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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: