HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 2 LT 4D
Date SOIL~ LOG · CASING LO(~
~z-~ ~/~,,.. SUBSURFACE EXPLORATION
TIME DISTRIBUTION HOURS
~BOR EQUIPMENT
Flared
Pickup
~ Welder
Pump
7
PERMIT NO,
r~lur4 1 (~: I L 'r T~r·
~DEPARTMENT ~HEALTH AND OF AI'4CH,.~RAGE
ENVIRONMENTAL . .OTECTION
825 'L' STREET, ANCHORAGE, AK.
264-4720
I.qELL PER£~ IT
( 810660 >
APPLICANT
LOCATION
LEGAL
RICHARD C. HOPE
E. 6BTH
L4~ B2 CAMPBELL HEIGHTS
2~15 E. 72ND 9~507
LOT SIZE
344-4292
12000 SQUARE FEET
MIHIMUH DISTANCE BETHEEN R HELL AND ANY ON-SITE SEt, AGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE HELL OR 150 TO 2~ FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC HELL.
HINIHUH DISTANCE FRO~ R PRIVATE HELL TO R PRIVATE 5EWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE I5 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT HITHIN 3~ DRY~
OF THE HELL COMPLETION.
OTHER REQUIREMENTS HAY RPPL~. SPECIFICATIONS AND CONSTRUCTION DIRGRRH~ ARE
AVAILABLE TO IHSURE PROPER INSTALLATION.
PERI"1 I T E×P I RES DECEMBER .7_~1.. -1981
I CERTIFY THAT
:.t: I AM FRMILI~C..~.. ~IITH THE REQUIREMENTS FOR ON-SITE SEHERS AND HELLS RS SET
FORTH BY>' THE £~JNTJ"~.IP. RLITY OF RNCHOP, P,~E.
,.
2: ! WILL ['~Ic~R-~-~E SYST,,.EM'" I~i-~,~RNCE HITH THE CODES.
ISSUED B _DATE__ V4. 0
MUNICIPALITY OF ANCHORAGE SEWER UTILITY
PROPERTY:
Name P/~---~. /-'/~'.~.~.- Address'~~.1.~'~ Z~7~/'~J~4~'l''~-- AcctNo
PlatNo. Subd. ~'--'~,"~/°m~-~- A,,,~:~.-~r ~-'~<'7-~. Lot ~/'~ Block
Residential ~ Commerlal C'1 Industrial 0 No. of units
CONNECT=
Main Tap ~: On Property ,~ Perm[I No. ~/ O.~'~:~ Size 4'
Drawing No. Size Ma~ ~3" Type z:::, / Depth at Connect
Insulation 0 Cleanouts Type
Connect Agent ~/"/,ac.hle. ,~,¥¢. Inspector /J///'c/'/a~.l /C~/7~/~-o Date
Comments
Connect Location
ASSESSMENTS~
Ll.D. NO. Private Dev. No.
Sewer Agreement [:::3 No.
Subd. Agreement C] No.
RT.E. 0 Roll No.
DYE TEST:
Positive C] Negative 0 · N.S.A. C] Date
Page No. M.H. No. Billing Cycle
Tested By
Comments
Indicate North
· INSPECTION APPOINTMENTS ·
~_IME TIME TIME
DATE DATE DATE
I NSPE CTO R INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE D£,~T.
DEPARTMENT OF H~LTH ~ ENVIRONMENTAL ~ROTE~N'M[NTAL
( ~.VmO.Mt.T~L S~,TAT,O. D,V~S,O. O UL 3 1 1981
I, PRO~ERTY~E~ I ~ / ~ / PHONE
2. BUYER PHONE
MAILING ADORE~
3. LENDING I~TIT~ION ~ PHONE
I
MAILING ADDRE~
~ REALTOR/AGENT I .~HONE
[~ [] One [] Four [] Other~
SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY I~ Three [] Six
7. WATER.S.~P,'LY
. ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
I-'] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.) [
~. SEWAGE DISN)SAL SYSTEM
[] INDIVIDUAL/ON-SITE" YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE I~IITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
I-'1 SINGLE FAMILY [] ONE i--I THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO I-3 FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[~] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON *SITE OATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
I TOTAL A~SORPTION AREA MATERIAL
Absorption Area lO nearest Lot Line
5. COMMENTS
~'~PROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 IRev. 6/79)