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Home My WebLink AboutSCHROEDER LT 86�jSIOch�oecler oso 052 µ2 D00 MUNICIPALITY OF ANCHORAGE \ %® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION q ENVIRONMENTAL ENGINEERING DIVISION - 825 L Street -Anchorage, Alaska 99501 Telephone 264-477-0 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT a NAMP/HONE NEW C�➢✓�id-C.❑UPGRADE MAILING ADDRESS / C�6 LEGAL DESCRIPTION "7 LOCATION NO. OF BEDR�MS Well^� Abs or n re DISTANCE TO:AA Dwelling - PERMIT NO.� b z Manufacturer j No. of c mpartmentsZ LLI `n ~ Liq.Lecj gallons [[JJ IF HOMEMADE: Inside length Width --� Liquid depth _ U Z H =' Well Dwelling DISTANCE TO: PERMIT NO. _ Liduid capacity in gallons a z rJ Manufacturernat-al Fou��n$$fatior Ne-esYloxline DISTANCE TO: WerA t r /FI%_T GF9 i -- .�yiL��y-I.�IyJ No. of lines / LienVgtVh o ac�,l31r(e Total oelis Trench`! P-�IT NQ. Distabe e�jn lines z Inches I _ Er F a Val ber th the - - - I 111-191. Top of the to finish grade t -h 6 f� le � HS' � inches-- Length Width eptlt a Total eff fictive absorption area PERA4IT NO. 4 F Type of crib _ Crib diameter C i- d p l Total effective absorption area a0. Nearest lot line w N Well Bui g foundation DISTANCE TO: J - w Class ,— eptb Bt cling foundation Duller Sewer line Distance to lot line Septic tank PERN41T NO. Absorption area(s) DISTANCE TO: OTHER - - -1 - - PIPE MATERIALS 501 L TEST RAT G — INSTALLE_ REMARKS —�-- - p -- - - - - ��i I APP QVE DATE � LEGAL Q V SIONVY`-1000110�� ` �EPHRTMEHT 11101- 01 HND E01V1RONMENTIT, TITECTIOH 825 'L' STREET HNCH3R�GE, RK99501 254-4720 PERMIT PW ( 5311029 ) HPPLICHNT ERICKSGNS 8OCKHOE SR BOX 4780 99567 LOCHTIOH �-,7R. LEGHL L SCHROEDER LOT SIZE TYPE OF SOIL HBSORPTION SYSTEM I5� TRENCH 22000 SOU�RE FEET MHXIMUM NUMBER OF ] SOIL RHTING (SQ FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL RBSORPTIOM SYSTEM IS. �E01�� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRH{PO' IELD� THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEH THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCRYIT! TION (IN FEET) THERE IS MO SET NIDTH FOR TRENCHES. THE GRHVEL DEPTH IS TME MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFROM PIPE HND THE BOTT0M OF THE EXCHVHTION (IN FEET) �R:�:- -1- Ism TQA AA 14; 3: 27 VE 0. CEO to 01 to 0010. 1 .. to 141 S:� PERMIT HPPLICHNT HHS THE RESPONSIBIL[TY TO INET ORM TH[S DEPHRTMEHT DURING Tp iE INSTHLLHTION INSIT, ECTI3NS UF HNY HELLS HDJHCENT TO THIS PROPERTY HND THE MUMBER OF RESIDENCES THHT THE NELL WILL SERYE, �.... ........ SO 171 ��:i- E �� E:�� ~� BHCKFILLING OF ANY SYSTEM WITHOUT FINHL INSPECTION HND HPPROYHL BY THIS DEPHRTMEHT HILL BE SUBJECT TO FT, ROSEEC: UTI8N MlNIMUM DISTHMCE BETNEEN H NELL HND HNY {TE SEWHGE DISP0SHL SYSTE)1 IS 100 FEET FOR A PRIYHTE MILL. OR 150 10 200 FEET FROM 8 PUBLIC WELL DEPENTING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO H PRIVHTE SEWER LINE IS 25 FEET HH� TO 8 COMMUNITY SENER LINE IS 75 FEET DTHER REQUIREMENTS M9Y HPPLY. SPECIFIUP, IONS AND CONSTRUCTlON DIHGRHMS H/�E HVHILHBLE TO INSURE PROPER INSTHLLHTION. TOEYR-11 !I W WS -110" 1 17%755 ED M Q ET 1-11 Rio NEE ITT 201./ 2. ism Q V I CERTIFY THHT 1. I HM FHMILIHR WITH THE REQUIREMENTS FOR ON^SIIT: SEWERS HND NELLS AS SET FORTH BY THE MUNICIPHLIT; OF HNCHORHGE, 2. I 101.1- INSTHLL THE SYSTEM lN HCCORDHNCE HIM THE CODES ]: l UNDERSTHHD THAI THE ON-SITE SEWER SYSTEM MAY REQUIRE EMLHRGEMENT IF THE RESIDENCE IS 01E10DELE0 TO INCLUDE MORE THHH I BEDR0041S. A \ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 825 L. Street, Anchorage, Alaska 99507 264-4720 TEST 6 SOILS LOG - PERCO/LATION TEST PERFORMED FOR: /G C1 N X 4 /i'C. /`�(,i � DATE PERFORMED: LEGAL DESCRIPTION: ,{+ � i�%OCole 1 2 3 4 5 6 7 8 9 10 11 12 '13 14 15 16 17 18 19 20 COMMENTS G PSS 4"/%r IF SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L O P E SITE PLAN Reading Date Gross Time Net Time Depth to Water NAt Drop PERCOLATION RATE Nl /f - —(minutes/inch) TEST RUN BETWEEN FT AND e FT PERFORMED BY: _£'j 33i]t;�iYt`t.-r'1 CERTIFIED 72-008 (6/79) DATE v. err . ( irb Uritti'ug :alwg by DOC Co. dba SULLIVAN WATER WELLS P. O. 80X 272, CHUGIAK, ALASKA 99567 e TELEPHONE 688-2759 OWNER OF LAND ;' DEPTH OF WELL ADDRESS f,:, e "J STATIC LEVEL OF WATER FT. LEGAL DESCRIPTIO � DRAW DOWN FT. DATF, -Started Ended GALS. PER HR PERMIT NUMBER KIND OF FORMATION: Ft. to From Ft. to -- .Ft.— From - _Ft. to - —!Ft. 1 From- Ft. to Ft._ From _Ft.to ",i 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. to Ft. From Ft. to Ft. From. Ft. to Ft. From. Ft. to Ft. MISCL. INFORMATION: KIND OF CASING From Ft. to— Ft. — From _Ft. to___Ft. — From- Ft. to Ft. From- _-Ft. to_ Ft From Ft. to— Ft_ From Ft. to MUNICIPALITY , ENVIRONME From Ft. to Ft. � From Ft. to_ F J From- _Ft. to_tg�__�_ From Ft. to Ft. From- Ft. to—Ft. Froin—Ft. to --Ft. — From_ Ft. to Ft. From From Ft. to—Ft. to Ft. From From- _Ft. Ft. to Ft. to Ft. Ft. DRILLER'S NAME ED, �� Cl FIT 0=4 Th I Q 1-1 Q FQ Hoy Q! 12:�� DEPHRTMENT � HEHLTH HND ENVIRONMENT]Il L 9OTECTION B25 ' STREET, H�CHORHGE, HK9� �1 2 1720 PERMIT NO ( 810849 ) l 4��[» HPPLICANT CHHRLES E BRYHNT ST RT BX2]2] CHUGIHK ` ' 688�2]27 LOCHTION SCH�OEDER S/D LEGHL LS6 Subdivision SD��S�on LOT SIZE 50000 SQUHRE FEET MINIMUM DISTHNCE EREETWEEN H WELL AND ANY OOSITE SEWHGE DISMAL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TU H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 �HYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MHY HPPLY, SPECIFICHTIONS HND CONSTRUCTION DlHGRHMS FORE HVHILHBLE TO INSURE PROPER INSTHLLHTION 1 -T- KIM Fo" 1: Q FEE W Kin Ell: Ci N M Ell PEE TO A A. .. A GO 090 1 I CERTIFY THAT HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPRLITY OF HNCHORHGE �S EWIL S I WIT_H SIGNEDHPLICHNT 4 _ THE CODES E BR9HNT --- INSPECTION APPOINTMENTS t F,. J_ 5 L _'RECEIVED ":IME 'TIME :)- TIME -- NUMBER OF BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other_ DATE DATE It C — L DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ❑ COMMUNITY ENVIRONMENTAL 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 00) days for processing.. 1, PROPS TY OWN R//�/ /Nt 1 _'"rj % J , ITr xf �pi RIF_ - INDIVIDUAL/ON-SITE** MAILIN DRE" �$, PROPERTY ESIDENT Of different from above)/// // PHONE /'ICLY eg 2. BUYER— - PHONE ,^ yt ck : zo i f t-_ - ? MAILI NG PADDRESSC�` /f'J {/ Y 3. LENDING INSTITUTION17 �� m 0/I e -VC - _ 7iON E MAILINGAIIDRESS- 4. REALTOR/AGE --� -- PHONE MAILING ADDRESS 5. LEG2D SC (T))ION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other_ ❑ Two ❑ Five ❑ MULTIPLE FAMILY; Three D Six 7. WATERPUPPLY- -/wC~ 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** _ % I_YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72 -oto (Rev. 6/79)�� a THIS SIDE FOR OFFICIAL USE ONLY 'I. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE. ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 'L. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL — DATE DRILLED LOG RECEIVED -- 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified _ PERMIT NUMBER DATE INSTALLED •CSCJ�O l INSTALLER ❑Septic Tank or ❑ Holding Tank Size: _ 100O If Tank is homemade give dimensions: SOILS RATING - - TYPE OF TANK - 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 I APPROVED FOR =3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 8Y —