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HomeMy WebLinkAboutSCHROEDER LT 46`jchroeder Sip C)Z 6 ® \ R MUNICIPALITY OF ANCHORAGE PROTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 -� ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR VIIELL INSPECTION REPORT P ONE A _ ' NEW DAMECJ`.•`Z5,! ❑ UPGRADE: IAILING ADDRESS 66 :GAL DESCRIPT� (9 l .00ATION � NO. OF BEDROOMS a""•® Well�+ „�.� Absorption arta ,f.. Dwellin, /„ -, DISTANCE TO: $0 z3 PE- IT;NO _ Mat i QManufacturer �j� L E No. of opartment LLJ I' Inside length Width to Liq. c l3ac ir. allons g �— u� IF HOMEMADE. Well Dwelling Liquid depth - PERMIT NO. O DISTANCE TO: JZ - --_--- --- — -- - Material - Liquid capacity in gallons X I_ Manufacturer WeII/!lD / Foundn i i W Ne-bt li e/a J TO: !J P1FTj N� �r T DISTANCE li _ _ w {I— -- Lu Y2 z No. of lines Length off��art line TotaU th oaf'lines Trenc Nth L inches Z / Distance _ w - Top of the o nigrade N Opel be r1E tinvule } c/ --- —,j !7 .� �l�•' .�slyf inches L Total effective abs tion area - _ — Length Width Depth PERMIT NO. m C7Total Q N Type -0f crib Crib dia a er /)'�, Crib depth effective absorption area w ut _ WeII Building foundation Nearest lot line m DISTANCE TO: Class , ry e nh _ _ Driller __---_------� Distance to lot line PERMIT NO. w Building foundation Sewer line Septic tank Absorption areas) DISTANCE TO:— _� - OTHER PIPE MATERIALS C' __S_01L TEST RATING INSTALLER REM RKS AIV _- � Cep • /�]]Jr//C � (� 1457• eo.:. •1 ;1000, ES — �\� �.I��1� — — AP 0 0 � DATE LEJU�G /A(jL� - ��@ THE RE/%|?�� STZE OF THE SOIL HBSORPT[3� ���TB1 I�� ��RM[T HPPLICHNT 1 JHS THE RESPO�!���lLITY TO lNFORM THlS �EPHR�ME�!� DU��NG T!�E IMSTRLLRT�ON I�SPECTIONS �F ��Y �'ELLS HDJRCEHT TO THIS PROP�RTY HND THE �!UM8ER OF RESIDEMCE� T�H7 THE HELL HILL SERVE I �HCKFILLINS �F �HY'�YSTEM |�IT�OUT FlNRL INSPECTl0H HND �PPROYPL SY T�IS DEPHRT���T !'!lLL 8E SUBJECT TO P�OSECU�I�� �r����'M �I�THM�E BETHE�H H WEISHL SYSTEM IS ���^F�ET FOR H PRIYHTE-WELL U� 158 TO 2@0 FEET FROM H PUBLlC HELL �E�ENDING �P3N T�E T�PE OF PUBLIC HELL�TE WELL TO H yH pRITE SENER L[�/� 1S 25 FE�T HND M1�IHUM DIST9�CE FROM � ������ ~ TO H CUMMU�ITYES[WEPHL�NEpIS 73SFEETICHTI0HS HM� ���STR;CTI�� DlHSR�M� HRE HVHI!.HBLE T0 I�!SURE PROPE� IMSTHLLHTIO� I CE�`�FY�TJ ITHR HITH THE REQUIREME��TS FOR ON~�ITE SEHERS HND !�ELLS HS SET � . p`RTH Pv T�E MUNICIPHLITY OF HNCHORHGE �' I WILL IN�THLL THE SYSTE� �H HCCORDHMCE HITH THE CO�ES �' I UHDFRSTqND THHT THE O�!~S[TE SEWER SYSTEM MHY REOUIR� EHLHRGEMEMT IF THE ���SlDEH�E IS RE�D�ELED TU IHCLUDE MORE THHQ ] BEDROOMS SIG�E�� ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE 11 PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR:�/f"� � / DATE PERFORMED: LEGAL DESCRIPTION: d— L/� sc.) - lr�2 eLLJ"-� SLOPE SITE PLAN DEPT 1 / /�o / A - 2 3 J 4 5 r..•—, 6 u a 7 8 6 9 10 11 12 0 13 Date Net Time Depth to Water Net Drop 14 n r1" •,.a.,,.aQa2 15 LIN ( .r r 16 Roheri A, £1: f0T 17 csr >� No. 1437 FO mv 18 �0 P9QFESS1000 dw 19 20 COMMENTS WAS GROUND WATER S ENCOUNTERED? N �,v%/) L O P E IF YES, AT WHAT DEPTH? _ Reading Date Gross Time Net Time Depth to Water Net Drop a i� 3 t� d LIN cu ' es'a WAS GROUND WATER S ENCOUNTERED? N �,v%/) L O P E IF YES, AT WHAT DEPTH? _ Reading Date Gross Time Net Time Depth to Water Net Drop a i� 3 t� d LIN PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND ®® FT PERFORMED BY: CERTIFIED 72-008 (6/79) DA Trr.tfirb l5ritting lKwo by DOC Co. dba SULLMN WATER WELLS P. O. BOX 272, CHLIGIAK, ALASKA 99567 o TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE • Started Ended PERMIT NUMBER DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAWDOWN FT. GALS. PER HR KIND OF CASING - KIND OF FORMATION: From Ft. to ` Ft. " From— Ft. to Ft. From_ Ft. to Ft._ r, "' Froin -Ft. to Ft. — From_ Ft. to Ft._ F+' `' Froin -Ft. to Ft. From Ft. to Ft. il'" From Ft. to_Ft — From T' ' Ft. to ' Ft.— ``' From Ft. to—Ft— o Ft From From-Ft. 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. 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. to Ft. From Ft, to Ft From_ Ft. to Ft. From_ Ft. to—Ft— MISCL. INFORMATION: a y, DRILLER'S NAME / HPPLlC9NT ��ILL�H� CROUSE PO BUY 6�5 ER LGC�TI0H CRRLH ST �9'/-25�9 LESHL L46G SC�RSEDER LOT SI�E 12�0S SQCH�E FEE� I CERTIFY THHT 1�pl�HM�FHMILIRR HITH THE REQUlREMENTS FOR DN`SIT� �B��RS SM� NELL'HS �E` ~� / � !ME MUNICIP�LITy OF �NCHURRGE ' � � 2 � N�LL IHSTRLL TH� SYSTEM IN HCCORD�NCE WITH T�E �3�E� I R AS -BUILT I hereby (,ej:ljfy that I have, surveyed [he following described property: Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roachvays, transmission lffie8 or other visible easements on Said property except as indicated hereon. Dated of F4w3c River, Alaska day ()f-. --`:.-._.- ROBERT C. JOHNSON SCALE: Registered L,ind Surveyor No. 880U� z Box 4516, Etqflc River. Alaska Phoric, 19071 01-2543 UAAB-HD-i GRrATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 2`i)-25111 INSPFCTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM -- �� DISTANCE FROM i 11Z 7// �' DEPTH MAILING �G" .� c� �✓ ADDRESS,4cUX ✓ 7 -� _PHONES —, its ,� �z ✓ �. NEAREST SEPTIC 7 �/ / SEEPAGE G9,� / OTHER-- SOURCES— LOCATION��� — —� / `�%i /� �� �� LEGAL D ESCRIPTION�OT�� SEPTIC TANK: DISTANCE FROM WELL >12- MATERIAL LIQUID CAPACITY G' �� D --GALLONS. INSIDE LENGTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / _OUTSIDE DIAMETER NUMBER OF / _COMPARTMENTS— ) LIQUID _INSIDE WIDTH DEPTH_ �----- _OR WIDTH, LENGTH % , DEPTH_` 4E,/CSG , DISTANCE FROM WELL— BUILDING FOUNDATION"�G SQ FT NEAREST LOT LINE �c TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPT AREA DEPTH: TOP OF TILE TO FINISH GRADE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)_ r/ TOTAL LENGTH NEAREST LOT LINE— , OF LINES _ DISTANCE BETWEE LINES _-TRENCH"WIDTFf` IN. TOTAL EFFECTIVE SQ. FT. LEN T F EACH LINE — DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE_ WELLTYPE/�� �� DISTANCE FROM i WATER SAMPLES—. NEAREST �' DEPTH BUILDING FOUNDATION.�GI —, its ,� �z ✓ �. NEAREST SEPTIC 7 �/ / SEEPAGE G9,� / OTHER-- SOURCES— LOT LINE G'�5� Uj SEWER LINE ,TANK / �/ �' SYSTEM E CESSPOOL DISTANCES /�r--� c�/.'��_ /.cis✓ .min%� i DIAGRAM OF SYSTEM APPROVED. DATE� 'HEAL41 AUIHORIIY >v APPROVED. DATE� 'HEAL41 AUIHORIIY GAAP '4D-2 GREii ATEL ANCHORAGE AREA _ 7)ROUGH Case No. =2 �H HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279.2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT LkcZv}lld_IWWIIIM�[:� V MAILING ADDRESS— ,S vZ PHONE NO.s/22 RESIDENCE ADDRESS L's Z�- � ��ALPN-OCATION OF INSTALLATION__ E,./E LEGAL DESCRIPTION .l0 % Z_� t5_C' A,6 o t' d V_ APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT `__P ,DRAIN FIELD OTHER e TO SERVE THE FOLLOWING FACILITY ,2 ddak Ila V" /g_zg — '>� TO BE INSTALLED BY '�l Nt> n� FINANCED THROUGH_ ,S' SIC PERCOLATION TEST RESULTS. 'a`.� �1�� ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS A AVL PERMIT TO INSTALL A V�5 AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED __a___B/ A 16-8 .SEPTIC TANK SIZE _,Z1,ji20TYPE SEEPAGE AREA %'/ TYPE C, CL/ AA �L L� DIAGRAM OF SYSTEM DISTANCES Health Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. l DATE 17 APPLICANTS SIGNATURE / 4' GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT CASE, 9 327 EAGLE STREET ANCHORAGE, ALASKA 99501 Performed For pin C . r>� Ely . ct1. Date Performed Leg'a' Description: Lo Block Subd rision� �,��1 This form '4& Re'orts a, Soils Log, m � ercolation-Iest� Depth Feet: Soil. Characteristics GLj U)O i ( I WC10-d ujru-t POS%� �.ilJl?. C�P.c^_R�!>.fSIf1Q C�C�.c! �RP�aiLYl.l j '.SQ�K.C� 0f.moi!S -(4fw Location Sketch rroposed Cnstallationi Seepage Pit / Drain Field Depth Of Inlet z Depth 'To BoT.tom pf Pit Cr 'a'ronci� Test Performed By, Data Certified By a=e-)O) Date. 70 N Now ■ rroposed Cnstallationi Seepage Pit / Drain Field Depth Of Inlet z Depth 'To BoT.tom pf Pit Cr 'a'ronci� Test Performed By, Data Certified By a=e-)O) Date. 70 N Time APPLY NT PILLS OUT UPPER MA' ONLY Property Own, ^r _ <; -c_ _ Phone Mailing Address 6, Zip Code Buyer Inspector Inspector Address Zip Code Lending Institution APR :t 5 1983 Phone Address Zip Code ( CAPPROVED BEDROOMS Realty Co. & Agent () ( DISAPPROVED Phone Address DATE Zip Code BY: Legal Description r Street Location Date Sewer Installed Well To Absorption Area Type of Residence Septic Tank Size ,,49— Single Family -- ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply O-.Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). A Public Utility Sewer Disposal "- Individual Year Individual Installed: Public Utility When Connected to Public Utility: i I Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Inspector Inspector Inspector Inspector Field Notes: APR :t 5 1983 "Municipality of Anchorage" " popt, of Health R ( CAPPROVED BEDROOMS rn 'CONDITIONS OF APPROV ronmen a nn r0 e0 i () ( DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: r Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank ]2-023 (31B2t