HomeMy WebLinkAboutASPEN HIGHLANDS #3 BLK 3 LT 2
MUNICIPALITY OF ANCHORAGE
13EPARTMENT 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
NAM.~ ~ IPHONE [~I~EW
LEGAL DESCRIPTION ~
LOCATION . . r ,~ ' NO. OF BEDROOMS
I
DISTANCE TO: ~ ~ ~ ~ 3 5 ~
"~ ~ r~ o~partments
Liq~a~allons IF HOME,DE: ~~gth Widt~ Liquid depth
~ ~ Manuf~tu~r ~~ ~~
-- ~ Liquid ca~
~ ~~ No. of lines~ Total length of lin~ ~ Trench width~ (~ inches Distance between lines
Total effecti
~ Top of tile to finish grade ~ Material beneath tile ~ inches ~orpti~narea~o
~ength Width Depth PERMIT NO.
~ ~ Crib diameter Grib depth ~foctive absorption aroa
. ~ C~ Depth Driller Distance to lot line PERM~s
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS I
REMARKS /
~ ~~ / -~ f
~ --
L
72-013 (Rev. 3~ B)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6650, Anchorage, Alaska 99B02 276-2224
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
3
5
6
7
9
10 J'~ ?~AS GROUND WATER
1 1 ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
13
14
19
20
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND ~ FT
COMMENTS
CERTIFIED
72-008(7/76)
Certified Well
For.
Location..,
Date com.pleted..:..~ ....
Depth of we',
Size of casing ...........
Distance to waterl ......... :".~,~...L'.: .................................................................................
90 '
Distance to water while' pumping.,: ........ ~.., ........... : .......... : .......................... at rate
I'-certify the above true and correct.
Driller
' R
Jo.hns .. oad
SPENA. RD~ 'ALASKA
We advise yOu to. attaCh thii' certificate to your deed.
! '~ MUNICIPALITY OF ANCHORAGE __ _~J~ ~&c
DEP~ARTMENT OF HEALTH & ENVIRONMENTAL PROTEC3'3'ON '~ ~0 ~-CTION
' 825 L Street - Anchorage, Ale.ka 99501 '
~ ENVIRONMENTAL LNG'NE;reNO D,V,S,ON SEP 2 0.1979
, = ' Telephone 264~720 ~ E C El 'V [ O
? REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
PI RECTIONS= Complete all parts on page 1. Incompl,~ reques= will not be proceed. Please allow ten (10) days for processing.
1. PROPERT~:pWNER ' - ' ~ , I PHONE
2. BUYER ~ ' ' ~ :- ~ " PHON~ ''
/
, y
3. LENDING INSTITUTION .... ~ /~ ~ ' ~ ~, ~
4. REALTOR/AGENT ' ' ' ' ' ' j P~ONE'"
MAILING ADDRESS ....
I 6. TYPE ~F RESIDENCE ' ~ NUMBER OF BEDROi~MS
[] One [] Four [] Other
[~ Two [] Five
[] Three [] Six
* 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.)
**If individual/on.site, giv~ installation date / ~ ? _~).
If system is over two (2) years old an adequacy test is required
by this Department.
iNOTE:THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78) ~ '
SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
~' INDIVI DUAL/ON-SITE**
[] PUBLIC uTiLITY
TIME
)ATE
NSPECTOR
I~IRECTIONS:
THIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
TIME
DATE
INSPECTOR
DATE RECEIVED
TIME
DATE
INSPECTOR
1. TYPE OF RESIDENCE
i--I SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] I NDIVI DUAL/ON -SITE
[] PUBLIC UTI LITY
Connection Verified
I-'-ISepti'c Ta_nl~_or [] Holding Tank
Size: 1~,~ _~3 If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
[] ONE
[] TWO
NUMBER OF BEDROOMS
[] THREE [] FIVE
[] FOUR [] SiX
[] OTHER
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
SOILS RATING
MANUFACTURER ~ ~.~_.~
MATERIAL,~[ ~
' Septic/Holdi ng Tan k. a
Sewer
Line
iNearest Lot Line
5. COMMENTS
[~'~ APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
LEGAL DESCRIPTION
72;0~10 (Rev. 3/78)
Septe~9~er 26 ~ 1979
Gary R./Dor~hhy A. Tiley
3216 Baxter Road
Anchorage, Alaska 99504
Subject: Lot 2 Block 3 Aspen H&~hlands Subdivision
Approval for your individual sewer and water facilities
can not be granted untiltthe following items have been
completed:
(1) A well log submitted to this department.
~ne water analysis report be delivered to this office
from ~em Lab, 5633 B Street, for ourereview.
The depression or pit around the well casing needs to
be filled with impervious type soils ~o that it slopes
away from the %~ell casing.
Please notify this department for a re-inspection when the
noted descrepancies have been corrected. If there are
any further questions, please contact this office at
264.~4720.
Sincerely,
Robert C. Pratt~ R.S.
Associate Specialist
RCP/iJw
First National Bank of Anchorage
Post Office Box 4-~2090 99509