HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK A LT 3 REM
NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~//~ PHONE
We~l Absorptioa area
D~STANC5TO: I~/~ ~ ~/ ~
Manufacturer
Inside length
O ~ IF HOMEMADE:
Dwelling
DISTANCE TO:
Manufacturer
Well Foundation
DISTANCE TO:
No. of lines Length of each line Total length of lines
Top of tile to finish grade Material beneath tile
Width
Length
Depth
NO, OF BEDR~.~MS
PERMITNO. ,o~r.z/Ot¢,/,// ~,
Dwelling
Materi,~· No. of compa~ments~ s
Type of crib Crib diameter Crib depth
Well Building foundation
DISTANCE TO:
IWidth
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Material
Nearest lot line PERMIT NO.
Trench width Distance between lines
inchesinches Total effective absorption area
PERM T NO.
;lass Depth Driller
Building foundation Sewer line
DISTANCE TO:
OTHER
Total effective absorption
Nearest lot line -
Distance to lot line
Sept c tank
area
PERMIT NO.
Absorpt on area(s)
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED J
DATE LEGAL
16
F'ERMIT NO.
.... w~._.. 14. :L1 PIONEER HOME
RPPL t CRNT M I TCHELL ~' MFtF. r I E MFtLONE "':'"~'
L. OL-:RTION MILE 4.. R E. R.
_ . ~ p ', LOT SIZE
LEL-iRL L~: BLF,]K R bLR_.IEF-: ',/IEN HTS
TYF'E OF SOIL RBSOF.:PTION _-,T_-,TEfl IS DRRINFIEL~i,
SEI.,.IE ,F..: L~F"~_31F~-.F4E:,E F EF.~'I ][ T
344-4550
26t00 SC'JRRE FEET
t',IRN!MUM NUMBER OF E:E£)ROOMS = -'.': SOIL RRTING ,"~.] FT,.'E,F..-
THE REQLIIRED .:,I¢.E OF ]"HE SOIL HB:,UF. FTILN :,~_,TEM IS:
C.,EF-TH:= ~ LE[~L-~TH= '"'-"--'~ ,'-~F.'R%."EL [:"EF'TH
THE LENGTH DIMENSION IL--., THE LENGTH ,'IN FEET':, OF THE ]F...EN_.H r]F.'. L":,RRINFIEL.[:,.
THE [EF]H OF FI TF'.ENCH OR PIT IS THE [:,ISTRNCE BETHEEN ']-HE SUF.:FRCE OF THE
GROUND RND THE BQ]'TOM OF THE EXCFtVRTION ,'IN FEET).
THE GF.'.RVEL DEPTH IS THE MINIMUM DEF'TH OF' GRR',,,'EL BETHEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EY, CRVRTION ,'IN FEET:).
f~: E ~i:., El ][ F: E [:. S E F' m I C: m Fl ["-.~ 1--% '-- I ...~: --
PERMIT HFF_ICBNT HRS THE RESPONSIBILtT'¢ TO INFORM ]'HIS [)EPRRTMENT [:,URING THE
INSTRLLRTION INSPECTION':; OF RN'¢ WELLS RDJRC:ENT TO THIS F'F.'.OF'EF.:T'¢ RN[:, THE
NUMBER OF RESIDENCES THRT THE NELL WILL SERVE.
T [--~ C, ,:'. ~_---" .":, I ~'-.~ Z-=~ F" E,2:-r I L~ 1" &_ F~ ~-. E - --
E:FI]:KFILLING OF RN'¢ .:,~_-,TEM WITHOLIT FINRL INSPECTION RND RF'F'RO',,,'RL BY THI_,
DEPRF.:TMENT WILL. BE SUBJECT Tn PRQSEL-:LI'rION.
,- -- t~ I "~
MINIMLIM DI:,THN_.E BETWEEN R WELL RND RNY EN-_,ITE SEWRGE DISF'OSRL S¥S'TEH IS
:tOF~ FEET FOR R F'RT',,,'RTE 1.4ELL LR :'LDO TO .':.'00 FEET FRnM R F'~IB~ IFf WELL DEPENDING
IJF'L]N THE TYPE OF PUBLIC WELL.
MINIMLtH DISTFtNCE FROM R PRI',,,'RTE 14ELL TO R F'RIVRTE SEWER LINE 'rs '2~ FEE'[.' RNE:,
-- II ' '~ '- , '
TEl R L:UMM_N'rT~ _-,EHEF.. LINE IS ~5 FEET.
OTHER REQUIREMENTS I"tR'¢ RF'F'L¥. spEcIFICRTIONS RN[:, ]:ON'STR_CTtL]N D'rRGR. RMS RRE
R'v'R'rLRE,'LE TO INSURE PF._FEF. INSTRLLRT'rON.
F'E F..."~"I :I T' F-:--=." F' :[: FL'-. F:S r:,EL-:E~",IE~EF-=-" .72: ::L.., :.1_"_-,.. ......
I CERTIFY THRT
l: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND b.IELLS RS SET
FORTH B'¢ THE MUNICIPRLIT'¢ OF RNCFIORRGE.
.2: I 14ILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
_-<: I I. JNDERSTRND THRT TFIE ON-SITE SEWER SYSTEM MFI¥ REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 2: BEDROOMS.
RPF'LICRNI" MITCHELL 8: MRRIE MRLONE
',RTE ~_~ ~
ISSUED B'T'---V- .......... [ ..............
¥'-~V ~ ,~ ~, DATE RECEIVED
,e'" ." INSPF~TION APPOINTMENTS
INSPECTOR~
~ ' ~UNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE
k TIONAnchorage,'Alaska 99501
825 L Street -
ENV RO. "TAL SA. TAT O" D WS O"
Telephone 264-4720
)IRECTIONS: Complete all parts o~ page 1. Incpmplete requests will not be proceed. Rease ailow ten (10) days for processing.
J PHONE
1. PROPERTY OWNER
MAILIN¢ ADDRESS
EROPERTY RESIDENT (If diffarant from above) PHONE
2. BUYER
MAILIN~ ADDRESS
3, LENDIN~ PHONE
INSTITUTION
MAILINQ ADDRESS
I PHONE
4; REALTOR/AGENT~ ~~
MAILING ADDRESS
5. LEGAL DESCRIPTION
Loc $
STREET LOCATION
6. TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[~] One [] Four
~ Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
~ INDIVIDUAL*
[] COMMUNITY. / ~) 7~'
[] 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 well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** /~ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010 (Rev, 6/~
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
:~ERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
~ERMIT NUMBER
3, SEWAGE DISPOSAL SYSTEM
J~]INDIVIDUAL/ON -SITE DATE INS'I~ALLED
E]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [~Holding Tank
Size:_ . If Tank is homemade SO~LS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank iAbs0rption Area iS.wer Line JN.r~st Lot L,ne
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL {letter must accompany certificate)
[~DISAPPROVED
DATE BY
ALASKA erlUiRonml~nTAL CONTROL $1~RUICeS, Irlc.
t~n§ineefin~ 8 ~nuJronmental $1udJes
MAY 22 1981
ABM ESCROW
410 DENALI STREET
ANCHORAGE AK 99501
SELLER - MALONES
SUBDIVISION-GLACIER VIEW HEIGHTS BLOCK-A LOT-3
THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
2 BEDROOM HOME.
1220 Lgcst 251h/~uenue ,, An&oraq¢, Alaska 99503 ,. (907) 276-1361
lC i00o '