HomeMy WebLinkAboutCONIFER HEIGHTS BLK 2 LT 55'0'
PARc.
L.
015-
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
NAME
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
1PHONE ~1 [~1~1 EW
MAI LING ADDR~
LEGAL DESCRIPTION
Manufacturer ~ l O Mate! l
Liq. capacity in gallons IF HOMEMADE: I Inside length ~ Widg ~
DISTANCE TO: Well I Dwelling
DISTANCE TO: Foundation Nearest lot line
nes I~e ~ Total length of lines~o(~ Trench width
Top of tile to finish grade ~ t Material beneath tile ~
Length Width Depth
INO. OF BEDROOMS/~
PERMIT NO......~ ff 0 5 ~ ~1~
No. of compa<~.~ents
Liquid depth
PERMIT NO.
PERMIT NO.
Dista n ce bet we~.)l iT~
Total effective abs~tion area
PERMIT NO.
Type of cri
TO:
DISTANCE TO:
Crib diameter Crib depth effective abs~
foundation
Building foundation
Driller Distance to lot line
Sewer line Septic tank
PERMIT .o. 790
Absorption area(s)
OTHER
PIPE MATER IA, J..S
SOl L TEST RATING J
I NST~
REM~,RKS
72-01 ~' (Re~/..~/78) ~
DATE LEGAL
F:'t!i!~RM I 'T' NO.
I:::tF:'F::'L. :t: CI:::Ii'.,H" .]'FtP'IEi:S
L.O(:::I:::i'T' ;[ []b,t SI...I[:~iF:tF.: [3 :[
L.F.:!:[:!it:::IL L.,5 F.i!:;~]l C[]N I F::EF;;: I'"I"t"S
'THE I....EI'.,IGTH 1)I HE':N:!!!; I ON I E; THE!: L.f!!!]'.JGTH ,:: :t: N F'tiii:E3" ;', OF::' THE:: TI:;i:EI",ICH OF;ii I:::,RI:::I :[ I'.,1!::';1: EL..I:::,.
'T'HliE E:,Iii~.t:::"T'H OF::' t::1 TR'.E:I'.,ICH OF;?. F::':l:"r' IS THE [':,ISTF::II'.,ICE E~E:'T'I.,.tEEi'.,t THE SL.tF;iIF:'FICE
GF;?.OI_II'.,IE:, FIND TI...IIE E:O'T"T'OH OF 'T'Hl~ii: E",:.:',CFI',,,'F~.TIOI'.,1 ,:: :1:i'.,I F::'I!EET::,.
"I"I...II~.:.':I:;i:E: IS NO SI!ET t.,.IID'T'H F'OF;i: TF~:E]'.,ICHES.
THE: GF;i:I::I',/'EL. I)E::F'TFI .rE; THE I',1:[i'-,1:1:1','t1..11','1 [:,EF:'TH OF:: [:iiFi:f::t'v'lii!:L... E:I!!!3"I.,.It~i~E]'-,I "FHI!!i: (:)t...ITF::'!::iL.I .... F'Ii:::'E:
FIN[::, THE t?,OT'T'OH OF THE: E',:.:iCF:f,/F:fT' I Ot'.,t ,.: I I'.,I F'EI~...:'T' .':,.
F::'EI.:?.H I 'T' I:::IF'F'L.. :[ CF:II'.,IT FIFIE; 'T'Hl!ii: RESF::'OI",IS I E: ]i L. :[ 'T'h" 'T'O I NF::'OF?.H 'T'H ! ~':; [:,EF'FIF~:TME:NT !:::,I...IF;i: 1' I",IG THE:
I I",I:!ii;TI:::tL..I_FIT :[ 01",t t I'.,I:iE;F'ED:3T I Oh,tS OF 1::It'.,!¥ t.,.IELL. S I::t[)J'F:IC['.:.:I'.,I"I .... Fi) '1"1-..1I S F::'F;?.OF'E]:;i:'T".r' I:;:11'.,11:::, "f'l...ll~:
F,itJHE:F.!~F;?. OF:' F;itE:i!i;I[:,I~.3'.,ICE:.S TI.'.IF~T THE: L,.!E]..~L.. I,.I]:L.L SEF.'?v'E.
I'd I N t I'"ILIH [:, I ::!:TT'I:::INC':E BETI.,.IEE:I'.,I FI WEL. L. f:tt'.,t[:, Fll",l"r' Ol",l-"':'ii; 7[ T'IiE '.'.=.'; E: I.,.i F:t [3 E: E:,
:1. O0 F'E:E:T F::'OI:;i: I=t !::'F?.I',,,'FITE: I.,.IE':L.I....~ 017.
:1.50 "l"(::i ;:700 I:::'E:E3" FI'~'.OH FI F='UE:LiC I.,.IF.:i:LL. E:,E:r.::'EN[::,:[N[.:J 1...IF::'OI'.,I "r'l.-~: 'T".r'F:'li!i: OF::' l::'l...l[iilL... :[ [.':: I.,.!I!EL.! .....
I.,.IE]...L.t....OGS I::II:;i:E.: RE:[;:!U:[F:d!!!:[::, F:tt'.,II3, I',II...IE;'T' E',I}.:.': F~tE3"UF~t!',,!E[::, 'TO THE: E:,EF::'F:IF?."H','IENT I.,.!.:t:"r'!...l:[l'.,I :7!1:o C, !:::! '.r".!!!;
OF' THE: I,.tEI....I .... COHF::'L.E:"r'I' ON.
i:::l"l"l...lt!i~f;i: F;i:E(i:!Lt :[ F~:E:HI!.:.':I'.,ITE; f'lFl"r' FIF:'F'L h.'. E;.r'::'liii:C :[ F:' ]: CF:IT' ~ OI',IL:~ FIND COI'-,IE;TF~'.UC"F :t.'
t'::1',,/1:::t :1: LI::IE:L.E: "r'o I NFj;I...fI:(iE-: PF~tOi:::'E:R I I'.,tE;TFIL. I....Ff'F I ON.
I C I.:~: F::.:'T' I I:::'"r' 'T' I'"1 FI T
:1.: ]: I:::t1'"1 FI:::IH:[L.~II::IF.': I.,.IITH THE F.':Iii[C.:!LIiFi:EHEt'-,ITS FOF;?. OI",t-SITF.::: '.:.:.';EI.,.IF.!!:F~:::!i!; FIN[::, I.,.IE]....!....S FIE; E;L".:i3"
FOF;?.'T'H IE','.r' THE!: I"IlJN
;~;i:: :1:I.,.1 ~ LL. I I",I'.i.:.';TI:::IL..L. THE: S'.r'STEr,'I :t: 1'.,1 FICCOF?.DFtNCE I.,.t :[ '1"I...1 THE; CO[:,E.2i!!;.
ii:: I Ut'.,I[::,E:F;~:E;TI:::II'.,t[::, 'T'HFtT THE: ON.....SITE E;Et.,.IER '.E;'-r'E;TEH l'"lFl'.r' F,::IE[:':!U:[F~'.E: EI'-,IL..I:::IF;i:I:::'iE:HE]'.,I'T' IF:' "r'HliE
RES ]: [:,!i!!:NCE: I:5 F~:'.E]','I[]L'::,fi.::]..Ji~:D TO I I'.,IC:L..LI[:,E: I','IOF?E THf::II'.,I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION
Pouch 6.650, Anchorage, Alaska 99602 276-2221J
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
'~" 4
5
8
10
12
~4
17
20
DATE PERFORMED:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
I~u/7'~ ~'~ ~..A~/~,..~'DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
(minutes/inch)
FT
COMMENTS
72-008 (7/76)
m'm'm
DA'fE'R EC~(~IVED
INSPECTION APPOINTMENTS (;~:~L~ ~
TIM~ TIME TIME
DATE DATE DATE
INSPECTOR
INSPECTOR
INSPECTOR
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT, IO.N
825 L Street- Anchorage, Alaska 99501 ~I UI~J 9 1980
ENVIRONMENTALSANITATIONDIVISlO.I~ECEJVED
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
MAI LING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
'2. BUYER PHONE
MAILIN~ ADDRESS ~
3. LENDING INSTITUTION PHONE
MAI LING ADDRESS
4. REALTOR/AGENT PHONE
MAI LING ADDRESS
STREET LOCATION
6. TYPE 01= RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
[] Three [] Six
[] Other
7. WATER 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.)
8. SEWAGE DI~SPOSAL SYSTEM
[~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
~EAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
I--]Septic Tank or [] Holding Tank
Size: /~)~(~ If Tank is homemade
give dimensions:
[] ONE
[] TWO
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
NUMBER OF BEDROOMS
[] THREE [] FIVE
[] FOUR [] SIX
DATE INSTALLED
INSTALLER
SOl LS RATING
[] OTHER
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
MANUFACTURER ~
IAbsorptionSept c/Holding Tank Area
lSewer Line
INearest Lot Line
5. COMMENTS
[~~APPRov ED FOR .'~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
72-010 (Rev. 6/79)