HomeMy WebLinkAboutHENDRICKSON LT 3
PERMIT NO.
I m::I[ ,aL IT¥ OF Fqf~C:H~--.RF-li]E
DEPARTMENT OF HEALTH 8ND ENVIRONMENTAL PROTECTION
825 'L~ STREET~ 8NCHORAGE~ AK. 99501
264-4?20
~ELL PER~! IT
)
APPLICANT
LOCATION
LEGAL
DAVID HUTTON
RIDDLE AVE
L~ B1HENDRI.,Kz, ON
f IEF..I_. ¢ DR
BO>~: t70 ' '"'
LOT -qlZE
694 940?
12900 $~2LIRRE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ~NY ON-SITE SEWAGE DISPOSAL SYSTEM IS
±00 FEET FOR 8 PRI98TE WELL; OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS ARE REQUIRED 8ND MUST BE RETURNED TO THE DEP~RTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY, SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
A98ILBBLE TO INSURE PROPER INSTALLATION.
F'ER~'I I T EXP I RES [)EmZ:EI~1BER .~-t-:iL.. ~1_'_-~79
I CERTIFY THAT
t' I BM FAMILIFiR WITH THE REQUIREMENTS FOR ON-SITE _,EWER_ 8ND WELLS 8S SET
FORTH BY THE MUNIOiF'RLITY OF ANCHORAGE.
~. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
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
NAME
MAILING ADD,I~ESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO: Well Absort~tion area~-~ , Dwelling
Manufacturer ~ ~.~ Mate[iai ~
Liq, capacity i Inside length Width
'¢ ;L~ ( IF HOME~DE:
ISTANCE
Well
DISTANCE TO: I
No. of lines ,.~ I L~ngth of each line
Top of tile to finish grade
Width
Foundation~p ~) (?
Total length of
Nearest lot line
beneath tile ~ ~
Material ._~.'L~!/~,i~/ ~'inches
Depth
Type lepth
Depth
PHONE ~ NEW
~ DISTANI
NO. O FBE D R OO~S(~
NO. '7 ~o
NO, of compartments
PERMIT NO.
in gallons'""-
· PERm o "7
Trench wid~LDistance between li~
Total effective ebso~ )don area
PERMIT NO.
To~~rea ~--
~earest lot line ~~
Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation.~_ Sewer line 'ff~ ;_.~/~ Septic tank. l_
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
REMARKS
U
Absorption area(s)¥_, ~ (~ O
APPROVED
DATE LEGAL
/ ,
~' .... "~::':::~ '!' ",~l:::' ! icl
'f'HE LE'N(};Tb) [;:' ;[ h'. .E i' ! :!_; ?. i;i?'. T?.: THE i.I:!!;.'J'L'i"i'". ,:; T.'q Ft}i!;E*'i"::' Ii)F: "f'F'H!~; 'T*~;;:,:!!i;'X;i:I'~ r"d:;? )...,..! .... · ....
THE [;:'iEF"TI'i EIF !:::i TB:E?'~E:b} Oi:;i; F'Z[T :('."~; TH.E; );)Z:i;'i'FiNCE' J!!!:)::~")"i,!~};l}!i;~",l "?HIE '.!i!,UF;?.F:'F::I(;:E; OF:
O!:;;%iLli"J[;:' F'~NE:' THE; E:ErT'i'OP)I;'d::: THE.'; )i~:;:.:',E:F!',/F:!T ;E ON ,:;lIN
'Tt.tE~'.I!:; ii; :~!; NO :::!;t:~;T N '.)i )?I,'i.) F'OR
'r'lhr'Z (;iiJ:Ri::¢,,,'t~:.L. E:,E!:::'T).! ;ii:!!i; 'T'NE i"!XNiEhlUhl f':,!EF'TH OF: E!iI:;i'.F¢,/I.i{I_... t2, E"f'!,.E;%N 'T'!"!E OU'i*'Fi:::&..! F:';~F:'F:'
F::~ND THE E'.O')"'TEd"I ];;;iF::' '1"l-H:!i; F!}Z;:.:;CFI'v'F:~T*];EI?.,) ':;:);!",i
]2
St, even A, Johnson "~" ~ ~i Soils Log
BOX 76 A Percolation 'Pest
Chugiak, Alaska 99567
Phone: 688-3085
Legal Description
Test Pit I,ocation
CL
o +o I'
Total depth this test ....... /~ feet
AVENAi3E A]3SOiPd~'%'!ON Ai%EA P'&i~E.iii~D FN. OF, SOILS lsOG = ___i~h~_% .... ft,2/bdzl~'
Percolation rate
~' ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PR-OTECTi'~ .~, ,, ,,Z..~ ,7,-'., ~-"f~--
825 L Street - Anchorage, Alaska 99501 ,' ~NVI,~ONM[NT/\L I-;~J~
ENVIRONMENTAL ENGINEERING DIVISION jun 9 'i;}Tg/
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplbte requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
~MAILINGADDRESS
PROPERTY RESIDENT (If differ~from abov~ PHONE
2, BUYER PHONE
MAI LING ADDRESS
3, 'LENDING INSTITUTION I PHONE
MAILING ADDRESS
4, REALTOR/AGENT ~ PHONE
I
MAILING ADDRESS
5, LEGAL DESCRIPTION
STR E ET LOCATION
5. TYPE OF RESIDENCE
/~ SINGLE FAMILY
~l~ MU LTIPLE FAMILY
NUMBER OF BEDROOMS
[] One ~ Four
[] Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL~
[] COMMUNITY
[] 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**
[] PUBLIC UTILITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EAcH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL'USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DA'rE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [~] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] 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 DATE INSTALLED
E~PUBLIC UTILITY /0 r- ) Off/'
Connection Verified INSTALLER
E~]Septic Tank or []Holding Tank ~.~
Size: /~.~-o If Tank is homemade SOILS RATING
give dimensions: I
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES Septic/Holding Tank Absorption Area ISewer Line Nearest Lot Line
1
WELL TO:
Absorption Area to nearest Lot Line
E~--'~CONDITIONAL APPROVAL (let~.~nust acco~4pan~certificate)
[] DISAPPROVED YZ (
72-010 (Rev. 3/78)
(~NIL~IX3)