HomeMy WebLinkAboutSHEETS LT 5O5/ 06Z 66 001,
MUNICIPALITY OF ANCHORAGE
Hea. -i and Environmental Protet on
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
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"'TdLiNG ADDRESS�Ox PHONE
LOCATI01',171-_'.""`_'-__---J^--- LEGAL uESCRIPTION ___L.Q
SI-PI-IC TANIK
DISTANCE r_ - NUMBER OF-
FROM
F
FROM W:LL�.. MA;Ut i'C' ur?ER _COMPARTME
NTS
INIDF. LE1`4CIH INSIDE VIDI LIQUID 1-3-PT11 LIQUID CAPACITY GALLONS.
TILE DRAIN FI1.__LA):
TOTAL LENGTH
DIS ___FOU�JOTATION-_------._NEARF.S1 IGT I LINF_ -----OF LINE
of Lines Bt IVIJEEN __ [RENCII %','IUTI IN. TOTAL EFFECTIVE
A SO. 1-1. LENGTH OF EACH EINE
0I I IiU TO 1 IMSA GRADE
---- - -- F[ �P A C E
DI :> M' _I ER
DEFTli OF FILTER,
I3U'-!EATII TILT.._.__
OR WIDTH L E.!J G 1 !-1 ___ DEPTH
IN. AHOVF _FI LE IN.
Log Crib —Rings Crib Size: ClAk"Ll ER01SI'ANCE FRONT: WELL__------.
'I ( 0 T:�L. EFFECTIVE
Pull NEAREST LOT LINE A6 SG R P I ION AREA (\V A L I - A R -_ A) ____ SQ. F1.
Well
Class: Depth:
Well ]Distance To: Lot Line
Bldg: Sewer Line:
Pipe Materials:
i of Bedrooms:
Installer:
Remarks:
DATL APPROVED
�~���� �� ����������
DEPHRTMENT P"" HEALTH HND ENVIRONMENTHL P9OTECTON
825 'L STREET/ HNCHORHGE/ H9� 1
279~2511
PERMIT 11-11D... 777]5 )
�PPLICHNT WILLEY DENSON,
.00HTION ��BI�D�STREET
.EGHL LOT 5 SHEETS SUB DIV
TYPE OF SOIL HBSORBTION SYSTEM IS
�HXIMUM NUMBER OF BEDROOi 6
BOX 966 F. R. 99577
TRENCH
LOT �IZ�
22967 SQUHRE FEET
�OIL
RAT ING (SQ FT/BR5
THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS:
�������� �
THE LENGTH DIMEN�ION IS THE LENGTH (IN FEET) OF THE T�EN�H OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCF. 8ETWEEhI THE SURFFICE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATI ON (IN FEET).
THERE IS NO S�T WIDTH FOR TRENCHES�
THE GRHV�L DEPT� IS THE �INI�JM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVATION (IN FEET).
�FE". l=` T� 1 IC- ��" [I-<"
CIA IC-) VA�
� _~
_----- �������C"" V� F=4 L.. FN PA ... V F:41"' 1 VA
H PHCKHGE PLANT MAY BE I@STAL[,ED AT THIE TTEE/S OPTIO04 TO THE
FOLLOW' NG CONDITIONS:
1 E�THE� H CLHSS I OR II NSF APPROVED PLHNT MHY BE INSTHLLED
2� H CONTINUOUS MHINTENHNCE HGREEMENT V ;REQUIRED. I� H MHINTENHNC�
HGREEMENT IS NOT KEPT CURRENT YOU �HY BE REQUIRED TO ENLHRGE THE SOIL
HBSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION
H_�� ���-`j F-` F F-����������
BHCKFILLING OF HSYSTEM WITHOUT FIN
NY HL INSPECTION HND HPPROVHL BY THIS
DEPHRTMENT WILL BE SUBJT_KCT TO PROSECUTION.
MINBN
IMUM DIST�NCE �TWE�H WELL HND HNY I- ANL SEWHGE DISPOSHL SYSTEM �S
100 FE�T �OR H PRIYlTE WELL OR 200 FEET FOR H PUBLIC �EL��
OTHER REQUIREMENTS MHY HPPLY. SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS FIRE
HVAILHBLE TO INSURE' PROPER INST�LLHTION.
F" IF;? 0'��
CRTI ETFY THH
FHMILIHR WITH THE REQUIREMENTS FOR ON�SITE SEWERS
FORTH BY THE MUNICIPHLITY OF HNCAORHGE�
2� I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITA THE CODES
]� I UNDERSTHND THAT THE ON-SITE YSTEM I"IHY REQUIRE
6 BEDROOMS
RESIDEWCE IS REROD�L�0nu�c
SIGNED�~�� _ �==-
HPP�ICHNT W1LLtY�1mSum
HND WELLS HS SET
ENLHRGEMENT IF THE
\ 'r GREATER ANCHORAGE APPA COROOG ,
Deportment of Lnvironmental Qua lily
3330 "C" Street
. ; Anchorage, Alaska 91J�03
n
SOILS LOG PE' OLATION TFST
Performed for ate Pr_rforr; .+ -26e"15'
- -- --� PRI W�._._CR1REiS__�'XS.�A1tA'f1►Jc�___•-----____-- _-- .. -� . _ - - -___._
Legal Description:_ j„p-
ihis form reports: Soils log -x --— - _ _ Percolation test:
Depth
Feet
.2-
3-
4-
5 - 20 I ®"
G\N .1 85
12 - Io'— la' GM : 225
13 -
14 -
Was ground water encountered?
If Yes, at what depth? —
----
Reading
Date
Gross Time
Net Time
U
epth to Water Net Drop
Percolation rate minute.
Proposed instai latio Seepage Pit Drain Field
Depth of Inlet Depth to bottom of pit or trenci
C011,1ENTs: Sells _Jass�F � hv_rs:uo
Pr rformcd [3Y:Certified Qy: - - date:
5-33EQ-040 (6/74)
5. LEGAL DESCRIPTIONf�..
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR,,,..
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION - -
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION
0*
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPER Y ER -
PH NFA
� �
PUBLIC UTILITY
MAILING ADDR
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
PROPERTY RESI DEN (If dif a ent rom abo
PHONE
?.BUYER
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
MAILING ADDRESS
4. REALTOR/AGENT
PHONE
MAILING ADDRESS -
5. LEGAL DESCRIPTIONf�..
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑ One ❑ Four ❑ Other
❑ SINGLE FAMILY
❑ Two Five
Lid/ MULTIPLE FAMILY
❑ Three [L' --"Six
7. WATER SUPPLY
❑ INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ �GOMMUNITY
since June 1975. For wells drilled prior to that date, give well
� PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE D SPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
f _L� 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)
d
72-010 (Rev. 6/79) J'F�/ �� !/•
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
El SINGLE FAMILY
IJ' MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE
EJTWO
❑ THREE El FIVE EDOTHER
❑ FOUR CJ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
El OMMUNITY
PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SSE AGE DISPOSAL SYSTEM
L INDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
7 5�
DATE INSTALLED
7
INSTALLER
eptic Tank or ❑ Holding Tank
Size: I %,J O If Tank is homemade
give dimensions:
SOILS RATING
p
0 S�
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption_ Area to nearest Lot Line
5. COMMENTS
L7 APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE �j
BY
d
72-010 (Rev. 6/79) J'F�/ �� !/•