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Home My WebLink AboutGEORGE SEHM LT 13 ~ ~. ' 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 PHONE / ~.~UPG RAD E NAME LEGAL DESCRIPTION I~ I DISTANCE TO: I -~ I ........ - - I Material No of compartments I m Li~ cnpac tV jrt ga OhS I Inside length Width Liquid depth I "-~'~ IF HOMEMADE , ~ ] IWell ~ Dwelling PERMITNO. ~.. I DISTANCE TO: I ~ ~ ~ I -- . ~ I /~ ~'/ ~ I Materiel Liquid capacity in gallons ~_~ ,v,anu~ac~urer ~ I Well J ~ I DISTANCE TO: I ~ ~ ~ I NO of lines- ~ Length' ~each li~ Total length of lin~ I Trench~i~h . Distance bet~e~i~es ~z~ ' / ~-~ F~ ,~ F, ~ ,.~h~ /~/~ - ~ ~ I ~ ' -;'- ~ ~=-;~h -r~de -- Material ~ene~th tile ~ I Total effective a~so~ption area ~ /L~ng,h ' '-- W,d,h Depth IPE"M'TNO. ' ~ ~ I Type of crib Crib d~ameter Crib depth . I Total effective absorption area ~ I Well Building foundat on Nearest lot line " I DISTANCE TO: I . I i t . .to,otIi.. $ / DISTANCE TO: I I, OTHER PIPE MATERIALS (~'~'~'7"- ~ SOIL TEST RATING INSTAF LER REMARKS DATE LEGAL THOflPI_, F~PPLICRNT GRRr.~'.r' ' - LOCATION 4 NHEEL DRIVE RD LEGAL T'¢PE OF ';I]IL HB:,U~.E, I I_N :,T:IEH IS: DRRINFIELD I_OT :,I~:E '2S:25¢91Zi bLT.!L.IRF'E FEET MAXIMUM NLME, ER OF E:EE,F.'OOf'IS : SOIL RATINR ,::SC). FT,.."BF.:>= ±50 THE REbqt_IIF.:E[:, SIZE OF THE SOIL ABSORF.>Ti-qN --iYSTEM IS;: THE LENGTH!"r)I~,IENSION IS ,THE LEN;~TH /TN FEET::, OF THE TRENCH OR [:,RFiINFIEJ_D. I'NE DEPTH ~]F R TRENCH OR PIT IS 'f"HE DISTFINI]:E BETNEEN THE SLIRFFtCE OF THE GROUND AND THE BOTTOM OF THE EXCRVA'f'ION ,'..'IN FEET>. THE GRAVEL_ DEPTH IS THE MINIMUM DEPTH OF GRR'v'EL BETWEEN TNE OUTFFILL PIPE FIND THE BOTTOM OF THE EXCRVFtTION ,::IN FEET:'.,. PERMIT RPF'L. ICFINT HAS '['HE RESF'ONSIBILITV TO INFORM THIS DEPARTMEN'f DURING THE INS'I"RLLRTION INSPECTIONS OF RNV NELLS R[:,JRCENT TO THIS PROPERTY RN[:, THE NUMBER OF RESIDENCES THAT THE NELL WILL SERVE. BACKFILLING OF ANY SYSTEH NITHOUT FINAL INSPECTION RNE:, APPRO',,,'FIL. BY TFIIS DEPRRTHENT NILL BE SUBZECT TO PROSECUTION. ~ HINIHUH DISTFINCE BETNEEN A NELL RNE:, RNV ON-SITE SEI4RGE [:,ISPO%FIL S'¢%TEM I5 ' l. OE~ FEET FOR A PRIVATE WELL; OR ~ ~58 TO 20E~ FEET FROM R PUBLIC WELL DEPENDING UPON THE T'¢PE OF PUBLIC WELL. :OTHER REQUIREMENTS MR'¢ RPPL'¢. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION PE:~:bl I T E:*~F' ~ ~:~]~ [)E~Z:~Z~-lBE~: ]~: :~-- :1..59 7':E: I CERTIFV THAT i: I RM FAMILIAR NITFI THE REs~UIREMENTS FOR ON-SITE SEWERS AND NELLS RS SET F'ORTH Btr' THE MUNICIPRLIT'¢ OF ANCHORAGE. 2: I NILL INSTALL THE SYSTEM IN RCCORDANCE WITH THE CODES. ~:: I UNDERSTAND THAT THE ON-SITE SEWER S'¢STEM MRS' REC!UIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE TFtFIN ]c 8EDROOCdS. : Z q':;UED B'¢ -'~'" ~ 2204 C-~eveland~-~/ Ancho_a.e,~ o Alak~'~ 99503' x ~ * .u D~te Performed /~/~/ /~' Percolation Test ' _ This form Renorts Soils lo. ~ ~;~/ 5~, .nenth Soil Characteristics 20 - WaS C-rou nd I¢ YeS, At Water Encountered?.~ what-Depth? I Readinq Date ' Grnss Time Net Time Depth to H20 )~et Dron t-- )finute Percolation Rate -- Drain Field Frnposed ]osta--i-i~-tion: Seenaoe Pit · Dent--i~ 'T~ Bottom Of Pit Or Trench ,.~ ~.~-~ "- DATE RECEIVED , ~ INSPECTION APPOINTMENTS - '~-IME : TIME TIME DATE DATE DATE I NSPECTO R INSPECTOR INSPECTOR /\ DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE "NVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONI: ' 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C El V E D REOUEST 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. 1. PROPERTY OWNER ,/~ .,~,~ PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ~'"'~,,'"' MAILING ADDRESS 4. REALT.~OR/AGENT ~ PHONE MA~DDRESS J 5, LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE! J~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four ,J~ Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well Icg is required for all wells drilled . since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** ,1~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI ~ITY '1// NOT~THE'INSPECT40N FEE ~UST ~GC~PANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY / 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~'~"~1NG LE FAMILY [~] ONE [~]jTH R E E [~] FIVE [~ OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY E~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED E~PUBLIC UTILITY Connection Verified INSTALLER [~ptic Tank or [] Holding Tank /~;.~t'; Size: //~ ~ IfTank ishomemade SOILS RATING give dimensions: // TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS [Z;]~'PP ROVE D FOR r~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-01o (Rev. 6/79) ~ ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PR~ ENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENWRONMENTAL ENGINEEmNG D WS ON OCT $ 0 1978 Telephone 264-4720 }I~TIO~S: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAI LInG ADD~ESS P~OPEflTY ~ESlDENT (If different from abog~ PHONE 2, BUVER PHONE i MAILING ADDRESS j3. LENDING INSTITUTION [ PHONE : MAILING ADD~E88 14. REALTOR/AGE~ PHONE C L MAI LI N~ADDR ESS 5. LEGAL DESCRIPTION STR E.~L~OCATI O N TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four ~ Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available,) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/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, 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE 0 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 UTII-ITY Connection Verified. INSTALLER E~Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION-AREA MATERIAL 4, DISTANCES Septic/Holding Tack Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS ~"~APPROV E D FOR '~ BEDROOMS [~ CONDITIONAL AppRovAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAl2 DESCRIPTION 72-010 (Rev, 3/78)