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Home My WebLink AboutSCHROEDER LT 25Schroeder SID Ijimt MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMELPHONE lil o ❑ UPGRADE MAILING AD FESS LEGAL DESCRIPTION -- LOCATIO cc NO. OF BEED�DROOMS v Y DISTANCE T0: Well /�� Abso tiign area / DwellincL j PERMIZJVA.0 o- Q Manufacturer Material No. of compartments n gallons I_iq. capacity i�� DQ IF HOMEMADE: Inside length VV, 11, Liquid depth OJaZ DISTANCE TO: -- Well Dwelling PERMIT NO. �s 2,-< Manufacturer Material Liquid capacity in gallons ® -i= U DISTANCE T0: Well J / Found�tio Nearest lot lire PERI a� a w Z F. z cc No. of lines / Length 9 ea J lne Total le h,& Titles L �} Trench w inches Distance between lines xF 0 Top of tile to finish grade Material beneath tile / / l4 inches Total effecJve absorption area �)G0 w (7 Length Width Depth PERMIT NO. I F- w Type of crib Crib diameter Crib depth _ Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line J -1 Class Depth Driller Distance to lot Iine4 PERMIT NO. A �> ' DISTANCE TO: Building foundation Sewer line Septic tank Absorption OTHER �areas) PIPE MATERIALS SOI L TEST RATING — - INSTALLER REMARKS 2 CJS G�fJ L� atq Ic coo J APPROVED DATE LEGAL 2-lll31HP.V. V/X1 RVI ��X F_`11 9 1p: * V �lr", ��C_': 11 1 �� DEP8RTMENT O/ HEHLTH HND ENVIRONMENTHL PTECTION 825 /L STREET/ RNCHORHGE/ HK99L � 264~4720 C, p"i~^"T lK-4 �H, I C Fr, VD, N 9 0 `iPERMIT NO � RPPLICRNT WHYNE C0USINEHU PO BOX 76I ER LOCRTION MHRCUS ST LE(ii HL 1...25 SCHROEDER S/D LOT SI2E 12000 SQUHRE FEET TYPE OF SOIL HBSORBTION SYSTEM TRENCH MHXIMUM NUMBER OF BEDROOMS � ] SOIL RHTlNG (SQ FT/BR)� 98 THE REQUIRED �IZE OF THE SOIL HBSORPTION SYSTEM IS� ��= nK.. ��VA H31 " If- � �Q 10 "VEH: L.. RED PIE �M 1-1 ==g GL THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DITHRICE BETWEEN THE SURFHCE OF THE GR0UND HND THE BOTTOM OF THE EXCHVHTION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET). Hot PEE Ge U 1: IT: to! to. IS us: Fw w 1: av no; �lin �� :1. IER Q CA ��U. PERMIT APPLICHNT HRS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURIHG THE INSTHLLHTION INSPECTIONS OF HNY WEL[S RDJRCENT TO THIS PROPERTY HND THE NUM8ER OF RESIDENCES THF -11, THE WELL WILL SERYE A: 1=2 PEE NO W 1 C) PAN EEL A FT TH to! PHE (71 u x in! a It, BRCKFILLING OF HNY SYSTEM WITHOUT FINRL INSPECTION HND RPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE 8ETWEEN R WELL HND RNY ON~SITE SEWHGE DISPOSHL SySTEM IS 1Q0 FEET FOR H OR 150 TO 200 FEET FROM H PUBLIC WELL DEPE@DING UPON THE TYPE OF PUBLIC WELL OTHE� REQUIREMENTS MHY HPPLYSP�CIFICHTI�NS HND CONSTRUCTION DIHGRHMS HRE HVHILH8LE TO I�SURE PROP�� INSTHLLRTION �� U�� - I CERTIFY THHT 1� I HM FHMILIHR WITH THE TE SEWERS HND WELLS HS SET FOHTH BY THE MUNICIPRLITY OF HNCHORRGE 2� I WILL INSTRLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTRND THHT THE OH .... SITE MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THON ] BEDROOMS SIGNED� ~~... ..... .... �~~^~�~~~^~~�~ HPPLICRNT WHYNE COUSINEHU G Et E GE TECHNICAL Efi DEVEL-OPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-22.80 Russell Oyster 694-2774 $OIL LOG Earl Ellis Soils Et Foundations 688-2280 Land Development Performed for: Name: 1LSINz- �; / �.� el c - "--Tel. No. Mailing Address: Legal Description: _2,-, /V X'_ De th feet Soil Characteristics 0 1 2 3� i 6 7 1 8 9,. 11. 12. 13 ILL e r t; r. 15 16 m� Ground Water Encountered: Yes- No. (-- If yes, what depthe�_ Proposed Installation: Seepage Pit Drain Field Comments: Performed by: (�.rrttftrb Brining i-Eug by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 6942588 OWNER OF LAND ? i ;.-,,; - '_) �_ ADDRESS LEGAL DESCRIPTION i _ -' ;'' i`l , r I•=<.=' DATE - Started Ended Z -% PERN4IT NUMBER KIND OF FORMATION: DEPTH OF WELL " STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR > =' KIND OF CASING` From Ft. toFt.-0�-''�,' i?iJ, �r-! From Ft. to Ft.__. From Ft. to Ft. J/) `-'/ `t f4?":'.'' _ -- From— Ft. to—, ----Ft. From /" _Ft. to��;-' Pt."- _) �i' r^-� Froin___ Ft. to Ft. From ' ' Ft. to Ft. From Ft. to Ft. From Ft. to �`` " Ft.— '� ;' `„'-� -.. �' From-- o Ft. to---Ft---- Ft From ,- From Ft. to 6 _Ft. Froin- --Ft to Ft. — — From_ Ft. to Ft. ----2,-/ ;'` <-_ From _ Ft. to___ Ft. Froin. -Ft. to Ft._ From_ Ft. to Ft. Froin—Ft. to _Ft. _ Froin—Ft. to Ft. From Ft. to Ft._ From Ft. to--- Ft. _ From_ —Ft. to—. Ft. From Ft. to__ Ft. — From Ft. to Ft.— From Ft. to Ft. From Ft. to Ft. From Ft. to _Ft. From Ft. to Ft. -- From Ft. toFt.— _ From _Ft. to Ft. From Ft. to Ft. From _Ft. to Ft. From Ft. to Ft. From _Ft. to FL Frmn Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME �°:::� p::::c-11=�� -��'II :II:...,IL... ll'�:: ,.;; ��:::_ .fl: IfT-.". [iii:."==i:�: :_=� Iii::. °--:" Ila_: q`,��I Epi::" ��=:�: h=�^ :::��::::a�_. _�� ::JI_...".i� �7.r, ...^.,, ,,,.;, : _._ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264••4720 Application Date 'I. GENERAL INFORMATION (a) Legal Description (include lot, block, subdi ;Sion, section, township, range) - -— _ Location ( ddress or directions) (h) Applicant Name Aron" _._—. Hm Telephone: oe Businessusiness /� Applicant Address ---- (c) Applicant is (cheek one): Lending Institution Owner•/builder, Buyer El ; Other Ca (explain); (d) Lending Institution �f�C>r / /t'C/L Telephone Address .-- -- -- --- j 1— (e) Real Estate Company and Agent Address—— — ----- Te,I 'phone ---------- (f) .,ai]rl e HAA to the following address: 81 zRO 1296X W_ .� 2. TYPE OF RESIDENCE Single-Familyy Multi -Family ❑ Other Number of Bedrooms -- —_') __---_ . WATER SUPPLY Individual Wella Community 1-1 Public D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL OnsiteX Public 0 Community L 1 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 o', 02',,, n 1 84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEAACFI, DATA AND INFORMATION R Apr- As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investiga,: 'n of this t ;ealth Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functiorsl and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the infor--ation ol;tained from the Municipality of Anchorage files and from my investigation and inspection, the on-site wat.e- supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regul.,t nr.s in effect on the date of this inspection. Name of Firm Address Date ;.j�5? Telephone �/. k. AIreG'f'L�(?1 1 bedrooms by � "=� � —� ?:--T.� Approved for / l Date Approved _— _ Disapproved/L_____._.____ Conditional Terms of Conditibnal Approval CAUTION --ILIT� — ---- — -- 1 The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Au'.`crity Approval certificates based solely upon the representations given in paragraph 5 above by an independent profesa•snal engineer reei.;tered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes ant their le -"Ing institutions in order to satisfy certain federal and state requirements. f:mployees of DI IEP do not conduc! +nspect,c-6 or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions the professional engineer's work. Page 2 of 2 • �,urY OF �NVIRpNMEN�g1E �E�0 Ge MUNICIPALITY OF ANCHORAGE (MOA) PA'ON HEALTH AUTHORITY APPROVAL (HAA) l' ?C CHECKLIST - FEBRUARY 1984 264-4720 ecrl j t'D Legal Description: , 5 — A. WELL DATA Well Classification — s I If A, B, C, D.E.C. Approved (Y/N) Well Log PresentON) Date Completed - 3\ `19 — Yield 4— r t Total Depth e2l 2 Cased to °`� ''� Depth of Grouting �> Static Water Level — Pump Set At — t'_)- K Casing Height Above Ground — `,7 Sanitary Seal on Casing GIN) Electrical Wiring in Conduit 19N) Separation Distances from Well: To Septic/Hek4pg Tank on Lot 1 r� r= Depression Around Wellhead (Yo On Adjoining Lots _tL=_'ca `s To Nearest Edge of Absorption F=ield on Lot �a�` F On Adjoining Lots t To Nearest Public Sewer Line r, (A To Nearest Public Sewer Cleanout/Manhole ''S r'� To Nearest Sewer Service Line on Lot Water Sample Collected by e S �� <� ;(LC" ; Date _ Water Sample Test Results Comments 105C_rA�s� B. SEPTIC/HOLDING TANK DATA Date Installed 6` r? – r 9 Size No. of Compartments Standpipes &N) Depression over Tank (Y( Iy Air -tight CapsON) Pumping/Maintenance Contract on File (Y/N) r3 Holding Tank High -Water Alarm (Y/N) 1'� LA Separation Distances from Septic/WeWP* Tank: To Water -Supply Well \='r Foundation CleanoutON) (Date Last Pumped _ 2–? -0 - ; for .1 Temporary Holding Tank Permit (Y/N)� To Building Foundation To Property Line To Disposal Field t To Water Mein/Service Line/ l `Y To Stream, Pond, Lake, or Major Drainage Course 41A Comments Page 1 of 2 X C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _'9 13'x')AA-) . Date Installed Width of Field Type of System Design .Tynfo Length of Field 12_;�' Depth of Field __ N Car Gravel Bed Thickness Z N -- Square Feet of Absorption Area 6bo c� Standpipes Present, Y?N) Depression over Field (Y/9 _ _ Date of Last Adequacy Test to-2-6— Results -2.6—Results of Last Adequacy Test SA'i'rLS4"= Separation Distance from Absorption Field: To Water -Supply Well L 1.} To Property Line C ' ( k To Building Foundation t ` _ To Existing or Abandoned System on Lot /Ya On Adjoining Lots � � ` To Water Maid, Service Line U`� r k To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course �A _ To Driveway, Parking Area, or Vehicle Storage Area 15� ('t - Comments LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all�MO/A� and HAA guidelines in effect on the date of this inspection. Signed=.'aOEP1 Fli��'} 311- f33; — ---- Date 3 a S',.S Coriia}�yIU6� 6,GAKE�ZuZ — MOA No. _ o ,� •aa+at��; Receipt No. 5�UIX) � Date of Payment�ff Amount: $ 4q4a Page 2 of 2 72-026 (11/84) �`— DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE_, INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • ENVI RONMENTAL SANITATION 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 110) days for processing. 1. PROPE OW/�ER PPFIg� L4CC f, t✓ y / ///��e%C,�� MAILIN ADDRES PROPERTY REST E T (If different from above) PHONE 2. BUYER j ^ ( PHO�L,E NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MAILING A ESS s _ 3. LENDING INS ITUPHONE TION � J� � ' MAILING ADDRESS__ 4. REALTOR/AGENT P N MAILING ADDRESS } /_ c! 5. LEGAL DESCRIPT ON ST 'EL L CpATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Dl� Three ❑ Six �—s�— 7. WATER SUPPLY ❑ INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) _ 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** _YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 1 Rev. 6/79) 72-010 (Rev. 6/79) �— THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX PERMIT NUMBER s 2. WATER SUPPLY ❑ INDIVIDUAL DEPTH OF WELL — ❑ COMMUNITY ❑ PUBLIC UTILITY DATE DRILLED – Connection Verified_ LOG RECEIVED — PERMIT NUMBER 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY�7 Connection Verified DATE INSTALLED --- ❑Septic Tank or ❑ Holding Tank INSTALLER — Size: 1000 _ If Tank is homemade give dimensions: _ SOILS RATING — TYPE OF TANK MANUFACTURER — TOTAL ABSORPTION A13EA MATERIAL n 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line' Nearest Lot Line�— �� Absorption Area to nearest Lot Line �1� 5. COMMENTS ----s -- ❑ APPROVED FOR 3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE b -1- —� BY 72-010 (Rev. 6/79) 71 14, 19c2 fl)7. 05 oa<esn St. -77 Amjee«: fat 5 S »oeJev Si Jivieim1 o vzt .1- «o=1-mli-vi-clun 1, row -1 -1110 ware! j. 1, i ties can mm >3 3raeEeo lint -Al the- «011 I=e item save li0oli Thn w""Itnr alla 7 C) x, to 3 20 56.33 c ot oily rnv- t m 6 I -A C-11 to is Please t , flls v%nt FOY, » <einupectim\on L noted a «»netea, I£V'horc are ai'VII oTtice at 2 � I I a ---] 7 2 0 - gi'lloo-coly, , RPInG/r 0® s f l TZ MUNICIPALITY OF ANCHORAGE MUNICIPALITYDEF. C1 ANCHo DEPT. or I ALTI1 & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI" CTION tiVVIRONMEN7' _ 825 L Strout • Ancfiorago; Alaska 99501 - • ENVIRONMENTAL ENGINEERING DIVISION FEB I Telephone 264.4720 � r k�Y E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEiWE t � I S DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processad. Please allow ten (10) days for processing. 1. PROPER Y OWNER MAILING A ESS PROPERTY RESIDENT (f dif re o bove) Aglow? ! - PHONE 2. BUYER —_ O E— MAII_IN RE� 3. LE ING INff11lqr0N PHONE MAI LI NGADDRES _— 4. REAL OR/ 11 - HC- HC1 MAIL �DD S�____��Aide Z7. Adf�VJ6 J" me 5. LEGAL DESCIPTION W —' STREiET LOCATION/ Im 6. TYP�RESI NCEOle �� — -�— NUMBER O ED OOM SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ED Five ❑ MULTIPLE FAMILY� Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975. For wells drilled pr'or to that date, Giv well _ El PUBLIC UTILITYdepth (attach log if available.)® B. SEWAGE: DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date ❑ PUBLIC UTILITY 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. 10 ni/0/101 SD VIG THIS SIDE FOR OFFICIAL USE ONLY --- -. INSPECTION APPOINTMENTS DATERECEIVED . - TIME TIME _ TIMI?J DATE DATE- DATE - INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE a --EJ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER of BEDROOMS ❑ ONE --❑ THREE D FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2, WATER SUPPLY INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified_LOG PERMIT NUMBER 1� DEPTH OF WELL --- s RI DATE DRI _ LED _ )i RECEIVED 3. SEWAGE DISPOSAL SYSTEM -EOINDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified -_ PERMIT NUMBER C) Ltin, DATE INSTALLED R_--) _-)t INSTALLER ]Septic Tank or ❑Holding Tank1n Size; 1C)C)C). If Tank is homemade give dimensions: —_ SOILS RATING GlR TYPE OF TANK MA _ UFACTURER TOTAL ABSORPTION AREA MATERIAL Septic/Holding Tank -Absorption Area Sewer Line- Nearest Lot Line Fes' \C�(_'n' _— �. DISTANCES WELLTO: Absorption Area to nearest Lot Line 5. COMMENTS ]./APPROVED FOR ,ZBEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED - DATE - BY (Titles) LEGAL DESCRIPTION 72.010 (Rev. 3/78)