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HomeMy WebLinkAboutHIGHLAND PARK BLK 3 LT 8 Gr'"~TER ANCHORAGE AREA BORO~'~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N? 481 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: ADDREssMAILING ~'~' ~/"/~ LEGAL DESCRIPTION ~-¢'~-- DISTANCE FROM WELL ./"~-'~'~/d~. .,/-/...~ ~ LIQUID CAPACITY ./',~"J~' (-~ GALLONS. NUMBER OF MATERIAL ,,,..,s'/.~~ -~-'~--- -''~'~' __COMPARTMENTS INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: NUMBER OF PITS /' LINING MATERIAL..~ ~/~' NEAREST LOT LINE ,...~ ~/ / SEEPAGE PiT: ./ OUTSIDE DIAMETER ~':"~'-' OR WIDTH -~/~" , LENGTH ~"~"'-/ , DEPTH (.'. ~/J/~",'~/, '~";'~'~'JDISTANCE FROM WELL _r/'~_~.~,/""""""""'~· ./-~'/~.~ ~,~/ , BUILDING FOUNDATION ~_.o -, TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) Y"~""'~//'~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL ....-.--~"~ FOUNDATION NUMBER OF LIN~.,/ DISTANCE BETWEEN LINES ABSORP~ AREA SQ. FT. LENGTH OF EACH LINE / DEPTH: TOP OF TILE TO FINISH GRADE ., N~NE TRENCH % DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE W ELL: ~;/'¢/~'[~ TYPE//~./'-,,,/,~'~/~/'~'L~ _, DEPTH ~ / NEAREST ,,~..,~ SEPTIC LOT LINE , SEWER LINE. . TANK DISTANCE FROM WATER , BUILDING FOUNDATION '~-- SAMPLE SEEPAGE , SYSTEM ';'~" ,-'~C ESS P GOt , NEAREST OTHER ~' SOURCES DIAGRAM OF SYSTEM DISTANCES: ANCHORAGE AREA HEALTH DEPARTMENT Anchorage, Alaska 99501 OROUGH 279.2511 Case No. /'/'f':)/'_ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT ,/¢ NAME OF APPLICANT RESIDENCE ADDRESS APPLICATION TO INSTALL: SEPTIC TANK. TO SERVE THE FOLLOWING FAClLI,TY ~1~. FINANCED THROUGH / ~?¢~f* PERCOLATION TEST RESULTS ......... r:' · ,. ~ / ~ ;~ .~ I ~SEEPAGEPIT / ,DRAIN FIELD ,OTHER A~TIClPATEB DATE OF COMPLETION BI-'LOW TO BE FILLED OUT BY IlEAL'TH DEPARTMENT THIS IS TO SERVE AS ,/~q/2 ~/" 'I , PERMIT TO INSTALL A . AS DESCRIBED BELO~V. SIZE OF UNIT TO, BE SERVED ,.,~5 . SEPTIC TANK SI TYP . SEEPAGE AREA __TYPE DIAGRAM OF SYSTEM DISTANCES: I certify that I am fa~niliar with the requfl'ements of Greater Anchorage Area Borough Ordinance No, 2~. 68 and that thc above described system is in accordance with said code. )~,//~ )/ .~., /~ fl~:~¢"~/~ ::: ...... / DATE ':' _ APPUOANTSSIGNATURE ~:: :>t-:e ~ :.< ..... l:e oo ::, Lot Survey Certification Lot,'~ , Block .~ Anchorage Recording Prec:nct:, Alaska pREP~R:I) ~Y, CO','tTI~ACTIriG ErlGIHE[RS ANt)ASSOC. 270 '1792 1" It is tile responsibility of the owner, prior to construction, to verify proposed builuing graJe and utility connections and to determine the existance of any ease Illeii~S ~ COVeiiaiits ~ or restrictions which do not ~U)l~qA.g.on ti~e recorde,: plat. ~i,.~t. GREATER ANCHOF. AC, E AdEA HEALTII i)EPAI,:TF, EWF CASE 327 UAGLE S]'REE~ ANCHORAGE, ALASKA 99501 Performed For ~, ),,~,/ ,' ~"~- ) .... ~:' iDat~ })er, forned This Form Reports a: So~.ls Log h. .Fe~coJ. atxor lesz. Depth Soil Charac.eristics Location Sketch Reacl2. np j lU. te Gross Time Net Time Depth To H20 .............. ..& .................. ~.~ . Net Drop l)ata Certified By: Date: ,, .. - ,. .-~ , §~70I Chivig;~o¥ ~c~we:r, World yo~ pleas~ cheek ~o~r re~rds to vc~l~ that tho ~truetuuu(s) is connectio~ h~;i b~en made, Yc, u ~u',~t apply fi)r u oonneotlon permit from the po~tt officer for tho ~:1unieipattiy of Anohorag~, 3500 l{aat q?udor Ro~d. ]fy'~l hnvo ~ny quesilo~m, r~ardin~ tho ~¢;ineo~'ely, .Principal Envlrom~enti~l Control Ofileor cO P,O., STATE AND ZIP CODE OPTIONAL SERVICES FOR ^DDITiONA[ FEI~.S -- RETUIIr~ N 1. Shorts to wi]o~ and date d~live[0d ....,.... ']5~' RECEIPT. [~ With delivery to addressee on y ....... 65d ]/ 2. Shows to whom date and wllero del verec:' 35~ SERVICES ~, With deliveryto ~ddresseoony .......... 85~ OEUV~ff TO AOD[{ESS~E Om~ ~'"': ............. z'"-":....-..; ........ 50d s~c~ o~gw~v (~,o ~ ..... q.~,od; .................................. PS Form Ap~, ]o71 3000 r40 INSURANCE ~0VERAGE PROVIDED~ fla-( FO~ INTERNATIONAL UAIL RETURN RECEIPT REQUESTED O SENDER: Complete items 1, 2, and 3. Add your address in ihe "RETURN TO" space on 1. The following service is requested (check one). [] Show to whom and date delivered ............ 15¢ [] Show to whom, date, & address of delivery.. 35¢ [] RESTRICTED DELIVERY. Show to whom and date delivered ....... :~ .... 65¢ [] RESTRICTED DELIVERY. Show to whom, date, and address of delivery 85~ 2. ARTICLE ADDRESSED TO: flK/lw Evelyn Holland, 6701 Chevigney Anchorage, Alaska 99502 3. ARTICLE DESCRIPTION: REGISTERED NO. I CERTIFIED NO. INSURED NO. I 740946 (Always obtain signature of addressee or agent) I have received the article described above. SIGNATURE [] Addressee [] Authorized agent "/DAT~F DELIVERY 6. UNABLE TO DELIVER BECAUSE: Address.. User / Tenant.. -- ~ddres~., DYe' Y~'S'i'., [] Pos/l/ve ~-~ Negat/ve ~L INFOt~MA T~ION,_z Off~ce.. ~INICIPALITY OF ANCHORAGE I)~J(:~ HEALTH & I:NVJRONMJENI'AL PROT~Ci'ION MAY 3 5 RECEIVED Adm/nist~red By.. ~o¥~mb~ 30~ 1970 tmcimrag~', ~kla.M~,~ 99501 ~',o~r System for l,ot ~, Block Park Subdivision A sewer sy~;tem aptn'oved by tM.s Do'l)~r't, mont co,~ld bo until public sewer is availablo. It is projocted by tho Borough Public )qork$ ))epart~nent ti~at pt,blic sower will bo available this next Joha R. Lee, R.S. ,3ani tart an Richard D. Black July 17, 1970 Vetorans Administration P.O. }}ox 1399 Anuhorage, Alaska 99501 Sirs SOBjI~,CT: !'hi~ter and F~w~r for Lot 8, IJlock 3, Pork ~ubdivision, Km~m~th h. Berg ~lhe subject lot is :in a lateral i: l,romnent district and if constrtmtion goos ~ scheduled will be served b)' p~lic sewer this fall. A temporary sewer syste~n rmy ba installed and approved b7 thh; I~l.,arBmnt to sarvo tho subject lot md:il the sewer is available. l'hitor is supplied via Central Alaska Utilities whid~ is an approvod wt~tor supply. Sinccrol.y CLI FFORO I'..JLtDKI~-;, R.S. Administrative Di~'octor BY: Sm~itari~ J RL: Z~