HomeMy WebLinkAboutALDERWOOD BLK 2 LT 2
- I, NSpE,CTION~ REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC T~K: D~s~ce~5~C~fmm well [7~ . Mate~a~T~..t, }- N~e~. of, compartmnts. ~t"
Liquid capaci~allons. Inside len~h~Insxde w~dth ~ Liquid depth .
SEEPA~ SYSTEM: Seepage Pit: N~e~ of pits / Outside dfa~te~ o~
well 7~ , building fo~datim ~/~, newest lot line~ Total effective
~so~ption a~a (wall a~a)~ sq.
TILE DRAIN FIELD: Distance fPom well, , , fo~dation , nemst lot line _ .
Total l~n~h of l~n~ Nu~ of ltn~s Distan~ b~tw~n l~nes T~nuh
~pth: Top of til~ to finish ~ad~ ~p~h of f~lt~ ~.i~[ b~n~th
lot llne~, nearest sewer line... , septic t~k...Tg' seepage system
cessp~l_ , other sources
DISTANCES:
A-8= 75-/
DIAGRAM OF SYSTEM
DATE:
APPROVED
Health Authority
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Name of Applicant Mailing Add~ess ,,~, _ PL.
Residence Address Location of Installation
Application to Install: Septic tank_ _, Seepage pit,,
To Serve the Following ~acilit~
Financed Througk ..... To ~e Installed by
..., l~ain field__., Ocher
Percolation Test Results_ Anticipated Date of _~o~pletion .......
.... ~, , ,. ".,', ,-. ..,.,.:.- , ,., ..... .~-~ ~
This is to serve a~
DISTANCES:
~, permit to install a
. _as described below. Size of unit to be served
~DtiC tarnk size_.....___~pe Seepage Area~ _ , .... Type
DIAGRAM OF SYSTEM
certify that I am familiar with the requirements of Greater Anchorage Area Borough
9rdinance No. 28-68 and tha~ the above described system iS in accordance with said code.
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
~"~'~%~%.. Name .of person r~questing approval/~/._.~
2. ' ~e of prope~y~ owner
3. LeE~ de~riptio~ .~7 _.~. ~/~ ~.
N. Nu~e~o~ ~ooms in house
5. ate~Anal~ ~s:
b. Detemgent " .
6. , Well data:
a. Type D~-,//.~
c. Casing Size
Distance from well to closest existing or proposed:
1. Sewer line
2. Septic tank
3. Seepage Area
Cesspool' .
5. Property Line .
6.
houses, barn, drainage ditch, etc.
Sewage disposal system.
Other sources of Possible contamination, i.e., creeks, lakes,
/,8 o
b. Septic tank capacity in gallons, .~~ /
c. Name of septic tank manufactum~ _
If "home made" show diag.'am on reverse side of this form.
d.' Disposal field or seepage pit size and type
1. Distance to proper~y line_ ~ ~ /
tO house foundation ~, .~ .
~. Percatation T~st ~sults ~
f. Percolation Test performed by
Use tLe reverse,side of this form to show diagram. Diagram should include
~%he foJ],~,~ing information: p~operty lines~.well location, house location,
.... ~c tank location, disposal area location, location of percolation test,
aL4 d~ction of ground slope,
The ~'~,~'~.~',,.~on on this form is true and correct to the best of my knowledge.
'S'$gnature of Applicant
"' Date $i~h'ed
T~O. BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL
above described sanitary facilities are hereby approved, ,$,¢bje~c,t, to the
5ol!owing conditions: , ,
¢onditiona:
The above described sanitary facilities are disapproved for the following
reasons:
Date ~
' Approval is valid for one year following the date of approval.
· CPJ:cw
~, Alan P. LahAoou
6505 Air ~amr~ Road
Anehor~ot AXa~kl 99503
St~JECT: bptic Tenk-bopqe PAt
AXdor~ood Subdivialou
~ar M~. Richisoa ~
Thio As to #a~e as you~ perult to lustai.t a X,O00
f#t of #epqe ~ea a~ tho above Xoeation ~o oer~re
a ~hPoe bodr~om home,
Plo#o outiot thio offl# fo~ final hopeotion
end app~oveX p~io~ to backfill,
DAVID R. L. D~NCAM, If. D.
Envtr~nmntaX Ho&tth Dl~eeto~
October ~$, 196~
l~r, Dan aapalN
Ye'ceranm AdnLnJJtT~at i on
Box 1399
~nc, hoz~&~e · AXa~ika ggsol
SUaJ£CT: Approval of Sewe~ and
~ater System Installation· Lot 2,
Block ~· AXclervood SubdJ. vXston
~ear ~. Rapalee !
Thin Depar~nent has ~ade an inspeetion o~ the sub:~eeC
sever and water feallities and i'ound tha~ they need the
necessary health ~equlremnts.
Sin~e the hm will ~e served by a deep well· ye would
expee~ that a~eqGate s~plAea of sa~e water will ~e c~tained
the yell aa ~ other in the v~cinity.
Sincerely,
DAVID R. L. DUMCAM, M. D.
Hedical DL r~L~or
Dali/art
B~I
David S,' Xa~ee'"