HomeMy WebLinkAboutHOLLY HILL BLK 1 LT 1Artol t..ti I 5
IA
GAA~B-HD-I
GP,.~TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 27V.:2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
ADDRESS
LEGAL DESCRIPTION ~''~ / ~' ~' J~'""~ ~' ''~ '~ /
PHONE
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS,
MATERIAL ~ ~,'~'J,,Z.f~,z2~. NUMBER OF
COMPARTMENTS
//~,~..¢ -. i"~ ~-,.. J~'~ ~' ('~ .IQUID
NSIDE LENGTH INSIDE WIDTh DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH J~ . LENGTH i:~' . DEPTH
DISTANCE :ROM WELL BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA WALL AREA ~f:/~" .SQ, FT.
TILE DRAIN FIELD:
DISTANCE F ROT'/WELL
NUMBER OF Ii'ES
ABSORPTION ~,.R E A
DEPTH: FOP OF TILE TO FINISH GRADE
TOTAL LENGTH
FOUNDATION NEAREST .OT LINE .OF L NES
DEPTH OF FILTER MATERIAL BENEATF TILE IN. ABOVE TILE
'.' '~ WATER
WELL: TYPE ~,''j~ ~,.>-~L~g( . DEPTH ~' DISTANCE FROM "~ '
.BUILDING FOUNDATIO~ SAMPLE . NEAREST
LOT LINE "7 t NEAREST SEPTIC . SEEPAGE - OTHER
, SEWER .INE ., TANK ~'~t; . SYSTEM ~ ~:) ~ CESSPOOt
DISTANCES:
'=
DIAGRAM OF SYSTEM
DATE
HFAITH AUTHORITY
OAAB-~D-"S2' ~,
GREATE1 ANCHORAGE AREA, )ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
NAME OF APPLICANT ~ ~ ,~'~ MAILING ABDRESS ~ ~ ~ PHONE NO.
RESIBENCE ABBRESS ~ LOCATION OF INSTALLATION
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~ ~(~z.c.'/..~-~. , PERMIT TO INSTALL A ./~-~--C--z.~! .~/~~ ,
AS DESCRIBED BELOW. SIZE ~~ BE SERVED '~ ~;O~
7~ TYPE ~ SEEPAGE AREA .TYPE
DIAGRAM OF SYSTEM
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above d~'scribed sYstem is in accordance with said code.
DATE ~d,f¢. /Y,/~/'~ APPLICANTSSIGNATURE ~\~.'~ .~.~,-~ '~ .~-,',,,-.,-'----
· SEPTIC TANK SIZE
DISTANCES:
,~REAT~R ANCHORAGE AREA BOROU,~H'
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE
· r For Date Performed '. -¢
Legal Description: L~t -j~Block _ . S~d~vxs~on
' Form Re or~s a: S~l~%og / Percolation Test
Th.ts · ~P ............
Depth
Feet Soll Characteristics Location Sketch
Was Ground Water Encountered?_..~~
If Yes, At What Depth_.__~ . _ --
Reading Date
Gross Time
Net Time
Depth To H20
Proposed Ins.allat~on: Seepage Pit i~-~'~" Drain Field
De ~h Of
P nlet
COMMENTS.
Test PemfoPmed
Net Drop
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL HEALTH CASE REVIEW WORK SHEET
[] PLATTING BOARD [] PLANNING & ZONING
CASE NUMBER NAME
S-5667 Lot lA Block 1 H(~lly Hill Subdivision
DATE RECEIVED
April 8~ 1981
COMMENT TO PLANNING BY
April 17, 1981
FOR MEETING OF CASE OF
[~PUBLJC WATER N,.~.Q~ AVAILABLE TO PETITION AR EA
[~PU E~_I C SEWER ~!I"'~'AVAILABLE TO PETITION AREA
R EVIEWER'S COMMENTS: ~'~
/5
71-014 (Rev. 2/78)
SURVEY TYPE
.)~ AS-BUiLT
~_~ PLOT PLAN
[] LOT SURVEY
[] RECERTIFICATION AS-BUILT
It ~s therespons~bihty of the builde, of owner~ prior to
construchon, to ,~er~f)' proposed budding 9rode re!olive
to fro,shed grade and uhht¥ co~nechons and 1o determine
the existence of any easements, covenants or restrictions
which do not appear On the record,ed subdivision plot
Lot Survey Certiflcotion
! he~ eby cer fify ff~ol I hov~ su~v-
ck~scrlbed hor~(~, and tho~ ~
,.~c. ve rr.ents dt uated fhe~
or e w~; n the p~'ooerl y ~ ~
~s ~ ~ that
t~e ~ ~ ~d~,uhJity
LEGEND hub 8, tack-found [g set
iron rebor -found 0 set
iron p~pe -found 0 set
brass cop -found ~ set
alum. cap -found (~) set
Prepa~r ed by
HVA/CH M P RK
Professional Land Surveyors
Scale. 1" = 30' IDr°wnbY' REJ
)ate Surveyed Aoril'13~ 198~checm~d by: MLJ
DoteDrawn' April 13, 81 IGrId: 2135
Legal Descriptio~
Lot IA, Block 1, Holly Itills Subdivision
APPLI' ' NT FILLS OUT UPPER HA? iONLY
Property o~n~;' ~v~j/(~.\-¥~,d~ ,~ ~ ~ -' Phone
Address Zip Code
Phone
Address C :~' Zip Code ~.~g I ~
Realty Co. & A~nt Phone
Address Zip Code
LegalDescription L~T ~ ~j~ j J~o~J~ ~tjj& ~j
Street Locati~ ~0 ii H~J-~.~o~ Zo~ p
Type of Resi~nce
~ Single Family
~ Multiple Family No. of Bedroo~ ~
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility ~ Z ~-~ ~ Jq ~fl~
Sewer Disposal
~ Individual Year individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
~nsp~tor ~nsp~tor ~nsp~tor ~nsp~tor
Field Notes:
(.~) APPROVED BEDROOMS
*CONDITIONS
OF
APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
CHEMICAL & G~ LOGICAL LABORATORIES
TELEPHONE (907)-279,4014
274-3364
ALASKA, INC. ~.
ANCHORAGE INDUSTRIAL CENTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
I.D, NO,
Water System Name Phone No.
Mailing Address
City
SAMPLE DATE:
State Zip Code
Mo. Day Year
SAMPLE TYPE:
r~'Routlne
[] Check Sample (for routine sample
with lab ref. no. ,
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
I
,, I I
Time
TO BE COMPLETED BY LABORATORY
Analys~s shows this Water SAMPLE ~o be:
[] Satisfactory
[] Unsatisfactory
[] Samole[oolongintrans~t: sample should
no! be over 48 hours old at examination
[o indicate reliable,results· Please send
new sample.
Date
Received
Time Received ~ ,--~
Analytical Method:
[] Fermentation Tube
~YMembrane PIIter
Lab Ref. No. Result* Analyst
I I FT']
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collecte~ Source
Presumptive 1Omi 1Omi 1Omi 1Omi 1Omi 1.0mi 0.1mi
24 HOURS
48 Hours
~onftrmatory
24 Hours
48 Hours
EMB.
Multiple Tube Report:
Membrane Filter: Direct Count
verification: LTB
Final Membrane Filter Results
Repor te<l By
Broth 24 hours: Broth 48 hours:
10mi Tubes PoSitive/Total 30mi Portions
Collform/100ml
BGB
Collform/~00nll