HomeMy WebLinkAboutRAYMOND TEDROW BLK 4 LT 20
DEPAR'rMEN~ OF I-II~AI:I'I~& i~NVIRONMENT/~.! PIIOI'ECTION
ENVIRONMENI'AI_ENGINEERING DIVIgtON
ON-SITE SEWAGEI,I,~PO~,A,_" e '"' ' SYSTEMANI)/C~I~Wi21.LI'g,,PE(,o "-~',ON'IiI~PORT
LEGAL DESCRIPTION
iLOCATION ~ ~ rNO. OF BEDROOMS
/ Q /DISTANCETO' t h [O %~ ¢~l ~ / [ ' ~
JJ ~ ~~~J Manufacturer ~ ..... ~ater~h ~~ No. of~partments
/ Liq cappcLty cia els Flnsidelength [Width
e J ~ WeLl / W Foundation - - ~; ...... I ~7~;rr~-~
<1- ~peofc~ C,H]diamute, ~~;11 Fotai
~ [ .... Building fOLmdation S0ptic tank
~ ~DISTANCE TO: ' S0,~,' ~i,,~ -- -- / ~g~o~o~, ~,~
O-ridER
PIPE MATERIALS
SOIl_ TEST RATING
INSTAL LE.~
R EMARXS
APPROVED
72-013 fRev. 3!7'~) / /
I:::IF' F:'I . ]' "~ FI N T
L.F r" I:::1'1" ]I ON
L £:.' E~i1:11 ....
E:,EF'FJF:THEIN'F HEFIL'rH FINE:, EN',/
EE; E!E IL,,..~
Fff.,I[::,EF;i:'_::;ON E',I:;~:OTHEF":; F'. C
EC:HIT.~ :E;"F. ~, ,
LOT .::j, 7:~ E:L.k: 4 I:RFt"r'HE~ND TE[::'F.".OH
'T".dF:'E 2r:: '.50]:L FIE::.SCIF.:I::"T']:Eff.,I ..:.;'¢271"Etl ]:2;' 'T'F~:ENC:H
:5OZL. F::FIT]:I'.,IC-i ,:::.:;E! F'T,.."BF..:::,= :5:5
THE: F?.E~;!U:I:F?.ED :5]:;Z~/ OF THE 5EI]:L FIEtE;E~RF")'.'[OI'.,I
THE L.E:'N(!i'TH B, ]: i',IE:NS Lt: ON :.(::.:; THE LENGTH
THE [)E'F"rH O1:: F:I "i"F;:ENE:FI OR F:':[T :[~; THE E:, :J ::_:,TF1NE:E BE:TI.,.IEEN THE ~;Uf;.':F:Ft(:~:E OF' THE
GI;;:EIU!'.~[::, F:IND 'THE: BEFf'TEq',I OF THE EXE:R',,,'FIT]:ON ,: :IN FEET::,.
T'f...IEI:;~:E ]:E; NO 2;ET N~E:,TH rOI:;;: TF:EIqCHE:i5.
THE GI::d::I',,,'EL.. E:,EF"I"H :[ '.E; THE t',1:1: t'.,I ]:I',ILIH DEPTH OF EiI:RI:f'v'EL. E:E:i"HEEN THE: OLITF'FIL. L. P.I: F:'E:
FIN[::, THE En:3TTEfl',I OF THE EXCFI',,,'F:IT :[ ON ,.'.' :1:1'.4 F:'EET ::,.
F'EF:H :[ T FIF'F'L ]: C:FINT Hf:tE; THE Iq:[{.'::.:;F'Ol'.,l!:~; ]: B :[ I.. ]: T'-? 'TO :[ NFOf4:Ivl TH Z E; F)EF'FIFCI'HEI'.,!T .DIjF:: ]: I'.,tG THE
]:N:BTF:ILJ. J::IT:[ ':i'.,I :[NSI::'Ii.3::::T):OI'.,I:-':: 0I:: FII'.,I'¢ HELLS F. IE:,.:rF;IE:EI'.,rT TO TH.I.':E; F'F:CF'ERT'.¢ F. tNL':, THE
NLIHE!:EF: Eft:' I:;;:E:!~; :[ DEi'-,tCEE; 'T'HF:IT THE: HELL. !4 :[ LL E;EI:;.:',,,'E.
I',l!i'.,l;[i','lt..If,'l [::, ]: 'L:;]"FINC':E E:E/Tt.,tEEI',! F:I HELL. F:II'.,I[::, I:::11'.I'¢ EII'.,I~.E;ITE '.EiEHRI]E: D IE;F'I]I:SFIL. S'.,.'E;TEI"I
::LEu3 F'EET FOR FI F'F:I'v'FITE HELl... OR :1.50 TO 200 FEET FF.:C~H Fl F'IJE~LTC I.,.IELL. [:,EF'E:N[:,ING
UF:'Oi'.,I THE] 'r'.r'PE OF' F'UE~L.]:C I.,.IELL..
t',1 t 1'.,! ;I:t',!UP1 [:, :[ :BTFINC':E F'F:OH R F'F.'. ): 'v'FI"I"E: t.,.IEL. L. TO Iq F'I:;~: I',,,'FITE SE:f4EF?. L. I NE :[ 2; 2:5 FEE'T FINI)
TO F:I COI"IHUN :[ T'¥' SE:FIE:I::,: L I NE ): E; ';:'~i FEET.
OTFIEF: REE!U ): RE:I',IE:NT!.~; I"1F1'¢ FtF'F'L.'-r'. :E;F'EC ~. F :[ CI:;IT ]: l.':ff.,!'.:.:; FIND CON'.:.~;TF.:LIC:T I ON [:, I I::IGI~i:I:Ii'"IS
FI'v'R I LFI[:~fi...E: ]'O ~ NE;UF. rE PF:'.OF'EFi: :[ NE;TFILI._FIT ]: ON.
:[ E:EI.:?."r:[ F"¢ TFIF:IT
::L: ]: f:~i"l FF:IP'IZL:[FII:~: t.J. ITFI 'T'HIE R[EE!U:[f;:EiHEI'.,IT'.~-:; F'OF:: OI'.,I.-..:~]:'FE SEI.,.IEIR.',5 FIN£:, I.,.IELL2; F!':i; SET
I:':'OfRTH E','¢ THE: P'ILIN ]: C: ]: F'F:tL :[ 'T'"¢ OF' FINCHOF.:FIGE.
;~:: :[ I,.I :[ LL ]: NE;TFILL THE ~5'-r"_:'~;'1"[~1'"1 Z I",1 FflCCOF:tDI::II"~IE:E t.,.I :[ TH THE
::!i:: ~. LINE:,EF?.:!.-.:TFIND -['HFtT THEE EIt'.,I-..'E;~.TE SEI,.IEF:: :~;"r%TE:H t'"IFI'¢ REi~'~IJ ]: RE ENLFtf~:GEi"IENT Z F THE:
F~:EE', :[ I:.'."ENCE: :t: ,..r:; F::E:HL-~DE:LE[:.', TO :[ NCI...I..II)E: HOF.'tE 'THFff',t Z: E:EDF~'.OCff"I'-:5.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720'
SOILS LOG- PERCOLATION TEST
0~ SOILS LOG
I-1 pERCOL~yiO~J ·
TEST .' '
5
6
7
9
10
SLOPE
tl
12
13
14
15
16
17
19
20
S,T,P~A. ': ×4, ,: .:. ,
WA~ ~.ou.o ~A-~E. /,J 0 ,~
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
,,,',,,~din g Date Gross Nat Depth to Net
Time Time Water Drop'
PERCO LA'rlON RATE (minutes/inch)
TEST RUN BETWEEN FT AND ~ FT
72-008 (6/79)
DA~E RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DEPT, OF HEALTtt &
MUNICIPALITY OF ANCHORAGE~lXlV R-" ONME
NTAL
P~OfECTION
DEPARTMENT OF HEALTH & ENV RONMENTAL PROTECTION
825 L Street - Anchorage, AlaskagO§01 JUL ? 198'i
ENVIRONMENTAL SANITATION DIVISION
REQIJEST 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.
1. PROF(ERT¥ OWNER ~'~' " ' I PHONE
MAILING ADDRESS~/
PROPERTY RESIDENT (If different from'~bove) / - PHONE
3, LENDING INSTITUTION
MAILING ADDRESS
4. RECLTOR/AGEN'r I PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
S'~R~ET LOCATION ........
6. TYPE OF RE~IDEI~CE /' ~- / NUMBER OF~BEDROOMS
[] One [] Four
[~ SINGLE FAMILY ~ Two El Five
El MU/:TIPLE FAMILY [~ Three [] Six
[] Other
7, WATER SUPPLY BI INDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM I~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
2/
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] IN DIVI DUAL/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 ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line Nearest Lot Line
WELL TO:
I
Absorption Area to nearest Lot Line
5, COMMENTS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE ~ /~ z ~? ~
72-010 (Rev. 6/79)