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HomeMy WebLinkAboutRAYMOND TEDROW BLK 5 LT 4B MUNICIPALITY OF &NC4ORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONMENTALENG,NEERING DIV,SION 825 L Street- Anchorage, Alaska 9.9501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WEI.L INSPECTION REPORT ~PHONE MAILING A D D R?,S. DISTANCE TO: Man"factu"eX:5:£e ' IF NOMEMADE: Inside length Well Dwelling DISTANCE TO: of,,.? Top of tile to finish grade Width Crib diameter t/Veil Type of crib F°undati~l~ ~ Material beneath tile Depth IWdt~ Crib clepth DISTANCE TO: Depth Driller Building foundation Sewer line DISTANCE TO: Building foundation ~UPGRADE IMaterial Nearest inches NO. ~.BEDROOMS __ PERM??./i? s No. of Liquid dep'tl~' -- PERMIT NO. Liquid capacity in gallons Distance Total effective ~bsorption area PERMIT NO. Total effective al)sorption area Nearest ot ne Distance to lot Ihle Septic tank PERMIT NO. Absorpt on area(s) OTHER PIPEMATERIAL~0~ fl NSTA~LLER [~ i~ 3 EMAR KS ~App OVED - " DATE 79-0~3 t~. 3/78~ LEGAL 'I'¢.!!E L.!i[?.:!(i!iI"H ii:,!i'"!Ei'.,!:!l;I([II.,I IS 'i"I...!(!:: L.E?.,!(]'f'H ,:;;[I'.i i':'IEET> 01:::' 'I"?"i!!!!; "i"Fi:E!'..f([:H O!:;;: 'T!..iE' DEP'f'H ['F !:::i "i"!:;i:!Ei'.,IE:H Oi;;: p"'r' ~',:::; ....m-. ,. ........ tr,..:. [)l':i?l¥:li~..i(]:E[ !~i',EJ'?i.,.lli]]!!]'.,f "l"hi[:!] :i:¢l...ti:,i:!:::'!:::il:[:ii~[ 0!::' ....... !.. , !... i:::!I'.,!!:::, 'THE !;J~(i!']"T()!'i I.')F THE i~[;:.::lj:l::l',,,'l::'i"i" [[ 0!'.~ ,:[ ! i'-,! t':'E.](~J'r ). "' .... .......... I !-,:,E.!, ....! !!'...::,. ! -' !:':. ,:. ~;:. i'q ~'.ff"~ SET i,.I]:DTHFEI:;: ..... '"" ' ...... "" ~r",b ...... I.,,E.L. r' :'i:::,-r'l..~ fl-ii:ii [,'l 'f t'.J ? ',/ ~1'4 [)E!::'f'H ("IF '~t: ...... · E ...... f ::ii; .................. :,~: ." ,,, :. E',ETI.,.!!EEH 'i"biiE (]U TI:::I:::IL..!... ii::' ;i; I::: '. t'" fi41:::' ' ' n ~ i"'11N i i"!LIi"! ~t r !~)!;i! L!F':'Oi"'I THE; 'T'''¢F'Ii~ ()F F'[..I~?'I.,.!E: !'"!!.~;i..! .... i''I ]; i'"! i'{) i:::I 0 T Hl:ii;?;;: F¢'? fi:! MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION SOl LS LOG [] PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: O ~ DATE 2 3 4 5 6 7 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER //~/0 I~ ENCOUNTERED? , 0 P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) ,~ TESTz~UN BE:~]NEEN , FT AND 72-008 (6/79) F' MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 MUNICIPALITY OF ANCH©RAGF: DEPT. O[: ','.;_All , & ENVIRONMENTAL ENGINEERING DIVISI~)I~IIRON'V':NT:d' ~' ,. ;:C~'<)N Telephone 264-4720 ,- r' 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 ,,~' >~/r~ '~:W~ ~ ~ '~V~'~~ /~/1,,~/,:~' ~'...~/~ ~ ~ Y ~ MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE M~_ING ADDRESS ~/ ~/~ )',% .~",F' 3. LENDING INSTITUTION ~z ~' , , ~HONE MAILING ADDRESS 4. REALTOR/AGENT ~' ~ PHONE MAI LING ADDRESS ~.~ ~ b*' 5~ LEGAL DESCRIPTION / z-,':, ' ' "- '": ' STREET LOCATION i'"' 6, TYPE OF RESIDENCE ~SINGLE FAMILY ~ MULTIPLE FAMILY NUMBER OF BEDROOMS [] .One [] Four [~]/Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY 5,,/ 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.) S. SEWAGE DISPOSAL SYSTEM ~"~1N DIVI DUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date/':~/'/ 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, 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 [] 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 [] 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 ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS Ej~A~PP R OV E D FOR ~.~ BEDROOMS APPROVAL (lette / ust accompany certificate) ~ DISAPPROVED DATE LEGAL DESCRIPTION 72-010 (Rev. 3/78) MUNICIPALITFY OF ANCHORAGE DEPARTME~ OF HEALTH AND ENVIRONMENT PROTECTION 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: March 17, 1978 ~1: Time 9:30 a.m. ti2: Time ti3: Time Date 3-21-78 Tuesday Date Date Insp Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Darlene will meet you there. Lending InstitUtion Request: Spokane Mortgage Company Mailing Address: 3201 C Street, Suite 250 Phone: 277-0543 Property Owner: Mailing Address: Hector Gayton Phone: '% Darlene Nicolaysen, Sun Realty 688-9192/694-2509/u0~ 3. Legal Description: 4: Single Family Residence: (x) Multiple Family Residence: ( ) 5. Well System: Permit Lot 4B Block 5 Raymond Tedrow Subdivision Number of Bedrooms: ? Number of Bedrooms: ~2%1 Individual well ( ) Community/Public System (x) Construction Depth of Well Well Log on File ( ) Permit tt Septic Tank Size Absorption Area Bacterial Analysis Sewage Disposal System: On-site System (x) Public Utility ( ) Installed 1~6 Installer Manufacturer Soils Rate Material 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: Comments: Lot 4B Block 5 Raymond Tedrow Subdivision Approved~~._7~j~.~_k.~.:~.z_l,- · Disapproved: Letter Attache~: '"-(-.~_) ~ .-,,--. f)/ Date :'"~ -- _ ~ Date: .... Department Worksheet: MUNICIPALITY OF ANCltORAGE e"%??~C6 .~}~'~ Department of Health and Environmental Protechion ,~ .~<ed[~¥ ~ 825 L Street, Anchorage, Alaska 99501 ~,,',~.¢ ~'~, 2 6 4- 4 7 2 0 '~t~'~cluest for Approval of Individual Sewer and Water Facilities Property Owner: Mailing Address: Phone: Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Phone: Phone: Mailing Address: ~ /V~ Phone ,~tr et Location: Sinqle Family Residence: ~'~/Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply:.. *Individual Well ( ) Public/Community System If Individual Well, well depth If Conm~unity System, name of system Sewage Disposal System: *~-site System ( ) Public System ) If On-site System, date of instal]_ation: *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