HomeMy WebLinkAboutT12N R1W SEC 33 Parcel 5 Now DeArmoun S/D
GI~ ~.'rER ANCHORAGE AREA BORO~'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELt
LIQUID CAPACITY /_~ ,..<~'~f2[) GALLONS·
MATERIAl c~) 2'~:~ ~4~Z~_
7/('
INSIDE L OTH
NUMBER OF
,)//- '~ ,. / z'/// ' LIQUID
INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PI[:
NUMBER OF PITS _ _~ OU]SIDE DIAMETER
NEAREST LOT LiNE e ~,ij~ .... ~'OTAL EFFECTIVE ABSORPTION AREA (WAIL AREAI
____OR WIDTH_.
DISTANCE FROM WELL__.~ '
· LENGiH /2 , DEPiH
. BUILDING FOUNDATION
TILE DRAIN FIELD:
DISTANCE FR LI F
NUMBER OF STANC ETWEEN LJNE]~'-'-- E ~ IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH TO[~ OF T E TO FINISH GRADE
WELL.
' TYPE //~]/~ ,)
.DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
DEPTH
· BUILDING FOUNDATION. "~"_~/ SAMPLE
LOT LINE ~;.4-' , SEWER LINE (') ,Z:' , TANK ~:) "/ , SYSTEM ~'" ' '/ , CESSPOOL
DIAGRAM OF SYSTEM
DISTANCES:
, NEAREST
OTHER
, SOURCES__
DATE
GAAB~HD-2
GREATE'
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
OROUGH case No.
279-2511 ,~
NAME OF APPLICANT /7'0 (LC)
RESIDENCE ADDRESS I Y:~
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWlN8 FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
SEWAGE DISPOSAL SYSYEM - APPLICA¥1ON & PERMI¥
,]~r.~ C I~I~AII_ING ADDRESS ,¢? ~ , PHONE NO.
'~vt) LOCATION OF INSTALLATION
l~ SEEPAGE PiT ~ DRAIN FIELD ,OTHER
TO BE INSTALLED BY_
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
.... AS DESCRIBE~DLELOW. SIZE OF UN JT~T0/~/ SERVED r~ '~ .:'~J r) __
,SEPTIC TANK SIZE ~¢'~ ,TYPE ~t(SEEPAGE AREA__~/~ TYPE Z-~ ,.
DIAGRAM OF SYSTEM
DISTANCES:
I certzfy that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system if in accordance with said code.
REQUEST
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out
Hame of person requesting ~roval
b. Dete~ent
~all data:
d. Distance from well to closest exzstlng or propose~//m~
3, Seepage Ar, ea~6~ /.~.
5. Property Line ~7
houses, barn, drainaEe ditch, etc.
Sewafe disposal system,
b.
Other sources of possible contamination, i,e.~ creeks, lakes,
Age of system.
Septic tank capacity in gallons__~~,
Name of septic tank manufacturer ~/2,'~7~ .
1. If "home made" show dia?ram on reverse side of this fo7.
Disposal field or seepa?e pit size and type
l. Distance to property line to house foundation .
f, Percolation Test performed by
Use the reverse .side of this form to show diagram, Diagral~ should include
the fo]].o',llng Jnformation: ppoperty lines~ .well location, house location,
?~tf~c tank ].ocatlon, d~sposal area location, location of percolation test,
aLd d~rection of ground
T~e ~]~f~'~o~ on this form is true an~] correct to the best of my knowledge.
$if'n~ture of Applicant
Date Signed
~.~0~ B~E FILLED OUT BY HEALTH DEPARTliENT PERSO~INEL
The ~bove described sanitary f ' ' ·
..... .. . acllat~es are hereby approved, subject to the
Conditions:
The above described sanitary facilities are disapproved for the following
Approval .is valid fo~ one year. following the date of approval.
CPJ: cw
REQUEST FOR APPROVAL OF
II~DIVII)UAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
2,
3.
4.
irma of person requesting approval
b. geter[ent
data:
a. Type _ _ --,-.. ,.~
c. Casing Size ~tl
1. Sewer llne Q-~
2. Septic tank 9~__. ~'~)
3. Seepage Area_~.
~. Cesspool'
5. Property Line
6.
Distance from well to closest e×isting or proposed:
houses, barn~ dr'a~na~e d~tch, etc. ~
Sewage disposal system.
Septic ap
Name of septic tank manufacturer ~
1. If "home made" show dis?ram on reverse side of this form.
Disposal field or seepaFe pit size and type_~
1, Distance to property l~ne '~.~b { fou~dation__~,
to house
~., ?erco]atlon. Te~t Y.esn]r_s
f. Percolation Test performed by
Use the reverse .side of this form to show diagram, Diagram should include
~,he foJlowing information: ppoperty lines;.we].l location, house location,
:~e tank location, disposal area location, location of percolation test,
a~d d~rection of ground slope.
9, The ~,,~,~-,.~n~on on tkis form is true and correct to the best of my knowledge.
SiFn~'ture ~-~-~'{----- ...... Date Signed
~0~ .... BE FILLED OUT BY HEAL[L' ~ DEPARTHENT PERSOUNEL
above described sanitary facilities are hereby approved, subjec[ to the
--ollowzn? cond,~ions ~ -- ' '
Conditions:
The above described sanitary facilities are disapproved for the followinK
~.gna~u~.[~ ~r~lc~-~'~.~. - ~.' ~. ~ate -': ryZ?.,,-'~.¥ ...'
Approval ~s yard for one year followin[ the date of approval.
CPJ: cw
DATE
r ~ARTMENT OF HEALTH AND W£ \RE
DIVISION OF PUBLIC HEALTH
BACTERIOLOGICAL WATER ANALYSIS
OEEICE
4AME
ADDRESS
CiTY
SAMPLE COLLECTED BY
DATE COLLECTED TIME COLLECTED pnl
Well- [] Oug [~ Driven [] Drilled (~ Bored
SOURCE: [] Spring [~ Cistern ~ Olher
Dug Well or Cistern Conslrucgon:
BHck or
[] Of Well [] O~her
PURPOSE OF EXAMINATION: Illness Suspected? ~ Yes [~ No
Records in thls office indicate Ibis WATER SUPPLY Io be of:
[] Satisfactory [] Questionable [] Unsalldadory SanUary Status.
II an "Unsafisfaclory" or "Questionable" stalus is indicated above
you should take immediate action as recommended below.
__ I, Nolily consumers waler is polluted, Roll or chemically
R. Check chloril~atlnn end olher mechanical equipmenL Make cerlaia it is
6. Improve your (~ spring [] dug well [] driven well
[] drilled well [] cistern.
7. Relocate your well to a safe (aeolian in relationship fo your sewage
-- disposalsysfam. [] see enclosure
R. Sample leo long in lransib sample should nol he over 48 hours old at
examlnallon fo indicate reliable resulls, please send new sample.
[] RaDio Rroken in lransil, please send new sample.
9. Conlact your nearest E~ Local Health Department or [] Alaska
SANITARIAN'S REMARKS
Signalure
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
'Laclose Brolh 1Oct 10cc IOcc 10cc' J lOcc 1.0cc 0.1cc
1
24 hours
48 hours
Green
EMB
AGAR
.(Most probable No. per IOOcc )
Absen~