HomeMy WebLinkAboutSCHROEDER LT 25Schroeder SID
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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
NAMELPHONE
lil o ❑ UPGRADE
MAILING AD FESS
LEGAL DESCRIPTION --
LOCATIO cc
NO. OF BEED�DROOMS
v Y
DISTANCE T0:
Well /�� Abso tiign area
/
DwellincL j
PERMIZJVA.0
o- Q
Manufacturer
Material
No. of compartments
n gallons
I_iq. capacity i��
DQ
IF HOMEMADE:
Inside length
VV, 11,
Liquid depth
OJaZ
DISTANCE TO:
--
Well
Dwelling
PERMIT NO. �s
2,-<
Manufacturer
Material
Liquid capacity in gallons
®
-i=
U
DISTANCE T0:
Well J /
Found�tio
Nearest lot lire
PERI
a�
a w Z
F. z cc
No. of lines /
Length 9 ea J lne
Total le h,& Titles
L �}
Trench w
inches
Distance between lines
xF
0
Top of tile to finish grade
Material beneath tile / /
l4 inches
Total effecJve absorption area
�)G0
w
(7
Length
Width
Depth
PERMIT NO.
I F-
w
Type of crib
Crib diameter
Crib depth
_
Total effective absorption area
y
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
-1
Class
Depth
Driller
Distance to lot Iine4
PERMIT NO. A
�>
'
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption
OTHER
�areas)
PIPE MATERIALS
SOI L TEST RATING
—
-
INSTALLER
REMARKS
2 CJS G�fJ L�
atq
Ic
coo
J
APPROVED DATE LEGAL
2-lll31HP.V. V/X1
RVI ����X F_`11 9 1p: * V �lr", ����C_': 11 1 ����
�
DEP8RTMENT O/ HEHLTH HND ENVIRONMENTHL PTECTION
825 /L STREET/ RNCHORHGE/ HK99L �
264~4720
C, p"i~^"T lK-4 �H, I C Fr, VD, N 9 0
`iPERMIT NO
�
RPPLICRNT WHYNE C0USINEHU PO BOX 76I ER
LOCRTION MHRCUS ST
LE(ii HL 1...25 SCHROEDER S/D
LOT SI2E 12000 SQUHRE FEET
TYPE OF SOIL HBSORBTION SYSTEM TRENCH
MHXIMUM NUMBER OF BEDROOMS � ] SOIL RHTlNG (SQ FT/BR)� 98
THE REQUIRED �IZE OF THE SOIL HBSORPTION SYSTEM IS�
�������= nK.. ��VA H31 " If- � �Q 10 "VEH: L.. RED PIE �M 1-1 ==g GL
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DITHRICE BETWEEN THE SURFHCE OF THE
GR0UND HND THE BOTTOM OF THE EXCHVHTION (IN FEET)
THERE IS NO SET WIDTH FOR TRENCHES
THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
Hot PEE Ge U 1: IT: to! to. IS us: Fw w 1: av no; �lin �� :1. IER Q CA ��U.
PERMIT APPLICHNT HRS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURIHG THE
INSTHLLHTION INSPECTIONS OF HNY WEL[S RDJRCENT TO THIS PROPERTY HND THE
NUM8ER OF RESIDENCES THF -11, THE WELL WILL SERYE
A: 1=2 PEE NO W 1 C) PAN EEL A FT TH to! PHE (71 u x in! a It,
BRCKFILLING OF HNY SYSTEM WITHOUT FINRL INSPECTION HND RPPROVHL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTHNCE 8ETWEEN R WELL HND RNY ON~SITE SEWHGE DISPOSHL SySTEM IS
1Q0 FEET FOR H OR
150 TO 200 FEET FROM H PUBLIC WELL DEPE@DING UPON THE TYPE OF PUBLIC WELL
OTHE� REQUIREMENTS MHY HPPLYSP�CIFICHTI�NS HND CONSTRUCTION DIHGRHMS HRE
HVHILH8LE TO I�SURE PROP�� INSTHLLRTION
������ ������� ������U��� ��� ����-
I CERTIFY THHT
1� I HM FHMILIHR WITH THE TE SEWERS HND WELLS HS SET
FOHTH BY THE MUNICIPRLITY OF HNCHORRGE
2� I WILL INSTRLL THE SYSTEM IN HCCORDHNCE WITH THE CODES
]� I UNDERSTRND THHT THE OH .... SITE MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THON ] BEDROOMS
SIGNED� ~~... ..... .... �~~^~�~~~^~~�~
HPPLICRNT WHYNE COUSINEHU
G Et E GE TECHNICAL Efi DEVEL-OPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-22.80
Russell Oyster
694-2774 $OIL LOG Earl Ellis
Soils Et Foundations 688-2280
Land Development
Performed for: Name:
1LSINz- �; / �.� el c - "--Tel. No.
Mailing Address:
Legal Description: _2,-, /V X'_
De th feet
Soil Characteristics
0
1
2
3�
i
6
7
1
8
9,.
11.
12.
13
ILL e r t; r.
15
16
m�
Ground Water Encountered: Yes- No. (-- If yes, what depthe�_
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by:
(�.rrttftrb Brining i-Eug
by
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 6942588
OWNER OF LAND ? i ;.-,,; - '_) �_
ADDRESS
LEGAL DESCRIPTION i _ -' ;'' i`l , r I•=<.='
DATE - Started Ended Z -%
PERN4IT NUMBER
KIND OF FORMATION:
DEPTH OF WELL "
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR > ='
KIND OF CASING`
From
Ft. toFt.-0�-''�,'
i?iJ, �r-!
From
Ft. to
Ft.__.
From
Ft. to
Ft.
J/) `-'/ `t
f4?":'.'' _ --
From—
Ft. to—, ----Ft.
From /"
_Ft. to��;-'
Pt."-
_) �i' r^-�
Froin___
Ft. to
Ft.
From ' '
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to �`` "
Ft.—
'� ;' `„'-�
-..
�'
From--
o
Ft. to---Ft----
Ft
From ,-
From
Ft. to 6
_Ft.
Froin- --Ft
to
Ft. — —
From_
Ft. to
Ft. ----2,-/
;'` <-_
From
_ Ft. to___
Ft.
Froin. -Ft.
to
Ft._
From_
Ft. to
Ft.
Froin—Ft.
to
_Ft.
_
Froin—Ft.
to
Ft.
From
Ft. to
Ft._
From
Ft. to---
Ft.
_
From_
—Ft. to—.
Ft.
From
Ft. to__
Ft.
—
From
Ft. to
Ft.—
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to _Ft.
From
Ft. to
Ft.
--
From
Ft. toFt.—
_
From
_Ft. to
Ft.
From
Ft. to
Ft.
From
_Ft. to
Ft.
From
Ft. to
Ft.
From
_Ft. to
FL
Frmn
Ft. to
Ft
MISCL. INFORMATION:
DRILLER'S NAME
�°:::� p::::c-11=���� �-��'II :II:...,IL... ll'�:: ,.;; ��:::_ .fl: IfT-.". [iii:."==i:�: :_=� Iii::. °--:" Ila_: q`,��I Epi::" ��=:�: h=�^ :::��::::a�_. _�� ::JI_...".i� �7.r, ...^.,, ,,,.;,
: _._
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264••4720
Application Date
'I. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdi ;Sion, section, township, range)
- -— _
Location ( ddress or directions)
(h) Applicant Name Aron"
_._—. Hm
Telephone: oe Businessusiness
/�
Applicant Address ----
(c) Applicant is (cheek one): Lending Institution Owner•/builder, Buyer El ; Other Ca (explain);
(d) Lending Institution �f�C>r / /t'C/L Telephone
Address .-- -- -- --- j 1—
(e) Real Estate Company and Agent
Address—— — -----
Te,I 'phone ----------
(f) .,ai]rl e HAA to the following address:
81 zRO 1296X
W_ .�
2. TYPE OF RESIDENCE
Single-Familyy Multi -Family ❑ Other
Number of Bedrooms -- —_') __---_
. WATER SUPPLY
Individual Wella Community 1-1 Public D
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
OnsiteX Public 0 Community L 1 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 o', 02',,, n 1 84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEAACFI, DATA AND INFORMATION
R
Apr-
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investiga,: 'n of this t ;ealth
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functiorsl and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the infor--ation ol;tained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site wat.e- supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regul.,t nr.s in effect on
the date of this inspection.
Name of Firm
Address
Date
;.j�5?
Telephone
�/.
k.
AIreG'f'L�(?1 1 bedrooms by � "=� � —� ?:--T.�
Approved for / l Date
Approved _— _ Disapproved/L_____._.____ Conditional
Terms of Conditibnal Approval
CAUTION
--ILIT� — ---- — --
1
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Au'.`crity
Approval certificates based solely upon the representations given in paragraph 5 above by an independent profesa•snal
engineer reei.;tered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes ant their le -"Ing
institutions in order to satisfy certain federal and state requirements. f:mployees of DI IEP do not conduc! +nspect,c-6 or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions the
professional engineer's work.
Page 2 of 2
• �,urY OF
�NVIRpNMEN�g1E �E�0 Ge
MUNICIPALITY OF ANCHORAGE (MOA) PA'ON
HEALTH AUTHORITY APPROVAL (HAA) l' ?C
CHECKLIST - FEBRUARY 1984
264-4720 ecrl j t'D
Legal Description: , 5 —
A. WELL DATA
Well Classification — s I If A, B, C, D.E.C. Approved (Y/N)
Well Log PresentON) Date Completed - 3\ `19 — Yield 4—
r t
Total Depth e2l 2 Cased to °`� ''� Depth of Grouting �>
Static Water Level — Pump Set At — t'_)- K
Casing Height Above Ground — `,7 Sanitary Seal on Casing GIN)
Electrical Wiring in Conduit 19N)
Separation Distances from Well:
To Septic/Hek4pg Tank on Lot 1 r� r=
Depression Around Wellhead (Yo
On Adjoining Lots _tL=_'ca `s
To Nearest Edge of Absorption F=ield on Lot �a�` F On Adjoining Lots t
To Nearest Public Sewer Line r, (A To Nearest Public Sewer
Cleanout/Manhole ''S r'� To Nearest Sewer Service Line on Lot
Water Sample Collected by e S ��� <� ;(LC" ; Date _
Water Sample Test Results
Comments
105C_rA�s�
B. SEPTIC/HOLDING TANK DATA
Date Installed 6` r? – r 9 Size No. of Compartments
Standpipes &N)
Depression over Tank (Y( Iy
Air -tight CapsON)
Pumping/Maintenance Contract on File (Y/N) r3
Holding Tank High -Water Alarm (Y/N) 1'� LA
Separation Distances from Septic/WeWP* Tank:
To Water -Supply Well \='r
Foundation CleanoutON)
(Date Last Pumped _ 2–? -0 -
; for .1
Temporary Holding Tank Permit (Y/N)�
To Building Foundation
To Property Line To Disposal Field
t
To Water Mein/Service Line/ l `Y To Stream, Pond, Lake, or Major Drainage
Course 41A
Comments
Page 1 of 2
X
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata _'9 13'x')AA-) .
Date Installed
Width of Field
Type of System Design .Tynfo
Length of Field 12_;�'
Depth of Field __ N Car
Gravel Bed Thickness Z
N --
Square Feet of Absorption Area 6bo c� Standpipes Present, Y?N)
Depression over Field (Y/9 _ _ Date of Last Adequacy Test to-2-6—
Results
-2.6—Results of Last Adequacy Test SA'i'rLS4"=
Separation Distance from Absorption Field:
To Water -Supply Well L 1.} To Property Line C ' ( k
To Building Foundation t ` _
To Existing or Abandoned System on
Lot /Ya On Adjoining Lots � � `
To Water Maid, Service Line U`� r k To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course �A _
To Driveway, Parking Area, or Vehicle Storage Area 15� ('t -
Comments
LIFT STATION
Date Installed
Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I have checked, verified, or conformed to all�MO/A� and HAA guidelines in effect on the date of this inspection.
Signed=.'aOEP1 Fli��'}
311- f33; — ---- Date 3 a S',.S
Coriia}�yIU6� 6,GAKE�ZuZ — MOA No. _ o
,� •aa+at��;
Receipt No. 5�UIX) �
Date of Payment�ff
Amount: $ 4q4a
Page 2 of 2
72-026 (11/84)
�`—
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
•
ENVI RONMENTAL SANITATION DIVISION
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 110) days for processing.
1. PROPE OW/�ER PPFIg�
L4CC f, t✓ y / ///��e%C,��
MAILIN ADDRES
PROPERTY REST E T (If different from above) PHONE
2. BUYER j ^ (
PHO�L,E
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
MAILING A ESS s _
3. LENDING INS ITUPHONE
TION � J� � '
MAILING ADDRESS__
4. REALTOR/AGENT P N
MAILING ADDRESS } /_
c!
5. LEGAL DESCRIPT ON
ST 'EL L CpATION
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
SINGLE FAMILY
❑ One ❑ Four ❑ Other
❑ Two ❑ Five
❑ MULTIPLE FAMILY
Dl� Three ❑ Six
�—s�—
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 UTILITY
depth (attach log if available.) _
8. SEWAGE DISPOSAL SYSTEM
❑ 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 1 Rev. 6/79)
72-010 (Rev. 6/79)
�—
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
❑ TWO ❑ FOUR ❑ SIX
PERMIT NUMBER s
2. WATER SUPPLY
❑ INDIVIDUAL
DEPTH OF WELL —
❑ COMMUNITY
❑ PUBLIC UTILITY
DATE DRILLED –
Connection Verified_
LOG RECEIVED —
PERMIT NUMBER
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY�7
Connection Verified
DATE INSTALLED ---
❑Septic Tank or ❑ Holding Tank
INSTALLER —
Size: 1000 _ If Tank is homemade
give dimensions: _
SOILS RATING —
TYPE OF TANK
MANUFACTURER —
TOTAL ABSORPTION A13EA
MATERIAL
n
4. DISTANCES
WELL TO:
Septic/Holding Tank Absorption Area Sewer Line' Nearest Lot Line�—
��
Absorption Area to nearest Lot Line
�1�
5. COMMENTS
----s --
❑ APPROVED FOR 3 BEDROOMS
❑ CONDITIONAL
APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
b -1- —�
BY
72-010 (Rev. 6/79)
71 14, 19c2
fl)7.
05 oa<esn St.
-77
Amjee«: fat 5 S »oeJev Si Jivieim1
o vzt .1- «o=1-mli-vi-clun 1, row -1
-1110 ware!
j. 1, i ties
can mm
>3 3raeEeo lint -Al the- «011 I=e item
save
li0oli
Thn w""Itnr alla 7
C) x,
to
3 20
56.33
c ot
oily rnv-
t
m 6 I -A C-11 to
is
Please t , flls v%nt FOY, » <einupectim\on L
noted a
«»netea, I£V'horc are ai'VII
oTtice at 2 � I I a ---] 7 2 0 -
gi'lloo-coly, ,
RPInG/r 0®
s f l
TZ
MUNICIPALITY OF ANCHORAGE
MUNICIPALITYDEF. C1 ANCHo
DEPT. or I ALTI1 &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI" CTION
tiVVIRONMEN7'
_ 825 L Strout • Ancfiorago; Alaska 99501 -
•
ENVIRONMENTAL ENGINEERING DIVISION FEB I
Telephone 264.4720 � r k�Y E D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEiWE t � I S
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processad. Please allow ten (10) days for processing.
1. PROPER Y OWNER
MAILING A ESS
PROPERTY RESIDENT (f dif re o bove) Aglow? ! -
PHONE
2. BUYER —_
O E—
MAII_IN RE�
3. LE ING INff11lqr0N PHONE
MAI LI NGADDRES _—
4. REAL OR/ 11 - HC- HC1
MAIL �DD S�____����Aide Z7. Adf�VJ6 J" me
5. LEGAL DESCIPTION W —'
STREiET LOCATION/
Im
6. TYP�RESI NCEOle �� �— -�—
NUMBER O ED OOM
SINGLE FAMILY ❑ One ❑ Four ❑ Other
❑ Two ED 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 pr'or to that date, Giv well
_
El PUBLIC UTILITYdepth (attach log if available.)®
B. SEWAGE: DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date
❑ PUBLIC UTILITY 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.
10 ni/0/101
SD
VIG
THIS SIDE FOR OFFICIAL USE ONLY
--- -.
INSPECTION APPOINTMENTS
DATERECEIVED . -
TIME
TIME
_
TIMI?J
DATE
DATE-
DATE
-
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE a
--EJ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER of BEDROOMS
❑ ONE --❑ THREE D FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2, WATER SUPPLY
INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified_LOG
PERMIT NUMBER
1�
DEPTH OF WELL
--- s
RI
DATE DRI _ LED
_ )i
RECEIVED
3. SEWAGE DISPOSAL SYSTEM
-EOINDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified -_
PERMIT NUMBER
C) Ltin,
DATE INSTALLED
R_--) _-)t
INSTALLER
]Septic Tank or ❑Holding Tank1n
Size; 1C)C)C). If Tank is homemade
give dimensions: —_
SOILS RATING
GlR
TYPE OF TANK
MA
_
UFACTURER
TOTAL ABSORPTION AREA
MATERIAL
Septic/Holding Tank -Absorption Area Sewer Line- Nearest Lot Line
Fes' \C�(_'n' _—
�. DISTANCES
WELLTO:
Absorption Area to nearest Lot Line
5. COMMENTS
]./APPROVED FOR ,ZBEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
-
DATE -
BY (Titles)
LEGAL DESCRIPTION
72.010 (Rev. 3/78)