HomeMy WebLinkAboutSCHROEDER LT 74�j�Jn�oec.�er 51�
050 052. 3d ooh
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
NAME (� ((,�� (KNEW
❑UPGRADE
MAILING ADDR S
LEGAL DESCRIPTION / I
D j 7Cj
LOCATIO T��
!.
NO. OF BE
Wel ` Absor )tipn area.
DISTANCE TO:f(�Q t�
Dwelling p.
16
PERMIT N
Uy
h• 2
Manufacturer �
Material,��-��
No. of cora artinents
UJ--
w
Liq. c p�;ity ii^yallons Inside length
(� l./ IF HOMEMADE:
Width _—�
Liquid depth
v�
Well
Dwelling
PERMIT NO.
Qty
QManufacturer
DISTANCE TO:
Material
Liquid capacity in gallons
p
Foundation
TO:_Ju.Z
Nearest lot line �
PERMIT NO. conDISTANCE
No.of lines �I�'e�
7Length
Total I g of I�es Trench' idt y�
� 6 inches
Distance between linty¢ f �]z
V11 moi-
w
� h
Top of the to finish grade f -
—q
Material beneath the inches
Total effective � Og io xea
of
Length Width �—
Depth
PERMIT N0.
In
9
<F-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
-
w
n
Well
Building foundation
Nearest lot line
DISTANCE TO:
e
_v
Class
Depth
Driller
Distance to lot line
PERMIT NO.
w
.a
LU
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
..,�
OTHER
IPE MATERIALS
--
SOIL TEST RA INS_
5
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INSTALL R
REMARKS
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APPROVED DATE LEGAL r� ��
1
r.11_I r -.II C d. _" " 6 .. I 7`e d -- a C'= F_�'d l.'A d=== Fl d ---d F✓f--1 cs
�- L: �EF'ARTPlEP'.IT OF HEALTH AND ENVIRONMENTAL F'E<:O1 E;f TIrIPd _
25 ' L'' 'STREET, At�•qaiW HC RAGE'. HI;. ,-iSl5 0.1 9; 2 //1
vE}'Y--•4 ip.20 /
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�-•-II F r._.. rL_ I= a Ir -a A n_ a a _ -T- : s." -v : ��.; �° ° �� :�: ' ))
NO. < 800095
APPLICANT F DLIPar-:19N A. MC:L.E:OD SR 2 BW --1 7374
LOCATION DAVIS ST
LOTI :E l'a". _46 SQUARE
ge�lQo��Fe �4ubc�wi.s;m:
TYPE OF '.O I t.. ABSORPTION SYSTEM 1'::,: 'TRENCH
i..: ii `� F'I i�A.l
t'1Ar;IMUM NUMBER OF E:EDF�'.00MS� = _, SOIL.. RFITm%3 T'/BR =:
- l
1EN'1 IS:
THE Ra>!iJIRED SI E OF 'THE fE*.RPTIiNI--
i —I 4 -0=v .._. : A IL"f" -p tt
���
�" I - L_. "A
THE LENGTH D T MEN•dS I Otd 'IS THE: LENGTH ( I to FEET) OF THE TRENCH OF DRA I NFI E:L.D.
'THE DEP'T'H OF A TRENCH OR PIT IS THE: DISTANCE BETWEEN 'THE SURFACE OF THE
GIT:OL-ND AND THE BOTTOM OF THE: E;>;C:AVAT I O6I (IN FEET).
THERE IS. NO SET WIDTH FOR TRENCHES. m
THE GRAVEL DEPTH I:= THE rel I N I I'' UM DEPTH OF C RA v EL E•ETI.'.IEI td THE OLI'Tf'FII_L PIPE
At-* THE BOTTOM OF THE EXCAVATION (Ira FEET I.
-T'6=- P -a l" - X. ,v.'. FE: _n nd:d.o CjiIFA Il _ I .o::nIr-s°
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM M TH I'S DEPARTMENT DURING THE
T t•JS'TAL._LAT I ON I NSPECT I ON. ; OF AN WELLS ADJACENT 'T'O THIS PROPERTY FINE, THE
t•d1., vIBER OF F:ES I DENC:ES THAT THE: kIEL.L WILL SER''r E.
9.-A Cl ° : � � A' a e 6 ' EF I-:.-- -v � d! A IP "I a FI i R' k F:"
!f
BAC KF T I,._I._ :E t%IG OF ANY `- YSTE:r'I Id.T. TH LiT F IJ-1AI._ .T. NSPE-C:'T' I!"IN AtdD APP[ Ok.-'AL. BY 'I'll T. S
DEPARTMENT WI L.L BE SUBJECT _TEC:'T' TO F'R.OSECAJTION.
M I N I P11_IM DISTANCE BETWEEN A WE:_LI.... AND 4• N'•r' ON -•S T T1= SEHA(::il- DI SPO .FII_ E"`r'S TEM IS
OR A PRT')A*TE WELL OR 150 Tr.) 000 F=EET FROM A PI_IE.'LIC; DELL. DEPENC:-T.P.-IR
;100 FEET' F
UPON THE TYPE. OF F'UBI..., IC 1.4E:L_L.'. FEET
MINIMUM D T S�TAtiCE FROM F1 PRP' AT WEL.L. TO f l F'R I'v'f=l'I'E SEWER LINE T c:C
'TO A GOMt9i.. ,1I T',' SEWER LINE :E' 75 FEETT.
WELL U."XiS ARE REf> U I RED FIND MI_I' T BE RETURNED TO THE DEPFIRTMENT WITHIN T � �
ijF TFiE WELL COMPLETION.
OTHER. REG<IJ RE:MENTS I•'1A'r' APPLY. SPEC IF IGATIOr'd AND C:Crt•aSiTF..,UC:'T1ON•a DIAGRAMS ARE'
AVT111-ABLE TO TP• SURE PROPEF" II'64STALLA'TIOrl.
6 Y -" I' n U Ih'-1 F� EE IF:' 3 =' �... -„ .It.. ° a . d
I CERTIFI•r' TI -.1191"
A.: T. AM Ff-IPi T t_ I AR 1.11Thl TFIE: F Ei:ll._I I REI•'1ENTS FOR ON --SITE ' EWERS Flr•dC:l L'.IEI_i.. ; H ; =;E T.
FORTH BY THE r'1UNII:IPALI T'•r' OF At•4C:l-IOF:AGE.
I i•'.IIL1._ INS,TF-il, L. THE SYSTEM IN ACCORDANCE WITH THE C:OC-PS�.
I I.,IPdGIER: Tf INJD THAT 'THE ON --SITE SEWER SYSTEM MAY REGAUIRE ENLARGE.MP IT IF THE
RESIDENCE I' REI.IODELED 'TO IN LUC)E MORE THAt•d 3 BEDROOMS.
C/G�__...._.__........__........_._.__._._..-
APPL.I C:ANT I;}t_Ir IC f 1r,I E-1. h1Gl._EOf..:
h••�•••••••,•'^-�-
M.M. -ENGWEERINIV
SOILS LIM � .I� I��; TEST
+ porcolafiw t�
performed
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INSPECTION APPOINTMENTS
Ire
MUNICIPALITY OF ANCHORAGE DEPT. OF 111- ALTH 8A
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIftIVIRONMENTAL N OTECTION
825 L Street - Anchorage, Alaska 99501-
• j U 1.. 1 ) 1980
ENVIRONMENTAL SANITATION DIVISION
Telephone 264.4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ton (10) days for processing.
PHONE,
1, PIIIpp�ERTV OWNER 7`� �/� /� t !� �1�� aC (
2. BUXEIll
MAILING AD jRESS
3. -LEND N TITUTION
MAILI G ADDRESS
MAILING
NT
LI1�Q G I r M f
TION
6. TYPE OF RESIDENUh
[i-- INGLE FAMILY
❑ MULTIPLE FAMILY
7. WATER SUPPLY
I4 --INDIVIDUAL*
❑ COMMUNITY
❑ PUBLIC UTILITY
8. SEWAGE DISPOSALS STEM
❑ INDIVIDUAL/ON-SITE**
❑ PUBLIC UTILITY
Nl1MBER OFsBEDROOMS
Cl One E7 Four ❑ Other
0 ----Two ❑ Five
Three ❑ Six —
* 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.)
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) —�
/I �
/d 1 ,.onii,
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
®�
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified___
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified _
PERMIT NUMBER
DATE INSTALLED
_—(w0
_
INSTALLER -!r�^ n
V ` C_ ¢�C
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL n
4. DISTANCES
WELL TO:
Septic/HoldingTank
Absorptionon ArewraY'
SewerLin L�
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY
vn nan lame R/991