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HomeMy WebLinkAboutSEACLIFF BLK 3 LT 9Aeac Iiff Block 3 Lot 9A #011 -221 -28 Municipality of Anchorage Community Development Department Page � of On-Site Water and Wastewater Program 4700 Elmore St. ° P.O. Box 196650 Anchorage, AK 99519-6650 ° http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: PID Number: D )1 22(- L ❑ New [Upgrade Name: j� r Y � o r\ �.• �C.. �r l«r }. 6 �l ABSORPTION FIELD El Deep Trench E] Shallow Trench [j Bed El Mound Address S 2 , c 5 r � c rrq � Other S -&-c Phone Number of Bedrooms Soil Rating Total depth from orginappl grade 3 (1 Z GPD/SF -(• 3 Ft. LEGAL DESCRIPTION Depth to pipe invert fromoriginalgrade J, � Ft. Gravel depth beneath pipe 1 Ft. 6'eO 7 Subdivision Block Lot // / S�q C l 4 3 ?'4 Fill added above original grade D Ft. Gravel length / ! i9 Ft. Township Range Section Gravel width I CP Ft. Beds: Number of Lines I / Distance between lines / Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line p q Fel Ft. Well Z U©/,F Z �� {- / N Sd I.�, TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Ca Vh Surface Water (Up/iL_ 1001� Gal. Material Number of compartments Lot Line y0 f 114'+ NA Foundation101r ZO c� LIFT STATION Manufacturer Capacity Gal. Curtain Drain ,I� RemarksPump on level at in, Pump off level at in. High water alarm at in. 4-0. V1 h" t rYn r8 (�' v,1, /� a �v c� V n Pump make and el Electrical Inspections performed by Installer PIPE MATERIAL Housetotank Tank to 6 447drainfield 'WV( 1 / ,�// / L rl Lv erSdri P Drainfield / CO/MT / Inspector Nr:2e A BENCHMARK (Assumed elevation) !vo ft Inspection 1:1 Location and description dates: 2" a 3.a 4t COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL 4skamp b _ OF At Conditional Approval: Date .-g 49TH •.0 ..:.e.:..1.. ...:...� ��• MICHAEL N. ANDERSON g46� �A® Approved S� `lam ,�®®�l Date fsm �-� Inspection Report_1-1-1 .doc Permit No. OSP111042 Page of A I/ DATE: 4/16/2012 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SEACUFF, BLOCK 3, LOT 9A PID No.: 011-221-28 \ \ I \ 10-, EXISTING CONCR TANK PUMPED A \ CLEANED 0 Y \Fyj GARAGE 16X16 SEEPAGE PR \ \ CLEANED & NEW \ DRAIN ROCK \ \ INSTALLED. \ \ DO \ \ i� _ NO \\ \\ PROPERTY LINE TCO2 \ \ \ 1 TCO1 BENCH. GARAGE \ SLAB \ HOUSE B COMMUNITY WELL 200' RADIUS ------- ---I \ ,= ASBUILT SCALE: 1"=50' COMMUNITY WELL `\ 100' RADIUS ---- —` \,-- / 1 \ / Eco C01 TCOI TCO2 r r� ,OF. 49TH ;.� ♦� PtCj1j2j •••• •••••••••••••••� 09.8 0 0 0 . '......................... ..a D D D ♦ ';MICHAEL N. ANDERSON.i D D ♦1� No. QE X469 DRNx ROCK IXSTANEO •. •%/"tl/� (1�'�� SEPTIC SQQMN E%STING 0' CONCRETE SEEPAGE PIT �♦ X01 U. MARK \ A g GRND. PIP ELEV. ELEV. COI Z \ 95.2 cool a sz \ sa On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP111042 Tax Code Number: 01122128000 Work Type: Septic Upgrade Permit Effective Dates: April 28, 2011 to April 27, 2012 Design Engineer: ANDERSON CONSTRUCTION & ENG'G Subdivision: SEACLIFF Site Legal Address: SEACLIFF BLK 3 LT 9A G:2424 Owner/Address: KIMPTON RANDY LYNN & KIMPTON MACEY JO 5207 SHORECREST ANCHORAGE AK 995151030 Site Mailing Address: 5207 SHORECREST DR, Anchorage Lot Size in Sq Ft: 17282 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Recei Issue( MUNICIPALITY OF Community Development Department Development Services Division (*D On -Site Water & Wastewater Program ANCHORAGE Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Phone: 907-343-7904 Fax: 907-343-7997 Parcell.D. 01l-a-� 1—,2F Propertyowner(s) L4 r+, nfoti Day phone Mailing address Site address Legal description (Sub'd., Block & Lot) t f Legal description (Township, Range & Section) Lot Size / �noc,)+ Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Initial ❑ Absorption Field t C\Ton,n4 Upgrade Septic Tank Renewal ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. Perm/il ush Fees: to of Payment: Receipt Number: I Permit No. Cf) I I) CA a Waiver Fees: Date of Payment: Receipt Number. Waiver No. GABuild1ng\0n Site\Forms\Client Forms\Permft App_010411.d00 (Rev. 1/11) Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 April. 22, 2011 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Seacliff Subd. Blk 3, Lot 9 To Whom it may concern: Attached is an application for a cleaning of the existing septic system on the referenced lot. The existing system has a concrete tank and seepage pit and only need a good cleaning. The leach area around the concrete seepage pit will be enlarge for the correct size, it is currently 12' x 12' per the 1971 asbuilt. Additional sewer rock (18'x 18') will be added to make the system meet the correct 3 bedroom size. All of the existing cast iron piping will be replaced with plastic pipe. The subdivision is serviced by community water and all of the slopes within 200 feet are less than 3 percent. None of the neighboring lots will be impacted by this modification. If you have any question please call me at 727-8864. Sincere / Michael Anderson, P.E. 'AKF `ItK ANCHORAGE AREA BOP �U"H HEALTH DEPARTMENT / Np 768 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING `' �,_ NAME- - ADDRESS �.2//,:'%514!-S 2;/&C .Lfi ---- PHONE _% LOCATION LEGAL DESCRIPTION�����.e SEPTIC TANK:------- DISTANCE FROM WELL 4°- 2E?14'_114'_1' , MATERIAL NUMBER OF COMPARTMENTS ..E✓�/��,rs� %y7/ /9/y�Of��G .q LIQUID feu s.�•• LIQUID CAPACITY,Z4f'�-� GALLONS. INSIDE LENGTHLa2 ' � INSIDE WIDTH 4—.09•L DEPTH `— SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH,LENGTH/ DEPTH ' ��gcz�✓T' Cs�if/�'�9g LINING MATERIAL ��s"�.��lf�r rcii/�r , DISTANCE FROM WELL BUILDING FOUNDATION/ NEAREST LOT LINE /� / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '- SQ. FT. 74- TILE ` TILE DRAIN FIELD: N/y TOTAL LENGTH DISTANCE FROM WELL , NEAREST LOT LINE , OF LINES NUMBER OF LINES ��� DISTANCE BETWEEN LINES TRENCH WIDTH FT. LENGTH OF EACH LIN DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: DISTANCE FROM WATER TYPE DEPTH BUILDING FOUNDATION. SAMPLE NEAREST L� NEAREST SEPTIC SEEPAGE y-..- OTHER �--- LOT LINE SEWER LINE L-" ; TANK— SYSTEM , CESSPOOL — , SOURCES_ DISTANCES: DIAGRAM OF SYSTEM 'KF- `ItK ANL;HQKAGE AREA BOF -"V'4 �� •.J HEALTH DEPARTMENT 768327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME� MAILING ADDRESS PHONE 2� LOCATION LEGAL DESCRIPTION, -/ ';'__Z1 E� !.S-F�%�� s��✓• SEPTIC TANK: / DISTANCE FROM WELL ` G/, MATERIAL NUMBER OF COMPARTMENTS C✓�/.�0�.� % `�%/ /��dall�� �. LIQUID LIQUID CAPACITY GALLONS. INSIDE LENGTH Xl�'2 'r INSIDE WIDTH ��9•s" DEPTH `— SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH " f2- ,LENGTH ,DEPTH ��'c C>J✓T C'��i���7�T . LINING MATERIAL �c� ii � � /�G/ DISTANCE FROM WELL a'ZZI i/G BUILDING FOUNDATION NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. 7` - TILE DRAIN FIELD: IV/lJ DISTANCE FROM WELI NUMBER OF LINES ABSORPTIO ISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH NEAREST LOT LINE OF LINES , TRENCH WIDTH DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE ��•% •G�- ✓ DISTANCE FROM �� WATER DEPTH BUILDING FOUNDATION. SAMPLE , NEAREST NEAREST SEPTIC SEEPAGE `�OTHER LOT LINE SEWER LINE TANK SYSTEM , CESSPOOL - , SOURCES_ DISTANCES: DIAGRAM OF SYSTEM DATE APPROVED// T HEALTH AUTHORITY v c.;,ns-xn-z liKr:A"1" 'f` 111i1�11VKAlil: AKL�,_.1..,JKVUITtI Case No. HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 2�5TJ SEWAGE DISPOSAL SYSTEM - APPLICATION __8c PER�* LTPOE BOROUGH .rFR ANS -^ NAME OF APPLICANT Sumner Develn_ Corp.- MAILING ADDRESS 9311 Ja 1 it PHONE NO. 3dd-46a], Lane RESIDENCE ADDRESS LOCATION OF INSTALLATION LEGAL DESCRIPTION Lot 9 Blk. 3 Seacliff Subdivision APPLICATION TO INSTALL: SEPTIC TANK x , SEEPAGE PIT x , DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY 2 hAdroom-residential FINANCED THROUGH TO BE INSTALLED BY PERCOLATION TEST RESULTS " ;L ANTICIPATED DATE OF COMPLETION THIS IS TO SERVE AS BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED 2 bedroom residential SEPTIC TANK SIZE 1000 TYPE cement SEEPAGE AREA DIAGRAM OF SYSTEM DISTANCES: HEALTH THORITV IE OR LICENSED DESIGNER TYPE 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. DATE July 90 1971 APPLICANTS SIGNATURE G;TAC%OCAGL APFA A0 g o p i> ��A�PLO JA GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received December 18, 1975 Time of Inspection Date of Inspection OD-_ar»At /9 /9/% REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR VA 1. Approval requested by: AMFAC Mortgage Corporation Mailing Address: 705 West 6th Avenue, Suite 201 Phone: 277-8588 2. Property Owner: Alma E. Hicks Phone: 272-3018 Mailing Address: 700 hest 2nd Avenue 3. Legal Description: Lot 9A Block 3 Seacliff Subdivision 4. Location: 5207 Shorecrest Drive 5. Type of facility to be inspected Single Family No. of bedrooms 6. Well Data: Community Well System A. Type B. Depth C. Construction D. Bacterial Analysis I 7. Sewage Disposal System: On-site system. A. Installed 7 B. Installer C. Septic Tank: 1. Size /000 SoL , 2. Manufacturer D. Seepage Pit: 1. Absorption Area !(2,1'1)e'L 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Re( st for Approval of Individual ` 2r & Water Facilities Legal Description Lot 9A Block 3 Seacliffe Subdivision Approved 4 Disapproved Date Appro .Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) 2. 3 4. 5. GREATER ANCHORAGE ARLA BOROUGH 2 Department of Environmental Quality MUNICIPAITY FANCHORAGE 3330 "C" St., Anchorage, Alaska 99503 - 274Xlf"TMENT OF HEALTH& XNVIRONMENTAL PROTECTION REQUEST FOR APPROVAL OF DEC 18 1975 INDIVIDUAL SEWER & MATER FACILITIES RECEIVED Type of Inspection: CIMR0 VA xxx FHA CONV Property Owner: ALMA E. HICKS Mailing Address: 700 W. 2nd Ave. Day Phone 272.-3018 Nai1e of Buyer: NEWMAN, James M. & Kathleen K. Mtailing Address: 5207 Shorecrest Dr. Day Phone�,344-8660** Nate of Lending Institution: AMFAC MORTGAGE CORPORA'T'ION MaiIing Address: 705 W. 6th Ave., Ste. 201 Phone Name of Realtor or Agent: None Mailing Address:. Phone 277-8588 6.. Legal Description: Lot 9A, Blk: 3, Seacliff Sub. Location: 5207 Shorecrest Drive Anchorage, Alaska 99502 Single. family 7. .Tyke of Facility to be inspected: residence No. Bdrms. 4 8. later Supply Community ((( Type of Supply: Rnboh.c Utility xx individual If individual,.nurnber of dwellings presenitly.served if individual, depth of well 9. Sewage Disposal Systei-ii Type.of, System: Public Utility Individual (on-site) xx if Individual, date of installation Unknown - Previously approved i ** Mr. Newman's mother; Mrs. Krauss, stays with them and will be home during the day for your to make your inspection. Page 2 of two pages - R` est for Approval of Individual.---,/wer & Water Facilities ' 'Le4al Description /.,0/- 7 '9 car, Comments Approved Disapproved Date Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 1 certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. i SIGNED `�Date /Oc EQ -034 (1/74) �i p�Qn Gc7C I V tOorrIras cq]a CORPORATION 705 W. 6th AVENUE, SUITE 201, ANCHORAGE, ALASKA 99501 (907) 277-8588 December 17, 1975 Dept. of Environmental Quality 3330 "C" Street Anchorage, Ak. 99503 Re: Hicks to Newman Lot 9A, Blk. 3, Seacliff Sub. 5207 Shorecrest Drive Gentlemen: Enclosed is your form for requesting approval of on-site sewer system. The seller of this property is scheduled for surgery and it is imperative that the transaction be closed before year end. Anything at all that you can do to expedite this approval will be much appreciated. Please give me a call when the approval is ready and we will make a personal pick- up of same. if there anything we can do to expedite your processing and approval, please advise immediately. Thank you for your prompt'attention and courtesy. Yours very truly, y ;t� Z�+�+nto (Miss) Lean A ,P.S• - Also enclosed is the previous approval form if this is of any assitance to you. Thanks much for your help. EXECUTIVE AND ADMINISTRATIVE OFFICE- Portland, BRANCHES: CALIFORNIA: Burlingame. Sacramento, Tustin. Fresno. San Diego. Los Angeles, Torrance. HIGTON: Seattle. ARIZONA Concord.IDAHO nSaBoisetlNEVADA Reno uCOLORADO'tDenver ALASKASAnchorage. HAWAII AFFILIATE PAmIae Financ al CorlCity p . Honolulu FHA Form 2573 U. S. DEPARTMENT DEVELOPMENT J.1, 1958 B.dget Bu,eau N FEG,RAL HOUSING ADMINISTRATION AUTHORITYIts, HEALTH • INDIVIDUAL WATER SUPPLY • SEWAGE DISPOSAL PART • BE COMPLETED BY FHA MORTGAGEEINSURING OFFICE • MATAWSKA VALLEY BANK ;.NK 111:012828 203 TY ADDRESS Shorecrest Drive •` •.•� ' Alaska SUBDIVISION NAME BLOCKAnchorage; :I. •N TOTAL NUMBER: 6TXS__ Can aMc or other area be made IntoBASEMENT New installation 1 additional bedrooms? ■ LIVING UNITS 11FDROOMS � � rNoYes H■ ■■■■■■■■■■E■■■■N■mmm■■E■■■■■N■_■IN ■■n■■■�■����■■��■■■MEN ■■■NN■N■■loommosommom so■�■■ mmoom am am ■ E■■■■■■■■■■■■■■■■o■■■■■■■■■■■■■■■■■■■■■■■N■N■EN HNH■■■ ■■■■ Na�Emommo� ■■�■■e����min ■N T■mmormoommoommumo■�■���■NHt■rM■NE\�� am NEON mommo ■■N■■■■■■mommm ME 0 iW■■■i■MEMO i■■■■■■■■■EEE■■■■■.�■■.■�H HENNNi■■NMEN EENE■NO ■■HENEN■■ON■■1■■N■■■■■■■■■■■N■■■■■■■NN■N■N■■ N■■■■■■■■■■■■■■■N SOMEONE ■■■■■■■■■■■■■■■■■_■■■■■■■■■■■■3■■■HN■N■■'��■SEEMS ■■■■■■■■■ONE ■1■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■■m■E■■■ ■■■■■■■■■■■■■O■■m■■N■■■■■■■■■■■■■■■N■■■■■0■N■■■■■■EN■■memo ■E1■■■on ■ ■■■■■■■■■■■■■■ ■■H■■■NEN■■■E■■■■■.■e■E■■�■�.■■�■■EE■■■■O■N■ ■�.■■■ �■o■N■■■■■■■■■■N■■■■■WEEN ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■.■■ ■a■■■ ■ a■�a■■■■■■■■C�■■■■■■■■■■■m■■s■■■ili MENO■ENE■■■E■■NONE ■ ■■�■smom■■■■omKNOMME mosommommo so ammommon ME ON IN wasommomom 0 Now mom on ME MENEM N0■■aa M■ENM �mommo oommu■ m1omm11 1 MONSOON■a�����aN Mnoommoommmoso�■�■Hos No 00 00 wommummomommo MEMENERNMEEMEMEN ■■.■■■■..memo..........................■NEON.■■■O=E....E=OWN■issro■m■mmon ■■O MEN "No ■■MEMO =ON MEN ON JIM on MENEM ■■ ■■m■O■m■■ a MEN� ■O■■N■■■■ommommommoHW■■■■■MEOWS■■■■WON■■■SEE■ ■■■■■■ ■■■MENE ■IM ■■■■■■■■■E■■■■E■■■■■■ O■ NN■N■■O■ USE ■■p■W■■E■OW■■■ ■■NEON ■■■■■■■■ ■■ON■■■■■■■■■■■■O■■■iW■i ■■■■■■■■N ■■■■■■■■ONE■■NO■i■■■N■�■■ ■■■■■ ■soon ■■Ho■■O■■m■■■■■■■■■�■SEE OMEMO ii■ ■ Nom■m■mm■EE ■■W■■■■EEH�■■■■■ NEON ■H■■NE■MEMO O■■■■■■■ ■■E ■■■■■■ ■ ■■■■■■■■■■■� mom ■■ON■■■N■■N■■ ■■■■■■■EH■■■MESON ■■E■.�■�■■�■ MEMO HN■■�■moos■■■■■■■■■■E■ soon E■■E■■EN OEM ■N■�■■■OEM ESSEX mosimmus NNINERESSENS■NNMEN milinnsommommO■�omnommim\�mN� ommommon E� MENEM mommoommms 0 so= H■■■■ ■ p on ■ nosommm a= MM1mMM am HEALTH AUTHORITY APPROVAL FNA Form 2573 INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM Re, July 1958 REPORT OF INSPECTION -INDIVIDUAL SEWAGE -DISPOSAL SYSTEM PRIMARY TREATMENT consists of ❑ Septic tank. ❑ Cesspool. Septic Tank: Distance from well, feet. Material, — Number of compartments Total liquid capacity, gallons. Capacity inlet compartment, _._gallons. Inside length, feet. Inside width, feet. Liquid depth, feet. Cesspool: Distance from: Well, feet; foundation, __feet; nearest lot line at ❑ front, ❑ side, ❑ rear, feet. Inside diameter, feet. Depth, feet. Liquid capacity, _gallons. Lining material SECONDARY TREATMENT consists of ❑ Tile disposal field. ❑ Seepage pits. Other Tile Disposal Field: Distance from: Well, feet, foundation, _feet; nearest lot line at ❑ front, ❑ side, ❑ rear,__ feet. Total length of tile lines, —feet Number of lines,-------. Distance between lines, —feet. Trench width, _inches. Total effective absorption area in bottom of trenches, square feet. Length of each line,_. feet. Depth, top of tile to finish grade, inches. Type of filter material: ❑ Gravel. ❑ broken stone. Other — Depth of filter material beneath tile, _—.inches. Depth of filter material over tile, inches. Seepage Pits: Number of pits- . Outside diameter, feet. Depth, feet. Lining material Distance from: Well, feet-, building foundation, feet; nearest lot line at ❑ front, ❑ side, ❑ rear,__ feet. Inspection made by: ❑ State. ❑ County. ❑ Local Health Authority. Inspected by Date of inspection _--- 19 — — (Tlrce) REPORT OF INSPECTION -INDIVIDUAL WATER -SUPPLY SYSTEM Distance to nearest public water main,_ --feet. Size of main, inches. Individual wells ❑ are ❑ are not customary in neighb9rhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood ❑ are ❑ are not being developed with both individual water -supply and sewage -disposal systems. Lot size: feet wide,__. --feet deep. Dwelling set back from front property line, feet. Individual water supply from: ❑ Drilled well. ❑ Driven well. ❑ Dug well. ❑ Bored well. Distance of well from: Building foundation, _—feet-, nearest lot line at p front, ❑ side, ❑ rear, feet, cast iron sewer,_ —feet; tile sewer,__ feet; septic tank, feet; disposal field, feet; seepage pit,— —feet; cesspool, feet; other sources of possible pollution, feet. Well constriction: Diameter, inches. Total depth, feet. Type of casing, Depth of casing, feet. Approximate depth to pumping level of water in well, feet. Approximate yield, gallons per minute. Sealed watertight to depth of feet. Exterior space around casing sealed with: ❑ Cement grout. ❑ Puddled clay. ❑ Ordinary backfill. Well cover: ❑ Concrete. ❑ Wood. ❑ Metal. Openings in well cover watertight: ❑ Yes. ❑ No. Pomp: ❑ Shallow well. ❑ Deep well. Length of drop pipe, feet Pump capacity,_ gallons per minute. luxated in: ❑ Basement. ❑ Pumproom off basement ❑ Pumphouse above ground. ❑ Pump pit. Purnproom properly drained: ❑ Yes. ❑ No. Pump mounting watertight: ❑ Yes. ❑ No. Type of storage: ❑ Pressure. ❑ Gravity. Capacity, gallons. Has bacteriological examination of water been made? ❑ Yes. ❑ No. If answer is "yes," give date Qualny of water ❑ is ❑ is not satisfactory for human consumption. Installation ❑ does ❑ does not comply with approved exhibits, if any. Inspection made by: ❑ State. ❑ County. ❑ Local Health Authority. Inspected by _—- Date of inspection 19 (TITLE) 19— (TITLE ) 9_ GPO 889.088 EATER A, WHOPA GE APEA BOROUGH lj TIER M DFPARrP,,IE,\JT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 279-2511 DATE RECEIVE0 INSPECT: TIME: REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES FOR 1. Approval Requested By jj' Z-) Address Phone C��VV Cr�'-�i 2. Property Owner( 1 - dl Phone 3. Legal Description /f ; �,� �� /'�` ✓;i�.r > /',f �'` _ 4. Type of Facility to be Inspecte STREET: Number of Bedrooms 5. Well Data: A. Type B. Depth C. Size D. Construction E. Bacterial Analysis 6. Sewage Disposal System: A. Septic Tank (If homemade, show diagram on back) 1. Size 2. Age 3. Manufacturer 4. Installer 7---Z- � / Cl' t1l' Approva }equest for Sewa $ Water Facilities Page Two B. Seepage Pit i 1. Size ' 2. Lining C.._ Disposal Field 1. Number of Lines --- 2. Total Length 7. Required measurements A. Well to Septic Tank ) B. Well to Seepage Pit C. Well to Sewer Line D. Well to Property Line E. Well to Other Possible Contamination k F. i Foundation to Septic Tank /6" G. Foundation to Seepage Pit �f H. Seepage Pit to Property Line 8. COMMENTS: APPROVED VJj j& DISAPPROVED: DATE: '� !' % %� DATE: ti APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT ED1170