HomeMy WebLinkAboutBURLWOOD TERRACE BLK 23 LT 7 .... IvluNtclP~lTy OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT.~OF h~ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~-NVIRONMENTAL F'~OTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION JUL 2 0 1979
Telephone 264-47~
REQUEST FOR APPROVAL OF INDIVIDUAL WATER ~ND SEWER FACILI
DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proc~d. Pl'ease~allow ten (10) days for processing.
1. PRO~Y OWNER PHONE
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER ~ ~ PHONE
~3. LEN~INGJNSTITUTION I PHONE
MAILING ADDRESS
4. REALTOR/AGENT
5. LEGAL DESCRIPTION
STifF. ET LOCATION ~. i I
6. TYPE OF RESIDENCE -F~13~I~NUMBER OF BEDROOMS
[] One [] Four
[] SINGLE FAMILY [] Two ~ Five
~ MULTIPLE FAMILY (0 ~¢[~1~'~"~ [] Three [] Six
[] Other
7. WATER SUPPLY [3~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
* 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.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
[i~ PUBLIC UTILITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test 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 APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
MINGLE FAMILY
ULTIPLE FAMILY
2. WATER SUPPLY
[~] INDIVIDUAL
~ COMMUNITY ~'-~
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] IN DIVI DUAL/ON -SI~I~ -
I-]PUBLIC UTILITY
Connection Verified
I--ISeptic Tank or I--IHolding Tank
Size: If Tank is homemade
give dimensions:
I--i ONE [] THREE [] FIVE []
[] TWO [] FOUR [] SlX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
OTHER
Septic/Holding Tank
IAbsorption Area
ISewer Line
Nearest Lot Line
5. COMMENTS
[] DISAPPROVED
[~]~t~PP R OV E D FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
DATE
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Receive I
Time of Inspection q
RP. QUEST FOR APPROVAL OF
INDIVIDUAL SB'~ER & WATER FACILITIES
FOR
Address:
Phone:
Number of Bedrooms~ bec~
Well Data:
C. Construction D.
7. Sewage Disoosal System:
A. Installed
8. Installer
C. Septic Tank: 1. Size
2. Uanufacturer
D. Seepage Pit: 1.
E. Disposal Field:
Size
2. ~atertal
Total Length of Lines
8. Distances:
A. Well To: Septic Tank__
, Nearest Lot Line
, Absorption Area , Sewer Lines
, Other Contamination .
B. Foundation to Septic Tank
Absorption Area
C. Absorption Area to Nearest Lot Line ·
Request for Approval of =ndfvtdua] Sewer & Water Facflitt,?s
Page Two
g. Comments:
, / ,
Date
Ap~rov~d~.
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, Department of Environ~enta! Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true
and accurate renrn~;entation of the subiect sewer and water facilities located at:
Signed Date
September 19, lg7Z
Coast Mortgage
P.O. Box 1200
Anchorage, Alaska
gg501
Subject:
On-site sewer and water inspection for Lot 7, Block
23, Burlwood Terrace Subdivision
Dear Si rs:
Upon your request this Department investigated the subject
facilities on September 18, 1972. The sewer and water systems
are disapproved for the following reasons:
1)
The existing sewer system, specifically the cesspool
has begun to collapse. The lot must be connected
to publtc sewer as public sewer Is available.
The well is of an unapproved construction and therefore,
the 6 inch casing must be extended 12 inches above
the ground level.
In order for this Department to give approval of the subject
water and sewer facilities, the above improvements must be
made.
If you have any questions regarding this matter, please do
not hesitate to contact this Department.
Sincerely,
Sharron A. Harris
Environmental Control Officer
mb
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-9686
Date Received ,,,
Time of Inspection ~,"~
REQUEST FOR APaROVAL OF
INDIVIDUAL SEiNER & WATER FACILITI£S
FO?
Address: Phone
5 Ty~e of Facility to be ~ns~en+.e~: ~
Number of" Bedroom~: ~
C. Construction , D. Bacterial Analysis
Sewage Disoosal System:
C. Septic Tank: 1,
D. Seepage Pit: !.
Disposal Field:
B. Installer
3' ',. ~' ~,,,~;" · -
~ 1 z e~,.__~ 2 Manufacturer
Size 2. Material
Total Length of Lines
9. Distances:
A. Well To: Septic Tank
, Absorption Area
, Sewer Lines
Nearest Lot Line
· Other Contamination
Foundation to Seot~c T~nk
' > Absorotion Area
C. Absorption Are~ to Nearest Lot Line ·
REQUEST FOR APR.OVAL OF
na,t~, of person requesting approval
~.~n~,~: of property~ owner
2. Septic tank //-ILOi
3. Seepage Are~ . ._ ~ ~--
4. Cesspool-j(,,,O~ .
Sewage lsposal system. ~,~ ~/ ,~
b, Septic tank capacity in gall. ons 07~, ,~~'- .
d,' Disposal field om seepage p.i~ size ~nd t~pe
- ~, Distance ~o property line to house foundatio~
4. ]'Iuml,~-z. ~,f ke,lz.ooms in house..
W.2te'r. Analysis:
a.
c. C a sinE Size
a, ?ereo] ation~ Te'st '~results
f. Percolation Test performed by
Use t~ reverse side of this form to show diagram. Diagram should include
the fo]],o,,~ing information: p~operty lines~.well location, house location,
~'~!~{c tank location, disposal area location, location of percolation test,
a~ direction cf ground slope.
The l~[o~.~+~on on this form is true and correct to the best of my knowledge.
~ 'gn-~ture/f Applic~ant .... D~e $i~?ne-d~
~O BE FILLED OUT BY HEALTH DEPAET~.~ENT PERSONNEL
~?~e above described sanitary facilities are hereby approved, subje, ct to the
~$'llowing conditions:
Conditions /'~
The above described sanitary facilities are disspproved for the following
r~aSO~S: .
Signature of
Approval is valid for one year following the date of approval.
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