HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 3 LT 2BC^mi
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RCTUR~ TO:
STATE OF A~ASXA
· OEPARTHCNT OF NATURAL RESOURCES
14~ter lei Type Top ~tt~ 7~ f~'
~A~v. ~eel~ land lurflGI
~IIN~CIp~LI~ OF AMCHORAG~ 11.
DE~EI~IE~ Length of Dm. pi. ~ ft. C..~lty
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PERMIT NO.
DEPARTMENT O~.~HERLTH AND ENVIRONMENTAL P~OTECTION
825 ~[' 'STREET~ ANCHORRGE~ WK. ~ t
~64-4~2~
WELL PER[~ I T
APPLICANT
LOCATION
LEGAL
ROBERT MCCORMICK
E. 66TH
L2B B~ CAMPBELL HEIGHTS
i50~ PATTERSON
LOT SIZE
8820 SQUARE FEET
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC HELL.
MINIMUM DISTANCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS RND CONSTRUCTION DIAGRAMS ARE
RVRILRBLE TO INSURE PROPER INSTALLATION.
PERr~ I T E×P I RES DECEMBER
I CERTIFY THRT
i: I AM FAMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS AS SET
FORTH BY THE MUNICIPALITY OF RNCHORROE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED:-__
APPLICANT ROB~.T MCCORMICK
V4. 0
LOT
· o DAtE RECEIVED
'" . --' INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
,NSPECTO. ,NSPECTOR ,NSPECTOI_ ) C ..
JV[UNIClPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEFT. OF EEALrI~ &
~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~NMENTA~
825 L~tr~t - Angora,
ENVIRONMENTAL SANITATION DIVISION NOV 1 2 1981
Tele~one ~7~
1. PROPERTY OWNER PHONE
MAILING ADDRESS
PROPERTY RESIDENT {If dilferent from 8~) PHONE
2. BUYER PHONE
MAILING ADDRESS
~AILIN6 ADDRESS
4. REALTOR/AGENT I PHONE
I
MAILING ADDRESS
5. LEGAL DESCRIFTION
.4,.,,,/--.
STREET LOCATION
q / z o 'C.
6. TYPE OF RESIDENCE NUMBER OF~BEDROOM$
r-I One r-I Four [] Other
~ SINGLE FAMILY
[] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
7. WATER SUPPLY
~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
& SEWAGE DISlN~)~AL SYSTEM
I--I 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. 6/79)
b
- ' THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ·
I'--I SINGLE FAMILY [] ONE I-3 THREE [] FIVE [] OTHER
I-'l MULTIPLE FAMILY I--I TWO r-I 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
I-'IINDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified NSTALLER
r--lSepticTank or DHoldingTank
Size: If Tank is homemade BOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
Absorption Area to nearest Lot Line
5. COMMENTS
FOR ~ BEDROOMS
I--I CONDITIONAL APPROVAL (letter must accompany certificate)
I-'1 DISAPPROVED
DATE BY
72.010 (Rev. 6/79)