HomeMy WebLinkAboutHENKINS BLK 5 LT 10 MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION i,
t 825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. P/~OPERTYiOWNER 1 PHONE
MA~ LING A~D~ESS
PROPERTY ~ESlDENT (If different ~rom aB(~ve) '- ~ ' PHONE
2, BUYER PHONE
MAILING ADDRESS
:3. LENDING INSTITUTION I PHONE
I
MAILING ADDRESS
4, REALTOR/AGI~.I~IT J PHONE
MAI LING ADDRESS
5. LEGAL DESCRIPTION
STREW! LgCATIt)N
6, TYPE OF RESIDENCE
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
[] Two [] Five
[~;]---~T-h r ee [] Six
[] Other
7. WATER SUPPLY
[~NDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
[~NDIVI DUAl/ON-SITE~
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.) /<~ .~.~
**If individual/on-site, give installation date /J~,.~.. /~/~ ~
If system is over two (2} years old an adeq~;~/';est is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOIN-I'M ENTS
'IME TIME TIME
)ATE DATE DATE
INSPEC?OR
INSPEC1 OR
INSPECTOR
DIREC'I'IONS:
NUMBER OFBEDROOMS
1, TYPE OF I:IESIDI-.'NCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2, WITTER 8LIPPI.Y
[] INDIVIDUAL
[] CC)MMUNITY
[] PUBLIC UTILITY
Connection Verified
SEWAGE I:)ISI~OSAL. SYSTEM
EJ INI_"]IVII)tJAL/ON -SITE
EJPLIE, LIC UTILITY
Connection Verified
E] Se )l:ic~ax~,~, or E~] Holding Tank
Size _ ///,2~(-~ If Tank is homemade --
§ive dimansions:
[] ONE [] THREE [] FIVE
~_2 TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTI-I OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
?'
INSTALLER
SOILS RATING
TYPE DF TANK. MANUFACTURER
TO'I'A ../\BSORPTION AREA MATERIAL
4, DISTANCES
WI:LL TO:
Absor,:dion Are[] to fleal'esl Lot Line
Septic/Holding Tank
Absorption Area
Sewer Line
[] OI'HER
Nearest Lot Line
5. COMMENTS
~'!]'~' APPFIOVIED FOR ,~ ._ BEDROOMS
Eli CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
DATE
t. EGAt. DI=SCRIPTION
TBY (Title)
72-010 IIRev, 3/78)
DAVID SLENKAMP
694-9055
SRB 196X
EAGLE RIVER, ALASIiA 99577
21 August 1978
ROBERT A. SHAFER
Mr. Ron Harrison
P. O. Box A32
Chugiak, AK 99567
Dear Mr. Harrison:
A sewer system adequacy test was performed on your three bedroom
residence located on Lot 5, Block 10, Henkins Subdivision, Chugiak,
Alaska.
The septic tank was pumped on 19 August 1978 and the system consisting
of a seephg~ pit was charged with 1000 gallons of water. Percolation
over a 24 hour period recorded on 20 August 1978 will result in the
removal of approximately 1,179 gallons from the system or 393 gallons
per bedroom.
On the basis of the above survey and test it is determined that the
sewer system (septic tank and seepage pit) is adequate.
CF: Dept of Health and
Environmental Protection
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
4.
5.
6.
e
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 3/11/74
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
V.A.
Kassler And Co.
lO:OOam
3/18/74
319 W. 5th Ave. Anchorage AK 99501 Phone:
Donald E and Gail Gritzner Phone:
272-9501
688-2606
Legal Description: Lot 10, Block 5, Henkins Subdivision
Location:
Type of facility to be inspected
Well Data:
A. Type Drilled
Division S~reet Chugi,k AK
Single
C. Construction Standard
Sewage Disposal System:
A. Installed 1969
C. Septic Tank: 1. Size
D. Seepage Pit:
E. Disposal Field:
1. Absorption Area
Total length of lines
No. of bedrooms 3
B. DePth
D. Bacterial Analysis
Distances:
A. Well to: Septic tank
Nearest lot line lO'
B. Foundation to septic tank
B. Installer Wallace
1000 Gals 2. Manufacturer Wallace
2. Material Log
56' , Absorption area 108'
, Other contamination
, Absorption area
Sati~
, Sewer Lines 56',
C. Absorption area to nearest lot line __
E0-034 {1/74) Page 1 of two pages
Pa~e 2 of two pages - Re~st for Approval of Individual . .~er & Water Facilities
Legal Description
Comments
Approved~ ~ ~ Disapproved Date ~//2S/7?.
//n_.] for from date signed
Approval
Valid
one
year
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date