HomeMy WebLinkAboutLELAND STANFORD LT 2
NAME
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
MAILING ADDRESS
LEGAL DESCRIPTION
LoT
LOCATION
DISTANCE TO:
Absorption.~aarea
Liq, capacity in gallons Well
! 1~5~ IF HOMEMADE:
DISTANCE TO:
DISTANCE TO: .I20 +
No. of lines / Length of each.~oline
Width
Top of tile to finish grade
Length
Inside length
Dwe[ ng
Foundatio2~
Dwelling
Material
Width
PHONE ~N~W
~qq'~7¥9 [~] UPGRADE
NO. OF BEDROOMS
PERMIT NO.
No, of compartments
Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
Nearest lot line_.
Total length of lines Trench width ,.
~ 0 ~;~(~ r inches
Material beneath tile
~ ~ inches
Depth
PERMIT ~./~ ~
Distance between lines
Total effective.~s~t~.~ area
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Driller
DISTANCE TO:
Class
Depth
Sewer line
Building foundation
Distance to lot lin0
Septic tank
PERMIT NO.
Absorption area (s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
DATE
LEGAL
FEE~ ~OLLECTEO 8Y~' O~ FICER: ~
H :[ I'.,I :[ HUH r.:,i':ii::'T'F:INCE: E:ETI,JI!::E:I'.,! F:I HE:LL FIN[:, FIN'/ O1'.,F-.'.:.i;:['I'IE SEHFIGE I)!SF'O:~;FiI.... '.~!;'~.',.E;"r'l~!:r,'l i:5
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I...IF'E. iN THE TS.'F'E: O1::' F:'UDLIC NELl ....
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TO FI COI',1HUI'.,!:[T'./ ':T,i~!..:HE~:~: L~1'.,IE: ]:'"_-:; 7'5 FIEE:T.
HELL. L. OG'.5 FII:~:E F'.E6:!U:[I.~:E:D', FII'.~[::, I',IU~ST BE: F.'.ETLIF~:NE'E:, TO 'I"HE [::,EF'F:t[;Ui"FIENT I,.! :[ TH ]: t'.,I 2W.i C:,FI'~.':.~;
OF' TFIE NE:L.L. COHF'LE.:T.T. 01'.,I.
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FI'v'FI :[ I....F:tBL. E TO :[ t",l~SLIf~:[;: F'F;:CIF:'ER~ T I'.,IS'rFII_L. FIT :[ 01'.4.
Z CEF:'r'IF'./ THFIT
Z: 1' F.'IH F' FH'¢I :I: L.. :[ Fi [;: I.,.I:I:TH THE Fi:E6:!UZF:E:HE!'.,II'.'E; FOF'. ON...*:5]:'T'E: %EI.,.tEF;i'.:.~; FINE:, HELL.:E;., FI'.~!; ~i;E"f'
FOWT'H D'.r' 'T'FIE HIJN ]: C :1: F't:::IL. :[ T'~' OF FtI'.,ICHO~'.FIGE:.
Z:: :1: I.,-!.T. LI.._ !F,IETFILL THE :5'~':..STE:H ZI'.,I FtCE:OF:.:E:,FINCE !.,.I:[TH 'THE
.':.~.: ~ ..I1',IL:L:F...i.;'I'F:tNE: THr":iT ]'1'-I~: OI",I-..5ITE .::-;E:HE:F... .5~..~;TEH HFI~, F..E:i.:.:!UIRE Ei1'.,IL. FII.,o.~::.I,11::I.,II ZF !I-HiE
F,.E.::,I£.,I::NL.E'~ 1::, F!',EHOE:,EL.E:E:, Fu INL:LUE:,E. HUF.':E TFIFIN d. E~EF.,:,I;;:OOI',I:~:5. ---
,znpllng
DESCRIP TI ON
So// lype~ colo6 texlur~
e.~tlrnated porHcl~ sFze~
somple~' driving
depth~ circulation Iost~
no/es on drilling
Vegalallon ;
o Box 3 '~2 ~:C~ "
PHONE 34~-3792
D R I L L E RCS W E L L L'O G
LOCATION '-.~t-:' ,lc (/t~,</. ;' .~..../ ~-'~, /~,. ,<',..-z' ..:> ?,;'/,;,,
SIZE ,/,;., DEPTH ?.:/ CASING DEVi-H ¢.
- ~-, / GROUTING DFPTH
YIELD .,~- /,-"?/2~,~- STATIC WATER LEVEL?/~.'7" HOW TESTED ~.~
PUMP INSTALLED _e.., , F/,<~:;yE,~ TYPE ,'" ×' ".;.;¢/. ~.~,./¢ 2
FORMATIONS ENCOUNTERED AND APPROPRIATE DEPTHS
TO, ~;-~
T0..~
TO/"
TO ?'./
__ TO
TO
, TO
TO
M~j.N!C!pAI ITY O[: ANCHORAGE
DF. PT (7': I'!,~'ISH ~''
__ TO
__ TO
__ TO
1982
nrr_r. u D
__ TO
APPLI NT FILLS OUT UPPER HAl ONLY
, / ~./~. c'"'~l PHone
Buyer
Address Zip Code
Address .,~'~, ;~ [~- Zip Code
Realty Co. & A~nt Phone
Address Zip Code
Legal Desc~tiop' i f:-~ / / /'~ .
Type~_._ of Resi~nce Family
~ Multiple Family , No; of Bedrooms
~ Other
Water Supply
~ .Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
.-~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE iNSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESStNG CAN BE INITIATED.
Time Time Time Time
Date Date Date
Inspector / ~ Inspector Inspector Insp~tor
(~) APPROVED BEDROOMS ~IO~F~ER~AL
( ' ) CONDITIONAL APPROVAL*
Soils R~tlng Date ~wer nsta ed'-i;~z~,,.,. ~)~ Well To Absorption Area f~.t, , Well Log Received
}~ = ::~ q,. : ~ Welltomank //0 Septic T~k Size
72,023