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HomeMy WebLinkAboutO'MALLEY HEIGHTS LT 2 [~RADE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMEN]-Ai. PROTECTION ENVIRONMENTAI~ ENGINEERING DIVISION 825 l. Street - Anchorage, Alaska 99501 Tolm~hone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELl_ INSPECTION REPC)RT NAME "'~ PHONE i [~ NEW MAILING S LEGAL DESCRIPTION LOCATION ~// NO, OF BEDROOMS h~}~L~-~/'~ ~' Well ¢ Absorpt,on ;ca Dwetl,ng ~ PERMIT DISTANCE TO: ~ <" ~ ' ~ ~ ~ Manufacturer ~, ~ ~.~ ~atelial f No, of compartments ~' I Liq. ?,pocity in gallons I ........ ~ ~ Inside length I Width Liquid deptb ~ ~ m Nom~e~l Length of e~cll line~¢ ~¢~ ~otal length of lines Trench width [ Distance between Ihles < P I Top of the to finish grade - Material beneath tile ] Fotal effective absorption area ~ Length Widtb Deptb PERMIT NO. / ~ ~ I Type of crib Crib diameter Crib depth Total (~e~We absorption area ~ / Well Building foundation Nearest lot line - ~ DISTANCE TO~ ................ ~ss ~ Depth Driller Distance to lot line PERMIT NO. ~ ' ¢ N E T~ $~dd~n~ fou~]dat,o,~ Sewer hne- " ,-- 'S01;tic ta,~; .... ~-- A%sorption~rea(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER APPROVED DATE LEGAL M. UNICIPALITY OF ANCHORAGE . Department : Health and Environmenta: ,rotectlon . * * * HANDWRITTEN PERMIT * * * Permit ~ ~Q~Q~ . WEb.AND/OR ON-SITE SEWER PERMI~ Applicant: C, ~/' ~- ~C~(_<' ~ f) Mailing Address: Location: ,/ Phone Nu~er: / Type of Soil ~sorption ~stem Is: ' Trench: ~// Drainfield: Seepage Bed: Holding Tank: Maximum N~ber of Bedrooms: ~ Soil Rating(sq ft/br) _~. · DEPTH The Required Size of the Soil Absorptio~Q System Is: .LENGTH ~('~:'; CTS.'-_ GRAVEl_ DEPTH //: WIDTH Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 Q 2 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I under~tand that t~e on-site sewer system may require enlargement if the r~idence is r~modeled to include more that 3 bed/~ooms.. · S Date. /// ,/c ..... . The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = ~(<4_.C%~GALLONS * * 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. * * * TWO(2) INSPECTIONS ARE REQUIRED * ~ ~ Backfilling of any system without final inspection and approval by this department will be subject to prosecution. GR~&TER ANCHORAGE AREA BOROLI":H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAl_. SYSTEM SEPTIC TANK: MAltING LEGAL DESCRIP]ION..~. DISTANCE FROM WELL ,~=~2 ( ~ LI©UID CAPACITY__//O '~' C~ GALLONS. NUMBER OF M A Z E R I A L __ dC~?_z:f~./f/. _z~-:."~z'~--./~T/~'-:~ COMPARTMENTS Z/' LIQUID INSIDE LENGTH """~- INSIDE WIDTH ~ DEPTH SEE--PAGE SYSTEM: NUMBER OF PITS___ LINING MATERIAL NEAREST LOI LINE SEEPAGE PIT: OUTSIDE DIAMETER .... OR WIDTH /'~' ., LENGTH /'~ , DEPTH ~r~C:~'~- DISTANCE FROM WELL ./~? ''-~ , BUILDING FOUNDATION TOTAL EFFECIIVE ABSORPIION AREA (WALL AREA) ~) O SQ. Fr. TILE DRAIN FIELD: ~/~% TOTAL LENGTH DISTANCE FROMWE~.b-'~ ,FC~UNDAIION , NEAREST LOT LINE OF LINES__ , -..~- D'EPIH: lOP OF IILE lO FINISH GRADE DEPTH OF FILTER MAIERIAL BENEAIH TILE IN. ABOVE TILE WELL: LOT LINE /~.~'?/:~?~?~/k'"', DISTANCE FROM / WATER TYPE ~,.,~./z:..'-~-~-/.~ DEPTH J,/~ , BUILDING FOUNDATION, ./~ SAMPLE ~ , NEARESI ~) ,' /~ NEAREST /EPTIC ~ /~ SEEPAGE .~.~ OTHER , SEWER tINE .TANK , SYSTEM ~d) , CESSPOOl ~/ , SOURCES~ DISTANCES: DIAGRAM OF SYSTEM 4, 3 R ~t~',: ~:.- .'LI ¢IZ GAAB-HD-2 GREATE]r' 327 Eagle St. ANCHORAGE .AREA HEALTH DEPARTMENT Anchorage, Alaska 99501 SEWAGE DISPOSAL SYSTEM .- APPLICATION & PERMIT NAME OF APPLICANT d2~(Z-~5 ~'~ C~'L'~"U'g-TvlAILING ADDtqESS~_X/72~ :~ PHONE NO.__~ ~TEST RESULTS THIS IS TO SERVE A ~ ' ~"~'/ ,PERMIT'O 'NSTAkLA AS o~SCa~aas s~kOw, s~za .Sa,nCTANKS~Za~ ' ;EEPAGE ARE, DIAGRAM OF ~T I"- M I certify that I am familiar with the requirements of Greater Ancho~.e Area Borough Ordinan/06 No. 28-68 and that above described ?stemTin accordance with said c°de. LA/o,7 :~///)~/:/;4']~¢/~ DATE /~~'7' A p p I. I CA N T S S I G N A T U R ~~~)///,~_. ~A-~2 ,/~ ' _~?._~2.---''/ GREATER ANCHORAGE AF, EA BOROUGH HEALTH DEPA}':T;'IEN T 327 EAGLE STREET ANCHORAGE, ALASKA §9501 CASE p-,-,~o~d For /1-/.. (.,../.~< Date Performed ? ') >~,~.. /~-~ ~ ~ Desc~'i~on ~ Lot ~ Block/ ~uoa~v~.s~on (j ~//~. /~1.. ~ l)epth Feet Soil Characteristics ~e/.,/. Was Ground Water Encountered?/_~~ If: Yes~ At What Depth Date Location Sketch Reading Gross Time Net Time Net Drop Pmoposed Install~o~'~: Seepage Pit ...... a~' Depth Of Inlet ~_'<-, Depth To Bottom Of Pit Or COMMENTS' ' -- . · ; ' Test Performed B5,:~%~ Data Certified