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INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
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Name � .��..� l-�a '�t ling Address 1�0 obP, f $` 1' YoecleY'
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Loeation �'DA ti+ 6 Legal Description 6c_rKY2�i
SEPTIC TANK: Distance from well Material Number of compartments
Liquid capacity/000 gallons, Inside length Inside width liquid depth.
SEEPAGE SYSTEM: Seepage Pit: Number of pits Outside diameter or
width—/() , length ( , depthlining material a ra ,e -.L. Distance from
wellbuilding foundations , nearest lot line Total effective
absorption area (wall area) 1l& sq, ft.
PILE DRAIN FIELD; Distance from well, foundations, nearest lot line
'Dotal length of lines Number of lines Distance between lines Trench
width in. Total effective absorption areae sq, ft. Length of each line
e
Depth: Top of tile to finish gradDepth of filter material beneath
tile-_ in. Above tile
WELL: T ND`t: ', 4_��
WELL: Type , �epth i distance from building foundation, nearest
lot line., nearest sewer line_ , septic tank, seepage system ,
cesspool., other sources �16"A
_-_ DIAGRAM OF SYSTEM
DISTANCES: � a�'P�r�
c_
g f�1: m 'S'
/ 1
DATE: C:` , / I )I , j[C.?_
I
� l
APPROVED.
He lth Authority
tlugun t 20, 190;
IAS:. Dnn Rtpaloo
Local Re preaantat.lvr�
Vaternne Administration
VX. Box 1399
Anchorage, Alaahn 99501
sf##NIla'CT: Sewer and Water
home of Fir. Raahoo,
Stevonsong W69
Scshoodder Subdolow,
Dear Mr. Rapaa lee :
At SO time or within the next ye:at: there i8 no possiEjjlity that
public water or a0wox will be available to Wa subject: Tivat:ion,
Sincerely yout'rt,
WNW Wroc cor
David B. Hari<nesn' R.S.
August 18, 1009
Dan Rapalec
Local
Voterann Administration
P. 0. BOX 1398
Anchoraye, Alanka 99soi.
SUMM: Sewvqn and proposed water
favi litior for jot 69- Gy"ro(yonr
Subdivision, V.ACoco 9165-05,
I)ORIC of Robert
Dear Mr. Rapaloo:
The oxiotiny sawayn jimpoual ayntem yop thq Ipbloct locltjo,
consig" Of a 10DO Y0110n OPPVC tank in conjmnntion AW on,
adequato SeepaRe aroa, Our office Insnected thQ nystly at TY
Wo OV its installation 1" octobep OF 1968,
% thn Plot adQqu"to volumna of lafo wqter hnvo !Cqn nntJ!nJ(J
from a drillad =11 ).Qi w"On 501 and 00' in WOU in thiq nuh-
divIsIon, This well aho"In Ly located p minmun of Lon, frorr,
all exintinr nowalo apoai.
SnacrOy 1
OAVIn Q, L. DWAN, P,W
WON 94"Cntol,
01vill UnWICI)Cq�,
sauitarin-)
?H/V)I
July 2A, 100
Mr, Mort Hickmnii
padaral Aouslug AdmiulstuatioT,
P.O. box 4M)
Auchoparn, Ak. 99501-
qUMOCT: KwAn Mul Prmlulcd m("'
racillben "or Tot bq, Mahrowder
>wdt&aionl P,H.A. CIM! 1165-475
w Op. Hickmin:
Thp onintinv 1019"n diqn0la1 07"M " " """M Innation
consists Q o 1000 qallan septio tank iq COW"npt"H ""A a'
adoqmot„mom ni nvAa. Our office W=Wd th- '100 " th(--A
Kwe of Un Wduly 11on in ACLAy- W 1963.
H, woull emnont that an adequate volume OF MY" "enemy"
05c"W"d NOW a Avilled wall hKaeow sit lad Sn' in Amb, UP
s.1. m: be jacated a AM?= Of 1001 From all oxktinq Seep -
ago orols.
Sincyraly,
DAVID R, L. menw,
Andinil Mroctor
m:
Onvid
ANYTAPIM!
(�r�`: t�ta>b Dr*tfing Ing
by
DOC Co. tlCa
DRILLER'S NAMES
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567
• TELEPHONE 688-2759
/5,q rl,L!
OWNER OF LAND JE r' f �/Sr g� �,, ,'
DEPTH OF WELL
_ 8
ADDRESS t !
Z0 r i 5" C
STATIC LEVEL OF
NATER FT. D —_
LEGAL DESCRIPTION
4 6-!2 IY 2 4' 2'
DRAW DOWN FT.
X-1)
DATE - Started Z, 27
Ll Ended
GALS. PER HR
7—C�l
PERMIT NUMBER
/
G�
KIND OF CASING
KIND OF FORMATION:
From Ft, to r'
Ft.— �� �t �� �� �� ��'
From
Ft. to
Ft.
From ' Ft. torr�/tJ49
From
Ft. to__
Ft.
From.—Ft. to -Ft.
From
Ft. to
Ft. _
From-_/(f_Ft. to 7 2 Ft. ! <r" f
From
Ft. to_
Ft 2AGE
MUNICIP
From_LE-Ft. to
Ft.
FromFt.
to—
o
Ft II
--
From _Ft. to
Ft.
From—Ft.-to—Ft.
From__ Ft. to
Ft._
From
-
Ft. to_Ft.
From_ Ft. to
Ft._
From
Ft. to
Ft. p�cED
iy-►.,, � I YV
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:
DRILLER'S NAMES
SOAP 1 74, (112 5 A to 7 1 A 1 MY 0 owl --i�
DEPRR�MENT /�ERLTH HN� ENVlRONMENTAL �OTECTICH
^ 925 '� �TREETHNCHORHGE. Or 9Y. 1
264~4720
PERMIT PM ( 811186 )
HPPLlCAN T ROGER D EMGELSON
LOCHT[ON �HYIS ST
LEGHL L69 SCHROEDER
(l�\���1
8OX 158 DHVIS ST ` /
LOT SIZE
12629 SQUHRE FEET
I CERTIFY THAT
1 I RM FHMILI�R HITH THE REQUIREMENTS FOR ON~SITE SEWERS HNE:. NELLS HS �ET
FORTH BY THE MUNlMOM TY OF HNCHORHGE.
2 I WILL INST8LL THE SYSTEM IN HCCORDHNCE 111 T THE CODES
SlGNED
x -A/.
i1:15-1 J f
L ocE I ,Ott
I. I F;Na, "* I 1,iF I (-I hl W I I
HN k ) 04, v to it T., f :
F;f L I'l
--
'1:-.
Ok F; Ff': I YWI k, f -A-, t. I t.tf
# !_ "i F (,it'.
j
4 JIB 1 Y -T 04- r MA J C. HE 1. L.
IS ni F},i I. I ONCT I, tl.lM
N,! j lv,tVi P -L Pit P..! L J 14
SE ED 10 1.3 WE I S; 15
F U! I
N (!Ul [,.'f x, mum
Fs Knimporto ul nwT pf
MY
f-41011- Will JLM APB) ENUMFICUUM
EIRIARMIRS
ITT -
1C, 3 ;jFAQ;T ry,Ey jl4n,l
FA, ! f;l yllf
't- W ,M -1 , I - F- "51-1 _-I !I-,,;-- .-- , 1:0 f- I 'F- 1,11..;1 F. ! - . .-: i. ., 21 SINT: -1 -
1 FUI F pUll I I W: N T Z H I Ff NE Klkl I fa Pit PT I on I W& W& & 1 1 F 01 LONS I'M wr I- i.. -,. F;.,. _`-t:1
W WO All FRRM:WH- j I'll Lit
pil I I 111"IFU L low OsAmpi it!
L ,-,uN
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER. FACILITIES
(Fill out in Triplicate)
llama of person requesting approval 6
2. ;r�u�: of property-
3. :.e al r1A,,cr,j pt i nr
4. Numbez-nf,bedrooms in house 13
5. Water.A.nalysis:
a. Lacteri.al
b. Detergent
6, Wel]_ data:
a.
1Yp%
b. Depth
C. Casino, Size
d. Distance from well to closest existing or proposed:
1. Sewer ling
2. Septic tank
3. Seepage Area
4. Cesspool'
5. Property Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc.
7. Sewage disposal system,i`
a. Ape of system
b. Septic tank capacity in gallons.
C. Name of septic tank manufacturer
I. If "home made" show diagram on reverse side of this form,
d. Disposal field or seepage pit size and type_ /jar I l
1, Distance toert ro
P P Y lineto house foundation
e, Percolation Test results
f. Percolation Test performed by
n. Use the reverse.side of this form to show diagram. D.i=iFram should include
i,he fo-1lowi.nf, information: property lines;•well location, house location,
tank location, disposal area location, location of percolation test,
a<<d direction of Fround slope,
9. The i„s-,,,,+;nn nn this form is true and correct to the best of my knowledge.
Si.pnature of Appticant DateSigned
TO BE FILLED OUT BY HEALTH-DEPART';ENT PERSONNEL,
"The above described sanitary facilities are hereby c-pproved, subject to the
0110_ winf COnC� 1 ,is: wm
Conditions; !�7--
Q
The above described sanitary facilities are disapproved for the followinv,
reasons:
SiPnature oficia.
' Date k r
Approval is valid for one year followinL; the date of approval.
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