HomeMy WebLinkAboutSOUTHWOOD PARK Block 4 Lot 28 No parcel# No longer exists on tax book plats -K. Fogal 08-20-87~0
GRF-4TER ANCHORAGE AREA BOROU~-H
',~ HEALTH DEPARTMENT ~ ,/
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-~2511
N°. 8§1
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME '~'~:( ¢/ L' ADDRESS
LOCATION /: ~.~'/~',"': ~,'d':LdJ' ~"~:tc; !'/'b~'-i'/'(E~AL DESCRIPTION ~C'/" ~ '~'~ ."~/,"~' iii' c '... "-~ . ~"' f--~
SEPTIC TANK: ..7
DISTANCE ~' "" .
LIQUID CAPACITY /z C9 ~ (~' ~7/CGALLONS. INSIDE LENGTH
SEEPAGE SYSTEM: SEEPAGE PlI:
NUMBER OF PITS
LINING MATERIAL (':
NEAREST LOT LINE '~'
NUMBER OF
COMPARTMENTS
INSIDE-WIDTH~ ......... -DEPTH
OUTSIDE DIAMETER OR WIDTH / ~ LENGTH /
, *-: , DEPTH
~'~ /5'
~,~4~-~/ ,BUILDING FOUNDATION
OISTANCE FROM WEU
IOIAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FI.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMI~R OF LINES /
ABSORPTION AREA~
TOTAL LENGTH
FOUNDATION NEAREST LOT LINE OF LINES
-I~IS~NCE BETWEEN~ LINES '~R~N__ WIDTH ...... , ECTIVE
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: TYPE
LOT LINE
, i 'J~"~'>)/DEPTH
L t./c'( DISTANCE FROM
., BUILDING FOUNDATION
NEAREST SEPTIC SEEPAGE
, SEWER LINE , TANK , SYSTEM
WATER
SAMPLE
, CESSPOOL
, NEAREST
OTHER
, SOURCES__
DISTANCES:
DIAGRAM Of: SYSTEM
i "~ ' ~ : : ":: ~ : :' i : :-i : :
. "{ -;:
DATE
SEWAGE
GREA~R ANCHORAGE AREA BOR~gGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
DISPOSAL SYSTEM -- APPLICATION AND PERMIT
~ NS~ALLATION LOCATION
LEGAL DEscrIPTION
INSTALLATION OF: SEPTIC TANK
FINANCED THROUGH
MAILING ADDRESS
?.'7
SEEPAGE PIT
TO BE INSTALLED BY
/
DRAIN Field .
FHONE 27' 7
., OTHER
NOTE: THIS PERMIT iS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE ?~0 TYPE SEEPAGE AREA SiZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SePTiC TANK
FOUNDATION TO SEEPAGe PIT ~/~) DRAIN FIELD
SEPTIC TANK TO SEEPage PIt WALL
SEPTIC TANK . SEEPAGE PiT ,~--- , DRAIN FIELD
TO NEAREST LOT LINE·
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, , SEEPAGE PIT
SEEPAGE Pit /O0 I
ALSO CONSIDER AREA WELLS.
SEEPAGE Pit //~
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET into UNDISTURBED SOIL.
4 INCH Diameter CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT reMOVABLE CAPS.
DIAGRAM OF SYSTEM
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDing INSTALLATION.
LICENsEDHEAL~H AUTHORITYoRDEsiG ~
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.
DATE
ltEALT~i DEPA],;TIIEI4T
327 EAGLE STI<EET
ANCHORAGE~ ALASKA 99501
Legal Dcscz, ip~ion: EOto~_:~ ~.?'"':'¢ Block_ .::.
Th%s Fcrm Reports a; ou~o~ __.
Depth
Fee~ Soil Characteristics C,~-%5~ O Location Sketch
, f · ..
Was Ground Wa~e~ EncounZered?.,.~O
...... ~-- ~ --~ ---,---/~ -h ,
Reading f Date
Gross Time Net ~:~,~,,,e
Oepth To H20
"~ Drcp j
Proposed Installation: Seepage Pi~ ,,~'~ * Drain Field
Deo~h Of inlet Depth To Bo*c'~om Of Pi~ Or Trench
~o ' '" ' - -' · (: '
.,"::?:,,;,4:.-' < "1.',>'~ / /~1! ~::7,-t-,:-~::.;: ~,'( /,' .,% :<, ,. ::1.,;:., 0.:,'-' - , ,. -''
~e'~ormcd ~: ;z / ~[¢'¢ ~/:',:~/~,~':;7 /0"
,:4 ..:....../ . ·
Da'ca Cev%ified By~,< :: :;(:::.: ;;:~ '
· - RECEIPT FOR CERTIFIED MAIL--30~ (plus postage)
SENT TO
STREET AND NO.
P.O., STATE AND ZIP CODE
OPTIONAL SERVICES FOR ADDITIONAL FEES
RETURN ~k 1. ShRws to whom and date delivered ........... 15~
· With delivery to addressee only ............ 65¢
RECEIPT p 2, Showe to whom, date and where delivered .. 35¢
SERVICES With delivery to adc[~r.?~sse, e ,only',: ............
OELIVER TO ADDRESSEE ONLY ...................................................... SOd
SPECIAL DELIVERY (extra fee required) ....................................
PO~MARK
DATE
NO INSURANCE C0VERAGE PROVIDED--
PS Form
Apr. 1971 3800
NOT FOR INTERNATIONAL MAIL
(See other side)
GPO: 19~20 - 4~0~743
Chapt,~' i6, A~ti~le 1/{.4~{, l~e~ I6.45.0§0;
not ~e~ to ~ sanita~ ~e~, ~fl you please e~k you~
~, thefts, ~ you ~t
the ~ub~ p~ ~ p~bli~ ~ by
RETURN RECEIPT REOuF.qTI~D ~
· SENDER: Complete items 1, 2: and 3:, ~,~x,
Add your address in the ILExu~x~ ~v space on
reverse.
1. The following service is requested (check one),
~ Show to whom and date delivered ............ 1§{
[] Show to whom, date, & address of delivery.. 3§{
[] RESTRICTED DELIVERY.
Show to whom and date delivered ........ : .... 65{
[] KESTRICTED DELIVERY-
Show to whom, date, and address of delivery 85{
2, ARTICLE ADDRESSED TO'.
Larr N aell ~-
2733 Raspberry Rdq~',~c)~a
, REGISTERED NO. i CERTiFiED NO. i INSURED NO.
740262
(Al~ays obtain signature of addressee or agent)
I have received the article described above.
SIGNATURE [] Aj:ldressee [] Auth. o. pgj~'z~d_ agent
5:ADDRESS (~omple~e op~ if request d~
6. UNABLE TO DELIVER BECAUSE: CLERK'S
iNiTIALS
DyE TEST
~x Code:
~er / Tenant
'roperfy Address..
YE TES T:
~] Pos/five
Nogafive
ADDITIONAL INFORMA T/ON:
Off/ce: ,...: :
F/e/d:
Adrn/n/sfered By:
pw-062 (7-74) ,_.$~. \%.