NDERSTAND THAT .T~--SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE ~ I C:At~ R~DB MC~ EWEN I ..... ,:'Cl,.lEi" ~ B'~'-~ D8TE .................. 'v'.::.,"'" '2 LOG IVlt~NICIPALITY OF ANCttORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 9950:2 276-2221 SOILS LOG - PERCOLATION TEST i'iLI~(]OLATION 'TEST LEGAL DESCRIPTION:__ [)ATE PER FOtlMED: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUN1 IRED? IF YES, AT WHAT DEPTH? SLOPE SITE PLATY lib C:: S /~( ) L P I'C,5-' [ Gross Re;~ding Date Time I'[ ~C()LA'T ON HAT[] .................... Iminules/il~chl rEST RUN BEIWf:EN FT AND __ Fl' A£ASI~A []~LOP~IBtT COnSULTAnTS ~IDO~OLD S[WARD H I~HWAY A 5 - ZFZ//L 7- F.B. _ ?. / I::IF'F'L I CI::INT L 0 C AT I ON LEEiFIL ~ ~:Z:: ][ !1:' ... :][ -'r "T" [:,EPARTt,IENT 0~. rIEFILTH FIN[.:, ENYIRONf'IE:NTFIL P~.U~:C"I'ION 82.5 '"L.'" STREET., I--~I'.~C:I-IORFIGE., AK. 264-4?20 I.,.I ES_' L.b. F:' E ~-'-" I'"'t T 'T" 7806:~ E.'; ::' ROE:E F;.'T ['ICEPJEN RRBB I T CF.$:: L±7 FFI I F.'.IIOUNT .:, .' [ SRR E:.qX 4 ,' ,~:F L. OT SIZE 0 S~;:¢JARE FEET MINII'"IUM DISTANCE BETWEEN A WELl_ AND RNY ON--SITE SEWAGE DISPOSAL SYSTEf,1 IS t00 FEE"r FOR A F'RI',/'FITE WELL.~ OR: ..t50 TO 2El0 FE:ET FROH f.i PUBLIC WELL DEPENDING UPON THE TYF'E OF PUBLIC P.IELL.. NELL LOGS ARE RE(..'~UIRED AN[:, f,IUST BE RETURNED TO THE DEF'FIRTf,IEN'r NITHIN 3:0 [:,fi. PS OF THE WELL. COf,IPLETION OTHER. F.'.Ef:4UIREf,IENTS 1,1F4Y APPLY. SPECIFICATIONS AN[.', C'ONSTRUCTION [:,IRGRAHS RRE AVRILRBLE TO INSURE PROPER INSTALLATION. Y:" EE I:;.:: I1 I l'" E :=":.'. F:' :[ Fi.-: [E ~-3; C:-~ EZ mz::: EL f"l E: E: Fi: 72(: :1 .... :L. :-3, ';P' ;.S~: I ..E.F..I Il:' ¥ 'T'HF:IT F,E~._. RE.i"IENI.~ - JN'-z, ITE SEWERS AND WELLS I:IS SET /[.: I I::lf"l FFIf'IIL]:AR WITH THE ~ I'' .... '- FqR I- '- ' FOR:TH E'Y THE fl.INI_.IFHLIT¥ OF RNCHORRGE. 2: I I~'~ I~:[:,RNr'_:E WITH THE CO[:,ES. "~ INSPECTION APPOINTMENTS ~rlME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR IHUNICIPALITy OF ANC MUNICIPALITY OF ANCHORAGE DEP~ OF H~ HORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONEJ~IRO ' . ,,~ALTH & 825 L Street - Anchorage, Alaska 99501 NlvlENTAL P?'©TECTION ENVIRONMENTAL SANITATION DIVISION JUL 8 1980 Telephone 264-4720 D c,-.,..._ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1 PROPERTY OWNER I PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from~ above) PHONE 2. BUYER PHONE MAILING ADDRESS 3, 'LENDING INBTITUTION PHONE 'MAILING ADDRESS 4, REALTOR/AGENT I PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION ,~,4~-¢' ,~/1/ ~'~r ,'~'~"~K 12(,~4-b~ ~//~/ ~,~,~' ¢~/Z~F~ ~o~ (~,~ ~r~ ~=r o~' ~v/~'~ ~/ ~,r cl. 6. TYPE OF RESIDENCE NUMBER OF~BEDR~3~MS [~ [] One ~[] Four [] Other SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATE~R ~UPPLY ~] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * 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 ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS' [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL ' DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: ~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank [Absorption Area [Sewer Line I Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~ APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONL DATE RECEIVED~' . ' - ~_, INSPECTION APPOINTMENTS TIME ' Tli~IE ...... TIME ' ' DATE DATE DATE ' "' NSPECTO'R INSPECTOR INSPECTOR ' DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS , INGLE FAMILY [] ONE HREE [] FIVE [] QTHER [] MULTIPLE FAMILY [] TWO D~ FOUR [] SIX 2. WAT~R SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY · DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED []PUBLIC UTILITY 2" Connection Verified , INSTALLER [~'~eeptic Tank or [] Holding Tank Size:/~-~_ If Tank is homemade SOILSRATIN~' give dimensions:~3 4. DISTANCES Septic/Holding Tank A I war I Nearest Lot Line WELL TO: I I Absorption Area to nearest Lot Line APPROVED FOR~ BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATED~CR-~P"I'IO~I;''- BYe.. 72-010 (Rev. 3/78) JAY S. HAllf~O~D. EOVER~OFI DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCE~TRAL RE610#AL OFFICE ~ 33~ DEIIALI STREET I~IegfOIY BIIII~I#E, ROOM AIICIlORAEE ~I July 27, 1978 Robert B. McEwen SRA Box 472F ADchorage, AK 99507 Subject: Lot 17 Fairmount Subdivision Dear Mr. McEwen: We have considered your request to use your former domestic water supply well for irrigation purposes. We feel there is little chance for contamination of a water system (18 AAC 80. 020[c]) and consequently, the use of the well for irrigation is approved by this department. Sincerely, James O. Starr Environmental Engineer cc: DHEP GML