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HomeMy WebLinkAboutSCHROEDER LT 28Schroeder Sip LAS 61mr... G'ATER ANCHORAGE AREA BORO`7H HEALTH DEPARTMENT Na 628 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME / /C i� c!/L-� ��rr/� ADDRESS aI UC& PHON 9_2764 LOCATION1tU 17797?wN�j-LEGAL DESCRIPTI SEPTIC TANK: DISTANCE FROM WELL 7 / ' LIQUID CAPACITY GALLONS. EEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF JERIAL ©/tJ�/ COMPARTMENTS /�ovwolj-eb al - INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH_ NUMBER OF PITS / OUTSIDE DIAMETER —OR WIDTH /'5 / LENGTH /7 l DEPTH Q/ pi 11 Q / LINING MATERIAL D /ro X �� DISTANCE FROM WELL-BUILDING J, BUILDING FOUNDATIONp NEAREST LOT LINES TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SI SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF FOUNbATION , NEAREST LOT LINE - CE BETWEEN LINES-,. TRENCH WIDTH TOTAL LENGTH OF LINZ IN. TOTAL EFFECTIVE ABSO5KION AREA SQ, FT. LENGTH OF EACH LINE_ - DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL:y� �Q DISTANCE FROM y j WATER TYPE iQeJ11e1Q DEPTH BUILDING FOUNDATION._ —SAMPLE p NEAREST LOT LINE /NEARE/O !�' , EWERSLINE_ TANKC_L_ SYS TE q� / _, CESSPOOL SOOURCES&at DISTANCES: DIAGRAM OF SYSTEM V fwd I DATE /�®��/ APPROV.F.D=_ NAME OF GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT Li{���- e �1 �rye MAILING ADDRESS INSTALLATION LOCATION // LEGAL DESCRIPTION %...� INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE. SERVED FINANCED THROUGH ' X SOIL TEST RESULTS �� ✓ COMPLETION DATE ANTICIPATED "��✓` !� ke i ester SEEPAGE PIT DRAIN FI ✓ 14 /J' Inn / / () r/ PERMIT NO. /d LY PHONE OTHER TO BE INSTALLED BY - ..` 1' - NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /'" �`�, /v/ TYPE SEEPAGE AREA SIZE L`" �` �'J TYPE MINIMUM DISTANCES, REQUIREMEF�,TS FOUNDATION TO SEPTIC TANK �7 FOUNDATION TO SEEPAGE PIT � DRAIN FIELD ? SEPTIC TANK TO SEEPAGE PIT WALL ?� SEPTIC TANK � SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK �F SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT / LI DRAIN FIELD �~ _ r / SEPTIC TANK, ��� SEEPAGE PIT /y �l DRAIN FIELD . TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING /INSTALLATION. HEA LT hi AUTHORITY OR LICENSED DESIGNER DIAGRAM- OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA 130ROUGH ORDINANCE DESCRIBEED� 7SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE'APPLICANT'S APPLICANT'S SIGNATURE 28-68 AND THAT THE: ABOVE 1 NAME OF GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT Li{���- e �1 �rye MAILING ADDRESS INSTALLATION LOCATION // LEGAL DESCRIPTION %...� INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE. SERVED FINANCED THROUGH ' X SOIL TEST RESULTS �� ✓ COMPLETION DATE ANTICIPATED "��✓` !� ke i ester SEEPAGE PIT DRAIN FI ✓ 14 /J' Inn / / () r/ PERMIT NO. /d LY PHONE OTHER TO BE INSTALLED BY - ..` 1' - NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /'" �`�, /v/ TYPE SEEPAGE AREA SIZE L`" �` �'J TYPE MINIMUM DISTANCES, REQUIREMEF�,TS FOUNDATION TO SEPTIC TANK �7 FOUNDATION TO SEEPAGE PIT � DRAIN FIELD ? SEPTIC TANK TO SEEPAGE PIT WALL ?� SEPTIC TANK � SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK �F SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT / LI DRAIN FIELD �~ _ r / SEPTIC TANK, ��� SEEPAGE PIT /y �l DRAIN FIELD . TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING /INSTALLATION. HEA LT hi AUTHORITY OR LICENSED DESIGNER DIAGRAM- OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA 130ROUGH ORDINANCE DESCRIBEED� 7SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE'APPLICANT'S APPLICANT'S SIGNATURE 28-68 AND THAT THE: ABOVE REQUETr—rOtC- P@i/AL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) 71F Name of person requesting approval_ L .-'Y (�'�7%'/ C/ � 1 2. Name of property:owner 3. LePal descript 4. Number of bedrooms in housed , 5, Water .Analysis a. Bacterial e , b. Detergent 6. Well data: a. Type b. Depth C. Casing Size rj d. Distance from well to closest existing or proposed: 1. Sewer line 2. Septic. tank -AWL- , 75 3. Seepage Area.. /05- 4. Cesspool' 5. Property Line n n V 6. Other sources of possi.hle contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. 7. Sewage disposal system, a. Age of system ` b. Septic tank capacity in gallons l% c. Name of septic tank manufactuMv 1. If "home made" show diagram on reverse side of this form. d; Disposal field or seepage pit size and type 1. Distance to property Zine to house flu4ndation� m; e, Percolation Test results , f. Percolation Test performed by �. Use the reverse side of this form to show diafrae, ➢imam should include the following information: property lines; well location, house location, ngyp*ic tank location, disposal area location, .location & percolation test, awd direction of ground slope, 9. The toynt%%tion on this fora, is true and correct to the best of my knowledge. Sz nature r,pnit nt � � Date S�pned TO_BE FILLED OUT BY HEKTH DEPAPT ST PERSONNEL The above described sanitary facilities are hereby approved, subject to the .`ollowing conditions: Conditions: The above described sanitary facilities are disapproved for the following, reasons: Sa. attire o��i-, �c.• �.e�r'.`.�,_.�..,.�_-�..� �. _ _��,.—�.. •Date—'�' �.—.t, :'c .'. Approval is valid for one year following the date of approval, CPJ:cw REPORT OF INSPECTION—INDIVIDUAL SEWAGE -DISPOSAL SYSTEM PRIMARY TREATMENT consists of ❑ Septic tank. ❑ Cesspool. Septic Tank: Distance from well, feet. Total liquid capacity,_ Inside length, feet. Material, _ Number of compartments gallons. Capacity inlet compartment,_ gallons. Inside width,_ feet. Liquid depth, _feet. ._ .:,' - ,i �. t -- •. z ti - - - it 1 i�, -- • • • ■ _ mom 0 NEI No a IN:■:::....■■:■.. C..■......■....:.:...■..0:..;.:■■....;;.:C...B.■ :... ::.... ■ . .:::: ..... ..■�...... ....;......■.....■... a ..................... .. ....■ ■..■ ............ .r. r.■....i .r no �. ;■:::::::�:::::5�:::� .. ... .................... . ..... ..... ....:.:: am 9::.:_ .. ■ ■■■ . ■■ ■ ■ ■■■■ ■■.■■_....0 ■i ■rr.r ■ ■■ �� I■a ��a .■■ ....■■a ■. ■. ■� a- on am ...ON ;■.on on ... ME ■. .■ ■■ ■.;�:;.:■ ......... .. .■;:..■.:..■. . ... M:■ ■ �..■� :.:...:.. �: . . . . f�T REPORT OF INSPECTION—INDIVIDUAL SEWAGE -DISPOSAL SYSTEM PRIMARY TREATMENT consists of ❑ Septic tank. ❑ Cesspool. Septic Tank: Distance from well, feet. Total liquid capacity,_ Inside length, feet. Material, _ Number of compartments gallons. Capacity inlet compartment,_ gallons. Inside width,_ feet. Liquid depth, _feet. MONY Building Suite 104 1049 west Fiftli Avenue Anchorage, Alaska 99501 ROBERT H. REYNOLDS Attorney at Law ,,; l,j -� v, a r/ � ?f), 1,973 'lephone 277-4532 70,k xndlvlk-I�VJ omwm�yo 0iloporlo,), IJIYAO, MV -1h' trAnd '. ll �� 'r V(XAo yt, 3,- t -,,Aroy 4'Ah e Y, V110 ,I umllyo, kin "Ph i"W)rn� 7 t "'Iturthm" anpo,ax Ix -f,Tr I'Awrn And 1311000lovn 0;",P( xy, till -Moj�foovex: fnm"� movinov,�t�'; all ua-` -VAI)xAct "y"Vinn- A tromigictlomq Lim II G (0 A. -"t I z 4'V5 m, lo r 04 q o (4) P1 ro! 13 A'A T y TV A�,, ty vhlcl I irl o 7p It"I'm o"'u'ly ro'll ol" �9 -itirtr"o the pro!Apm of th"-xtr in 4cho dmlo 13, x, vv ?%,i !,ylvoo X ?R taG Oto caklf--W 0, th""Ar, olP tllfw4u. "llott Toon 11-4) point. pf@so X. a t, o o v V1, Ix 6i mm, w to p t kF v to i. x wh const Ai"vik1.114it thc� vv6 p't-ope"r vo o a tllo r4bo vocomon" r - -,kt,,)txAar o r -rcv,: th, o v n oor� Is Ft f7� t, m- 1xk VIC7 om trAnd '. ll �� 'r V(XAo yt, 3,- t -,,Aroy 4'Ah e Y, V110 ,I umllyo, kin "Ph i"W)rn� 7 t "'Iturthm" anpo,ax Ix -f,Tr I'Awrn And 1311000lovn 0;",P( xy, till -Moj�foovex: fnm"� movinov,�t�'; all ua-` -VAI)xAct "y"Vinn- A tromigictlomq Lim II G (0 A. -"t I z 4'V5 m, lo r 04 q o (4) P1 ro! 13 A'A T y TV A�,, ty vhlcl I irl o 7p It"I'm o"'u'ly ro'll ol" �9 -itirtr"o the pro!Apm of th"-xtr in 4cho dmlo 13, x, vv ?%,i !,ylvoo X ?R taG Oto caklf--W 0, th""Ar, olP tllfw4u. "llott Toon 11-4) point. pf@so X. a t, o o v V1, Ix 6i mm, w to p t kF v to i. x wh const Ai"vik1.114it thc� vv6 p't-ope"r cooxvf- C�' �3 ltox- '� I'lon '�;C'IYA.Ao A wv� pliQ-ation that thera ca Vk I. � the '5av'rlqn olim.nnull "Vstiowa waq bl. co'noll'onco txkl-h VvUi�. lills6son-111 -prop -Y), 0 V) otandnr65 , or the OrAp'liz-0-1,onn a(. vopl Dili Or, I arol rump -4 provil-dol-w of vulporrOl, Rovirlilxna `'iso" 5 I ­ r1l 'orroval ol" ar.0 �. ato-r FT., Rl' j ly 3 , Ll - '4 1w t'lo rx'woov Coot; o )"i ""A A�Oncrtptifm Ia Flo I-) V)OSWA ero 0 Orl o 9 e'?' dE 'n f" o 1) 0, A p'. Qmpar-Ativ of :1, Q a I I on 9 copy f on 30 1963 01,11M WM.Al .1k Apa t1brit 16tv", dm &) riwol-rO. of "';vvi'6 �' romply nw'l F-4fawaric, 01'r"Potoll aynto!m whAsr"h wnr�i, niq%'106 l'y olln '2 P o ro % Y -l') I Yidlqo(" o9w anco -Wlt"-A -PT-i.?k si-vul"Jardn -rlhlo tlao r-)rqpovc- y v4rwn approvod tr-," i -how V an lanotry -acl ikc)clyl v7h--lcall -wj)wl'comAm'1171 %PW(3av o "'naiAt'lod rol� -,,I of rho opird.ort Oxat, fc�o 'U'lorm )(tado to Olf" tho ietil-, nVI )'r I bv *,111w -16a ?lonitv at th'o ti-wo 't"I'lirl t e ovn n3 y5vo. 011 Ga w ii-' wcmlil appe'Ar that `}t '(t ba ct K el 0 n 1 T ov"a 0 c -.). VI -5.0s Ulvolvad _11 24'.Avv alk4or clslooior�br%6 J%Y'r;tic"o frow aw-'5 mr 'olom-' 1 11) v'lbtvj CW of e.. proper f�'-qwoqn $.ir3F (1 -1 v <-j 1). j 0 1� , - thip ; durl �f f4vjf n ocelrytwiv of T11(a7'oby yoo tho proror rinj)niMr raplmcn'lna')ts avkd' r0jwn.-Moyll-;-"' It"n x"o 'k -'r, 4o Kc-qmn"t' - j"I!, vimn ori"Anallyi to till PIP- 'ano, tho, orin"l-no.1 TA 4do nso't' Twoi: 'F��cmo 1"'I't-Illin tor c`avl' c')f- i-tAf" a t n I fjb'>"(j to ivv' jun{ y"Cloveo vi, F' tip n fAllitai'llo ' Action f3l, yo�i FICOoU--lY iia 4..j vyho I I I bo 4! oc! "rt lil? v h AY16W r,, )im� OP 3 Mr Volln"ll "Ocml� i ;/Lip �REQUEST FOP. APPROVAL OF �J(j f,LINDIVIDUAL SEWAGE AND WATER FACILITIES VsC G (Fill out in Triplicate), ,,I?W1 of person re 2, T? n.. „i properrty. 1 I '•�,t:al �leSrriPtinr l Ade M fJ 4, 11umLer of bed1,00ms in house -- 5. Water P.nalysis; a. Bacteri-al �c r b, Detergent 6, Well data; 7 a� •lype– h, Depth C. Casing Size 7 �Lh J.X l . % Lem --t / d. Distance from well to closest exist in or pr000sed: 1, Sewer line_ 2, Septic tank/ 3, Seepage Area�J, 4. Cesspool - 5. Property Line 6. _._._ Other sources -ofpossible rbntam,in_at.ion; e,, creeks houses, barn, drainage ditch, etc `77 - Sewage _,disposal system, \; a, Age of system�. Septic tank ca acity in gallons� C. dame of septic tank manufacturer. lakes, If "home made" show diagram on reverse side of this form. Disposal- field or seepage pit size and type 1, Distance to property line- to house foundation a e. Percolation Test results f. Percolation Test performed by 1 Use the reverse.side of this form to show diagram. Diagram should include -the following information; property lines, well location, house location, retic tank location, disposal area location, location of percolation test, anq direction of ground slope. 9. The information on this form is true and correct to the best of my knowledge. Sii-nature of Applicant Date Signed `PO BE FILLED OUT BY HEALTH DEPARVIENT PEPSONNEL I�The above described sanitary facilities are hereby approved, subject to the 'Pollowi.nP conditions: Conditions; The above described sanitary facilities are disapproved for the following reasons; Si nature bt f ie���. g � � :. Date b't Approval is valid for one year following, the date of approval. CPJtcw