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HomeMy WebLinkAboutMOUNTAIN SHADOWS BLK 1 LT 4 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 ~ H[FiTb'-N-E - EW MAILINGADDRESS~ , LEGAL DESCRIPTION LOCATION NO. OF B~ROOMS DISTANCE TO: Wall ¢¢, 'Absorptio~,~, Dwalling (¢0t PERMIT'O.Fy ~ ~ - ,' No. of compartments ~ ~ Manufacturer Inside length Width Liquid depth Liq.¢a~aci~ n gallons , /~;~O IF HOMEMADE: __ Well Dwe ng PERMITNO, ~ ~ DISTANCE TO: O ~ ~ Manufacturer Matarial Liquid capacity in gallons ~ Well ~ DISTANCE TO: /~;/ F°undati°" ~,~ Nearest '°t line/~ / ~ ~ O No. of lines Langth of each lina Total length of lines Trench ~th Distanca betwean linas -- ~ ~ / ~{ Total affective absgrption araa ~ ~ ~ Top of tila [o finish grad~ Materia) beneath tile ~ inches Langth~dth Depti~ -'- PERMIT NO. ~ Type of crib Crib diamater Crib depth Total effactiva absorption araa ~ Wall Building foundation Naarest lot line ~ DISTANCE TO: Class Depth Driller Distance to I~t line"~ PERMIT NO. ~ Building foundation Sawer lina Septic tank Absorption araa(s) ~ DISTANCE TO: .r~ OTHER DATE LEGAL 7%01: ~v. 3/78) J:"~ F]"I ]i 'T' · tF I L.. i ..HI4 I ..OCFI'I" ): 01'.,I JEGRL. E ~:'FHg. Tf'IEN OF: HEFtLTH FIN[') EN',,,'IRor.~F1EI'.J]"FiL. PROTECTZON o ¢: ._ 2; T F;..' E E "£ ~ FtN C F IO R R G E., Fl K. 9 9 5 ~[ t ,.' :~ ::3..$bb JOHN F. L4 E::'[. f'IT. ':.'T, HF:IE:,Okl'.'~ ~.J., [~ TIJL I K LOT ._ IZE ...... - ......... '.::';(i:!IJI::]E. iE FEET rYF'E OF SE ZL HE .:,L I'~.[:, FZ. LII',t .:, ?:, fbr, I Zz,. "FREt,ICH 'TI4E LENGTH DIMENSION :iS THE LENGTFI (:IN FEET) OF' THE TRENE:H OR DRRINFIELD, THE DEPTH OF R TRENC:H OR F'~T ~S THE [)~STRNCE BETHEEN THE SLIRFRCE OF THE GROUN[:, FIN[:, 'tHE BOTTOM OF THE EXCFIVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. ~ THE GRRVEL DEPTH :IS THE M'INZMLIM DEPTH OF' GRRVEI.. BETWEEN TH[a: OU'I'FRL~. PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEE'r). 'EF:ff,IIT I~FFLJ;_.HN7 HFt2~ THE RESPONS~BZL~TY TO ZNFORr,'I THZS DL~F. RFflENF [:,LRZM3 THE NSTFLLFi"'ZEN ZNSPECTZONS OF RNY NELLS RD..YRCENT TO THZS PROPERTY RND THE IUf"IE:ER OF RESIE:,ENCES THRT THE I.,ffELt... N[L.L. SERVE. IN]:MUM [.',ZSTRNCE 8ETHEEN R HELL RND RNY ON-SZTE SEWRGE [:,I!:~;POSRL. SYSTEM :[~; Oel FEE'[' F:OI:;.: R PRI',,,'RTE NEIZ...~ OR 5El TO 288 FEET FROM R PUE;L~.C NELL DEPEN[:,ING UPON THE TYPIE OF PUE',LIC klEL. I ELL. LOGS RRE REQUIRED RNI) MUST BE RETURNE[:, TO THE DEF"RRTMENT NITI-.IIN ]:e~ [:,RYS F:' ]'HE NELL COMPLETION. THER RE(;itJIRE}'IENTS HRY RPPLY. SF'ECZFICRT]:ONS RND CONSTRUCTION [:,IRGRRM'.E; FIRE VRILF:IEq_E TO INSURE PROF'ER INS. YrRLLRTIOIq. CERTIFY 'I"FIRT : ~ RM FRM[LIRR NITFI THE REQUIREMENTS FOR ON-SITE SEWERS FIN[) HELLS F'IS SET OF:TH f~'.~.' THE MUNIC[PRL. ITY OF RNCHORRGE. : [ I,.IILL INSTRLL THE SYSTEM IN RCCOR[:,RNCE [,.IZTH THE CODES. : ~ UNE)ERSTRN[:, THRT THE ON-)TITE SEHEI:~ SYSTEM MRY REQLI'.[RE ENLRRGEMEIqT It:::' THE ES IDENCE IS REMODELEE:, TO iNCLLIDE MORE THRN ]: BEDROOMS. ...... L'""'-"--"~"--'--""'"'-'"'l:lf: PL :[~NT JOHN F. ROSS ~;SUE[:, . .......... ~. ,,,,,]. ;~: 32'.' !;A~U,}] FTRF~T CA-C,P, d A~qC}IORA~?, ,qLAF:KA 99501 Performed For Icc'o//'o,, ~c¢,'e lcc~'l? /4a ~o ~/~/F/, ~a8 (;~ou~ Rater ~naountered?,~~ If Yes, At What Depth i ...... ~.Z~ZFZZZZZ: Location Sketch Depz), Of ichor -,' , . .... j~ Drain 7ield Test Performed BV'~;). ' ' ~ © © © 0 © © © © 0 ~, -V' Ii. D~,TE RECEIVED INSPECTION APPoINTMENTS TIME TIME TIME DATE iNSPECT~ / ~~ INSPECTDR INSPECTOR z DEPT. OF I:~ALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENLqL: ;L)TECTION  DEPARTMENT oF HEALTH & ENVIRONMENTAL PROTECTION 82~ L ~treel - A~chorage, Alaska ~9~01 FEB 5/980 ENVIRONMENTAL SANITATION DIVISION ~EQUEST FOR APPROVAL OF INDIVIDUAL ~ATEfl AND SEWE~ FACILITIES DIREOTIONS: Oomple~e ~11 p~rts on p~ge 1. Incomplete requests will not be proo~sse~. Plesse ~llow ten (10) dsys for processing. 1. PROPERTY, OWNER /~ I PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYE~ ,.~... MAILING ADDRESS 3~ LENDING INSTITUTION ~ PHONE I MAI~I~Q ADD,E88 4, ~EAI.TO~/A~ENT ~ J PHONE I BAILING ADDRESS ! LEGAL DESCRIPTION J I TYP~ OF R~SlDENC~ NU~BR~ OF~BED~OO~S ~ One ~ Four ~ Other ~ SINGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six 7. WATF~R .SUPPLY ~ 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.) 0,.)¢k~e..J,' C.~ ~,.Z YEAR ON-SITE SYSTEM WAS INSTALLED. 8, SEWAGE DISPOSAL SYSTEM "~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATE[:). 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified [~]Septjc Tank or []Holding Tank Size: [ *~,"';2~' IfTank is homemad~ give dimensions: PERMIT NUMBER 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line 5, COMMENTS FOR z.~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~/~ DATE BY ~ 72-O10 (Rev. 6/79)