HomeMy WebLinkAboutBROOKWOOD BLK 3 LT 8Ol&- I
G;"-~,TER ANCHORAGE AREA BOROI"~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? 152
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ~
NAME ~ -~,/~/,~/j/~z'~ ~j/~,~,.~; ADDRES~Z.///~/~/~/~'~T-?~ ~ ~~ PHONE
LOCATION %~ ~- ~~~ ~- LEGAL DESCRIPTION ~.~ ~fi ~/&~*/~'~ ~'
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY /z:~ ~' (_..,)
GALLONS.
NUMBER OF
MATERIAL z~- ~'~/~'~"~~'''-~-~ COMPARTMENTS
.~--_~"~'jx,/J'~' ~-"~ ,'"""~,.'~"'~"/"/'~ ./...~.. LIQUID
INSIDE LENGTH. ~ INSIDE WIDTH ~ DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
OUTSIDE DIAMETER
~ OR WIDTH
DISTANCE FROM WELL
NEAREST LOT LINE
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH /~<' , DEPTH
BUILDING FOUNDATION
'"~'~/'"'~' SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~, FOUND~t~O~
NUMBE~ DISTANCE BETWEEN LINE~
IN. ABOVE TILE
WELL:
LOT LINE
TYPE ~.,',,/~.z~Z.~i//_/~'; DEPTH ~
NEAREST z....-..~' SEPTIC
/ SEWER LINE ., TANK
DISTANCE FROM WATER
, BUILDING FOUNDATION.~'~'~' SAMPLE
~ SEEPAGE
SYSTEM , CESSPOOL
NEAREST
OTHER
SOURCES~
DISTANCES:
DATE
DIAGRAM OF SYSTEM
APPROVED
H E~LTH AUTHORIIY
GAAB-HD-2
GREATE[
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
)ROUGH
279-2511
Case N o. ~.,~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICAN~~--~ ~"~
RESIDENCE ADDRESS
MAILING ADDRESS ~ ,?~FTM PHONE N0.,
L0CAT 0N DF
LEGAL DESCRIPTION.
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT /-/"- , DRAIN FIELD , OTHER
TO BE INSTALLED BY ~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE TYPE SEEPAGE AREA ,?f~
DIAGRAM OF SYSTEM
TYPE
DISTANCES:
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
GREATER ANCHORA .... AREA BOROUG?
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 9§501
CASE #
LeKa] Descz, ip~soh: Lot
This Form Repo'~ts a: So~ls Log ,,
Depth
'7 ,, t[
Soil Characteristics
if Yes, At What Depth._.__ .-.._.-:: _--
Location Sketch
Reading Date Gmoss Time Net Time Depth To H20 Net Drop
P,~o~sed Instal~Seepage Pit Drain Field
Test Performed B3..: ~ ~ tom
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received March 8. 1977
Time of Inspection.
Date of Inspection .~-/
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
First Federal Savinqs & Loan Association
Post Office Box 4-2200 99509
Claus/Donna Hackenberger
Star Route A Box 1507D 99507
Phone: 274-6561
Phone: 274-5691 Claus
274-6561 Donna
Lot 8 Block 3 Brookwood
Loca ti on:
5. Type of facility to be inspected Single Family
6. Well Data:
A. Type Community
C. Construction
7. Sewage Disposal System:' On-site system
A. Installed 1970 B. Installer
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
8. Distances:
A.Well to: Septic tank
Nearest lot line
B.Foundation to septic tank
C.Absorption area to nearest lot line
No. of bedrooms 3
B. Depth
D. Bacterial Analysis
, Sewer Lines
2. Manufacturer
2. Material
, Absorption area
, Other contamination
, Absorption area
EQ-034 (1/74) Page 1 of two pages
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
1977
RECEIVED
1. Type of Inspection:
2. Property Owner:
Mailing Address:
3. Name of Buyer'
CMRO VA FHA
Claus & Donna Hackenberger
CONV X
SRA, Box 1507D, 99507
DayPhone: 274-5691 Claus
274-6561 Donna
Mailing Address:
Name of Lending Institution:
Mailing Address: ?. O.
First Federal Savings
Box 4-2200 99509
Day Phone:
& Loan Association
Phone: 274-6561
5. Name of Realtor or Agent:
Mailing Address: Phone:.
Legal Description: Lot 8, Blk 3, BrookWood Subd.
Location: off Huffman Rd.
Individual on site sewer
Type of Facility to be Inspected: & community water No. Bdrms.
Water Supply
Type of Supply:
Community
xFhJbti~ Utility X Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System:
If Individual, date of installation
Public Utility
1970
Individual (on-site)
RECEIVED
72-003(3/76)
Page 2 of two pages - R~ ~st for Approval of Individual ~er & Water Facilities
Legal Description Lot 8 Block 3 Brookwood Subdivision
Comments
Approved
Disapproved ~<'-~/~/ ~'Date.~/~ ,~
Approval Valid for one year from date signed
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
EQ-034 (1/74)