HomeMy WebLinkAboutDEBORA BLK B LT 18BLK..
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GRE.r`ER ANCHORAGE AREA BOF"'IGH
Department of Environment Quality
3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME 6440 S"'VAN MAILING ADDRESS PHONE
LOCATION ""CV NYE LEGAL DESCRIPTION L°r /S ^ ��°cr! 13 I gee Ad Jw6-
SEPTIC TANK:
DISTANCE
FROM WELL MANUFACTURER MATERIAL
NUMBER OF
COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL 120r'L FOUNDATION NEAREST LOT LINE OF LINES
NUMBER OF LINES
ABSORPTION AREA
DISTANCE BETWEEN LINES
DEPTH: TOP OF TILE TO FINISH GRADE
TRENCH WIDTH_ IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE —
DEPTH OF FILTER
MATERIAL BENEATH TILE
WELL:
TYPE CONSTRUCTION
_IN. ABOVE TILE IN.
DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION , LOT LINE . SEWER LINE , TANK , SYSTEM ,
CESSPOOL . OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
1144ALF (%w.
SEWER LINE DEPTH:
PIPE MATERIAL:
Cisr 1xie
LOT SLOPE: r_
REMARKS:
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Form PW -027
DIAGRAM OF SYSTEM
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DATIM 0 APPROVE
G.A.A.B.
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by.
60C CO. CPA
SULLIVAN WATER WELLS
P.O. BOX 272, CHUG IAK, ALASKA 89567 • TELEPHONE 688-2759
OWNER OF LAND �l DEPTH OF WELL
ADDRESS '''`^ `'`r�'�' STATIC LEVELOF WATER FT.
LEGAL DESCRIPTION ' /'< e' /� D!'' ' td /� { DRAW DOWN FT.
DATE • Started " Ended
F GALS. PER HR gy O
PERMIT NUMBER KIND OF CASING
KIND OF FORMATION:
From
Ft. to "� Ft.
n U/=111-1'
0/2? O'E nJ
From
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MISCL. INFORMATION:
DRILLER'S NAME
Time
APPLIC"NT FILLS OUT UPPER HAL"'ONLY
Time
Time
PrdDiny Owner
Phona
Y
Maiilna Address//
u�
Zip Code ! R
-3 •i L',J /
Date
Buyer
le -,,t
Fjt woes
Address
Zip Code
Inspector
Lending Institution
/JNJ/N%C{ A( /iLL✓•
f.Q• �• �/f
Phone
Address
�. - P11"'le c� Zip code "ur/3
c 7 2 0! 3
Reatty Co. 6 Agent
rwK LZ, -- � !c %.7 41i�✓•
< t �i`Ac�y
Phone
Address
^ 7'/ 4,1 Zip Code u
,17 /, 0000
Legal Description !t "ll -K
Street Location
4 - F _ i
( ) CONDITIONAL APPROVAL'
Type of Residence
$^8
❑ Single Family
G�Vultlple Family No. of Bedrooms
❑ Other
Solis Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Wale( S5,gly
drvidual
C G�C� �
ATTACH WELL LOG. A well log Is required for all wells drilled
since June 1975.
O Community
�'
For wells drilled prior to that data. give well depth (attach log
if available).
❑ Public Utility
Sewer Disposal
❑ InngWMtwl
�•I y,� 3
"^ w` 1 Year Individual Installed:
Public Utility:
G-fubtic Utility
When Connected to
❑ Holding Tank
lJ
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RECUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
\
f �f
Field Notes: //t C
/�
CQ.�M �'/ �
PJy, L.(,)f
,7
( ) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
ISAPPROVED
( ) CONDITIONAL APPROVAL'
$^8
DATE �jL���
BY:--ms`s'
Solis Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank SIZe
Well to Tank
rZon MA
1
December 7, 1983
M. Gallagher
6621 E. 12th Street
Anchorage, AK 995
Subject: Lot 18, Block B, Deborah Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
° Submit to this office a copy of
a community well from the State
Environmental Conservation. You
274-2533 about this certificate.
your certificate to operate
of Alaska Department of
may contact Mike Mathews at
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. if there are any
further questions, please call this office at 264-4720.
Sincerely,
Cory Willits, R.S.
Acting Sewer & Water
Program Manager
CW62/ej/E1