HomeMy WebLinkAboutT13N R3W SEC 32 SE4 SE4
J~ MUNICIPALITY OF ANCHORT~G~
; MUNICIPALITY OF ANCHORAGE DEPT. OF I::,'~LT~t &
~.~~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTJ~IRONMENTAL pF, O~ECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION kdAY ;;/979
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing.
1. PROPERTY OWNER ~V~--
MAJLINGADDRESS ' ~ ~ '
PROPERTY RESIDENT (If different from above) ~- PHONE
2. BUYER
MAI LIN G ADDR ESS
3. LENDING INSTITUTION
MAILING ADDRESS
PHONE
S. LEGAL DESCRIPTION
6. TYPE OF RESIDENCE NUME~ER OF BEDROOMS
[] One [~ Four
[] SINGLE FAMILY [] Two [] Five
~ MULTIPLE FAMILY ~-j~ [] Three [] Six
[] Other
7, WATER SUPPLY
INDIVIDUAL~
[] COMMUNITY
[] PUBLIC UTI LITY
8. SEWAGE DISPOSAL SYSTEM
~ INDIVI DUAL/ON-SITE**
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 welJ
depth (attach log if available.)
**If individual/on-site, give installation date
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 OFFIC SE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS ;.
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [~ OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[~] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[~]Septic Tank or [~] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
COMMENTS
~ RO D FOR ~'~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must~/c~ompan¥ certificate)
~ DISAPPROVED ,,~ // ,.,.,
DATE ~ BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
ISAACS PUiV1PING SERVICE
(Norm Tibbetts, Owner)
6218 Quinhagak Street
ANCHORAGE, ALASKA 99507
Phone 344-Ol14
3594
5H 528 ,,,~;~rm
JML
John M. Lambe, P.E.
-- _ et Anchorage, Alaska, 9950~. 907-279-8056
w.?Zo ~..t_~l~'~ ~r~,;/ PHONE NUMBER 276-~113
SOI, L ABSORPTION SYST~4 TEST
PERFORMED FOR:
TELEPHONE=
DATE OF TESTS:
LEGAL DESCRIPTION: ,~¢~ ~.-
NO. OF BEDROOMS: ~ RECORDS ON FILE:
CRIB ~/~ DRAINFIELD ~.~.~THER ~
TEST PERFORMED IN ACCORD~'~CE WITH JM[ STANDARD PROCEDURE ACCEPTED BY
MUNICIPALITY OF ANCHORAGE~ DEPT. OF ENVI~O~[ENTAL QUALITY ON
WITH THE FOLLOWING MCDIFICATiONS:
SURGE CAPACITY: ~
SOIL ABSORPTION SYST.~,~M (SAS)
SEPTIC TANK PLUS SAS
ABSORPTION RATE ~
AVERAGE 24 hrs STEADY STATE
OBSERVATIONS:
NO T~S:
JML
John M. Lambe, P.E. 4303 North Stsr Street Anchorage, Ala~a, 99503 ~07-279-8056
REFERENCE:
'DEP~ BELOW · METER ~EADING GALLONS pUMPED-
...~ ~. . ~ . ~
' ~ ~: ~ t ~ I ~ ~;" ~ ,~ ~:. ', ~::
,, . : i:' ~ ......
~- ... ~ ~ > ~ ~ ..
John M. Lsmbe, P.E. 4303 Norlh Star Steer
Anchorage, Alaska, 99503 907-279.8056
'. DEPT~ BELOW ,~ METER READING GALLONS PUMPED TIME ~
-. ~ ,~. /~.~.
:, '.._ ' ~ ~ ~
' kt '7" ~ 2 J ?Z ,. ; ~0 /% ', I g · :"
.., , }~>. ' ~r~:
I~ I t I -'Il . . ~ ~ , ·
.. · ~
JML
John M. Lambe, P.E. 4303 North Star Street
Anchorage, Alaska, 99503
g(}7~279-8056
LEGAL ~ESCRIPTION. ¢ G 0 ~
DEPTH B.E~OW ,,,METER READING GALLONS PUMPED TIME
~EFEREN.E ~,'~r,~l ( GALLONS ) ( ~ )
~ l" '-7 ,¢"71 5, ,¢~ /,¢;) o ff: o
.~' q"', "7 ,¢"q t s, (" ~o° ~: 3~
John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056
EXISTING DRAIN FIELD TEST PERCOLATION ADEQUACY
DATE ,.~/'1. ,"~Z~~ PERFORMED BY:
LEGAL DESCRIPTION: ~o~ ~
DEPTH BELOW METER READING GALLONS PUMPED TIME
REFERENCE ~ ! ( GALLONS ) ( 5rET ) ~.~,
~.!to" 74. I 7~,, {~ ~ t~ ,'
. ,, ~, r~ ~'
~ ( 1~ ~ '~
~ ',- ~ ~3/~ ' I ~ .. -5
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