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Home My WebLink AboutCREST VIEW BLK A LT 4A010-2:3t- 30 ' 17 - 11, . INDIVIDUAL SEWAGE AND WATER FACILIT~S (Fill ou~ in T~iplicate) Na~ .of person requesting approval ~~ %. ~k~iO~ (~-~%~ %~a~ of prope~y: owner Nu~x.o~ ~dr~ms in house ~ ,. , . ~ii~.l~ Water Analysis: a. Bact~ia l b. Detergent 6. W~]l data: c. Casing Siz-. Dislance from well to iloselt existin~ or proposed: ~~ 7/~:y~. 1.' 5ewer line... . _ . ~ 2. Septic tank -- Z) ' 3, Seepage Area- 5. Propemty Line... /0~ . 6. Other sources of Possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. . 7. Sewage disposal system. a. Age of system . b. Septic tank capacity in gallons c. Name of septic tank manufactu.~,~.~ 1. If "home made" show diagram on reverse Side of this for. n. Disposal field or seepage pit size and type _~ 1. Distance to pmope~ty lin~ to house fo~mdation Pereol~tlo~ T~st f, Percolation Test performed by . '~-~ Use the reverse ,side of this form to show diagram. Diagram should include i~,~he following information: p.~opePty lines; .well location, house location, m~t~c tank location, disposal area location, location of percolation test, a~'d d~rectlon of ground slope. 9. The ~o~{on ~n ~his form is true and correct to the best of my knowledEe. 'S'ig~atUre 'of Appiica{t Date Si~ned .... ~E__FILLED OUT BY HEALTH DEPART~,~ENT PERSONNEL The above described sanitary facilities are hereby approved, subject to ,the ~-~'61~owing con~,~ons: - ' Conditions: The above described sanitary facilities are disapproved for the following re asons: "Approval is valid for one year following the date of approval. CPJ: cw INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in T~iplicate) ~ 77-- Name .of person ~equesting approval ..~o/d.- -- ~. ~e of p~o~y~ owner .~ ~ ........ Nu~r- ~C ~rooms Water Analysls: b. Dete~gent.~ . · Well data~. ,., b, ~epth 75 ' · c. Casing Size . d. Distance from well to closest existing or proposed: l. Sewer line ....... 2. Septic tank 3. Seepage Area _ 4. Cesspool' . 5. Property Line . 6. Other sources of possible co~tamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. .. ... _. a. Age of system ....... · b. Septic tank capacity in gs c. Name of septic tank manufactun~'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 property line_, to house foundation Percolatio~ Te~t f. Percolation Test performed by Use the reverse .side of this form to show diagram. Dia~raTM should include "~he foilowing imformation: pwoperty lines;.well location, house location, ~pt~.c tank location, disposal area location, location of percolation test, a:~ direction of ground slope. g. The i~,fo~w~tion on this form is true and correct to the best of my knowledge. ~ignature 'of Applicant' Date Sion'ed TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL ~--~e above described sanitary facilities are hereby approved, subjec.t to the ~l!owing con~fons: - Conditions: ~ The above described sanitary facilities are disapproved for the following ~easons: Approval is valid for one yea~ following the date of approval. CPJ: cw __a,...,----- REQUEST FOR ^PPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) · of person requesting approval %la~ of property.- owner,, ,, ~ l%lu~ ~ ,, Numbez.-'oE l>edrooms in house Water. Analysis: a. Bact~_rial b. Detergent .... Well data: b. Depth Casing Size_ Distance from well to closest existing~ or proposed: 1. Sewer line 2~ Septic tank em 3. Seepage Area 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 . b. Septic tank capacity in gallons . c. Name of septic tank manufactum~,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 property, line to house foundation Percolat io~ T~st f. Percolation Test perfoPmed by ~-. Use the ~everse.side of this form to show diagram. Diagram should include .~ .~%he foilowing infor~nation: p~operty lines;.well location, house location, ~ptic tank location, disposal area location, location of percolation test, ~ direction of ground slope. 9. The h~a~ion on this form is true and correct to the best of my knowledge. Signature of' Appiicant Date Signed TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL ~-]~e above described sanitary facilities are hereby approved, subject to the ......... ~llowing con~t~onsi ......... Conditions: ~The above described sanitamy facilities are disspproved fop ~he following ~e as on s: :~~ ? ~-~ .....~< . //~~ ' S~'gnature of .,fi :~'~.~..~ v~.''~ 1."' 'if, ' Approval is valid for one yeam following the date of approval. CPJ:cw GF'~--~TER ANCHORAGE AREA BOROUGli'- 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 APPROVAL REQUESTED BY: ADDRESS: /~"Z~O ~m~ PHONE: ProPErTY OWNER: ~.o~ AL(~Ri~R PHONE: ; TYPE FACILITY TO BE INSPECTED: NUMBER OF BEDROOMS: WELL DATA: A. TYPE B. DEPTH C. SIZE STREET D. CONSTRUCTION E. BACTERIAL ANALYSIS SEWAGE DISPOSAL SYSTEM: A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK) 1. SIZE 2. AGE 3. MANUFACTURER 4. INSTALLER APPROVAL REQUE,,-,~ FOR SEWER & WATER FACILI1.,-.~S 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 COMMENTS' APPROVED: DISAPPROVED .^t~: ~^t~: ? ~-~-?~.~ APPROVAL VALID fOR ONE YEAR FROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY July 7. 1072 Civilian #tlttary Referral Office 1530 Gan~bell Anchorage, Alaska 99S01 St~hJect: Lot 4 ~: ~, Block A, Crestvtew Subdivision 4401 Van Duren Anchorage, Alaska 9~501 Dear Sir: The well at this location is in a nit, ~hich is no lonoer ~p~roved by this depart~ent. U~radin~ a drilled well in a pit requires bringing the casino l~ ~nches above ~round level end fillin~ in the ~tt. Mrs. Harold Aldrich was unable to locate the sewer system at the tt~,e of inspection end to obtain apn~oval, this systen~ must be tnsnected. Sincerely yours, Les ~(. Buchholz Envtornmental Control Officer CC: Harold Aldrich 4401 Van Buren Anchoraoe, Alaska 99501