HomeMy WebLinkAboutCOLONIAL PARK BLK 1 LT 1A
GREi
R ANCHORAGE AREA BORi
Department of Environmental Quality
3330 C Street
Anchorage, Alaska gg503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ~
FROM WELL MANUFACTURER ~- MATERIAL
NUMBER OF
COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH_
.LIQUID CAPACITY I~...~'(::~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
BUILDING FOUNDATION
DIAMETER I'~'l'~I OR WIDTH~1
CRIB SIZE: DIAMETER
, NEAREST LOT LINE I0I
ADDITIONAL ABSORPTION
~. I DEPTH ~¢
LENGTH ~''
DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) -? ~
SQ. FT.
WELL:
BUILDING
FOUNDATION --
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
, LOT LINE
OTHER SOURCES
DISAPPROVED
NEAREST
, SEWER LINE
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
, TANK __, SYSTEM
REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
I
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. LQ-031
DATE
App R OV ED/~r~44'I
//G.A.A.B.
SAM COTTE~ DRII G CO.
Box 29~
B~gle Pdver, Alaska 99577
MUNICIPALITY OF ANCHORAGE ~ VIPOP<:-','~IAc ;: ,..~tCTION
DEPARTMENT OF HEALTH & E"VlRONMENTAL PROTECTION
825 L Street-Anchorage, Alaska 99501 4 ;,-~-9
~ ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 ~C~J~
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proce~ed. Please allow ten (10) days for processing.
~A~LlaG ADDRESS /~
PRCE~TY RESIDENT (lCdifferent fro~above) ~ /
2, BUYE~ PHONE
MAILING ADDRESS
MAILING ~DR~c /
4. REALTOR/AGENT ' I PHONE
I
MAILING ADDRESS
5. LEGAT;C.~TION/ ~,//~__//~ / C~___~/d/'~ '1'"')1/ ,~_~ r~
;TREETLOCATION ' - - f ~ v - - · .
TYPE OF RESIDENCE
,~'~ NG LE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One J2~"'~6ur
[] Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
[~"'~ I V I DUA L*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~'~V I DUAL/ON-SITE**
[] PUBLIC UTILITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR I NSP ECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[--]Septic Tank or [] Holding Tank
Size: If Tank is homemade
give dimensions:
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SlX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
[] OTHER
Septic/Holding Tan k
IAbsorption Area
ISewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
~~APPROV ED FOR ff BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
LEGAL DESCRIPTION /
72-010 (Rev. 3/78)
#1: Time
Date
DEPARTMEN
825
10:00 a.m.
].0-4-77
~-MUNICIPALITY OF ANCHORAGE --
3F HEALTH AND ENVIRONMENTA
L Street, Anchorage. Alaska
264-4720
Date Received:
PROTECTION
99501
October 3, 1977
#2: Time #3:
Date
Insp Willis Insp
Time
Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska Teamster's Federal Credit Union
Mailing Address: 1200 Airport Heights Drive Phone: 274-6606
Property Owner:
Mailing Address:
Kelvyn/Betty Jarvis
127 Genora Street 99577
Phone: 694-3418
3. Legal Description: Lot 1 Block 1 Colonial Park Subdivision
4:
Single Family Residence: (
Multiple Family Residence:
Number of Bedrooms:
Number of Bedrooms:
??
e
Well System:
Permit #
Construction
Individual well ~ Community/Public System ( )
Depth of Well 89' Well Log on File
~ F . '~'? Bacterial Analysis
Sewage Disposal System:
Permit %
Septic Tank Size
Absorption Area
On-site System ~ Public Utility ( )
Installed ! ~ ~ Installer ~%~[c~c_~
_~ C~ Manufacturer ~ ~-QQ-~
~ ~ Soils Rate Material
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
~UNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection
' 825 L Street, Anchorage, Alaska 9~:~t
~j-~-25%~1, ext. 224, 225 ~.~,9
~-~- ~quest for Approval of Individual Sewer and Water
1. Property Owner: ,,~ / ~ d~'~'~
. _
/ /
Mailing Address: /~ ? ~ ~ ~ ~ ~J~ ~-~one:
Name of Buyer:
Mailing Address:
Phone:
e
Lending Institution: /~_~/~ ~ /'~m.~Z~.~. /~i~ _/~.,~eo/.-"Zz' ~-///~-~
Mailing Address: /~d~9 /'~>~,~o,,/-//~.~//~ ~o~. Phone
Realtor/Agent: ~P~/ ~7~-~cc.. - ~--._/~-~o/ /~/ ~---~?,,~/_
Mailing Address: ~lJ ~/.~ /+~), ~J~?j~ ~/~'~^ Phone:
Single Family Residence: ~ Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: *Individual Well
If Individual Well, well depth ~'
If Community System, name of system
Public/Community System ( )
Sewage Disposal System: On-site System
If On-site System, date of installation:
Public System ( )
*NOTE: A well lpg is required on ALL wells drilled since 6/75.
3/77
P~ ~e ~Two
' Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 1 Block 1 Colonial Park Subdivision
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
Approved:
Disapproved
Date:
Date:
Department Worksheet: