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Home My WebLink AboutSCHROEDER EAST BLK 2 LT 2I M-iptb�t 4 51f) V Municipality of Anchorage DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION POUCH 6-650 ANCHORAGE, ALASKA 99501 _ INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL NAME ,e��r v�`/ v r� LOCATION 5191 f4 M#,< i�� ps i v ADDRESS x le A"'=;— � LEGAL DESCRIPTION ��>� �, ��°r�� PHONE(S) '�– /�� y / '� Pcr r '� /�� `' �� ®�® ��J 7 / PERMIT NUMBER 4 #OF BEDROOMS ®® SEPTIC TANK ❑ TILE DRAINFIELD ]CAPACITY LENGTH EACH TOTAL LENGTH DISTANCE BETWEEN LINES TRENCH WIDTH IN GALS.MANUFACTURER FROM TANK MATERIAL ��'� ( #OF COMPARTMENTS INSIDE DIMENSION LENGTH WIDTH WELL DEPTH SEEPAGE SYSTEM ❑ TILE DRAINFIELD NUMBER OF LINES LENGTH EACH TOTAL LENGTH DISTANCE BETWEEN LINES TRENCH WIDTH DEPTHS: FROM TANK TILE TO GRADE FILL BELOW TILE FILL ABOVE TILE WELL EPAGE TRENCH OR ❑ PIT WIDTH LENGTH DEPTH 1 ❑ LOG CRIB ❑RINGS – DIA. FILL MATERIAL DEPTH TOTAL EFFECTIVE ABSORPTION AREA:f6_ S �' SO. FT. WELL CLASSIFICATION DEPTH PIPE MATERIAL INSTALLER DISTANCES TO SEPTIC SEEPAGE SEWER FROM TANK SYSTEM LINE CESSPOOL WELL WELL r LOT LINE FOUNDA �j TION J _ REMARKS DATE /0 -�f °r- l APPROVED BY-LY4`�'�� f �t`�•' LOT: _ BLOCK: SUBDIVISION: DEPH�TMENT OF vEHLTH HND ENVIROhMENTHL PR0rECTI0N 825 'L' REET, H�CHORHGE, AK995[ 279~251i qL- 1!�� PERMIT NU ( 77917 ) lHE REQUlRED SIZE OF [HE SOIL HBSORPTIO SYSTEM IS� ��-1 " F I! -A J. V.��9-1-1— othiso NA U40 pit N? V� 9 ��F - h-1-1� � ��X "Myl h; 1114: BEE R ? U 11-14 � 1:�� IRCKFILLlNG OF fNY SYS[EM WITHUUT FINHL INSPECTION HND HPPRUVH|. BY 1iAI9; )EPHRTMENT WILL BE SUBJECT TO PROSECUTlON 1INlMUM DISTHNCE BETWEEN H WELL HND HNY ON~SITE SEWHGE DISPUSHL SYSTEM IS i00 FEET FOR 8 PRIVHTE WELL OR 200 FEET FUR H PUBLlC WELL dELL LOGS HRE REQUIRED HND MUST 8E RETURNED TO THE DEPHRTMENT WITHIN ]� DHYS JF THE WELL COMPLETION OTHER CIFICHTIUOki HND CONSTKULTl0N DIHGRHMS FIRE: HVH[LHBLE TO INSURE PROPER INSTALLHTION ��1 "V vy:X& T T&T-5755 NA VT Kin 127 swUV40 TY vm� �Sm 10" 10 a nO, FC -f 1=') `.E_C ir)n SOILS L vI: P��ZCOLPMOI_' TEST Terry Sullivan Date Performed 9/8/77 I ___, sc-iatio Lot 2, Block 2, Schroeder East Subdivision 2 11 r O n 6 1� 1C' 2 Red -brown, sandy, silt w/organics (ML) 275 ft.2/bdrm Red -brown, silty, sandy gravel.(GM) 225 ft.2/bdrm Perc Test from -4 59 -6 feet h7ery dense, gray -brown, silty, sandy gravel (GM) Date Z;et Ti7ta Net Drop Perc Rate 9/8/77 30 min: 2.00 in. 15?min./in. 30 -3-0 min. _ T 1.30 in. — 23 min./in' min. 1.00 in. 30 min./in. 30 min. 0.90 in. 33 min./in. 30 ---------- 30 1----�--- min. min.0.78 0.80 in. 35 min./in. -------------- in. - -- -- 38 ----- — -- ---- - - min./in. ------ - --- - ----38 i,Iim,:!.es/inch ya vvy 9957", CA 9 m Aamu '41 'u'; o) t 611 tov vnizi d" Q M.1NIC T PAL15'Y Or AVvTCHLO A , DIV'IS1.0N 01 rNVZROMITEMMY, 1IM1`T11 DEPARTMENT' 01: 11F:A.1,7:1I AND k,N;JzROMM H' AJ, PRO7'1�;C I N APPLICATION FOR 11<',f LTH AUTHORITY APPROVAT, CER111VCATZ! Ia Genersal. Information Application Datel�� (a) Legal Description (include, lo/t, bloc, >ubdi. jinion, section, township, >;anga) Location (address or cUreeLlons) (b) Applicants Name /i �_(i/'�!; "� E� _ Telephone Homo - Businc.,s Applicants Address �C1 ajr, r ! �'`' cct (c) Applicant i.3 (check one) 7,-'nd3,�g !nsti.tu lora i Oe•��e,/bLJ,1.de) T { Buyer I a Other (d) Lending Institution _10.10phone Ad(h�ss (e) Real P- ti'.ate Co � S Agent. , ; , Y z_ Address/f�. /i cl , i>n Telephone th 11AA. to the following add'es> , 2. T Me of Residence S:+n1;l.a�n��mJ.ly r>_�� Lzult;i.-�1!a�il,y „-`I, Ot:hox: (ciescf'1bc) Number. of Bedrooms 3. hater Supply Individual WellComuun..ty Publ.i.c ��=4 Note: If community well system, must have written con_f-I mati.on from the State Department of Environmental. Conoetwatjon attesting Co Che: legality and stature 4. Sewage Disposal 0nsi t Public Community _� Holding Tank Note: If community well system, must have e•r1 i.Ct:en confirmation ,`:r.om the State Departments of Environmental. ConservatJ.on attesC9.ng to thn '.e,^,al.ity and status - [Page 1 of 2] M 5- ErLL-nT cring Iirm l-lroviding Tn9pecti011s7'.terts, Lil.e Scab ch, Data and inforLwitCon As certified by my seal affixed hereto and as of the validation date ,hoem below, I: verify that uay investigation of this Health Authority Approval shows that the Ou--site eater supply and/or «mstewater disposal, system is safe, function d and adequate. for. the number of bcdroomn and type of structure indicated hcrei.n� I ,'rather vor_ify that, based on the infor=mation obtained from the Municipality t.pality of Arichos:age. f Jles and front vly investigation and inspection, the on-site eater_ supply and/or wastcerater disposal systesa J.s ,,n compliance Erlth al! Municipal and State codes, ordinances, and regula- tions egu a-tJ_ons in effect on the date of this inspection, Mame of Vim Telephone Address !C.l'�4�-:.�, s CAJrA rON TIJP MUNICIPA.,ITY OF ANCHORAGE DEPAPUMETTA OF JiEAUT! AND :PROTECTIOINT (DREP) :CSSUE;a 11FALTI-1 AUTHORITY APPROVAL CERTT I;CATJ!-,S BASED SOULY Ul-ON I'JJE I2EPRESEKY- ATi3ONS GIVEN IN MLAGRAPF7. 5 ABOVE BY. All INDEPENDENT PROVESSION&L ENGI:,�EEP. IiEGI;STZMM IN 7IIE STATE OF ALASKA. TILE, DHEP DOES THIS AS A COU TESY TO PIRCIJASEI'S) 0, HOME9 AND THEIR LENDING I;NSTITUTI;ONS fN ORDER TO SATISFY CERTAIN YEDEPUL, AND STATE REQUT .Ec MENT'S. F;MPLOUES OF DREP DO NOTCONDUCT INSPECTION; OR ANALJ'X)< DATA REPO CE A CERTIFICATE zg TSSIJED. TIM RUNICi;PALITY OF ANCHORAGE IS NOT. RUPONS1BLV,, FOR ERRORS OR OMISSIONS T.N `I`kLL; PROFESSI0NAT, ENGINEER'S WOR" (DREP SEAT) ItR4/ej/DI8 [Page 2 of 21 7-19-84 Dane , J+� Fa, DI.IEP Approval Approved ro, bediool y�l,at Approved T f Disapproved -_ Conditional A Toms of Conditiorr,0_ Approval 7 l i`7 lX'� 0 r� ` !C.l'�4�-:.�, s CAJrA rON TIJP MUNICIPA.,ITY OF ANCHORAGE DEPAPUMETTA OF JiEAUT! AND :PROTECTIOINT (DREP) :CSSUE;a 11FALTI-1 AUTHORITY APPROVAL CERTT I;CATJ!-,S BASED SOULY Ul-ON I'JJE I2EPRESEKY- ATi3ONS GIVEN IN MLAGRAPF7. 5 ABOVE BY. All INDEPENDENT PROVESSION&L ENGI:,�EEP. IiEGI;STZMM IN 7IIE STATE OF ALASKA. TILE, DHEP DOES THIS AS A COU TESY TO PIRCIJASEI'S) 0, HOME9 AND THEIR LENDING I;NSTITUTI;ONS fN ORDER TO SATISFY CERTAIN YEDEPUL, AND STATE REQUT .Ec MENT'S. F;MPLOUES OF DREP DO NOTCONDUCT INSPECTION; OR ANALJ'X)< DATA REPO CE A CERTIFICATE zg TSSIJED. TIM RUNICi;PALITY OF ANCHORAGE IS NOT. RUPONS1BLV,, FOR ERRORS OR OMISSIONS T.N `I`kLL; PROFESSI0NAT, ENGINEER'S WOR" (DREP SEAT) ItR4/ej/DI8 [Page 2 of 21 7-19-84 A. WELL DATA IM MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification /v � fJ If A, B, or C, D.E.C. Approved Well Log ent (Y/N) _ Date Completed - Total Depth �, C _ Cased to Static Water Level _�•-- Set At _ Sanitary Seal on Casing (Y/N) Depression Around Wbllhead (Y/N)� Yie Id Grouting _ Casing Height Above Ground Electrical Wiring in Conduit (Y Separation Distances from Well: 7'0 Septic/i'x1 Tank on To Nearest Edge of To Nearest Public Cleanou Water Line joining Lots Field on Lot&e_�__---; On Acfjeining Lots To Nearest Public-Seyer /� To Nearest Sewer Service Line on �c:ted By ; Date__ Water Sa5Sle Test results SEPTIC, TANfC DATA Size �/'� No. of CcWartmants Date Installed _/ �= Standpipes Y ) Air -tight Caps ae_ Foundation Cleanout (Y Pumped Pum Last p ---- Depression over Tank ( ) -- Pumping/Maintenance Contract on File (Y �� for Holding Tank High -Water Alarm (Y/iT)/U _ `Temporary Holding 'Tank Permit (Y^ Separation Distances from Septic`Tank: / To Water -Supply Wall 2-0'42f To Building Foundation c l To Property Line ✓ 8 f -To Disposal Field To Water Main/6e25Lire ��- / _ To Stream, Pond, Lake, cm Major Drainage Course r �`' ci Gt � �- Comments—Z D A3 e iq 9 ^! ®d AJ46 1%' ✓V G^ `T - cam.. 149 V, s S C' c3 hl G_ 7 D 7-D Receipt #-LL14 [P Date Paid: _- 1,- -'sC- Amount: �1 p [Page 1 of 21 2-15-84 C. A13SORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design �L L1 Date Installed _ l %�? Length of Field 6 6 — / Width of Field Depth of Field ��w �_�, '^ ravel Bed Thickness _— Square Feet of Absorption Area ` Standpipes Present (Y/N) —_•— Depression over Field (r ) Daae of Last Adequacy Test _ '� 'Ok4 Results of Last Adequacy st Separation Distance from Absorption Field: To Water -Supply Well 0 C) /I- To Property Line To Building Foundation 1,2 To Existing or Abandor:ed System on Lot �U a AJ a=` f On Adjoining Lots To Water Main/Service Line e,:,:?;,D C4 To Cutbark(if present) /U To Stream/Pond/Lake/or Major Drainage Course /�1 D n�--- To Driveway, Parking Area, or Vehicle Storage Area _ i�z) D. LIFT STATION Date Installed Dimensions Size in Gallons Ma ole/Access (Y/N) "pump On" Level at _ -- � Off" Level at�— High Water Alarm Level at _ Vent (YM) —� Tested for __ Pumpin Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) -- -- nr Comments ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or, confcrned to all MOA HAA on the date of this inspection. Signed Date Company P., 01 ON •18BX MOA No. PFi. KBl /d5/s [Page 2 of 21 17 effect rw • ov¢ua 9ny¢•ea w T i a4t e� LtS , '�IIMf1 A. Shld9f � L�.{ No. 1457-E 2-15-84 01 SANI I ARY PUMPERS ;T P.O.- BOX 772226 EAGI.€ RIVER, AK 99577 694-2.405 978 Date l �19$5 #1: Time _ To _,_�Vii�l`q TT MAY f QNCT",RN — — Date _ Address -- —T In sp _ City -- -- RE ITIES 1, Lend in Mailin 2. Proper Mailin 3. Legal 4: Sing1E Multir 5. Well Ic Permit Constx 6. Sewage Permit S P PERS WILL PUMP THE CL. —_ ySTI M T n( ATRT) IN SCTIROT)yR_S�D . _. — -RI,TC 2 (Santa Maria Drive) TTPnN OF CURTTS Clip TSTTANSFN P MQUF. TQ PRTCF f HA�ICF� —s —_C.STTT�.TF.ET THANK YnTI, — Paula Brown — B9QKxPFPER Curtis Christianson agrees to pay if and when it is necessary any time before the sewer is hooked up. =-_dAadK_k E=_ [EER:EfQ1CF7CRMSTATEMENT 2 Septi, Absorption -Area )-7511 l-9792 _ty ( ) bVS13" nC"_U__ - -_ - _ 7. Distances: Well to Septic Tank to Sewer .Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area Page Two Department of Health and Environmental. Protection Request for Approval of Individual Sewer and Water Facilities Legal. Description: Lot 2 Block 2 Schroeder East Subdi=vision Comments: -T -- Affadavit Attached: ( ) Letter Attached: ( ) Approved. Date: Disapproved: Date; Department Worksheet: ESJ,-OOY �1O LLa[ OJD INN-IM01AVIM1111 HOJ .10H IL61 'adV OOflC 1"Jod (Oprs J01110 Oast O�OIAOHd ]OVIDA00 19MMS141 ON SKI - .----a��-- i -_— .— --— ._....... .IPeJlnhe� oP} oalxo� AN3All70 1V131dS ( I g - _ _ )"INO MMOav-0J-ainn10 J99 09E — 61u0 aOSSOMpa 01 61aAIlaP 1111/A "JanNaP OA911M 1111V aleP �W01115 01 SJi011$ Z I S3OIAU 3S JAM III A9 P9l ..... d1u0 aDmipPe 01 6J0MID13 IN!h1 .... ... Paaanllap aleP POe n1ayn 01 SraO_NS _ } UO!3U —_- 53OIAU'3S 1UN01Jd9_-- -_IUNOIdI00V-U09 3000 JI! Of•IJ 3JVJ5 '0'd ' /i 'ON ONV J:1111AS - '-LV" UO 01 JN3S NUVW!SOd- Weisod snlcl) OV—imAl 'UlLMAN 06-1220(a) Rev. 1973 DATE ALA° 'ARTMENT OF HEALTH AND SOCIAL SF' DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Unsatisfactory ❑ questionable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. ❑ Bottle broken in transit, please send new sample. INDIVIDUAL ❑ SEMI-PUBLIC ❑ CHLORINE RESIDUAL PPM REPORT RESULTS TO NAME _ ADDRESS - - — CITY ZIP CODE _ - -- ADDRESS - - OF SOURCE - - - - Lab No OFFICE SANITARIAN'S REMARKS COMPLETE THIS SECTION _ ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY -- DATE COLLECTED TIME COLLECTED Sample Collected from ❑ Kitchen Tap ❑ Bathroom Tap ❑ Basement Tap _ ❑ Other (List) Well — ❑ Dug ❑ Driven ❑ Drilled ❑ Bored SOURCE: ❑ Spring. ❑ Cistern ❑ Other— Dug Well or Cistern Construction: Walls—❑ Wood ❑Concrele ❑ Metal ❑ Tile Brick or Top -- ❑ Wood ❑ Concrete ❑ Metal ❑ Open Top ❑ Concrete — LOCATION: ❑ In Basement L) Basement Offset ❑Under House ❑In Yard ❑ Other _ -- Building Sewer Septic DISTANCE TO: or Other Drainage Pipe— Feet. Tank --Feet. Tile Seepage Cess - Field Feet. Pit Feet. Pool --- Feet. Privy --Feet. Other Possible - — Sources of Contamination — -- MATERIAL: Building Sewer - ❑ Cast Iron ❑ Wood ❑ Tile ❑ Fibre ❑ Asbestos Cement ❑ Plastic Joint Material - Type — GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No — When?— Diameter of Well Depth — Feet. Well Casing Depth Material — Diameter p -- Length of Water Depth Drop Pipe From Bottom Feet. --- Offset in In Utility PUMP LOCATION: ❑ In Well ❑ Basement ❑ In Basement ❑ Room On Top _ ❑ Of Well ❑ Other — PURPOSE OF EXAMINATION: Illness Suspected? ❑ Yes ❑ No New Source of Supply? ❑ Yes ❑ No Repairs to System? ❑ Yes ❑ No Signature — 06-1220 rot BACTERIOLOGICAL- WATER ANALYSIS RECORD Rev. 1973 am RFA D INSTRUCTIONS n t Received -'/ '• .—Time Received --pm Lab. No. ON REVERSE SIDE BEFORE COLLECTING SAMPLE Lactose Broth locc lOcc IOcc locc 1Occ 1.0cc 1.Occ_- 24 Hours 48 Hours - - - - - - -- Brilliant Green 24 Hours 48 Hours EMB — Lactose Broth, 24 Ins Coliform Density — MF Results -- Reported by This analysis indicates Coliform Onjanisms to be: -- AGAR — 48 -- Dale Absent Present Gram's stain -- - (Most probable No. per 100cc) a.m. 1,06O� i4M ICIPALITY OF ANCHORAGE Department of Health and Environmental Protection 825 L Street, Anchorage, Alaska a;E 264-4720 \6�1 -r%quest for Approval of Individual Sewer and Water Facilities 1. 2. 3 Property Owner: V,4 Mailing Address: F /3 '/<_� Phone: Name of Buyer: Mailing Address: r� Lending Institution: _ / `I "i r Phone: Mailing Address: ij/� �� Phone: '"� 7 S// t � n � �• �r �' 'i- --�'" 4. Realtor/Agent : _(1Z d "1 u J r /�_d,, . � _ Phone: Mailing Address: l j 5. Legal Description: r� - Street Location : �� •-� L, l�I�t r � �- `� ---- - 6. Single Family Residence: (,-)' Number of Bedrooms: Multiple Family Residence: ( ) Number_ of Bedrooms: 23 - 7. Water Supp] -y:,. * Individual Well (vj—'Public/Community System ( ) i If Individual Well, well depth _ ;'� S If Community System, name of system / 8. Sewage Disposal System: *"On-site System ( Public System ( ) If On-site System, date of installation: S f _. *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77