HomeMy WebLinkAboutT15N R1W SEC 9 LT 32A
GRE*...ir ANCHORAGE AREA BOR(. JGH
DEPARTMENT OP ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-630
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK --
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
SEEPAGE PIT i DRAIN FIELD OTHer
TO be ~NSTALLED bY
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE BUEJECT TO PROSECUTION.
~EPTIC TANK SIZE //~ ~ ~/ I / TYPE EPAGE AREA SIZE TYPE
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK J , SEEPAGE PiT
TO NEAREST LOT LINE.
WATER MAIN TO SEPTIC TANK
/6
, DRAIN FIELD
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
//'
SEEPAGE PIT
SEPTIC TANK, ., SEEPAGE Pit
TO RIVER, LAKE, STREAM.
DRAIN ]FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CR[B CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAmeTER CAST IRON SIPHON PIPES ON SEPT[C TANK AND SEEPAGE PIT
f~TTED With AIrTIGhT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
LICENSED DeSIGNer
] CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF REA~(
GREATER ANCHORAGE AREA OROUGH ORDINANCe NO. 28-~8 AND THAT THE ABOVE
DESCR~B ~D SYSTEM IS IN ACCORDANCE WITH SAID CODE.
GREATER ANCHORAGE AREA BOROUGH
Department of Envi'ronmental Quality
Eagle River Area
I I - 1~5 --) ~o
JIZ.
3330 "¢" Street, Anchorage, Alaska
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
FOSTER HOME
1. Approval requested by:
99503 274-4561
Date Received November 2, 1976
Time of Inspection
Date of Inspection
Mailing Address:
Phone:
2. Property Owner: Ralph E. & Joyce A. Hansen
Phone: 688-2387
Mailing Address: Box 392 Chugiak 99567
3. Legal Description: T15N R1W Section 9 Lot 32A
4. Location:
Valley Avenue & Hellava Road, Chugiak
5. Type of facility to be inspected Single Family No. of bedrooms 3
6. Well Data:
A. Type Individual B. Depth 30'
C. Construction
D. Bacterial Analysis
7. Sewage Disposal System: On-site system
A. Installed 1970 B. Installer
C. Septic Tank: 1. Size
2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
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
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA
2. Property Owner: / cc~.t,~ ~ -?L~'~? .//-~,
CONY_
3. Name of Buyer:
Mailing Address:
Day Phone:
4. Name of Lending Institution:
Mailing Address: Phone:,
5. Name of Realtor or Agent:
Mailing Address:
Legal Description:
Phone:
7. Type of Facility to be inspected:
No. Bdrms.
Water Supply
Type of Supply: Public Utility.
If Individual, number of dwellings presently served
If Individual, depth of well -JO ~ 6~'-~'¢'~'
Individual
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site)
72-003(3/76)
Page 2 of two pages - Rec ;t for Approval of Individual S ir & Water Facilities
Legal Description T15N R1W Section 9 Lot 32A
Comments
Approval Valid for one year from date signed
Date
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I 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)
06-1220(al Rev. 1973
DATE
ALA( -DEPARTMENT OF HEALTH AND SOCIAL SE }ES
DIVISION OF:PUBLIC HEALTH
· ~ INDIVIDUAL AND SEMI.PUBLIC
BACTERIOLOGICAL WATER ANALYSIS
Lab No.
OFFICE
INDIVIDUAL []
SEMI-PUBLIC ~ CHLORINE RESIDUAL PPM
REPORT RESULTS TO
NAME · '. ~ ~ '~.~
A.
ADDRESS
CITY
ADDRESS
OF SOURCE
ZIP CODE
Analysis shows thls Water SAMPLE to be:
Satisfactory
Unsatisfactory
Questionable
Sample too long in transit; sample should not be over 48
hours old at examination to ~ndlcate reliable results. Please
send new sample.
Bottle broken in transit, please send new sample.
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN [NDIVIDUAL-?SUPPLY
SAMPLE COLLECTED BY ~ ~
DATE COLLECTED ,', ~ / TIME COLLECTED
Semele Collected ~rom/ [~ 'Kitchen Tap [] Bathroom Tap [] Basement Tar
[] Olhar (Listl
£oo -- [] Wooc [] Concrete []Metal J~ Open Top []
LOCATION:
Biameter of Wel Depth Fe~t.
Well Casing
Material Diameter Depth .
~ength DE Water Deoth
Drop FiDe From Bottom Feet.
~ Of Well [] Other
PURPOSE OF EXAMINATION: Illness Susoected?
[] Yes [] No
[] No Repairs to System? [] Yes [] No Signature
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
0B-1220 o BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev 1973
Lactose Broth 10cc 10cc 10cc t0cc 10cc 1.0¢c 1.0cc
24 Hours
4S Hours
EMB __ AGAR
Lactose Broth, 24 hrs. 48 hrs. Gram's stain
Coliform Density' Most orobable No. per 100cc)
~,F Results
Reoorted Dy
1'his analysis indicates Coliform Organisms to be: