HomeMy WebLinkAboutBENITO BLK 2 LT 1
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
IPHONE [ [~I~EW
LEGAL DESCRIPTION~ ~~
LOCATION NO. OF BEDROOMS
~ ~ Manufacturer ~ ~ ~ ~~~ ~ ~ Material~~ ~ No. of compartments
Liq.~in gallons IF HOMEMADE: Inside length Width Liquid depth
~ DISTANCE TO: Well Dwel,~ PERMIT NO.
~ -- ~ Manufacturer Material Liquid capacity in gallons
PERMIT NO,
Well Nearest lot lin~
~= DISTANCE TO: /07' ~~ Foundation ~ '
~~ No. of lines / Length o~a~ line Tota~l~gth of lines ~/ Trenc~dt h ' inches Distance between lines
~ Top o, t, le to finish ~rade Mat.r,al beneath tile Totat effectiv~b~, area
~ '~O ~~ /~ ~ inches
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER "'
PIPE MATERIALS ~
SOIL TEST RATING
REMARKS
.,
_
APPROV ED DATE LEGAL
72-013 (Rev. 3/78)
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O Et E GEO' ~CHNIC DEVEL PM O~ ;
~. Box 90, Davis St., Eagle Rjlli~Alaska 9957,7.~
· ~' %; .... :':'~'" 6 :~ "' ' ~
Russell ~,ter -? ~- ~'- "~ ~-' /:~ '"-:" ' '"', ":~ ~ .... ~
694-2774 SOIL LO~
Soils ~ Foundations .... '~'~
Performed for: Name: /$~-~
Matltng Address:
Legal Description: ~/~-t- t
Depth (feet)
2
Ear/Ellis
688-2280
Land Development
$otl Char~cterlst1¢;
4
5
7
8
10 ,
11
15
Ground Water Encountered: Yes No._..___ If )t~s, wha~dail~th .... .
Proposed Installation' seePage Pit
i
~ :~:
. . ,, ~..:.,~
A & L DRILLING COMPANY
BOX 9?,£AGLE RIVER, ALASKA 995?? · TELEPHOIME694-2588
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION /_ t /5</( i~,
DaTE-Started '~-/f // 7 ~' Ended
PERMIT NUMBER ? ~;' c~ //...~
!
DEPTH OF WELL /
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR / ~''-~ o
KIND OF CASING
KIND OF FORMATION:
From ~') Ft. to ~ Ft.
From d2 Ft. to <~ Ft.
From "i~ Ft. to ,Y~ Ft.
From ~],~ Ft. to--Ft.
From ~:'C* Ft. to Jg ~ Ft.
From [~)~ Ft. to. ]d~ Ft.
From___Ft. to__Ft.
From__Ft. to__Ft.
From Ft. to Ft.
From__Ft. to Ft.
From Ft. to__Ft.
From Ft. to__Ft.
From Ft. to___Ft
From__Ft. to Ft
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft
From Ft. to~ Ft.
From~Ft. to_~Ft
~<~rom~Ft. to~ Ft.
From~Ft. to~Ft
From Ft. to Ft.
From~Ft. to__Ft.
From~Ft. to Ft.
From~Ft. to Ft.
From~Ft. to Ft.
From~Ft. to Ft.
From~Ft. to~Ft
From Ft. to Ft
From Ft. to Ft
From Ft. to Ft
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft
MISCL. INFORMATION:
DRILLER'S NAME .. i.., : ~ . '~:'
F:'EI:;?.M ! T' I",lll],
[:,EF'FIF..:TME:NT C. HEFIL]"H I::IN[:, ENV I ROI'.,tHENTF.:IL ]TECT I Of.it
Fi~;2:5 "L'" S"FREET., F~NCHOF~'.F:tGE, FIK. DS~50:1.
;2:6~.1 ......... ~. 7;;:.'::0
~...-li E: L.... II .... It:::::" ['!!E IF:;:-.': ~'"'11 ][ "]! ....
,:: 780±±3 ::,
F:t F' t:::' L. I C R N T
I~..OCFtT I ON
t....EGFIL.
RUSTIC HOi'dES OF FIL. F~'_z:,I<R
F O O T H I L.I_ FIVE
L:I. B;.=:'. BEN ITO :S,."E:'
F'O [-30',=: 55.~4 EF:II]iL.E RI',,,'I.:ZI:~::
I_.OT S ]: ZE
~.S5,4
t8000 SQLIFIRE FEE'I"
Fl I I",11 MI.JM D I S"f'F:INCE: E:ETI.,.IEEI",I FI P.IE:LL I:::11'.,I[:, RN"r' ON-S t TE SEI.,.IRGE D I SI:'Cdi;RL S'.,.'s"r'E}'I I S
'.1. OO F'EET FOF.". FI F:'F.'.I'v'FITE t.,.IELL.~ OR
:1..50 TO ;200 FEET F:ROM Ft PUBLTF: P.IELL. E:,EF'E:I"4DING LIF'ON THE 'I"'¢F'E O1::: PLIE:I_IC WEL. I .....
I.,.IELL L..OErZ:; FIF;.".E REQUII:;?.ED FIN[..:, MI...IS'I" BE F.'.ETLIRNE[:, TO THE [:,EF'F:If;.:THEI"4T I,.II'T'HII'-,I '2:0 E:,F:I'-r":_::;
OF:' 'T'HE WEL. L C:OMF'LETIO1'-4.
OTHER R[i=(;:!LI t REMEI",ITS MFIY FIF:'F'L."r'. SPEC Z FI CI=IT Z ON% FIN[::, CONSTF;.:UC':T I ON [:, I FIGI:;.'.FIMS i:::tF;?.E
I:'~"," I:::t I L.t:::I B L. E T O 11"4 S LI R E P R O P IF: R I I'-,1'.:.:.'; T FI L L.I::I"I" ! O 1'4.
I C: E R'T' I F"r' T H FI T
:1..: I RI"1 FFtMILII::tR WITH "I'HE REQLIIRE:MEN]"S; F'OR ON.....SITE: SE[I.,.IER.':S FIN[:, t.,.IEi....L.S F:I:.{'.:; S;ET
F'OF,?.'T'H B"r' THE Mt. IN I C: I F'FIL
2: I 1.4.'t: LL I NSTF:ILL 'T'HE S;"r'STEM :l;.')jq FICCOF.:DFINCE I.,.t I TH 'T'HE CO[:,ES.
/'
::..:, I'.,I E [:,' ......... .....................
I::tF'PL..[CFIt",IT F.'.USTIC I-iL]~E!.:.; OF:' FIL. F~':".".:KI=I
, ..... "
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LOT 1~ BL~, 3
/,3o
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
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
MAILING ADDRESS
PROPERTY R~DEN~'(If differen~ from above) / PHONE
2, BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION ~ PHONE
MAILING ADDRESS p~
4. REALTOR]AGENT / I PHONE'
] 307
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four [] Other
[] Two [] Five
~ Three [] Six
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
**If individual/on-site, give installation date f¢7c'~
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
NSPECTO R I NSP ECTO R INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. ~,~,OF RESIDENCE
I~J SINGLE FAMILY
[] MULTIPLE FAMILY
2. _~E/R SUPPLY
INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. i~NDAGE DISPOSAL SYSTEM
IVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[~eptic Tank or [] Holding Tank
Size: /~2 If Tank is homemade
give dimensions:
TYPE OJF TAN~ ~..--~
TOTAL A BSO R PTI~N~~'
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
[] ONE ~I' THREE [] FIVE
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
7 :o/'I
PERMIT NUMBER
i' ,
DATE INSTALLED I ~ 71~
INSTALLER
SOILS RATING
MANU~
MATERIAL ~/.~.~~
Septic/Holding Tank Absorption Area
[] OTHER
ISewer Line t Nearest Lot Line
5. COMMENTS
[~APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
LEGAL D/ESCR~IPTI O N'
72-010 (Rev. 3/78)