HomeMy WebLinkAboutHENKINS BLK 5 LT 8
''-~N ;~_., MUNICIPALITY OF ANCHORAGE
· , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~1 ~/~L~
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE ~ NEW
MAI LInG AdDR ~SS
LEGAL DESCRIPTION
~OCATIO~ ~0. OF BfiD~OOMS
Well Absorption area i Dwelling PERMIT NO.
~ ~ Manufacturer ~ Matedal / No. o~compartments
~ ~ Liq. capacity in gallons Inside length Width Liquid depth
~ ,~; IF HOMEMADE:
, Well Dwelling PERMIT NO.
~ ~ ~ Manufacturer Matorial kiquid capaciW in flallons
~ Well Foundation Nearest lot line PERMIT NO.'
~ ~~ No. of lines/ Length of ~ch~li~ ~ Total length of lines _ Trench width Distance ~tween lin~s
~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area
Length Width Depth PERMIT .
~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
INSTAELER -- ~
REMARKS ~~ ~
APP~D .~ / DATE LEGAL
i72-01; . 3/78)
.4F'F'L. ICFqNT =, I PNLE'r SMITH
~ L.O C R T Z 0 N E:' Z V ~ E; Z 0 N
LEGFIL L5 E:E: HENKINE; :,~ [.
F'3 E:O::':: 63:6
Lcrr '::; I ZE
TYPE OF SOIL RBSORE,'TION SYSTEM IS: TRENCH
MRXIf'IUH NUHE:ER OF' BEDROOMS = '"~:
THE REgIIJIF::ED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
L--:. E: F" l' E-I == :E." L_ bE ~-.~ ,ii -F H
THE LENGTH DiMENSiON iS THE LENGTH (IN FEET) OF THE TF.:ENCH OR DRRINFIELE:'.
THE DEPTH OF R TRENCH OR PiT .IS THE DISTRNCE BETHEEN THE SUf;.'.FRCE OF' THE
GROUND RND THE E:OTTOM OF THE E;:-:",CFI',/RTION ,::IN FEET).
THERE ibc NO SEET 14tEE, TH F'OR TF'.ENCHES.
THE .,P..H,EL gEF FH ]:~; THE MiN.IMUM [:,EF'TH OF GRI-3',,"EL BETHEEN THE OUTFFILL F'.IF'E
RND THE BOT"I'OH OF: THE EXCR',,,'R'rZON ,::.IN FEET:'.,.
.... ,-, 'l ..... REE,~3NSIE:ILiT~ TO iNFORM THIS E:,EPRF.:THENT [:,IJF.:INI] THI:'
PERHIT HFFLI_.PN[ HFIE; THE
.INSTRLLRTION IN'.E;PEC:'FIONS OF RN"r' bi[ELLS RDJFICENT TO THiS PROPERTY RN[:' THE
NLIME:ER OF: RESZ[:'ENCE:5 THRT THE HELL HILL SERVE.
BRCK'FILLING OF FtN"r' S"?STEM 14.ITHOUT FINFIL INSPECTION RN[:' RPPROVF:IL EW THiS
DEF'RF.'TMENT NILL BE SL.IBJEC-F TO PF'.OSEC:UTION.
................ -~.n~,,-~. rr-T,t~n,.I ~ [,IP'! RND RN'T' -N-CITE '-,E !-.-I dUE [:,IbFU::,HL ::.'r.::,l'Efl ......
I'lJ.l'~J. fqU['J L'tJ.''''/nr~'~'~- ~:,l~.¢,l::.r~., .......... b n ', I - -- -( ~"
f¢J.E! FEET FAR R PRIVFITE !.,.IELL.~ OR
-jl~ TO 2Eu.:.'~ I:"EE"r FROH t;:I F'UE:L.IC HEL. L [:,E¢'EN[:,ZNG UPON THE T'rPE OF FUE:I...IK: HELL.
OTHER REQUIREHENTS HFI"? RF'PL"r'. '.E;PEC.IFiCRTZONS I::INE:' COI'.,IS';TRUCT.ION DZFIGRFtNS FIR[:-':
FIVFIILFIE:LE TO INSURE PR. OPER Ii'.,ISTRLLFITION.
F:'F_'EEE."['"'] Z -F bE ::..:." F" ]: F.".FZ S; E:,E.'
i r':EF.:TI F'¢ THFtT
!: I RM FFiMILIRF-: I...IITH THE RE.::JIREMENTS FOR ON-S.ITE SEHERS RNE:, [,JELL'.--_; RS SET
FORTH B'-r' THE M_NI .~:.IF'IRL iT'S OF FiNCHORRGE.
2: ~ NZLL ZNSTRLL THE SYSTEM ZN RCC:ORE:,FINCE HZTFI THE COE:,ES.
Sc,: Z IJNE:,ERSTRNE:, THRT THE ON-S~TE SEHER E;'¢STEH MR'¢ RE2.ZRE ENLRRGEf'IENT Z F THE
RESZE:,ENCE Z:5 REHODELEB, TO ZNC:LU[:'E MORE THFIN 2: BE[)RZOP1S.
~f4T S'~' Sf,lI TH
l SSUE[::' E?¢-.--~---"{'~ .................... [: FITE ............................... ' 'L:'. 2
~;,~ .... O Er E GEC~,_,ECHNICAL Er DEVEL~C)PMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Soils a Foundations
Performed for: Name: /~:
Hailing Address:
Legal Description: Z~.~ ,~
Depth (feet)
lo
11
12
13
Earl Ellis
SOIL LOG 688-228o
Land Development
$otl Characteristlc~
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit~
If yes, what depth
Drain Field ~
Comments:
Performed by: Date:
lo
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,
PRO~ERT~RESIDENT (If differe~fro~ above) - / ~ PHONE
2. BUYER PHONE
3, 'LENDING INSTITUTION ] PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT f PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION,~
6. TY.E o. RESIDENCE '
~"~'N G L E FAMILY
~ MULTIPLE FAMILY
7, WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
NUMBER OF BEDROOMS
[] One ~ Four []
[] Two [] Five
[] Three [] Six
Other
*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 ins'[allation 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,
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
h~IME TIME -- TIME
DATE I DATE DATE
I N~-C~ INSPECTOR I NSP ECTOR
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
L~ COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY ,.,
Connection Verified .... LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] I NDI VI DUAL/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, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Line Nearest Lot Line
AI)sorption Area to nearest Lot Line
PPROVED FOR 3 EDROOMS
E~ CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
LEGAL DESCRIPTION
72-010 (Rev. 3/78)