HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 5 LT 66 oclC:
Name of Applicant
Mailing Address
Legal Description
TYPE OF PERMIT:
MUNICIPALITY OF ANCHORAGE
D,.,.artment of Health & Environmental Protecti¢~l
On-site Sewer/Well Permit Application
Sewer Only
Sewer Upgrade
Well Only
PERMIT#
Day Phone o¢'~/-~'¢/-~/'~
Zip Code
Number of Bedrooms ,~¢..y-L2Z../L.//d~-~,,.L¢~.~A~¢.- /.)-dY- ..~L y/
I plan to have the necessary inspections conducted by:
Municipal Inspectors
(Included in the Permit Fee)
~ Approved Engineering Firm
(Permit Eee_Ls3A/a~ed)
Combined (Sewer & Well)
FOR DEPARTMENTAL USE ONLY
Soil Rating
Total Depth
For upgrade only: Add
72-012 (6~82)
TYPE OF SYSTEM: Pit Drainfield
Seepage Bed Mound System
Gravel Depth Width
to length and/or add gallon tank.
Fee Collected
Trench
Handwritten
Receipt #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
ISOILS LOG
[] PERCOLATION
TEST
DATE PERFORMED:
1
2
3
4
5
6
7
8
9
10
11
12
13
SITE PLAN
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
", '" ~' Gross Net Depth to Net
!: 'R~sd ng Date
· Time Time Water Drop
14
15
16
17
18
19
PERCOLATION RATE /~ ~ (minutes/inch)
TEST RUN BETWEEN FT AND FT
20
PERFORMED BY:
72-008 (6/79)
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DRILLING COMPANY APt? 1_ 0 1981
OWNER OF LAND
ADDRESS '
LEGAL DESCRIPTION
DATE - Started ' s Ended _
PERMIT NUMBER ' ' :
DEPTH OF WELL :
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From -Ft. to Ft
From__ Ft. to Ft,
From Ft. to F1
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,
From Ft. to Ft,
From Ft. to Ft.
From__Ft. to _ Ft.
From Ft. to Ft
From Ft. to -Ft
Fr6m 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,
Frmn Ft. to Ft.
From__Ft. to__ _Ft.
From Ft. to Ft
MISCL. INFORMATION:
DRILLER'S NAME