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HomeMy WebLinkAboutT15N R2W SEC 25 LT 14 (2)Tt] 50* A) stc Z500b w M.2 00 /& Soo Smq c REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES Fill out in Triplicate) Name of person requesting approval - 2 \. iYame of property owner Al 3. Legal desi,ript ioq /U 1404 '4--- 16S 4. Number, -of -bedrooms in house ` r- rr- 5. Watex\,Analysis: — u rrtL J a. Bacterial -11 y/Q b. Detergent (\"ii/. Qj WeU data: ( ^ COY a. Type C' -,k apt_ VV 1r 1p ( j , b. Depth (/A ti . n1" fes¢ c. Casing Size1 ©+D7 d. Distance from well to closest existing or propose :S7 7 1. Sewer line 2. Septic tank _ --/Z& 3. Seepage Area o ;Z 4. 5. Property Line_ 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. 7. Sewage disposal system. . a. Age of system AWYV""' b. Septic tank capacity in gallonsrpv 2±5 c. Name of septic tank manufacturer L frill 1. If "homemade" show diagram on reverse side of this form. d: Disposal field or seepage pit size and type / a /--,)/ q 1. Distance to property1ine1"Lb ( 4- rt0 house iZndation e. Percolation, Test 'results f. Percolation Test performed by Use the reverse side of this form to show diagram. Diagram should include he following information: property lines;.well location, house location, septic tank location, disposal area location, location of percolation test, an direction of ground slope. 9. The Information on this form is true and correct to the best of my knowledge. i Signature of Applicant Date Signed TO BE FILLED OUT BY HEALTH DEPARTMENT PERSONNEL fhe above described sanitary facilities are hereby approved, subject to the following conditions: Conditions: 4(2 The above described sanitary facilities are disapproved for the following reasons: Approval is valid for one year following the date of approval. CPJ:cw July 20, 1970 Veterans Administration P.O. Box 1338 Anc3noraaBe, Alaska 99501 SUB.XXT : Sewer and nater facilities for dome, N 2001, 105' of Lot 14. See. 25, Tgl5id, Mt S.M; Birchwood Loop Area, irroy Betts„ Nflor Dear sirs: alt the roquest of 3r. Leroy Totts, an insI)eetion was made of the sea«or and water facilities for the subject how. dater is supplied by a 79' drilled well which rnaots this Do- pairtrva's approval. A water sa ale taken from this well was satisfactory. Tfae sewer system consists of a log cesspool 102' .from the well. In order .for the sewer syst®e, to meet this Delaartrlent's apl?rovalp it will be necessary to install a 19000 9011011 septic tank. This septic tank )nay be installed between the 110))1a and thn eXisting cesspool. Upon installation of the sefat-ic taankx taaaother instsecti.on ofthe seaaor %yste t will be scheduled. Since3rely, GL11+'CItD 11. JUDVIAy;, R.J. Aciniaaistrative Director BY: ure, M. .as au Sanitarian E s ran cc: Leroy Betts Zrmada Realty