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HomeMy WebLinkAboutGRANITE VIEW BLK 6 LT 8' Olff 301 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 [PHONE NAME MAI LING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: Manufacturer G ' Liq. capacity in gallons IF HOMEMADE: DISTANCE TO: No. of lines IAbsorption area \0 Widtb-~ Dwelling ND. OF BEDROOMS PERMIT NO. Liquid depth PERMIT NO. Liquid capacity in gallons Well Foundation PERMIT NO, DISTANCE TO: Total length of lines ,[ Materi a~l G~__[ ~ ' o Material beneath tih; Depth inches Crib depth Building foundation Driller Sewer line Length of each line Top of tile to finish grade Leogth Type of crib DISTANCE TO: Depth DISTANCE TO: Building foundation Distance between liqes ~ 1 ~,~ Total effective absorption area PERMIT NO. ' Total effective absorption area Nearest lot line JPERMIT NO. "~1~ Distance to lot line Septic tank OTHER PIPE MATERIALS SOIL TEST RA~ING '~C) O .~ DATE LEGAL .... : ' ]: :!i; I't:;;'I:::H :1! TI'II!:: L.[:i:l",ll:i'l"H I::' ;: 1'"1[i:I",t:!:!; ;: I::I!'.,t :I: :ii; '1"1 'ffi:; !..E:N~}iT'II ':: ): I",1 I:::!!;[i!:i' ::' 01: I I"11: '1F;'.[:i",K::H 'Fill::: I::il~:()l...ll'.,![) l:::lh,ll::, 'll't[i: I:~CrlTOI"I Of::' '1'!'1[; [':;:':;(;:I:::I',)I::!X :[ ~:;:1t",! ':: ]: I',1 I:::'l::!i:'l ::,. T t- !Iii: F;:[!:: 'ti'Il:i: FII",!I) "1't 'Il:i: SOILS LO~ MUNICIPALITY OF ANCHORAGE DEPAR'FMENT OF HEALTH AND ENVIRONMENTAL PROTEC¥1ON' D PERCOLATION Pouch 6-650, AnchorNl~, Alaska 99502 276-222'l TEST SOILS LOG- PERCOLATION TEST S LOI rE / / .\ SITE PLAN 8 ENCOUNTERED? 12 IF YES, AT WHAT 13 DEPTH? Reading Date Gross Net DeFth to Net Time Time Water Drop 14 15 17 18 19 20 PERCOLAT(ON RATE (minutes/inch} TEST RUN BETWEEN FT AND ---- FT 72-008 (7/761 [] SOILS LOG ,:.: -% MUNICIPALITY OF ANCHORAGE · /?-[~ -,~ '[~/ PERCOLATION ,. · ~,~..~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST II~.~i[l'~ J!l Pouch 6-650, Anchoraga, Alaska 99502 276-2221' ~ SOILS LOG - PERCOL. ATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop TEST RUN BE~EEN ~_ . FT AND © © © 0 © © © © © 0 © © DATE RECEIVED ,r INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATF- MUNICIPALITY OF ANCHORAGE MUNICtPALI~ OF ANCHORAG~  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~Ep[, OF 825 L Street - Anchorage, Alaska 99501 ENVIRONMENr, xL [ ,t;~'i ~CTION' (~) ENVIRONMENTAL SANITATION DlVlSlONTelephone 264~4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~E DIRECTIONS: Complete all parts Oll page 1. Incomplet~ requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER ~ PHONE I MAI LING ADDRESS PROPERTY RESIDENT {If different from above) PHONE ~ ~ PHONE MAILING ADD~ESS 3, LE~DINGIN~TITUTION . ~ PHON~ MAI LING ADD~E~8 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS  I~] One [] FOur SINGLE FAMILY [] Two [~ Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY PUBLIC UTI LI-fY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available~) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLEDi NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE pROCESSING CAN BE INITIATED, 72-010 (Rev, 6/79) l/-~) ---~ THIS SIDE FOR OFFICIAL USE ONLY I1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SlX 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 []PUBLIC UTILITY ~ _~ ~ Connection Verified INSTALLER []Septic Tank or [] Holding Tank \~. '~ Size: .,/~-7..30 If Tank is homemade SOILS RATING give dimensions: ~(~ TYPE OF TANK MANUFACTURER i~1. ~.' TOTAL ABSORPTION AREA MATERIAL WELL TO: / d O Absorption Area to nearest Lot Line 5. COMMENTS "~] APPROVED FOR ,-~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany/ee~ificate) [] DISAPPROVED DATE BY MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SI-'WER FACILITIES DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing, 1. PROPERTY OWNER ' PHONE MAILING ADDRESS' PROPERTY RESIDENT (If different fro~ above) -- PHONE 2. BUYER PHONE MAILING ADDRESS 3, I. ENDING INSTITUTION I PHONE V1AI LING ADDF~ESS ..... i ' 4, REALTOR/AGENT ! ' I PHONE MAI LING ADDRESS 5. LEGAl. DESCRIPTION STREET LOCA'TION ' 8, TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two ~] Five [] Three [] Six Other 7. WATER SUPPLY NDIVIDUAL" [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYS'rEM INDIVIDUAL/ON-BITE** PUBLIC U-'I LITY ATTACH WFLL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, (~i ve well depth (attach log if available.) f individu8 /on-site, give installation date ! f 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 DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1, TYPE OF' RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY b~ TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY I~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DA'rE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or E]Holding Tank Size: ~5'6)O If Tank is homemade SOILS RATING give dimensions: TY~ 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 APPROVED POR _(' BEDROOMS [] CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED DATE BY (Title) /---/ LEGAL DESCRIPTION 72-010 (Rev, 3/78)