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HomeMy WebLinkAboutBRUIN PARK BLK 4 LT 12 MUNICIPALITY OF ANCHORAGE Hea .h and Environmental Prote~ ~on Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM~ NAME LOCATION MAILING ADDRESS I~Oy. oh. IlO LEGAL DESCRIPTION ~-- I ~)- CIO. SEPTIC TANK: DISTANCE FROM WELL_(O INSIDE LENGTH MANUFACTURER ~\q~-[~ MATERIAL '~'\(~::~ INSIDE WIDI'H ~/~/~, LIQUID DEPTH NUMBER OF COMPARTMENTS. LIQUID CAPACITY I, 6o OGALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL ~ of Lines ~ ©EPTlt: TOP OF TILE TO FINISH GRADE IOClLFOUNDATION I O ' TOTAL LENGTH .NEAREST LOT LINE J O ' OF LINE DISTANCE BETWEEN LINES~4~f?gfJ~iCf~I:I~RENCH WIDTHS----~-- IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINED ~-OC:~' ~) q I DEPT~t OF FILTER SEEPAGE PIT: Log Crib Rings BUILDING FOUNDATION__ DIAMETER--OR WIDTH__ Crib Size: DIAMETER___ , NEAREST LOT LINE__ EENGTH , DEPTH DEPTH. .. DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. Well Class:~ Depth: Well Distance To: Lot Line Bldg: ~O Sewer Line: Pipe Mater,ials: # of Bedrooms: . Installer: Remarks: F'EF~:PII '1" NO. I::1F' F::' L I C I"::11",i"1" L. O C I:::1 'T' Z O I",1 L.E GI::II~. 'T'"r'F:'E OF ::.';C) t L.. I::IBL":i;OI:~'.['3'T' I L3N 2;"r":2:;TE:f'l I."Z;: TF?.E:NC:H "f'Hl!i!: L. EIq0:iTH E'., ]; hlt'"'"'1",l~ii~; I O1",1 1 21 THE: L.E:I",IGTH ':; I I",i t::'EET > OF 'T'HE TREIqC:H OR E:'t'T::l:::l I NF' I [ELD. 'T'HE E:,E!:I:::"t"I'"I CIF' FI TF:'.E1"'ICH OR F'I'T' Z"2 'T'HE C'I:STR1"'ICE BETI.,.IEE1"'I THE :!~UI:;.".F:I:::IC:E; CII::: THE GI";?.OLJ1",ID I"::11",11:::, THE: 13OTTOH OF THE EXCR°,,,'RT.T. CII",I ,::T1'.,I FE'".ET::'. 'T'I"iE:Fi:f:!!: IL::: I",10 :'~i;E-I" P.IID"f'H FOR ........ THE; GF::F:I',,,'E:L.. DEF'TH I:5 THE H T1'-,IIHI_IH E:,EF'TH OF GRR',,"EL BETI.,JEE1",I THE'-" OUTFFILL F'It:::'E 1:::1t"4[.':' THE 13OTTEd"I O1:""' THE E',."::C:I:::I'Vt:::ITIOI",I (]:1"'1 F'"EET>. F'ERPII '1" FII::'I:::'L. I C:f:INT I'-tl:'%'T, l"HE f:]:ESPON2~; t E: I L.. I T"r' 'T'O I NFOF:'.M TH I S E.',EF'F:II::'.."T'ME~N'I' I:::, U I:;?. 11",IG 'Fl"iEi: I N':'.::;TI:::tLLf::IT I ON 11",I??,P[!'".CT '[ EI1'-,t'.:::; CIF F:IN"r' HELL.:."-_'; I:::ID.]'FIC:[::1",IT TO TH I'..5 PF?.OF:'EI:;?.T"r' I:::IN[::' THE NUP'IE:E:t:;?. OF:' IRE~i;t[::'t:ZNCtES"; THflT THE I.,.IELL 14ILL. ':-:;EF.:VE. ............................ 'T It..-..1t F.":~ ,::: ;?..":, % IP-,I1 :.:25; IF:> [iiE: C..::: 'T' :]t: Cu ~"-,tl "':E; IFil I1::;.1: lEE: 'IF,U:: E ~::;:.~ ILJI ][ IF:.:.': [EL: IE:" BFICI-':.'I::'I LL.. 1 1",IG OF' l:'"tN"r' ~;'¢$TE:1"1 H I THOLIT F 1 1"'IFIL. I NSPEC:T I ON FIND RF"PF.':O',,,'I::tL. E,"T' 'T'H I S [::'IEF"I:'"'It::i:TI"IEt",IT H I'LL. li!i:E :!i!; U E: .S E C: T TO PF~:O'"SECUTION. PII1",IIP1UP1 I."."I'.'SI"I::II",ICE E:ETHEI:ZI",I I::1 F.IELI_ F:I1'"ID RN"t ON.....9I"rE ~,EI.,.IRGE D I'.';F'O':'..:";t:::IL :i..T,'.r"..'~:;'T'EP1 t':5 :1. O~3 F:'EET FOI:~'. R F.'F::I',,,'RTE HELL..~ OR :'L.~:.;~il 'l"O ;.:ZEIO F:EET F'.'RCIH F:I F'UE:I..IC HEL. L. E:,EPE:NDI1'.,IG UF'OI'.,I THE 'T'.¢F'E O1:::' PUBLIC HELL. I.,.IEL. L I..OG~.:.; FII:;;:E: F?.Eg!UIF?.EE:, FII'.,I[> I',IU:ST E:E." RETURNED TO THE DEPFIF?.THEI'.'IT H I'T'H:[1'.'I .:!i:C~ C,t:::t'T"..'.".; OF' THE; HELL C:OHF'I...IZTIO1'.,1. OTHEI:~: F:'.E~.QU I F?.IEI',II?ZNT':.:; HFI"r' FIF:'F'L"r'. SPEC I F I CRT I L-iNS RND CO1",t:STF.".UC:T 1 O1",1 [::' I FI G F:: FI t"I ':!!; FIF?.E F:I","I:::I I LF:Ili'3L.E TO I I",ISUF:'.[':: F:'F::CIF"'E~Fi: 1 1",I2";.,TfrlLLI::IT I O1",1. I CE:I";?.T I F:'"r' ]"HI"":iT t: I f::ll"l I::'I"":IPIILIFIF.': HITH THEE I':?.EEQLIIF?.E:P1ENT.?.'i; F'EIR CIN.....E;ITE :]i; [E FI [:"' [;.': 5 FINE:, I.,.IE:L..L.~ii; t':1'.:'2; 2i;E'l" t:::'Ci[~:TH I3"r' THE PIL.II",I I C: I PI::IL I T"r' OF' I'":iI",ICHOI;?.I'"::IC:ilE. 2: I H I L.L I N2:;TIRLL 'T'HE ':"";"r':..E;TE'f'I I N FICCOf~:DlaNC:E H I TH THE COE:,E"2,. ]i:' I U1",tI::'EI~::?FF:IN[:, THf:iT TI'"I[::: CIN-"-'."!:iITE "2EI.,.IER S"r'".ET';TEH Ht:::l"r' I:;]:EL:.iU]:I';:[':': [::.1",IL."'[."' "~' '"':,1 ........... 1"1[:.1',11 Il::'" "I"HliE I:?.E"2IE:'E'NC:E IRE!; F?.E"'hlODEL[:::D TO INCLUDE HORE THF:IN ]~.: BE:.DROOft:5. I:::IF'F"I~I" I"::LONI:> I I':::E I'::;L IFF t':::ON:!i.'TT'. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222~ SOILS LOG - PERCOLATION TEST [] SOl LS LOG [] PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: ~.~)'T" ! ~ ~-~ LIC. z/_ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN WAS GROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L O P E Gross Net Depth to Net Reading Date Time Time Water Drop ~ I ~-,~/-?,¢ 0 m,~ 0 m;~ ,.,n. ~" 0 ~o ,, RD ,, ~. ,~5" .~? ~ "~ ~ " ~0 " ~0 " ~, ~" , ~0 PERCOLATION RATE Z~' m"~./~, {minutes/inch) = ~'-)O'¢ TEST RUN BETWEEN 7, ~ FT AND /(¢~- :~. FT 72-008 (7/76) · E FAM I-LY [~""IN ** .... IV - N S TE** If ndlv, D IDUAL/O - i . rail we is required THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED iNSPECTION APPel NTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2, WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Veri'fied 3, SEWAGE DISPOSAL SYSTEM [~]J, NDIVl DUAL/ON -SITE []PUBLIC UTILITY Connection Verified I--ISeptic Tank or [--]Ho!ding Tank Size: t ~ CJO If Tank is homemade give dimensions: [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING TYPE OF TANK MANUFACT~,~,~.~ TOTAL ABSORPTION AR EA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line MATERIAL Septic/Holding Tank IAbsorption Area ]Sewer Line [] OTHER INearest Lot Line 5. COMMENTS -"A"PROVED DATE BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) DISAPPROVED LEGAL DESCRIPTION 7~-010 (Rev. 3/78)