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Home My WebLink AboutSHEETS LT 6`UNICIPALITY OF ANCHORAGE Heal and Environmental Protec. )n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 _ INSPECTION REPORT ON-SITE SEWAGE DIIySiU'COS�," L SYSTEPA MAILING ADDRESS �-'�J ! """' 4C- PHONE�C`��' LOCATION ,`1`��'`� ��" LEGAL DESCRIPTION SEPTIC TANK: DISTANCE PI°(-' FROM WELL_ i_()C'k MANUFACTURER MATERIAL '_S4e_ 0 NUMBER OF COMPARTMENTS- INSIDE OMPARTMENTS INSIDE LENGTH--- — INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 5�GALLONS. TILE DRAIN EIELD7_\Z �' pcwp TOTAL LENGTH'/ / DISTANCE FROM WELL 1Oo*_FOUNDATION_ NEAREST LOP LINE--�v OF LINE 6 # of Lines ___� DISTANCE BETWEEN LINES —TRENCH WIDTHI2 L IN. TOTAL EFFECTIVE ABSORPTION AREA—__� SQ. FT. LENGTH OF EACH LINE � F - DEPTH OF FILTER 4 � DEPTH: TOP OF TILE TO FINISH GRADE 3'� MATERIAL BENEATH TILE –4.IN. ABOVE TILE — IN, SEEPAGE PIT: DVAMETER OR WIDTH., LENGrH__, DEPTH Log Crib _Rings_ Crib Size: DIAMETER_____DEPTH__DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDAT ION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. GREATER ANCNORACI_ ARLA IJORUDIm h_ Department of Inv ironmen1.al Quality 3330 "C" Street Anchorage, Alaska 99'.,0;; SOILS LOG - PEROI,ATION TEST Performed for F'RI1JG E_i� KXC,�V 4ilA� - L;;Ite Performed Legal Description:__��-.�2`f--I�-------__�L�T=.__u5D1V_ Sko_11_------_----- - -- This form reports: Soils log �t� —--- Percolation test. Depth r� P (Z X Feet: ®mZ,� Top Be>i 2 3 - GW 855- 6- 7- m 8 9- i0 - $� .� 16; G M 22.5 11 - S/01)6, Was ground water encountered? _ A� _ If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Kercolation rate minute. Proposed installati r Seepage it Drain Field _ Depth of Inlet Depthtobottom of pit or trenci _ _T --. COf4P4EP1TS : Sof S __ � ]RC.0 lc _ _ 1 d ,b� ulsu-alyt,-- - - - -- -- — - Performed [3y: - TA.-- ----Certified 6y: - -_-- gate 15 -37 -EQ -040 (6/74) 0 ,) . � d6' (qc�6) 171 h � C-cj 5. LEGAL DESCRIPTION , DATE RECEIVED STREET LOCATION INSPECTION APPOINTMENTS 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS TIME ❑ One ❑ Four ❑ Other TIME - TIME LJ MULTIPLE FAMILY DATE 7. WATER SUPPLY DATE DATE * ATTACH WELL LOG. A well log is required for all wells drilled INSPECTOR since June 1975. For wells drilled prior to that date, give well INSPECTOR INSPECTOR - B. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** L 1 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF ANCHORAGE r rl DEPARTMENT OF HEALTH 81 ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720a - REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete uests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER . PHONE I Z� - s MAILING ADDRESS PROPERTY RESIDENT ( differen from above) el PHONE 2. BUYER PHONE MAI LING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION , G� STREET LOCATION - 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other ❑ NGLE FAMILY ❑ Two Elive LJ MULTIPLE FAMILY ❑ Three 0 Six 7. WATER SUPPLY ONDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled OMMUNITY since June 1975. For wells drilled prior to that date, give well Ln PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** L 1 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) /`XPi(,(/ av, 72-010 ( Rev. 6/79) � d'e�!wp/ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY Er MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED - - 3. SSE AGE DISPOSAL SYSTEM L INDIVIDUAL/ON -SITE7� ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER S DATE INSTALLED / 9r �% /77 INSTALLER E19eptic Tank or ❑ Holding Tank Size: /6-00 If Tank is homemade give dimensions: SOILS RATING �5 TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption. Area to nearest Lot Line - 5. COMMENTS n APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE % BY / U /`XPi(,(/ av, 72-010 ( Rev. 6/79) � d'e�!wp/