HomeMy WebLinkAboutEAGLE RIVER HEIGHTS NORTH BLK 4 LT 2/._oW
GR! .... ER ANCHORAGE AREA BOROU'''~
DEPAFITMENT OF ENVIRONMENTAL 0.UALI1,
3500 TUDOR ROAD ANCHORAGE, ALASKA ggS07 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING ~
ADDRESS 4'~""~' ~;~9; ('~fl'~- ~'~'"~-/~ PHONE
DISTANCE FROM WELL
LIQUID CAPACITY_/~'((
GALLONS.
NUMBER OF /
MATERIAL (.o(.j~, ~t~u,~ ~*'~: COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH DEPTH__~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAL
" OR WIDTH / '~'" , LENGTH /~c" ' , DEPTH ~'' /
DISTANCE FROM WELl (/~'"~7/~'/ BUILDING FOUNDATION ~"-"%~ ,
· TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '.,~'Y SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL _/ . FOUNDATION "'-'""'"'-~ NEAREST LOT LINE
NUMBER OF LINES///'/~ DISTANCE BETWEEN LINES ~DTH __
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES ,' ,
.T~OTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
.DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
WELL:
TYPE(ZI~'t/I//(.~/I:"~"~ , DEPTH.
NEAREST -.- SEPTIC
LOT LINE , SEWER LINE , TANK
DISTANCE FROM -- WATER /£"O~::',r~
,BUILDING FOUNDATION. SAMPLE ., NEAREST
OTHER
-- SEEPAGE --
, SYSTEM , CESSPOOL , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATEE - ,NCHORAGE AREA -)ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS
LEGAL DESCRIPTION Lot 2_
APPLICATION TO INSTALL: SEPTIC TANK ~z , SEEPAGE PIT.
TO SERVE THE FOLLOWING FACILITY ._T~'~', :'~ ~.cL
FINANCED THROUGH
PERCOLATION TEST RESULTS .//' C z', j/~ /
MAILING ADDRESS~'/~Q "/////~&' (~- ~2/, PHONE NO,
LO~ATIO~ OF I~STALLATION
~ , DRAIN FIELD , OTHER.
/ J
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
/~,. . ~ (~/~.', . SEPTIC TANK SIZE ./(('~ TYPE (c.,(,,~ ~ SEEPAGE
'~ DIAGRAM OF SYSTEM
DISTANCES:
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 APPLICANTS SIGNATURE
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
ADDRESS: J? /'~i //' /
PHONE:
'.~...----P~" ,-', "~ PHONE:
2. PROPERTY OWNER::
3. LEGAL DESCRIPTION: ....
4 TYPE FACILITY TO BE INSPECTED: .... ' "' ~: ~ '~'' STREET:
NUMBER OF BEDROOMS:
5. WELL DATA:
A. TYPE
B. DEPTH
C. SIZE
A. SEPTIC TANK
1. SIZE
2. AGE
3.
4.
D. CONSTRUCTION
E. BACTERIAL ANALYSIS
SEWAGE DISPOSAL SYSTEM:
IF HOMEMADE, SHOW DIAGRAM ON BACK)
./,?
MANUFACTURER
INSTALLER
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DIS R~SAL FIELD
1. Nt~xBER OF LINES
2. TOTA~ LENGTH
REQUIRED MEASUREMENTS
A WELL ~xSEPTIC TANK.
B WELL TO X~xEEPAGE PIT
WELL TO S[X~R LINE
WELL TO PROPT~xxRTY LINE
WELL TO OTHER ~OSSIBLE CONTAMINATION
FOUNDATION TO SEPTIC TANK ·
FOUNDATION TO SEEPAGE PIT
SEEPAGE PIT TO PROPERTY LINE
8. COMMENTS:
APPROVED
DATE: i
.... /' DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY
~,K& IrG~s,.s 2573s
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
Form Approved
Budget Bureau No. 63.R0296
~ ~jC h o~Su~a omc[
rage, ,Alaska
Associate Builders
River Heights
TOTAL ~iU.L;,~ ~':
~ Public system
Public system
MORTGAGEE t SEEBAL
Peoples Bank and Trust
NO.
Chatanika Loop, Eagle River
[ moc~.o. J LOT NO
] Yes
F-~ Individual
'-']No
BASEMENT
installation
IE] Yes F-] ,~o .
[-'~ Community system
[] Individual j l[~] Yes ~ No
] CommUnity system
It is the opinion of the [] State [] County
~_~ is [] is not ~:mtisfactory as a domestic water supply for the subject property. Public Water
[-~ Local Department of Health that this individual water-supply system
it is the opinion of the [] State [] County
tern with proper maintenance:
[~ C.~n be expected to function satisfactorily, and
' ~s not likely to create an insanitary condition
Local Department of Health that this individual sewage.disposal sys*
E~] Cannot be expected to function satisfactorily
/') I TITLE
PAULY Illl.~FO~ USE OF F~JA OFFICE
[ h~v~ ~c~d thC ~or~o~n~ ~nd ~h¢ p~mncm FHA CompUm~c~
Individual wster-supply system ~ considered ~ Acceptable ~ Not Accep~ble
~wage dis~sal ~ considered ~ Acceptable ~ Not Acceptable.
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