HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 2 LT 4BC^ P
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LoT
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014
Date completed ....... /.O -. Z~.7..~ ........................
OEPT. G~ H:ALTH
water' .~/~ ~u ~C~ 6cRECEIVED
~istance to ............................... ~ ........................ = .................................
Dist~ce to water while p p g ........................................................ ~ rate
of ........................................... ;....gallons per. hour.
Formation
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Driller
DELTA DRILLING COMPANY
5RA BOX 394 B
ANCHORAGES. ALASKA 99~50~'
~ , ~ DEPARTMENT' ~ HEALTH AN~ ENVIRONMENTAL' ,~OTECTION
.... ' 825 'L' STREET, flNCHORRGE, AK.
' IWELL PERM I T
PERMIT NO. ( 8~25 )
APPLICANT CiE ENTERPRISES PO BOX i0-991
LOCATION 67TH AVE
LEGAL ~[~8-B~OCK2-~CAMPBEL[-HEIGHTS'~
LOT SIZE
~44-44~
88~8 SQUARE FEET
MINIMUH DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE WELL OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMU~ DISTANCE FROM A PRIVATE WELL TO A PRIVATE ~EWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS fire REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM T t EXP T RES DECEMBER :~::L~ :::L981[~l
I CERTIFY THAT
l: I 8~1 FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY Of ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
S I GNED:
APPLICANT C&E ENTERPRISES
V4. 0
v4.~a i
0° LY..)' I~"
APPLIC~qT FILLS OUT UPPER HAI'"~,ONLY
Address Zip ~e
ingle Family
~ Other
mm~lty For wells elll~ pdor to thM date, give well depth (attach I~ If available),
Holding Tank
NOTE: THE INSPECTION ~E MUS~ ACCOMPANY EACH RE~EST ~EFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Inspector Insp~tor Insp~tor Insp
( ) CONOIT~NAL ~PROVAL*
BY:
TIm~ - , Time
I:~te Date Date
Inspector Inspector Inspector
Comments Conditional Approvel
Date Sewer Installed Permit No. Septic Tank Size
Holding Tank Size
Soils Bating Well TO Absorption Area Well Log Fleceived
Well to Tenk
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner ~.~.-.-.~~r '. -, :': C". ~.'*'7"~ , .. - ;_; '~> (.,~-t r'/~ ~ /"~/q~4A ~,. Phone
Address ~
Lendlnglnstltutlon ~/~,~ P~ ~ ~ ~'C ~ ~ L Phone
-"~' /
Address
ResIty ~. & Agent , , Phone
Address - ~~
Typ~ Residence
~Single Family
B Multiple Family No, of Bedrooms
~ Other
Wate~upply
~ivldual/ A~ACH WELt. LOG. A well log Is requlr~ lot all wells drlll¢ since June
~mmunlty
~' ~1/~ 1975. For wells drilled prior to that date, give well depth (attach log If
~ Public Utility available.)
Sewage Disposal
~lndivtdual . . Year Individual Installed:
~ Public Utility ' When ~nnected to Public Utlllt~
~ Holding Tank
NOT~ THE INSPEcTIoN FEE MUST ACCOMPANY ~CH REQUEST BEFORE PROCE~ING CAN BE INITIATED.