HomeMy WebLinkAboutCREEKSIDE PARK #2 LT 2KS icl
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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
PHONE:
2. PROPERTY OWNER: PHONE:
3. LEGAL DESCRIPTION:
NUMBER OF BEDROOMS:
WELL DATA:
A. TYPE
B. DEPTH ,~"~.'"'~"'
c. SIZE / tt
D. CONSTRUCTION
SEWAGE DISPOSAL SYSTEM:
SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK)
2. AGE
3. MANUFACTURER
4. INSTALLER
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
B. SEEPAGE PIT
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
F. FOUNDATION TO SEPTIC TANK
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
8. COMMENTS:
APPROVE~~SAPPROVED:
DATE: DATE:
APPROVAL VALI/D FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALIT
~lanuary 13
January 14o 197;~
Mr. Rtchard North
7749 Old Harbor Road
Anchorage, Alaska 99504
Subject; Lot 2, Creekstde Park Addition.
Dear Hr. North:
This Department was unable to determine the condition
or construction of the well. We can, therefore, netther
approve nor disapprove the water system.
If you have any questions regarding the above, please do
not hesitate to contact thts offtce.
Sincerely,
Lynn S. Coad
Environmental Specialist
st
cc: Ctvt1&an Mtlttary Referral Offtce
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
REQUEST FOR APPROVAL
INDIVIDUAL SEWER AND WATER
FOR
OF
FACILITIES
APPROVAL
ADDRESS:
PHONE:
REQUESTED BY:
PROPERTY OWNER:
LEGAL DESCRIPTION:
TYPE FACILITY TO BE
NUMBER OF BEDROOMS:
INSPECTED:
WELL DATA:
A. TYPE
B. DEPTH
C. SIZE
D. CONSTRUCTION
SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK
(IF HOMEMADE, SHOW DIAGRAM ON BACK)
1. SIZE
2. AGE
3. MANUFACTURER
4. INSTALLER
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
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
F, FOUNDATION TO SEPTIC TANK
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
8. COMMENTS:
APPROVED: DISAPPROVED:
DATE: DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALIT
.~~~~~ REQUEST FOR AP?RO AL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
Name of person mequestin~ approval u--.///~
2. Name of property~ owner~, ......
5. Water..Anatysis:
a. Bacterial
b. Detergent~
6. Well data:
c. Casinff Size
d. Distance from well to closest existing, or proposed:
1. Sewer line
2. Septic tank .
3, Seepage Area
Cesspool'
5. Property Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainaEe ditch, etc.
Sewage disposal system. /
a. Age of system .... ~1~ y,,,~, · /1~'~0
. 000
b Septic tank capacity in gallons /j
c. Name of septic tank manufactume, r
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type
1. Distance to prope~y line to house foundation ....... ·
e, Percolatioz~ Test 'results
f. Percolation Test perfermed by
Use the reverse.side of this form to show diagram. Diagram should include
<he foilowing information: p~operty lines~.well location, house location,
~ptic tank location, disposal area location~ location of percolation test,
and direction of ground slope.
, .-/,~~ ~ ~~ n.w~._.~ .. ....
Signature of Appllc t Date Signed
TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL
~--~e above described sanitary facilities are hereby approved, subject tO ~h,.e,
........... ~61!owin~ condi~ions:
Conditions:
The above described sanitary facilities are disapproved for the following
reasons:
Approval is valid for one year following the date of approval.
CPJ:cw
2.
3.
4.
5.
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
Name of person requesting approval
Name of property owner
Legal description ~/'~f~
Number of bedrooms in house
Water Analysis:
a. Bacterial ~ ~.~¢~;~.__~_ ·
b. Detergent .~ ~L~¢~;~ -
Well data:
b. Depth
c. Casing Size
Distance from well to closest existinE or proposed:
1. Sewer line
2. Septic tank ,/¢20' .
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.
a. Age of system ,/ ~_g~'arxf ·
b. Septic tank capacity in gallons /~,~_~ ~
c. Name of septic tank manufactu~.r
If "home made" show dia?ram on reverse side of this form.
d. Disposal field or seepaFe pit size and type ~D~
/
· /
1, Distance to property line
f/~.~ to house foundation
e. Percolation Test results Z<~'' ~.jz~' /~/ .~// ~Z[ ~/T- '3~~-~W~z~ ~rZ~?
f. Percolation Test performed by ~~ ~~'~ '
Use the reverse side of this form to show diagram. Diagram should include
the followin? information: ~operty lines ~ .well location, house location,
septic tank iocation, disposal area location, location of percolation test~
and directien of ground slope.
The information on this form is true and correct to the best of my knowledge.
giFnatUre 0f A~pl' ' ~( signed
TO Bg FILLED OUT BY HEALTH DEPART~'~ZNT PERSONNEL
· 'The above described sanitary facilities are hereby approved, subject to the
.......... ~f~llowing condi~ions:
The above described sanitary facilities are disapproved for the following
reasons:
Signature of ~f~iaiA.'-l..:: -~' .... ,. ? L
Approval is valid for one year following the date of approval.
CPJ:cw