HomeMy WebLinkAboutRAYMOND TEDROW BLK 5 LT 3B3
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 9950'1 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE
NAME
MAI LING ADDRESS
LEGAL DESCRIPTION
LOCATION
Wel~, " Absorption ar/ca Dwelling
DISTANCE TO:~ Material~-
I- ~ Manufacturer
Inside length I Width
NO. OF BEDROOMS
Dwelling
Material
Nearest lot lille
Foundation .~2! ./ '~.
Total length o~f lines Trench width
_
Matorial beneath tile ~
PERMIT NO.
No, of comp rtments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effective absorption area
~: DISTANCE TO:
.a ~ ~ NO. of lines // Length of,~c~j~li~e
inches
Width Depth PERMIT NO.
Crib diameter Crib depth Total effective absorption erda
Wall Building foundation Nearest tot line
Length
~f crib
Depth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
DATE LEGAL
72-013 {Rev. 3/78) /
PEI;,:I','I I 'f' NO.
DEPRRTMENT O' 4EFIL. TH FINE) EN',/
825 '1...' :'mEET, RNCHORR6E, AK.
RPPL l E:I::tNT
L,OCRT l ON
L.EGFIL
IVERSON CONSTRUCTION BOX ]~:L2 E. R.
ECHO STREET
LZ4E: 8 5 RAYMOND TEE, ROW SUE,'
LO]' SIZE
694-2]:40
8550 SQUARE FEET
TYF'E OF:' SOIL FIE',SORBTION SYSTEM IS: TRENCH
MI::~XIMUP'I NUMBER OF E',EDROOMS = Zc
SOIL RATING (SQ FT/OR)= 85
THE REQUIRED SIZE: OF THE SOIL RBSORF'TION SYSTEM IS:
TNE LENGTH DIMENSION IS 'f'HE LENGTH (IN FEET) OF 'FNE: TRENCH [)R DRRII'.4FiEI_D.
THE [)EF'"rH OF Ft TRENCH OR PIT IS THE PlS'FFINCE BETIqEEN THE SURFACE ELF:' THE
r3F..'OUND RNE:, THE BOTTOM OF Tt4E EXCRVFITION (IN FEET::,.
]]--IERE IS NO SET WIDTH FOR TRENCHES.
]"HE GI:;.'.RVEL DEPTN I:!~; TME MINIMUM DEPTEt OF GRFIVEL BETI.4EEN THE OUTFFILL F'IF'E
F'II",ID THE BOTTOM OF THE EXCR',;'RT[ON (:IN FEET).
PERMIT RPPLICRNT NAS TNE RESPONSIE,'ILITY TO INFORf'I THIS DEPFIRTMENT DURING THE
INSTRLLFITION INSPECTIONS OF FINY WELLS RDJRC:ENT TO TI-lIS PROPER'rY AND THE
NUMBER OF RESIDENCES THaT Tt4E WELL WILL SERVE.
8[~CKF'ILLINC~ OF RN"r' SYSTEM WITHOUT FINFIL INSPECTION AN[:' FIF'PROVI:~I_ BY THIS
DEPFIR'I'MENT 14IL. L BE SUO..¥ECT TO PROSECLJ'f'ION.
MINIMUPI [)ISTRNCE [~,ETWEEN FI WELL AND RNY ON-SITE SEWI~GE DISPOSflL SYS'¥EM IS
iOO FEET FOR R PRIVATE WELL.~ OR
:;I.50 TO 200 F'EEf' FROM R PUBLIC: P~ELL DEPENDING UPON THE TYPE OF PUBLIC P4EL..[ ....
OTHER REQUIREMENTS MAY APPLY. %PECIFICRTIONS AND C:ONSTRUCI'~ON [:,IRGRFIMS FIRE
RVBiLRBLE TO ~NSURE PROPER INSTALLATION.
I C:ERTIFY TI4RT
i: I 8M FRMIL. ItaR WI'TH THE REQUIREMENTS FOR ON-SI"fE SEWERS AND WELLS RS SET
F'ORTH BY THE IdUNICIPRLITY OF RNCHORRGE.
2: I. WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
Z;: I UNDERSTAND THRT THE ON-SITE 2;EWER SYSTEM MAY RE(4UIRE ENLFIRGEMENT IF THE
RESIDENCE ~S REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
S I GNE[); ................
F~F'F'L ~ C:RN F I VERSON CONSTRIJCTZ ON
O ~ E GEO'I 6CHNICAL ~ DEVELL,?MENT CO.
Russell Oyster
694-2774
Soils Et Foundations
Performed for:
Legal Description:
0
6~
7~
9
~0~
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Earl Ellis
SO:IL LOG 68~-2280
Land Development
_~_o_ tl Charactert~s_t_lcs
Ground Water ~ncountered: Yes No v/ If yes, what depth~
Proposed Installation: Seepage Pit__ Drain Field
Comments: _~:,/~? ~,,~L.~ ~~_:'
Performed
~ DATE'F~ ECEiVED
INSPECTION APPOINTMENTS ·
INSPECTOR INSPECTOR / INSPECTOR
MUNICIPALITY OF ANCHOR,~GI=
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTII &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~I~,~/IRONMEN'FAL pROTECTION
825 L Street - Anchorage, Alaska 995~1
ENVIRONMENTAL SANITATIONDIVISION JUl., ~ 5 1981
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete ~11 parts on page 1, Incomplete requests will not he processed, Please allow ten (t0) days for processing.
I.~OPE RTY OWNER
PROPERTY R~S~DEN~ (1~ different from above) /
2, BUYER ....... '-' PHONE
MAIEING ADDRESS
3. LENDIN~ I~STITUTION PHONE
MAI LING ADDRESS
M~ ADDRESS ~
Hid
5. LEGAL DESCRIPTION
STREET LOCATION
lz .'F.
6. TYPE OF RESIDENCE
[~NG LE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
TT WO [] Five
hree [] Six
[] Other
7. WATER SUPPLY [] INDIVIDUAL*
~ COMMUNITY
PUBLIC UTI LITY
* 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
E[]--~ I N DI VI DUAL/ON-SITE**
[~] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE; THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-O10 (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
2. WATER SUPPLY PERMIT NUMBER
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
I--~ INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[~'~eptic Tank or [] Holding Tank
Size: /;~0 If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
[~'~PPROV ED FOR --~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE B~~
72-010 (Rev. 6/79)