HomeMy WebLinkAboutT15N R1W SEC 9 LT 83 E2
GP-~,TER ANCHORAGE AREA BOROI'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N°, 7~I
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING .~ ' ' ~
ADDRESS /,¢':r/~;Z ~--;f%~Z~Z _. PHONE
SEPTIC TANK:
DISTANCE FROM WELL
L~QU~D CAPACITY !~
GALLONS.
~ NUMBER OF
MATERIAL ~")'~ ~ COMPARTMENTS /
~6/~/~ l ~7~~ L,QU~D
INSIDE LENGTH INSIDE WIDTH__DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT: ~/'~-/~/' CC'~d;~~ ~,j~/~/~'/~C-/~..
/ ,
NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH / ~ , LENGTH ~ ~ , DEPTH
LINING MATERIA~ [~W~ j2/~.~ DISTANCE FROM WELl //~ / , BUILDING FOUNDATION
NEAREST LOT LINE ~"~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ ~Q. FT,
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL ~FOUNDATION , NEAREST LOT LINE ,OF LINES .
ABSORPTION ARE/~// SQ. FT. LENGTH~CH LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
(~ ~'~.~.~f DISTANCE FROM WATER
WELL: TYPE. '"/ ., DEPTH .,BUILDING FOUNDATION. SAMPLE , NEAREST
NEAREST SEPTIC //~ SEEPAGE /_~ ! OTHER
LOT LINE , SEWER LINE ., TANK , SYSTEM , CESSPOOL , SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPRO?I/~~/ ~
HEALTH AUIHORITY
G^^.-.D-2 GREATEiANCHORAGE AREA 'OROUGH CaS"NO.
HEALTH DEPARTMENT
327EagleSt. Anchorage, Ala~a 99501
279-2511
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
LOCATION OF INSTALLATION
· SEEPAGE PIT
DRAIN FIELD
TO BE INSTALLED BY.
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
PHONE NO..
, OTHER
THIS IS TO SERVE AS
DISTANCES:
· SEPTIC TANK SIZE
, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
TYPE SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
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 APPLICANTS SIGNATURE
-- DATE RECEIVED
INSPECTION APPOINTMEf 'S ~ '~O..~
TIME ~ TIME
DATE DATE
,NSPECTOR ,NSPECTDR
DEPT
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION-,. '
825 L Street - Anchorage, Alaska 99S01 '~VJ~O~M~ ~AL
ENVIRONMENTAL SANITATION DIVISION JAN 2 3 ~981
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE~L"~I~S
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing,
1,~ROPERTY OWNER , PHONE
M~LING A'D DR E~S
PROPERTY RESIDENT (If different'from above) ~ PHONE
2: BUYER / PHONE
MAI LING ADDR ESS
3. LENDING INSTITUTION ~ PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT / PHONE
5. LEGAL DESCRIPTION iJ~.
bD ., An l-
TREET LOCATI(~ //\
6. TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
~ Three [] Six
[] Other
7, WATER SUPPLY
INDIVIDUAL'
COMMUNITY
[] PUBLIC UTI LITY
E. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE'"
PUBLIC UTI LITY
ATTACH WELL LOG. A well log s required for all wells drillec
since June 1975, For wells drilled prior to that date, give weil
depth (attach log if available.) ~ ~.~ ~"'
/~70 YEAR ON-SITE SYSTEM WAS INSTALLED,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
THIS SIDE FOR OFFICIAL USE ONLY ·
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE I'~ THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[~] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMtT NUMBER
--I INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: /~_,~'-0 if Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/H°lding Tank IAbs°rpti°n Area) "~ ISewer Line INearest L°, Line
Absorption Area to nearest Lot Line
5, COMMENTS
I
~' APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 ( :~e¥, 6/?9)
ALASKA ~nUIRO~lm~I1TAL CONTROL $~RUIC~$, inc.
~lll]jl~l'jl~q ~- I~nuiroflm~lol $1udJ~s MUNiCiPALITY C'F ANC'~C~RAGE
RECEIVED
13UIE:I;):ZLJ;Z!B]ZCIN....'Tt:IHFiI;N !31ECT 9
TI"iiE TYF:'EE i3t::'
'fl"liE
'fl"tlE ~iC)]IH...!]i I:/AT]ZNC.; (3F:' 'TI"IIE ~YI3'TIEM ~&'l' i;iCiNI~i'TI:/LICT;ZC)N li~!~i 131:S AN[) NON
ill ~i ~1
1220 LUcst 25lh Auenuc · Anchoracl¢, Alasb 99503 * (907) 276-1361
.... ~ n .' ~ Hay ?~
Date of" - .....
:nspa~,o,q May 22
FOR AP?ROYAL OF
FOR
VA
Appxoval .eq~s~e '
?roperty Owner:
Address:
Coast Mortgage
P.O. Box 1200 And% 99510
J e~nes Carawan
CAugimk
n ..... 688-2.510
'l~' R1W
~, ~...-, - E 1/2 Lot 83, Sec 9,
o. ~uSal Oescriptiom:
4. Loc~tion: Aurora Drive Peters Creek
¸6.
~y?a o, ~c~lity>tO be ':nspacSea
Well Da~a:
~ Type flrqll~J
C. Construction
Single
O ~ ,..,~ Analysis Sa'tisfscto~/__
S~.va.g: Msposai Sysco,,.
A. ,-'~,led 1970 B. "'~":'~ ~°"~ Wallace
C. <~ '~" Tan'.<: ~ Size 1250 Gals p. ¢-~ ,~-~ "' '~'~'~ Wallace
~pu~c . .
~. S~9~ge Pit: !. Absorption Area 225 sq/~t2. R~n$s
E. ~isposal Field: Total length of lines
Distances:
113' ' ,,, +' 133'
, Aoso, p~,un are~
, Oun~, contamination
~ A.~, H~lon area
20'
A. x~l to: Septic tank
,x~ es~ lot line
~..-eunda~on ';o septic tank
C. Absorption area to neares~ lot line
Approval Va]'id ?or o;qe year from da'Ce s
Greate'r Anchorage Area Borough Depar'cment of ~, ~ ...... " ',,,,
DLa, GRAM OF SYSTEM
ce,%~Fy tha~ the ~n'format~on conta~nec] in ...... ' ' request, for approval
~ccura'ce representa%~on of the sub.iect sewer and wa~er facilities ........
~re operat'ing satisfactorily.
Date