HomeMy WebLinkAboutBROWNS RESUB LTS 8 & 9Onsite File
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SREATER ANCHOR,a. GE ,~REA BOROUGH
HEALI~I DEPART~NT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
279-2511
DATE RECEIVED
INSPECT: 7-"-
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REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
FOR
Approval Requested By_ _,~:~d./~,,' ~~__.~ ,.,~,,~.
Address__ '?-~'~ ~-~-/'f ~~ ~~,r .....
Phone . ~ ~ ~. ~//
Property Owner .6~d./~' .~----~-~'~'~'~'~~ _ phone .~_ ..~ ~--,_.c-/..e'/./ .....
Legal Description~.~.~.~ ~-~ ..j~~/.~/..,'"/.-'a~', .......
"/1/// 77/...~37 ; ..~/~ f.~-.-'~.,~.
Type of Facility to be Inspected -~ ~'~'~ STREET:
Number of Bedrooms
5. Well Data:
A. Type ~,~
B. Depth /,~..~ /
C. Size ,~"//
D. Construction -
E. Bacterial Analys~s_~~.
Sewage Disposal System:
A. Septic Tank (If homemade, show diagram on back)
1. Si ze_ ~-~/~
2. Age. -7 ,,---/:
3. Manufacturer
4. Installer
Approval Request for Sew,
Page T~o
Facilities
B, Seepage Pit
1. Size
2. Lining .~/~~
C ..... Disposal Field
1. Number o£ Lines
2. Total Length
Required Measurements
A. Nell to Septic Tank
B...Nell to Seepage Pit
C. Nell to Sewer Line
D. Nell to Property Line
E. Well to Other Possible Contamination
F. Foundation to Septic Tank _5- ~
Foundation to Seepage Pit ~
Seepage Pit to Property Line
8. COMmeNTS:
APPROVE~ DIS~. PROVRD:
APPROVA~ VALID FOR ONE Y~AR FRO~..I DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT
~.Dl170
Wate~.AualFsls:
a. Bactem].a].
b. Detez. Eent
Well data:
Casing Size
Distance from well to closest existing or proposed:
1. Eewer line .
Septic tank
3, Seepage Area
Cesspool'
5. Property Line
6. Other sources of Possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc.
a. ^ge of syste~ ..... .
b. Septic tank capacity in Eallons
c. Name of septic tank manufactu.~er
1. If "home made" show diagram on ~eve~se side of this foPm.
d.' Disposal field or seepage pit size and type .= ...........
1. Distance to property line
to house foandation .
. e. Percolati~ Test '~esuits .
f. Percolation Test performed by
Use the reverse .side of this form to show diagram. Diagram should include
-%he foilowing information: ~operty lines;.well location, house location,
~ptic tank location, disposal area location, location of percolation test,
~ direction of ground slope.
The i~fo~ration on this form is true and correct t? the best of my knowledge, j
Si[nature of ~pplicant ~ -D~'e ~i~ne~
TO BE FILLED OUT BY HEALTH DEPARTS.lENT PERSONNEL
'The above described sanitary facilities are hereby approved, ,subject to the
......... '~__'6'1 lowin ~ cond~o~.s_.~ -
Condition8:
The above described sanitary facilities are disapproved for the following
reasons:
Approval is valid fo~ one yea~ following the date of approval.
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, (rill out in T~iplicate) ' - - .
Name ,of person requesting approval ?CA/ ~ ~FF~ . ~ _J ~,~, ~, ~d~f,
~e of pPope~y~ owne~ ~0~
Number-o~ ~rooms in house~. ~: :.. ~ m~O~i//op~~
aten...Anal~s:
a. Bactemial~ ../~, ~¢ ,. .
b Detergent "
Well data:
, .
b. Depth 7'
c. Casing Size ~ '/
Distance from well to closest existing or proposed:
1. Sewer line
2. Septic tank __
3, Seepage Area
g, Cesspool~
5. Property Line ,, .
6. Other sources of Possible contamination, i,e., creeks, lakes,
houses, barn, drainage ditch, etc... _A/~A/~ ·
7. Sewage disposal system.
a. Age of system 7~
b. Septic tank capacity in gallons, ~Q, .3--0oo
c. Name of septic tank~'manufactu~e.r..._UOe-Ra ~ ~ , .~. ~ ~:~ .
1. If "home made" show diagram on reverse side of this fo~m.
d.' Disposal field or seepage pit size and t~e .Lpg.
1. Distance to property line
to house foundation
CMRO
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
~.~ ~ama~..of person requesting approval _ Don
2. %~ma of proper~y, owner ~nn
3. ~'~3 de~Pti~Ol~ 101 ~. 301. 30~ P~ck Aye.,)_ Lot 8 & ~ Br~ Subd.
Numb~x, o~ ~k.ooms in house 4
5. Water Anal~is:
a, Bacteriai n,m ·
b. Detergent "-' '
6. WeLl data:
a. Type__ __drilled
b. Depth 167'
c. Casin~ Size 6'
d. Distance from well to closest existing or proposed:
1. 8ewer line 38'
2. Septic tank 81'
3, Seepage Area 135'
~. Cesspool~.__
5. Property Line .
6. Other sources of Possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc. none
Sewage disposal system·
a. Age of system .... 7. ~ea~s
b. Septic tank capacity in gallons_t~ 5~000.Bal. steel tanks
c. Name of septic tank manufactu~.r~were~tanks..off .tankers .....
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type_ log crt~ 8,xS'xp'
1. Distance to property line
to house foundation
e, Percolatio~ Test ~esults
f. Percolation Test performed by
Use the reverse side of this form to show diafram. Diagram should include
· ~he foilowin~ information: p~operty lines;.well location, house location,
~eptic tank location, disposal area location, location of percolation test,
and direction of ground slope.
9. The tnfo~mation on this form is true and correct to the best of my knowledge.
ON FILE AT HEALTH CENTER
Signature' 'of Applicant .........
9-23-68
Date Signed
TO BE FILLED OUT BY HEALTH DEPART~,~ENT PEPSONNEL
IX--~X ~The~- above described sanitary facilities are hereby approved, subje¢~t to the
........... '~6~llowing cond,i~lons:
Condit ions: NONE
The above described sanitary facilities are disapproved for the following
reasons:
David B. Harkness, Sanitarian
Approval is valid for one year following the date of approval.
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Percolatlon~ Te~st '~emults
f. Percolation Test performed by ,
Use the reverse .side of this form to show diagram, Diagram should include
'~he foJ].o~ing information: ~operty lines~-well location, house location,
~s~c tank location, disposal area location, location of percolation test,
a~d direction of ground slope.
T.~O BE FILLED OUT BY HEALTH DEPARTMENT PERSONNEL
~'T~e above described sanitary facilities are hereby approved, s. ubje. c~ to the
........... ~611owing c0n~ons: .......
Condit ions:
The above described sanitary facilities are disapproved for the following
reasons:
.... ' "' ". ~ate' ~.' 'i ~.!,'" ~ .... ---~'
. ,
Approval is valid for one year following the date of approval.
CPJ:cw