HomeMy WebLinkAboutBRUIN PARK BLK 1 S75' N400' OF E2
//~_~~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION
I ENVIRONMENTAl. ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELl_ INSPECTION REPORT
MAILINGA~DRESS --
LEGAL DESCRIPTION
~ DISTANCE TO: t00 Cf ¢ ~ - ,
~ Z Manufacturer
Material ¢ ¢ Nc. of compartments_
Uq. cap~c~ons IF HOMEMADE: Inside length Width Liquid depth
~ ~ Well Dwelling PERMIT NO.
~ ~ Z DISTANCE TO:
%_~O ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot line
~ Nc. of lines . Length of each line Total length of lines Trench width Distance between lines
opo ti e to finish grade Material beneath'tile Total effective absorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well ~- Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area{s)
OTHER
INSTALLER
'~PPROVED DATE LEGAL
72-013 (Rev. 3/78)
PERMIT NO.
DEF'FIRTMENT C HEFIL. TH FIND ENVIRONMENTFIL ~ ..OTECTION
:DZ~ 'L' STREET.,
264-4'720
FIPPLICFINT ROBERT L_. DODGE SRFI 80M t76]:-[)
L. OCFIT ION LFIKE OTIS RD
_,. ,...FT.,,E,F N. 4.~.tOFTOF E-I,..'~ P~z.~
LE~SRL. ': --"~ .... ' ' LOT' SIZE
"F"r'F'E OF SOIL RE:SORPTION "5'.r":;TEM IS: TRENCH
349-4057
2i000 SQUFIRE FEET
MFIXtMUM NUMBER OF BEDROOMS =: 2:
SOIL RFITING (SD FT/BR)= i20
THE REQUIRED SIZE OF THE SOIL FIBSORPTION SgSTEM IS:
[:,, I::,'E F" 1- H := :1. E', L E 1-.! r3 T H = .S-': L." r3 R R %.' E L [:, E P T H =: ~:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR [:,RRINFIELD.
THE: DEPTH OF R TRENCH OR PIT' IS THE DISTFINCE BETWEEN THE SURFFICE OF' ]'HE
GROUND FIND THE BOTTOM OF THE E:.'..':CFIVRTION (IN FEET).
I"HERE IS NO SET' WIDTH FOR 'TRENCHES.
THE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OUTFFILt. PIPE
FIND THE BOTTOM OF' THE EXCFIVRTION (IN FEET).
F:',: t,_S rS! IJ .][ F,: E [:, S; E F" T I C: "'Ir' R 14 I< S I Z E =.: i
PERMIT FIPPLICRN'r HI=tS THE RESPONSIBILITY TO INFORf'I THIS DEPFIRTMENT DLIRING THE
INSTFILLFITION INSPECTIONS OF FINY WELLS FIDJFICENT TO THIS F'ROPERT'¢ FIN[.', THE
NUMBER OF RESIDENCES THRT 'THE WELL WILL SERVE.
............. ]- 14 ri ( 2 ) I 1-,t S F" E C: T I ri 1-,I S R F: E R [:-] (-.:! IJ ][ F.: FZ-: [:,,
BFtCKFILLING OF FIN'-r' S"r'STEM WITHOUT F'INFIL INSPECTION FIND FtPPROVFIL B"r' THIS
[:,EPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTFINC:E BETWEEN FI WELL FIND FINY ON-SITE SEWFtGE DISPOSFIL SYSTEM IS
2LO~Z'~ FEET FOR R PRIVFITE WELL OR t50 TO 2..'00 FEET FROM FI PUBLIC WELL DEPENDING
UPON THE T'.r'PE OF PUBLIC WELL
MINIMUM DISTFINCE FROM FI PRI',/RTE WELL TO FI PRIVRTE SEWER LINE IS 25 FEET ¢~ND
TO FI C:OMMUNIT',~,' SEWER LINE IS 75 FEET,
OTHER RE(.)LIIREMENTS MFI'.r' FIPPL'.r'. SPECIFICFITIONS FIND CONSTRUCTION [:,IFtGRFIMS FIRE
FI',,,'RIL.¢~BLE TO IN':ltJRE PROPER INSTFILLFtTION.
F' F£ E". I"1 ][ ]- E :4 F' I F.: E S [:, E C: E I'1 E: E F: 2: :.1_ .. ::L :9 E: :1.
I CERTIFY THR'f'
t.: I FIM FRMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS FI.'_-'; SE'¥
FORTH B'~.' THE MLINICIPFtLIT'¢ OF FINCHORFIGE.
2: I WILL INSTFILL THE S'¢STEM IN FICCOR[:,BNCE WITH THE CODES.
]:: I UNDERSTFtND THBT THE ON--SITE SEWER SYSTEM M8'¢ RE~!LIIRE ENLBRGEMENT IF THE
RES I [:,ENIZ. E I E, REflODELE~) I NCLI_I[:,E MORE THRN 3. BE[:,ROOM=].
ISSUE[:' E:'¢~ '~~~ .......... =~~[:'RTE~/ ¢ ~_[ ._~ ....... ',,"4 ~'
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
9
W
40o Y¥
~LOPE
DATE PERFORMED:
SITE PLAN
~ 10
11
12
13
14
15
16
17
18
19
2O
4)a~ O. Talbot
~io. 406~ -il
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
S
L
O
P
E
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND FT
COMMENTS
PER F O R M E D B Y: '~~_~~/~-'
72-008 (6/79)
CERTIFIED BY:
GAAB-HD-I
GarATER ANCHORAGE AREA BORO~''~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
DISTANCE FROM WE,
LIQUID CAPACITY
GALLONS.
COMPARTMENTS '/
INSIDE lENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT: ~'")('/..5"/'"/N~'~ ~z~d/~-'
NUMBER OF PITS / OUTSIDE DIAMETER ~-- OR WIDTH
LINING MATERIAl ~¢'~'"*~' DISTANCE FROM WELL ~;;~"~--
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH ~ , DEPTH
BUILDING FOUNDATION.
,/~,~)~"'~L"~f,,/j,~ 'T.~"~:- SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
NEAREST LOT LINE
TOTAL LENGTH
OF LINES
TRENCH WIDTH
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILI~
IN. ABOVE TILE
WELL: TYPE ~j~z-~ , DEPTH /~- 1¢ DISTANCE FROM Bt WATER y~--~.
., BUILDING FOUNDATION · SAMPLE NEAREST
~-' ~j~,.! NEAREST SEPTIC ! SEEPAGE ~'~ ~'~)~ / OTHER
SEWER LINE ~'~ ! ., TANK ~(/'J , SYSTEM , CESSPOOL '~ , SOURCES
LOT
LINE
DISTANCES:
DIAGRAM OF SYSTEM
DATE ~/~'~/~ APPROVED
' - HEALTH AUTMORITY -
,.~
GREATEL, ANCHORAGE AREA . .)ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No.
m
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
MAILING ADDRESS ~ X. /7~ ~-~,-.~'
LOCATION OF INSTALLATION
PHONE NO.
, SEEPAGE PIT , DRAIN FIELD
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
,OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED_. ~ ~~7
DIAGRAM OF SYSTE~
DISTANCES:
Jealth Authority
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.
r•.
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARIME.'JT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICAY
1. General Infcrmaticn Application Date-F,z1
(a) Legal Description (include lot, block, subdivision, section, township, range)
S 7•i',.f a f CYr cfRoct: R,„r.,V,ek SEB ao T/.g.V A-341
Location (address or directions)
(b) Applicants Nano DoeJoc, Th le hone. C;
3�y xxz o/
Applicants Address IZO 4 L-•X��+} Rd.
(c) Applicant is (check one) Lending Irstitytio j Owner/builder
B ;
• Other Q (e lair)• S=L
uyer xp�1
(d) Lending
Institution
7r"ii s / •f .v 7
•�//�
Address
Y 1r't Js
e:.
(e) Ictal Estate Co. s Agent
Address
Telephone
2. Type of Fe silence
Single -Family IM
Multi -Family [� Other (describe)
Number of Bedrooms 7-
3.
3. Water Supply
Individual I\b11 -><' Ccmunity Public
Note: If camunity well system, must have written ccnfirmaticr. frau the State
Department of Enviror=ntal Conservation attesting to the legality and status.
Is the well adequate for the nrfber of bedroans specified in this HAA YM)i ;
4. Sewage Disposal
Orsite,pE�:j Public F -::l Camunity f:::l Holding Tank
Is the wastewater disposal system adequate fcr the runber of bedrooms, RM)r;r-'
U
(Page 1 of 21
2-15-84
5. Engineering Firm Providing Inspections, Tests, Data and Information
I certify that I have checked, verified, or conformed to all MA HAA Widelines in
effect on the date of this inspection.
S
Nacre of Firm
Date SIH-fy
Address 17en N li3cn Arm,. INK
'� O` Al
N \ •..
Signed by �%.p': ' '::
Date O =•".•��M
r.
C. Rcid, Jr. ; PJ`
s
( ENGINEER SEAL) �a. 2251•E � •`,��y,
look
6. DHEP Approval �(� S%
Approved for bedroom By �4 u e- -t - u'��"-Gt- Date /' 2
Approved I X I Disapproved E::j Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Environmental Protection does
rot guarantee the continued satisfactory perfcrmaroo of the water supply and/cr the
wastewater disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and funs
ticnal for the rJ tuber of bedrooms and type of structure indicated.
(CHEF SEAL)
7. Mail the HAA to the following address:
rte, V'1--. , C �3Vu -;t
KB2/d5/s
(Page 2 of 21
2-15-64
1 I MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH I
MUNICIPALITY OF AWHO AGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) MAY 18 1984
CHECKLIST - FEBRUARY 1984 R E C EIV E D
Legal Description:
A. WELL DATA F�n n Ianr� 19•1 4'5 c4 AI4/W,'e
well Classification TLiV J P If A, B, or C. D.E.C. Approved(Y/N)
Well Log Present (Y/N) do Date Colpleted ()nknnL.wv. Yield
Total Depth - Cased to - Depth of (routing
Static Water Level - Pump Set At
Casing Height Above Ground I1 Sanitary Seal on Casing Y )
Electrical Wiring in Conduit (7,M) L46 Depression Around Wellhead
Separation Distances from Wall:
To Septic/Holding Tank on Lot /Ubl ; On Adjoining L.cts +1C)L1'-
To Nearest Edge of Absorption Field on Lot +/ODS ; On Adjoining Lots tloo'
To Nearest Public Sewer Line 64 To Nearest Public Sewer
Cleancut/Manhole nJp' Tb Nearest Sewer Service Line or. Lot
Water Sample Collected By � .Nngl ; tate 5 -7 -8N
Water Sanple 'lost Results
Comments
/(
B. SEPTIC/HOLDING TANK DATA
Date Installed 22 :Sol,(, Size r .* No. of Ccq:)arbTents Z
Standpipes (Y/N1 —Air -tight Caps —(Y )0 Fourdatior- Cleanout (Y/N)
Depression over Tani (( Y o Date Last Rmpeg 9 y
Pumping/Maintenance Contract on File (Y .) for
Holding Tank High -Water Alarm (XM) Temporary holding Tank Permit (YIN) -
Separation Distances from Septic/Holding Tark:
To Water -Supply Well /DOS To Building Foundaticn q9l
To Property Line 1►0' To Disposal Field .50
To Water Main/Service Line tlt), To Stream, Pond, Lake, or Major Drainage
[Page 1 of 21 :-
15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 12-0 Type of System Design r
Date Installed ZZ 3 �l,f I qpq * Length of Field ,31'
Width of Field a(a" 'r Depth of Field
Gravel Bed Thickness 6' A
Square Feet of Absorption Area _ 3 7 7- 16 Standpipes Present dy-YN) s
Depression over Field (Y u, Date of Last Adequacy Test 57-7*y
Results of Last Adequacy Test _ Abcc?uATC-
Separation Distance from Absorption Field:
To Weter-Supply Well *100' To Property Line [Q�
To Building Foundation 5gi To Existing or Abandoned System on
Lot till, ; Cn Adjoining Lots +.3a`
To Water Main/Service Line In To Cutbank(if present) Al/(}
To Stream/Pond/Lake/cr Major Drainage Course
To Driveway, Parking Area, cc Vehicle Storage Area n�1q
Ca®nts
D. LIFT STATICN
Date Installed 4Ip- Dimensions
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Cements
Manhole/Access (Y/N)
"Pump Off" Level at
Vent _(_YIN)
Pumping Cycles during Adequacy Test. Meets MDA
** Check Permitted Bedroom Rating Against HAA Request **
' I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection. '
Signed r Date-ld 89 .: CP•OF�Q% Sib
C an %4.r d,(L(us MOA No Z4 * � •�t�7l0
�4 Y n uuau nt �. �o� or . s3'iltGll s s.
KBl/d5/s
[Page 2 of 21
oY C. Roid, !r.
No. 2251E
........... %11
2-15-84
n �
ALASKA bi lUIROfl nTAL WOOL S614COS, InC.
Engincerinq & Enuironmental Studies
MAY 17 1984
ROBERT DODGE
1209 E KLATT ROAD
ANCHORAGE AK 99515
SELLER — ROBERT DODGE BUYER — SUPKO
SUBDIVISION — BRUIN PARK BLOCK — 1 IAT — 222B
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 372 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 450 GALLONS.
ED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
2 B DROOM HOME.
SEPTIC TANK WAS PUMPED5/17/84
FLOW TEST ON WELL
THE WELL FLOW RATE WAS 4.5 PM FOR 3 HOURS.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 2 BEDROOM HOUSE.
OF AC
0
. Raid, Jr.
2251-E ..
1200 West 33rd Auenue. Suite B • Anchorage. Alaska 99503 • (901) 561-5040
I' ~ ` -MuuTIPLE FAtal'BY I ~ TWo ~ FOUR ~ SIX
· -. ~ PUBLIC UTI EI,TY -'
1
' '11 _ ~_ -2 :;-_~_~:.-_- ...... .. N. 'MB R - - ' ~'-
~ I- Connect on. Ver. lfm, d . , , I INSTALLER ~ ~ ~
"-ISize:~ IfTankis homemade '~ SOILS RATING / _~
- '. lgived~e~ons:-' , . . , I
I
- , I TOtA L -~a~OR,TION A~ EA MATERIAL
~ ~4. Lm~WELL TO' ' Septic/ olding Tank I~bserptionAre~' ISewer Line
- Absorption Area :~o neai'~st, Lot Line
":~ - OVED'FOR -. _~ BEDROOMS - ~ ,
C:] CONDITIO~IAL APPROVAL~" (letter must accompany'certificate) - - '- . -
, ~ [] DISAPPROVED
-72;010 (R'ev. 6/79)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
~330 "C" Street, Anc.horage, Alaska 99503 274-4561
~ ~- Date Received January 20, 1977
Time of Inspection
1-75-77
Date of Inspection .~
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES ~C)
V.A.
Security Pacific Mortgage Corporation
Approval requested by:
Mailing Address: 1101 East Tudor Road, Suite 190 Phone: 276-1933
2. Property Owner: Vince Bates
Phone: 344-6352
Mailing Address: NHN Lake Otis Parkway
Legal Description: S75' of N400' of E½ Block 1 Bruin Park
Location:
NHN Lake Otis Parkway
Type of facility to be inspected Single Family
Wel 1 Data:
Individual
A. Type
C. Construction
No. of bedrooms
B. Depth
D. Bacterial Analysis
7. Sewage Disposal System: On-site system
A. Installed 1966
B. Installer
C. Septic Tank: 1. Size
2. Manufacturer
D. Seepage Pit: 1. Absorption Area
2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
, Absorption area
., Sewer Lines ,
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
,v,dNICIPALITY 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: CMRO
2. Property Owner: ¥ince Bates
VA ×× .... FHA_
,CONV_
Mailing Address: NAN T,~e Otis Parkway
Name of Buyer: T,. C. T,amberson
Day Phone: 344 6352
Mailing Address: 1575 H. St.
4. Name of Lending Institution: Security Paciffic Moz~bgage, Corp
Mailing Address: 1101 East Tudor Rd Suite 190 ,,
Anchorage A~aska 99503
5. Name of Realtor or Agent: ]~fna.~lc Reality
Mailing Address: 501 W. Northern Llghts Phone:
6. Legal E~escription: S 7~' of N 400' of E 1/2 Block i Bruin Park
Location: NHN LsAe O~is Parkway
Day Phone: ~one
Phone: 276 1933
279 7611
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
sfr
No. Bdrms. 2
Public Utility.
,Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
none
unknown
Individual (on-site) xx
If Individual, date of installation
1966
72-003(3/76)
Page 2 of two pages - Re st for Approval of Individual er & Water Facilities
Legal Description s75' of N 400 of East ~ Block i Bruin Park
Comments
Approved
· _ .Disapproved ~. .
Approval ~Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental/
DIAGRAM OF SYSTEM
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)
~Ay 17~ 1977
Security Pacific Mortgage
1101 East Tudor Road
Suite 190
Anchorage, Alaska 99507
Subject: S75' of N400' of E% Block 1 Bruin Park subdivision
The well has not been approvea per our memo to you on
March 1~, 1977. Or original approval state~ completion by
May 15, 1977. A~ yet we have not made a final approved.
If there are any further q~estions, please contact this
office at 279-2511, extension 224 or 225.
Sincerely,
L~s N. Buchholz,
Sanitarian
LNB/ljh
Copy of old memo
Copy of letter
1101 East Tudor Ro&d
Anchorage, Alaska 99507
3ubjeot: S75' of ~400' of S% Block 1 Bruin Park
The well must be upgraded by ext~nding the casing
twelve (12) inohes above the ground surface and
the existing pit fllled with earth.
The well u~rade must be c~lete~ bM~M 15, 1977.
X~ t~Ire ara any Eur~h~c queeticma, please contact
this o£~ica at 279-2511, exteheion 224.
Les
San£tarian
TO Security Pacific Mortgage AT 1101 East Tudor Road, Suite 190
I
SUBJECT S75' of N400' of F~ Block 1 Bmuin Park S/D IDATE March 18, 1977
Th~s department was asked to inspect a Well upgrade on the above subject
property on March 18, 1977.
The inspection revealed partial compliance as of March 18, 1977. The well
pit must be filled with earth to a level equal or above the surroundinq
grmnnd.
Sincerely,
DATE I SIGNED
Itedi~rm ~
SEND PARTS 1 AND 3 WITH CARBON INTACT -
4S 469
Po y Pak 50 sets 4P469 PART :3 WILL BE RETURNED WITH REPLY
.......... ............ ~ ~:: ~:~:~ .......... ............... i:~:: ~:~: ~: i~ ~,:~.~~
DETACH AND FILE FOR FOLLOW-UP
v-'~, . -~M~/_~--L/ REQUEST FOR APPROVAL OF L. 7 7. -~. %"~3 /
,.~;~ ] ] il/~.,/.f~ ~ INDIVIDUAL SEWAGE AND WATER FACILITIES
/"~,~. [/~ (Fill out in Tmlplicate) ~..
~.,..,.~ ......... ~. Name .of person requesting approval , ~;~ ~y .........
~ ~Y '. : ...... ' ' " ........ 7 .'~" ...........
, . ~.-~ ~. ~ -5 ~.. ~ ......... ~ ~ _ .....
d.
Distance from well to closest existing or proposed:
1. Sewer line ~ / .
2. Septic tank_ ~¢'! .
3, Seepage Area.. f~/ .
4. Cesspool' ~ .
5. Property Line _~" .
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc. .
7. Sewage disposal system.
a. Age of system .. /¢~; ? .... .
b.
c.
Septic tank capacity in gallons
Name of septic tank manufactum~r
1. If "home made" show diagram on reverse side of this form.
Disposal field or seepage pit size and type._. .........
1. Distance to property line to house foundation
Percolation Test '~esults
f. Percolation Test performed by
Use the reverse ,side of this form to show diagram. Diagram should include
'i~',%he following information: p~operty lines~ .well location, house location,
~I~c tank location, disposal area location, location of percolation, test,
a~ direction of ground slope.
9 The ~ ~ · ·
· ~n'fo~_~*~on on this form is true and correct to the best of my knowledge.
'S'ign~ture 'of Appli'cant
Date Signed
T~O BE FILLED OUT BY HEALTH DEPAET~.~ENT PERSONNEL
he above described sanitary facilities are hereby approved ~ubject to the
~6~llowin? con~ons: ' ~-
Conditions:
The above described sanitary facilities are dismpproved for the following
reasons: -
Approval is valid for one year following the date of approval·
CPJ:cw
Mr. !}an Eapalee
Local Representative
Veterap$ Administration
P.O. Box 1399
Anchora~l~, Ak, 99501
SUBJECT: 5owa<e System Ce~vin;~
S 75' of ~-; nOa' L 1/2 of ~lock
1, Bmuin Park Subdivision, Home
of Mr. Locke~t.
Dear ~. ~apalee:
Personnel of ~ne {]rea~er A~¢!;ora~<e Area Borou:¢~ Health
De~artr,,er, t h~ve ~,~ade a reeen~ in3;..ect~on of the subjac~
sewap:~ facilities.
In o~de~~ for' ~ha system to ~r~e~ our re~$~uir~:gn~s fer' a
two bedroo,]~ hola¢, it will De necessar¢ to [n:~rall a 750
f~allo.q se[~tic tank in oor~junction with an ~K~,gua~e seep-
Sinc~:~elY,
DAVIS i<. L. Du,qCA~,
DH: rn
Cc: ~{r. Lockett
BY: