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Home My WebLink AboutROLLING HILLS ESTATES BLK A LT 4 ANCHORAGE AREA BOR' GH Department of Environment Quality 3500 Tudor Road Anchorage, Alaska 99507 NAME LOCATION INSPECTION REPORT ON-SITE SEWAGE DISPOSALS~STEM ~O6,~A''-~ MAILING ADDRESS .~ff3 ~ /~,~ ~D /~// PHONE SEPTIC TANK: DISTANCE FROM WELL /~ INSIDE LENGTH INSIDE WIDTH LIQUI'D DEPTH NUMBER Of COMPARTMENTS LIC~UlrD CAPACITY , GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL /,~ NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE i ....~ i TOTAL LENGTH NEAREST LOt LINE ./~ OF LINES /1 ~ FOUNDATION DISTANC~BET~FEEN LINES m///:~ TRENCH WIDTH IN. TOTAL EFFECTIVE /ENGTH go' DEPTH Of FILTER MATERIAL BENEATH TILE IN. ABOVE TILE IN. WELL: TYPe BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION ~/~: ~ DEPTH NEAREST NEAREST SEPTIC SEEPAGE LOT LINE__, SEWER LINE__ TANK SYSTEM , OTHER SOURCES DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: DIAGRAM OF SYSTEM DATE ~/ ~' '73 APPROVED 3500 TUDOR f~'3, AB ~NCHORAGE, ALASKA 99502 CAS£ # Leoal Descrintion: .._X_ .P., 1~o c .~_~- This ~orm Reoorts Soils Lofl___~__ Percolatio~ Test ~epth Feet Soil Characteristics i I i Nas Ground Water Encountered?.._~/__~&s IF Yes, At what Penth? Reading I Date I Gross Time Net Time Denth to H20 ! Net Drop; i - APPLIC~T FILLS OUT UPPER HAL,~"~ONLY ,,~ropert~ O&ner '~ \l = O Phone Buyer Address .......... ~ ~/~ ~ Zip Code ~ ~ ~ . Phone Lending Institution ~/~ ~ ~ ~OO ~/Fj ~ ~ ~' ~ Address ~-~ ~-- ~ ~/2 ~C ~ ~C.~ ~ Zip Code Realty Co. & Agent Phone Address Zip Code Type of Resi~nce Family No. ~f Bedrooms~ ~ Multiple Family ~ Other Water Supply ~dividual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975, ~ Community . For well.led prior to that date, gi~e well dept~ attac~log if available), Sewer ~.o~ ~ / ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE N TIATED. Time Time Time Time Date Date Date/ ~ ~,'~ '~ ~l Dat~// -~- - ~?(1/ Inspector Inspector Inspector Inspe~r Field Notes: MUNICIPALITY OF ANCHOP-,AGI~: /-/- '2~ ~ X~'/~ DEPT. OF H~/',LTH ENVIRONM.~NTAL PROTECTION RECEIVED ( ~,kAPPROVED BEDROOM8 *CONDITIONS OF APPROVAL I I D~s. PP.OVED I I COND,T~ON^' APPROVAL' Soils Rating Date Sewer Installed Well To Absorption Area / ~ ~-~ Well Log Received // ~ 7 3 Well to Tank / ~ Septic Tank Size (;;RE..~ER ANCHORAGE AREA DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8~56 SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT PERMIT NO. - NAME OF APPLICANT INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITy TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS P.ON SEEPAGE PITi V DRAIN FIELD · OTHER NOTE; THIS PERMIT I$ NOT VALID WITHOUT COMPLETION DATE ANTICIPATED FINAL INSF'ECTIONi ;i4 HOUR NOTICE RE:QUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENT~ DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK ~/ · DRAIN FIELD. FOUNDATION TO SEEPAGE PIT .~ DRAIN FtELO I sEimc TANK TO SEEPAGE PiT WALL SEPTIC TANK . , SEEPAGE PiT DRAIN FIELD TO NEAREST LOT LINE. W'LLTOSE.,CTA.K 5-0' /oo (0' I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO. 2S-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) 2:'~ama of property:owner , ~ 4. Number..o~ ~drooms in house 5. ~ate~..Anal~is: . We ll data: b. Depth_ ~90 c. Casing Size Distance from well to closest existing or proposed: 1. Sewer llne 2. Septic tank 3. Seepage Area 4. Cesspool' 5. Property Line.,...'~% 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. Sewage disposal system. a. Age of system b. Septic tank capacity in gallons /fO~) . Name of septic tank manufacturer /~ '~o~ 0 ' 1. If "home made" show diagram on reverse side of this form. d.' Disposal field or seepage pit size and type 1. Distance to property line to house foundation e. Percolatlo~.T~st'~sults f. Percolation Test performed by Use the reverse.side of this form to show diagram. Diagram should include ~he foCI.owing information: ~operty llnes~.well location, house location, ~'~qc tank location, disposal area location, location of percolation test, ~ direction of ground slope. The ~'[¢)~,~on on this forT%is true and correct to the best of my knowledge. '% ~gnatUre of APplicant ' Da~e Si~ned T~O_BE FILLED OUT BY HEALTH DEPARTMENT PERSONNEL ~T[e above described sanitary facilities are hereby approved, sUbjec~ to the ........... ~6'l~owi____ng con~i~ons: Conditions: --X~'~.L_~ ~ The above described sanitary facilities are disapproved for the following reasons: is valid for one year following the date of approval. CHEMICAL & GEOLOGICAL LABORATORIES ¢~-h ALASKA, INC. ~ TELEPHONE (907) 562-2343 5633 B Street ~, "~ Drinking Water Analysis Report for Total COliform Bacteria ~ TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Water System Name Mailing Address City SAMPLE DATE: Mo. Day Year SAMPLE TYPE: /;~Routlne . E] l~heck Sampm (for with lab ref. [] Special Purpose SAMPLE NO. 1 2 3 4 5 LOCATION I I TO BE COMPLETED BY LABORATORY Analvs~s shows this Water SAMPLE to be: ~' Satisfactory [] Unsatisfactory [] Sample too long n transit: sam31e shoul:d not ~)e over 48 hours old at exammahon to indicate rehable results. Please send ~new sample. Date Received ime Received tical Method: Tube tembrane Filter Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Rev, 1978 Data Collected Source PresumPtive 10mi 10mi 10mi 10mi 10mi 1.0mi 0.1mi 24 Hours 48 Hours Confirmatory 24 Hours 4g Hours EMB Broth 24 hours: Multiple Tuba Report.' M~mbrane Filter: Direct Count Verification: LTB Final Membrane Filter ReSUltS Broth 48 hours: 10mi Tubas Positive/Total 1Omi Po~tlMt$ Collform/100ml 8GB Collform/100ml o.,. /--/?' Time- // .5-~h a.m. GREATER ANCHORAGE AREA BorOUGH 3500 TUDOR ROaD ANCHORAGE. ALASKA 99507 DEPARTMENT Of ENVIRONMENTAl-QUALITY December ~, 1972 Ray Rodgers 5~33 West 73rd Street Anchorage, Alaska 99502 Subject: Permit to install sewer system Dear Sir: A permit was issued to you by this Department for the installation of an on-site sewer system and at this time we have no record of this system having been installed. Please complete this form and return it to this Department at your earliest convenience. yes no ~-~ ~ 1. The system has been installed. The system will be installed later this year. Void my permit; the system will not be installed. The system will be constructed during the next construction season. Your cooperation is requested as we have a great number of outstanding permits for 1972 and we would like to clear our permit files out as much as possible. ~7~ ~./~.~/~-Nan k_ you, / /~ohn R. Lee, R.S. ///Environmental Services Supervisor