HomeMy WebLinkAboutRAYMOND TEDROW BLK 4 LT 205 0 15--5-- oz. -
· i
-NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Tolephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
-- ]PHONE ~RADE
LEGAL DESCRIPTION
LOCATION
Well
DISTANCE TO: ~4~/~-'~t ~ ~ ~'r-?
Manufacturer -}
Liq. capacity in gallons
DISTANCE TO;
~ · ~:)~ NO. OF BEDROOMS
PERMIT NO.
No, of compartments
Liquid depth
IF 140MEMADE:
Well Dwelling PERMIT NO.
Manufacturer Liquid capacity in gallons
No. of lines
We
DISTANCE TO:
Length of each line /
I 2 ~-~'
Top of tile to finish grade
Absorption area/
Inside length
Length Width
Type of crib Crib diameter
Well
DISTANCE TO:
Depth
DISTANCE TO: Building foundation
IDwelling
Ma~
_
Width
Material
Nearost lot line
Foundation 2~"~t
Total length of lines Trencl~ widt ~
~ _~ ' ~ inches
Material beneath tile
/~?~ inches
PERMIT NO.
Distance between lines
Total effective absorption area
Depth PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller Distaoce to lot line PERMIT NO,
Sewer line Septic tank |Absorpt on area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
REMARKS
APPROVE~?
DATE LEGAL
72-Q13 (Rev. 3/78)
]i N'i!F!' F:!I I J:::1 J
N U I"! E!:IE !:~?. 13!:::'
O 8 E GEr TECHNICAL Er DEVE OPMFNT CO.
tCusse// Oysfer
694-2774
Soils 8 Foundations
Performed for:
Legal Description:
0
8~
Box 90, Davis St, Eagle River, Alaska 99577
694-2774 or 688-2280
Earl Ellis
SOIL LOG 688-228o
Land Development
- ' '~"' ~ . ~ /,1/~l -~/,
Name: .... m,,')7,L~.,:'-~--~~k~/x' , /x ~;;.-7¢.';-~/ ......... Tel
S_¢l_l]_~haracter~
/
(.:,-j / ~
Ground Water Encountered:
Proposed Installation:
Yes No
Seepage Pit
'~/ If yes, what dep.th
Drain Field "~'
Con~ents:
Performed
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 SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
PHONE
1. PROPERTY OWNER _ --
MAILING ADDRESS
PROPERTY RESIDENT (if different from above) PHONE
2. BUYER
MAI LING ADDRESS
MAILING ADDRESS
4. REALTOR/AGEN'r - PHONE
MAILING ADDRESS
6, LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
SINGLE FAMILY
[] MU[.TIPLE FAMILY
NUMBER OF BEDROOMS
[] One ,~ Four
[] Two f-] Five
[] Three [-] Six
[] Other
7. WATER SUPPLY [] INDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
ATTACH WELL LOG, A well log is required for all wells drilled
since ,June 1975, For wells drilled prior to that date, give well
depth (attach log if available,)
8, SEWAGE DISPOSAL SYSTEM
.,~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
/
*~lf individual/on-site, give installation date~J~'''~ 7 ~.
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.
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 L~ TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER
[] 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: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTIQN AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line ~ Nearest Lot Line
WELL TO:
I
Absorption Area to nearest Lot Line
5, COMMENTS
~APPROVED FOR ~ _ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~
DATE By (Title) ~
LEGAL DESCRIP~FION~
)(Rev. 3/78)
January 1t~ 1979
State of Alaska
Veteran' s Administrahion
907 W~st Northe~rn Lights Boulevard
Anchoz'age ~ Alaska 99503
Subject= ]]o~: 2 ~look 4 Ra~lond ~'edrow f~ubdiv3.szon
%'his erect does not have public wator or sewer, '~he
p).)~w~t wells. This do~artmen~ has no objection to
this typ~3 of development.
If thence are any further questions~ please contac't
this office at 264-4720.
~incerely,
Les N. Buc. hholz~ RoS~
senior Y]nvironmental ~}?ecialist
Dahe
Insp
DEPAR'FMEN
825
4-1_~.8 Tuesday
P r a~t~_
MUNICIPALITY OR ANCHORAGF'
OF HEALTlt AND ENVIRONMENT,
I, Street, Anchora~r~, Alaska
264-4'720
~OTECT I ON
99501
Date Received: April 6, 1978
Time
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILT. TIES
1. Lending Institution Request: Spokane Mortgage _~_/~a3[[~')r~ ~ k,o.f,
Mailin~ Address: 3201 C Street, Suite 250 99503Phone: 277-0543
,,
Property Owner: A.K. Andrews
Mailing Address: 9308 Roy Street
Phone: 243-8720
Legal Description: Lot 2 Block 4 Raymond Tedrow Subdivision~'~L~V'
Single Family Residence: (x~
Multiple Family Residence: ( )
Number of Bedrooms: Three
Number of Bedrooms:
Well System:
Permit ti
(,on~truc[ion
Individual Well ( ) Community/Public System (x)
Depth of Well Well Log on File ( )
Bacterial Analysis
Sewage Disposal System:
Permit tt
Septic Tank Size
Absorption Area
On-site System (x) Public Utility ( )
Installed 1971 Installer
Manufacturer
Soi].s Rate Material
7. Distances: Well to Septic Tank to Absorption Area
t,o Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Page Two '
Department Of Health and Environmental Protection
Request f!or Approval of Individual Sewer and Water Facilities
Legal Description: Lot 2 Block 4 Raymond Tedrow Subdivision
CORIKK~ ~ t S:
Af fadavit Attached
Disapproved:
Letter Attached: ( )
Date:
Date:
Depar%ment Worksheet:
31V(I )JO
}IHVlI~£SOd
MUNICIPALITY OF ANCttORAGE
/~ (,~ ~<, Department of Health and Environmental Protection I'~ ~6
// ~'~F~ i, J 825 L Street, Anchorage, Alaska 99501
Request l:or Approval of Individual Sewer and Water Facilities
Mailing Address:
2~
Name of Buyer: _
Mailing Address:
Phone:
Lending Institution:
Mailing Address:
Phone:
Realtor/Agent:
Mailing Address:
Legal Description:
Sqreet Location:
Single Family Residence:
Multiple Family Residence:
Phone:
Number of Bedrooms:
Number of Bedrooms:
Water Supply:.. *Individual[ Well ( )
If Individual Well, well depth
If Community System, name of system
Public/Community System
Sewage Disposal Sysbem: *~n--site System ( ) Public System ( )
If On-site System, date of installation: /~"~
*NOTE: A well log is required on ALE, wells drilled since 6/75.
** If on-site sewer system is ever 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