HomeMy WebLinkAboutALYESKA BASIN #5 BLK 6 LT 5
GreaTer ANCHORAGE ArEA Borough
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-45611
PERMIT NO.
SEWAGE DISPOSAL SYSTEM
APPLICATION AND PERMIT
ADDRESS PHONE
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OP~ ~ TANK
TYPE AND S~ZE OF FACHJT¥ TO BE SERVED
P~NANCED TH ROUG~
SOIL TEST RESULTS
cOmPLETION DATE ANTICIPATED
SEEPAGE PIT__ , DRAIN FIELD OTHER
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS
/y-~/_~,/.~/~_' ..--- ./
FOUNDATION TO ~ TANK ~
SEEPAGE AREA SIZE TYPE
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALl
C~?T.~ TANK SEEPAGE Pit , DRAIN FIELD
TO NEAREST LOT LINE. /~2~
WELL TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO '~Z~t:~ TANK SEEPAGE Pit
DRAIN FIELD
~C TANK, . ~ SEEPAGE Pit ., DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 PEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FitteD WITH AIRTIGHT REMOVABLe CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
G .A .A .B.
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT iAM FAMILIAR WITH THE REQUIREMENTS OF GReater ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DATE APPLICANT'S SIGNATURE ,
FORM NO, EI~-O1 6
1
' ' I · THIs SIDEFoR OFFICIAL USE ONLY
- ~ INSPECTIONAPPOINTMENTS
DATE - - ~ ' DATE -
INSPECTOR INSPECTOR '
- I: 'REcT'O _
IDENCE
[] SINGLE-FAMILY
[] MULT, IPLE FAMILY
: [] INDIVIDUAL
C0MMUN,TY'
- [] puBLIc UTILITY
' Connection Vedfied
3. sEwAGE'DISPOSAL SYSTEM
~ iN DIM/DUAL/ON -SITE
[]PUBLIC UTILITY
Connecti(~n Verified ,
I--ISepficTank or [] Holding Tank
'Size~ If-Tank is homemade
givedimensiens: _
TYPE OF TANK
[] ONE
[] TWO
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
[] THREE
[] FOUR
[] SIX ~
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
-TOTAL ABSORPTION AREA 'MATERIAL ; ~ '- .
4; DIS:TANCES Septic/Holding Tank · Absorption Area Sewer Line - NeareSt
_ - ' ' ' WELLTO:
-- Absol;l~:ti0n_ Area to nearest Lot Line
' '5, OM NT ..... -~1
· I "[] CONDITIONALAPPROVA.L (letter-must accompany certificate)
- I- [] DISAPPROVED
'qUNICIPALITY O~ ANC~OR,'. .....
DEPARTME, OF HEALTH AND ENVIRONMEN', .i~ROTECTIOI , ~1~'~1'
825 L Street, Anchorage, Alaska 99501
264-4720
Date Received: September 22, 1977
#1: Time Morninq
#2: Time #3: Time
Date 9-22-77 Thursday
Date Date
Insp Kennedy . Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request:
Mailing Address: Phone:
2.. Property Owner:
Mai~ing Address:
3. Legal Description:
Lester C. Sheppard
Post Office Box 8-747 99508
Phone: 333-7171
Lot 5 Block/ Alyeska Basin Subdivision
4:
Single Family Residence: (x)
MUltiple Family Residence: ( )
Number of Bedrooms: Three
Number of Bedrooms:
Well System:
Permit #
IndiVidual well ( ) Community/Public System (x)
Depth 'of Well Well Log on File ( )
Construction
Bacterial Analysis
e
Sewage Disposal System: On-site System (x)
Permit % Installed Installer
S~~l~ ~OO ~ Manufacturer
AbsOrption Area Soils Rate Material
PubliC Utility ( )
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Pa,ge Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 5 Block 4 Alyeska Basin Subdivision
Comments:
Affadavit Attached: ( )
Disapproved:
Letter Attached: ( )
Date:
Date:
Department Worksheet:
MUNICIPALITY OF ANCHORAGE
/~ J Department of Health and Environmental 'Protec~ion
//~~/ 825 L Street, Anchorage, Alaska 99501
'"'~ ~uest for Approval of Individual Sewer and Water Facilities
Property Owner:
Mailing Address:
Phone: ~ 3 3~'71TI
Name of Buyer:
Mailing Address:
Phone:
Lending Institution:
Mailing Address:
Phone:
Realtor/Agent:
Mailing Address:
5. Legal Description:
Street Location:
Phone:
Single Family Residence:
Multiple Family Residence:
(>4) Number of Bedrooms:
( ) Number of Bedrooms:
Water Supply: *Individual Well ( )
If Individual Well, well depth
If Community System, name of system
Public/Community System (~0
Sewage Disposal System: On-site System
If On-site System, date of installation:
Public System ( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77