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HomeMy WebLinkAboutSHEETS LT 2 PETERS CRK TERR TWNHMS PH 3r • - � �' •r it THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS ECTI ECEIVED 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS L--'�APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER 2' MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX PERMIT NUMBER -. 2. WATER SUPPLY DEPTH OF WELL ❑ INDIVIDUAL (�--COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY LOG RECEIVED - Connection Verified DISPOSAL SYSTEM 3__. PERMIT NUMBER //SEWAGE IJINDIVIDUAL/ON -SITE DATE INSTALLED ❑PUBLIC UTILITY Connection Verified INSTALLER Septic Tank, or ❑ Holding Tank SOILS RATING Size: 1,!�V If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. -DISTANCES Septic/Holding Tank Absorption Area Sewer Line - Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS 72-010 (Rev. ;3118) L--'�APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE n BY (Title) LEGAL DESCRIPTION 72-010 (Rev. ;3118) QVATM,fi MUNICIPALITY OF ANCHORAGE A 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 NAME \ J \ G- _ PHONE ��" 1.r�7a NEW ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION \P0) NO. OF BE ROOMS Uy15 DISTANCE TO: rW�ell \ Oii� p Absorption area Dwelling 1 % PERMIT N0. —A1�)() 8 - P z 0.4 Manufacturer Material No. of compartments Liq. cgacity in gallons j IF HOMEMADE: Inside length Width Liquid depth \ `� jv ® y J0z DISTANCE TO: Well Dwelling PERMIT NO. O z Q 2—F Manufacturer Material Liquid capacity in gallons LU DISTANCE TO: WellFoundation t �q Nearest lot line k 71 PERMIT NO. � 7aB-A-(1 J LL Z P ? cc No. of lines , Length of each line © t3 Total length of line � Trench width t ej •— (U 0 inches Distance between lines 1v Q F 0 Top of tile to finish grade tt Material beneath tile p G C) inches Total effective absorp_iion 1..�. W Length Width Depth PERMIT NO. x N wa Type of crib Cr 'a to Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line Jlass J Kc Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER \ J PIPE MATERIALS 22 qq •J% "�i^Y_ t) r SOIL T ST RATING t> A rUV INSTALLER REMARKS a ! \ v\oUu 3. --s VT 5 a PROVED al� ( &-IF DATE LEGAL �\) x�vvi /Z -U73 tHev. 3/7251 ^ lHE R[QUIRED S/ZF OF THE SOlL H8SORPTION SYSTEM l � KV&PP" VP A—. ';!-D, �t ...y: :r 1!`11 ��= �� �F ik PERMIT HPPLICRNT HRS THE KES"Opt :IBILITY TO INFURM IFAM III LHTION INSPECTIONS OF HNY [old L& RDJHCENT TO NUMBEH OF RESII)ENCFS THRT THE WELL WlLL S£RVE THIS DEPHRTM�N'[��]RING THE T|iIS PROPERTY HND 71 E 11 POD ,, vs: A 1, &VTO I P M� C � I'1 If M 1 1 � iv WIT [V JPC Q T E � 12! 1�. , 1� 1; � �: I .::� � F� BRCKFlLLING OF MY SYSTEM NITHOUT 171 FIR! INSPEC[ION RND RPPROVHL 8Y THlS DEO8RTMENT Ida K. BE SU8JECT TO PROSECUTlOH. MIN/MUM DISTHNCE 8ETWEEN H NE\] HN|) MAY 0N~SITE SFNHGE DISPOSHL 014f 1101 IS 100 FEET FOR H PRIVHTE WELL/ OR 130 TO 200 FEET FROM R PUBL]C NB.L DEPENDING UPON THE TYPE OF PUBLTC WELL OTHER REQUIREMENTS 1, 11:1 HPP1 HN0 C0MSTK12TIUN DIHGHHMS HRE HVHILHR|E 110 IIASURE PROPFR INSTHLLHTION. 17Y V POO Pic V 1 r 7 7V V � .0 UP P ± Yv 10 V, 17 � L�� 1`;P 0 1 ��C� 1. : � I:^ �: ;, :�. �:;� I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUlREMENT; FOR 0NAITE SEN£RS HND NELSET FORTH BY THE MUNlC[PRL[TY OF HNCHORHGE 2� l WILL INSTHL| THE SYST[M IN HCCORDHNCE NlTH THE C0DE� �T 1 'lNM. THAT THE ON~5ITY SEWER SYSTEM MHY kEQUIInk ENLHRGEMENT IF THE VI2 GREATER ANCIIORAGL APLII LOROUGi, Department of LnvironmeriLaI Quality 3330 "C" Street Anchorage, Alaska 99.,1)3 — SOILS LOG PEROIATION TEST Performed for __..S.P.RI_taC,_-- I - Legal Uescri rtiun: This form reports: Soils og,t _ Percolation test Depth Feet .e.,.2 � - 2 ' M L : Z7,5 3- 4 - 14 cow: cow : S5 9- 12 - 13 - 1 4 - Was ground water encountered? S If yes, at what depth? Reading Date Gross Time Net Time Depth to Water - --- ---- ----- Percolation rate minute. Proposed installation: Seepage Pit Drain Field Depth of Inlet Depth o bottom of pit or trench COMMENTS: c_assi is __ 41 S�-S_------- - -- Sot�y l y--��s� Y - - - Cc rt i f ed By -- - - - — 5-38EQ-040 (6/74) MUNICIPALITY OF ANCHOR AUL MUNICIPALITY OF ANCHORAGE DEPT. OP I `L I" - CTION DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTECTIO IdVIRONh/ENTi:' 825 L Street - Anchorage, Alaska 99501 NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other • FE� ENVIRONMENTAL ENGINEERING DIVISION ❑ Three C+KSix Telephone 264.4720��� ��F D L I S REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE since June 1975. For wells drilled prior to that date, give well DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. P?OPERTY WNEF � **If installation date%f`�sZ3� PHONE -, _ MAILIN KESS ❑ PUBLIC UTILITY PROPERTY DENT f if rent from ab PHONE PHONE 2. BUYE �r----- . - MAILING ADDRESS - 3. LEN HVq IN TITUTIO �t ` PHONE ' MAILING ADDRESS �2Ct PHONE 4. REALTOR/AGENT MAILING ADDRESS 5. LEGAL DESCRIPTIO ' STREET LOCA p 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other ❑ SINGLE FAMILY ❑ Two ❑ Five P --'-MULTIPLE FAMILY ❑ Three C+KSix 7. WATER SUPPLY * ATTACH WELL LOG. A well log is required for all wells drilled ❑ INDIVIDUAL* ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well �f PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSALSYSTEM � **If installation date%f`�sZ3� lam- INDIVIDUAL/ON-SITE** individual/on-site, give If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. I A 72010(3/78) y '',I -A—�.