HomeMy WebLinkAboutT12N R3W SEC 33 LT 147-A
!~-%/~,~ ~[~'~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL ~ROTECTION
ik ,~,~ ~'fF- ~ll ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NA.,~[E ..... PHO~
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION ~ ¢ , NO. OF BEDROOMS
~ell , IAbsorptionarea Dwelling ~2 )) PERMITN~
DISTANCE TO: ~ ( OO '
~ p~" Manufacturer ~/~ Material. ~¢~__¢ No. o~omp~rtme.ts
t_iq. capacity in gallons Inside ~ength Width Liquid depth
~ ~ ~ DISTANCE TO~_ Well Dwelling PERMIT
~ Well Foundation Nearest I~t line PERMIT NO,
~ ~ DISTANCE TO: t ~ (¢) (:~ -~ ¢ ~ ~-/ O
~;~ No. of Hnes-- -- Lengtl, ofeacl, ~e¢ Total length of li~es Trenohwidt% Distance~w~ines
~ Top of tile to finJsh grade ~aterialbenesth tile , , Tota[effe~ti~¢narea
'. Typeof%~L ia~t'r% ~ h~- Totaleffec.~orptiona~a
~ ~ANCE TO: 'Well ~ ~uilding foundatior~ ~rest Io( line
%~ DeI~¢ %~ Driller Distance to lot l,ne PERMITNO.
~ DISTANCE TO: Buildingfoundat[on -- Sewer tine Septictan~.[ ~ Absorption area(si
OTHER
72-013 (: 3t78)
DEF'I'":IF;:"f'HEI'qT OFr HERLTH f:'ll",lD, EN',,,'IF;'.'ONHENTFII...
i~25 "L 51-R[EE'r., Ffi'..ICNE)F;'.RG[.::., F;II<. ~?..
,~: 61 q...- ,'1. 7 ;:2. C1
CII ~'-,,i ---- S:~; :E "~' lEE .?;; lEE ~.~ E~: IF~: Il:::::" EEC F: ~"'1 ]:: "-t"-
E i :~.~: _l..E:t :,,~:._ FINCI~IOF;'.FIGE
TRENCH /'
'_:';O T L. I:~:FIT ! NG
THE R['Z(~I...IIF;'.IEE:, SIZE Of: '['HE :SOil.. F:IBSE)RF'TIOI'4 SYSTEH IS:
THE LEI',IGTH £:'IHEI',ISIOI'q IS TI'IE: LEN(.:iTN (IN I::EET) OF 'T'HE TF;:ENCH OF;: DRFI]:NFIEI...[:,.
THE DEPTH OF' F;I TF;:ENC:H OF;: F'ZT IS THE [::,ISTF;INCE E~ETI.4EIEN TI'IE SI_IRFf~CE OF THE
GF;'.OI...II",ID FINE:' 1"HE BL-q'I'OFI OF::' TNE E:',"~',CF;IVFI-FZON '::ZN FEE'r':~.
THEF;:E I:E; NO SET I.,.IZE.,TH F;'OF;: 'I"F;:IEI'.tCNEE;.
THE GIRFi',,,'EI.. DEF'-FH Z:E; THE HINIHUI',I E:,EF:'TI.I OF GF;:FI',,,'EL BtETI.,.IEEN 1"HE OIJTF'FIL. L F'IF'E
FII',I[:, THI.'_:: BOTTOH OF' 'I"N[Z Ei,.,:CFI',,,'I::I-F ]: ON ( I N FEET ::,.
F'ERI"I I T FIF'I:::'I._ I CFII".IT l"lFl:i.:; THE F;:ESF;'OI".I:E; I B I L I T"¢ 'T'l]i ~[ NFORH TN :[ S DEPIaR]"HEI".IT DUR I I',IE'J THIE
]:I'4STFILL. F;ITIOi',I ]:I",I'.E;F'ECTIOI',IS OF FIN"r' klELLS FII%J'FICENT TO THIS I::'ROPEFi:T"¢ FINE) 'T'FI[~:
NLIHE',EF;'. E)F F;:ESI[.'ENC:ES THF;IT THE I.'.IEL. L klILl._
BFICKFII-I..INEi CitF' FtN"r' S","S1-EI'I I.'.II']-HOUT FINFtL INSPECTION l:tl",tD RPF'ROVFIL. E:'¢ THIS
[::,EPF:IF;..'TI,IEN-r HII._L. BE SIJE',..:rEC:T TO F;'F;:OSI:ECIJTIOI'.,I.
i,IINIf'IIJH DISTI::II',ICE BIETI4EEIq FI NELl.. RI'.,IE:, F;IN'¢ ON..-.SITE SEI.,.IFIEiE D]:SF'OSFiI_.. S'¢STEP'I :I:S
:L(ii~;.i FEET [:'0[;i: FI F'F;'.IVlaTE 141ELL OF;'. :LSC~ TO ;~.'tZjEl FEET FF;'.Of'l R F'UE',L.:[C 14ELL E:,EF'ENE:,II',IEi
I...IF'(]N TNE T'¢F'E OF PL.IBI~ZC P.IEL. L.
I,I]:f.,I;[l'"ll. Jl'"l [)]:STlaI'.JC:E FF;:OH F'I F'F;:I',,,'IaTE 1.4ELL TO la F'F;:Z',/RTE SEI.,.IEF;: I...]:NE IS 25 FEET FII'.,IE:,
TO F;I COPIHUNIT'T' SEFIEF;: L.]:NE I:'~; '?5 F'EET.
O-f'FIEFi: F;:E(;!UIRE:H[~-.I'.,I-I"'.E; I',1F1'¢ F:IF'F'I_'-¢. SF'ECZF'ZC:FITIONS FINE:, CONSTRUC'F];OI'.,I DIF;IE!iRF:IH:~: I::IF;:E
FI',/FIZI.FIBLJE TO INL:;UF.:E: PF;:OF'EF;: ;I:NSTF~I_.L. FITION.
I CEF;'.I":[F'~.' THFIT
iL: I FiH FFfl,I;[L..IRR I,.IITH THE RE(;[LIIREI"IEN-I'S F'QI~: OF,I-'.BITE SEF]ERS laND HE:LLS RS SET
F'OF;~TH IB"r' THE HIJN I E. I F'FIL 1"1"¢ OF RNCNOF'.FIGE.
,~: I 14II_.L II",ISTFIL. L. TFIIE S'¢STIEPi IN F;ICCOF;'.DFINCE 14:["rN THE CODES.
:~.: I IJhI[)EFt:E;TFIN[) TNF;IT TNE ON-SITE SE[qEF;'. S'.r'S'FEP'I I"'iF;I'.¢ F;'.E6fl. J IF'.E ENLF:IF;'.C4EfflENT IF: THE:
F;:ESI[:,Ef~-I.S~-4~Ef, IE)E:,ELEE:, TE) INC:L.U[:,E I"IORE THFIN ~: BE[:,F;'.oE~f,IS.
I~F'F'I_.. I CI::INT F'FIT I<:~Z~:F;: ~
MUNICIPALITY OF ANCHORAGk
ENVIRONMZN~'/\L PRor~¢nON MUNICIPALITY OF ANCHORAGE
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6-
7
8
9
SOILS LOG
RECEIVED.
-F-I IXJ
PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /-
TEST
· ! ':' '~."
~.¢ ,L¢(}=~825 L, Street, AnchoraBe, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST /J/CF,? ,.57Z2~ (5~,¢
~L
SLOPE
SITE PLAN
10-
11
12
13
14
15
16
17
18
19
2O
· ~ AS GROUND WATER
q re~ .~,~4- ~_: q ¢ave_~cou N~ E ~ E D? ,
IF YES, AT WHAT
DEPTH?
Reading Date
'Fh~m Tg
tH~o 10:5 7
+Ifao I1:0
lbo I l toO
Net Depth to Net
,-/~'
, 7~
I o .,%9 . O ~
. ?¢
t0
/o ,cE ,/8
~ ~ Time . '~
Date Date Date
Inspeot(~ Inspector Inspector
?. -
'-Co~nment s .... i Conditional Approval
..m. %
~ ,
Holding Tnnk
Soils Rating ~ Well To Ab~o~ ~rea W~II Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Buyer ~ .~
Address
' - = ' ' Phone
Lending Institution
Address
RealtyCo,&Xgeet ~, 0'"'~, ~ - ' Phone
Legal Description ~~ ~ /~ -7 ~.~ '~ % ~-{~ N~ ~ Z~ ~ ....
Type~ Residence
E>Slngle Family
~ Multiple Family No. of Bedrooms
~ Other , : -
Wat~Supply
~ individual A~ACH WELL LOG. A well Icg Is required for all wells drilled since June
~ Community 1975. For wells drilled pdor to that (late, give well deptiq (attach Icg if
~ Public ~tilit~ available~
Sew~e Disposal
~ individual Year individual Installed:
~ Public Utility When Connected to Public Utllity~
El Holding Tank
NOTE: ~HE INSPECTION FEE MUST ACCOMPANY EACH REQUES~ BEFORE PROCESSING CAN BE INITIATEB,