HomeMy WebLinkAboutT12N R3W SEC 33 N2 Lot 113 Deactivated Hwy Proj. (Seward Hwy)Sec
GE' TER ANCHORAGE AREA BOROU' H
D~-r,~RTMENT OF ENVIRONMENTAL QUALI~.
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING '~ ~
ADDRESS_._////~// /'/~ .ffZ)/-'~/' ~ PHONE ~
LEGAL DESCR PT ON ~Z~ ~5//~
7-'/~ .~/~
DISTANCE FROM WELL.__
LIQUID CAPACITY .~_5~0
MATERIAL ~"c~-7'-~:'~Z" .COMPARTMENTS //
LIQUID
GALLONS. INSIDE LENGTH. ~ INSIDE WIDIH ~ DEPTH__
SEEPAGE SYSTEM: SEEPAGE Pll: .,z~'~'-~'"/~'~-4/~'~'
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE //) ' 7'0 ~c~) ~.,~.~/' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH___ /~'-- DEPTH
· BUILDING FOUNDAIION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL_ /~r.~)~IFTD~ON, NE'~Rt~c~OT LINE.
NUMBER OF LINES ~..? DISTANCE BETWEEN LINES ___ IRE WID[H
ABS~RP[,I~N AREA SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPIH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGIH
, OF LINES
IN. TOTAL EFFECTIVE
IN, ABOVE TILE.__
WELL:
LOT LINE
TYPE.,,~/~.,~:~' DEPTH .-'~',~::~ / DISTANCe FROM WATER ~_~/,
· BUILDING FOUNDATiON,__~ SAMPLE , NEAREST
/~ ,.~ NEAREST /~ ~ SEPTIC ~ / SEEPAGE ~ , / OTHER /~'
, SEWER LINE ., IANK~ SYSTEM_ _~ , CESSPOOL~ , SOUrCEVieW/
DISTANCES:
DIAGRAM OF SYSYEM
G.A,A.B,
GREATER ANCHORAGE AREA BOR~)UGH
DEPARTMENT OF ENVIRONMENTAL, QUALITY PERMIT NO.
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
.~,, ., /C~,~'~- x
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH --
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED __
DRAIN FIELD , OTHER
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL
FINAL INBPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE BUBJECT TO PROSEC*UTION.
SEPTIC TANK SIZE /'~''/'l/'~/)L' E¢ TYPE
SEEPAge AREA SIZE
MINIMUM DIB'I'ANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK --~L'--
FOUNDATION TO SEEPAGE PIT , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL _ / ~}--
SEPTIC TANK , SEEPAGE PIT , DRAIN FIELD .
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAiN TO SEPTIC TANK
DRAIN FIELD
SEEPAGE PIT
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
/ / HEALTH :1~THORITY
TYPE .
DIAGRAM OF SYSTEM
I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA ~OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DATE /¢,~ ~//,/¢/¢~ APPLICANT'S SIGNATURE !~//'~ ~'~?'~'~/~//~'~/ /
77"
IP
3330
GREAI'ER ,dtCttOI1A.:,E AREA BOROUGI!
Dep~ment of Enviror~mental Quality
"C" St,, Anchorage, Alaska 99503 27zt-~561
REQUEST FOR APPROVAL OF
INDIVIDUAl. SEWER & WAFER FACILITIES
1. Type of Inspection: CMRO VA FIIA
2, Property Owner:
Mailing Address:
3, Name of Buyer:
Mailing Address:
CONV
Phone s~k~-_.93~zP~ ....
Charles A._~_~z_~i~At~iei~k_¢a~
~639 Abho~tt Loo_p_Rasa/ ~Day Phone 3/~,-738~ --
4. Name of Lending Institution: ,lst Nationa_l BAuk, of__/Lunho_rAga
Mailing Address: P.O. Bo× ~20 ~/o Ms. L~pe~t~9_q~279=41~l ext 233__
5. Name of Realtor or Agent: Puckett & Associste_~_~_
Mailing Address: 423 East 5th.~e _~hone279-1~
6, Legal Description: The No~_th $~8--~__Feet of
R3W SoM.
Location:Box 401]~_.Star Rout~
7, Type of Facility
8. Water Supply
Type of Supply:
If Individual,
If individual,
9. Sewage Disposal
to be inspeoted: __]Ze~z~[ No. BdrmS.Two __
Public Utility
number of dwellings
depth of well _!2A feet
System
Type of System: Public Utility
If Individual, date of installation
Individual _ XX.
presently served one
Individual (on-site)
GI.~I'ER ANCHORAGE AREA BOROUGh
DEPARTMENT OF ENVIRONMENTAl_ QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686 ~
REQUEST FOR APPROVAL OF
INDIVIDUAl_ SEWER AND WATER FACILITIES
FOR
APPROVAL REQUESTED BY:
ADDRESS:
PHONE:
· 2~/ ~x~PHONE:
2 PROPERTY OWNER:,/,./27<_:,
3. ~[~a~ ~[sc~p~ou:
4. TYPE FACILITY TO BE
NUMBER OF BEDROOMS:
WELL DATA:
B. DEPTH
c. SIZE_____~," ~.]-:~,.:,~t
D. CONSTRUCTION
E. BACTERIAL ANALYSIS
SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK (IF HOMEMADE,
1. SIZE
2. AGE
SHOW DIAGRAM
ON BACK)
3. MANUFACTURER
4. INSTALLER
APPROVAL REQUES'[ FOR SEWER & WATER FACILIq'~IE~
PAGE TWO
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1, NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
A. SEPTIC TANK
B SEEPAGE PIT
C SEWER LINE
D PROPERTY LINE
E OTHER
F FOUNDATION TO
G FOUNDATION TO
WELL 'FO
WELL 'FO
WELL TO
WELL 'FO
WELL TO
POSSIBLE CONTAMINATION
SEPTIC TANK
SEEPAGE PIT
SEEPAGE PIT TO PROPERTY LINE
COMMENTS:
APPROVED: ~'J '~7]/"?' 4?
DATE' ~ ~,',.' //'// DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY
slit j~ct
cc: V~, :~.}'ans Ad,:'inistpat ion
DATE
~" ',I~¥MEN? OF HEALI'H AND WEI 'rE
DIVISION OF PUBLIC HEALTH
BACTI-'RIOLOGICAL WATER ANALYSIS
SAMPLE COLLECYED BY.
DATE COLLECTED TIME COLLECTED pm
SANITARIAN'S REMARKS
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
J]rilJianiOreen24 hour. --LI :L I:-~
'7 9
,)o,i nFS ,, ,lc l'ani: on '1 1/? of I.o't: 113.
~f
06-1220(a) Rev. 1973
DATE
ALAS, DEPARTMENT OF HEALTH AND SOCIAL SE~ ,ES
DIVISION OF PUBLIC HEALTH
INDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS
Lab No. _
OFFICE
INDIVIDUAL
NAME
SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
ADDRESS
CITY
ZIP CODE
ADDRESS
OF SOURCE
Analysis shows fhis Water SAMPLE to be:
[~ Bafisfaclory
[] Unsatisfactory
[] Questionable
[] SamMe too long in trans[t; sample should not be over 48
hours old at examination to indicate rel[able results. Please
send new sample.
[] Botlle broken in transit, please send new sample.
SANITARIAN~S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED TIME COLLECTED
[~ Other (List)
[] Of Well [] Other
PURPOSE OF EXAMINATION: illness Suspected? [] Yes
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
.actose BrotB 10cc 10cc 10cc 10c¢ 10cc 1,0cc 1,0cc
24 Hours
24 Hours i I
48 Hours
G~[!A1}..R ANCHORAGE AREA BORO!.J6H
l)epartment df Envlronnanta. Qua!~tv
3500 Tudor Road, Anchorage, Alaska 99507
Date Rece{ved
R~qUEST FOR APFROVM, OF
,
IND~V'~DUAI, SE~;ER & WATER FACZL].TILS .~.~¢.~_~. FOR
~ Phone
I, oca~ion:
Tvoe of Facility to h,e Inspected: ./,~ ~
..... 7- "7 ..... yr---
Number of Bedrooms: ~
6. ~e]l Dets:
^.
C. (.onset latz on D,
7, Sewage Disoosal System:
Manufacturer
Distances:
A, Well To:
Size ~P,
Seepage Pit: ] .... _-~_~.~_s.~ ~_ ...... :----C~L~= .-
Disposal F..e] d
Septic 'rank .... L:_~]-.: Absorption Area ~'() , Sewer Lines
-- .,~ , .
, Nearest I. oL [].ne._~.~. , O%ber Contamination
Foundation to Septic Tank ~g) ~ AbSorotto~ Ares
C. Absorption Ares to Nearest Lot Line
Request for Approval of Inoividual Sawer & Water Facili}te,.
Page Two
9. Comments:
Approva] Valid for One Year From Da%e Signed
Greater Anchorage Area Borough, Del'~rtment of Environmental Quality
D~'AGRAM OF oYS'II2M
I certify that the information contazne~ in this requesfi for approval to be e true
and accurate representation of the subject sewer and water facilities located at:
DIVISION OF PUGLIC HEALTH
BgCYERiOLOGICAL WATE ANAL g S
DATE
If on "Um~allafcmtory" or "Questionable" stcRus i~ ~di~fed a~ve
you ~hould I~ke ]mmediale ~ction ae recommended bolow,
L Nolify consumers woler ks pollulod. Boil or chemically
Ireol Ih~ w~tor as outlined In the enclosed leoilet
Check chlorlnaRon and other mechanical equipment Moke ce~lain E ~
~ drilled well ~ cbtom
SANITARIAN'S REMARKS
NAME
CITY
kDDRESS
Well [] Dug [~ Drtvon [] brillorl [] Bored
$OURCEt [] Spflnq [] Cl. tom [~ Oflmr
REAr) INSTRUCTIONS
0~-1220 (b)
BAGTERIOLOGICAL WATER ANALYSIS RECORD
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE