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RE Q UE ST~r~O~[ - AP ? RO V ^ L OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate.) ~ , ~-
p~operty~ owner ~ ~
CasinE Size
Dis~nce from well to closeTt e×isting or proposed:
1. Sewer line
2. Septic tank_:: ~0~ '%
3, Seepage Area__
5. ?moperty Line
houses, barn, drainage ditch, etc.
Sewage disposal system.
Other sources of Possible contamination~ i.e., creeks, lakes,
a. Age of system / '.' ~.'
c. Name of septic tank manufactu~ ,7- :- ~-'
1. If "home made" show diaEmam on reverse side of this fomm.
d.' Disposal field or seepaCe pit size and type
1. Distance to property line
to house fmmdation
e. Pe~'co] at ion~ Te'st
f. Percolation 'Pest performed by ,
Use the reverse .side of this form to show diagram, Diagram should include
~the foJlowing information: p~operty lines'~ .well location, house location,
~-~!~t~c tank location, disposal area location, location of percolation test,
j ·
a[~ d rectlon of ground slope.
The h~fo~.,~*~ion on t~Rs form is tr'~e ~d co~rec~ to ~e b~st/ of my k~owledge.
FILLED OUT BY HEALTH DEPAETHENT PERSONNEL
The above described sanitary facilities are disapproved for the following
l~e asons:
^pproval is valid ~or one year followin~ the date of approval,
CPJ: cw
02_
L0t:
'10
REQUEST FOR AP?ROVAL OF
INDIVIDUAL SEWAGE AND WATER F/CILIttES
(Fi!l out in Triplicate
I~ama .of person requesting
'
Casing Size
Number'of, bedrooms in house
Uater Analysis:
a. Bacterial
'b. Detergent
Well data:
a. Type
b. Depth /7/~ ~
C.
d, Distance from well to closest existing or proposed:
1, Sewer line
2. Septic tank
3, Seepa~fe ~,A~_,;
4. Cesspool'
5. Property Line
6.
Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc.
Sewage disposal system.
b. Septic tank capacity in gallons 7,~'~ ~
c. Name of septic tank manufactu~e.r "7,
1. If "home made" show diagram on reverse side of this form.
Disposal field or seepa~e~ize and type ,
1. Distance to property line__ to house foundation ,
· e, Percolation. T~$t ~esults
f, Percolation Test performed bye. ~
Use the reverse side of this form to how d~agram. Dzagram should znc~ude
~he foilow.ing information:' ~poper~y lfne~.~ell iocati~n, house locatzon,
~e~ic tan~ location, dlspo~6! ~rea loca~ton, location of percolation
and direction of ground
The l~fo~nation on ~his form ~s true and correct to the best o~ my knowledge.
S£~nat~A Of-App$~can~
;? ' TO BE FILLED OUT BY HEALTH DEPARTNENT PERSONNEL
~e above described sanitary facilities are hereby approved subject to the
.......... ?~'llowing ~on~io~s: ~ -- ·
Conditions:
The above described sanitary facilities are disapproved for the following
reasons ~
?
~?p/oval is valid for one year following the date of approval·
CPJ: cw
1399
anchora}~,~, Alaska 99~01
for Lot D, Bli~ck 10) :;urry 5;ub-
diviMon [6757 lk~scwood]
was rode this day, Fobrt~iry 2$, 1970. ~m inspection
~;tandtu!~ sm,,'a~;e ired surface uater peeled il~ thc back
star~dpipe wire iccated in the back yard also but it was
uithin n~akJ, ng it i~lmsMbl~ ta clm~}; the level of the
the seepage pit,
It is tho ttmlm-,stamlinl~ o£ this l)ewn, t~',m~t. , ,
.-, ............. t,mt thc :~e~,:e'r system
conMsts of a septic tank and seepage pit. lowever, in the
~:,resent c{mditlon it cannot be +t,.i rc.v,d. :~pproval could be plven
by this llepart~mat if it could bo detemined why the sewage was
flowtn,, to the
,,., .~tll ,.~CO O:F ~e ~Wou~d alld ?)ri peI' coTrcctioi~s were
~:~ade so that there ~ould not be a re~curre~:e.
,it [mSt) the ..qmctionJwj oF m~ on-site sewage di. spc-.sal
~mr?.tnal in ihJ'- area because of !mot soil '
advised by the ih'eater Anchornle tXrea Borom[h )'ub!tc fVorks ti'mt
Borolll~h 5ela,et'a ~'tI. 1 probably not be available to ~arry
5i911 ~ ~IS COF'i~lt}.~
l'?ater for the subject residence is provided via a I10' well M~icb
,v,~.;ets our approvM.
Administrative Director
Sanitarian