HomeMy WebLinkAboutTURPIN BLK 3 LT 100( - Oq4
L, oT
Voturams A&ainis tration
Box i309
y~c):orage, Alaska 99501
t.ql.jl~.J[!CT: [louse and
Lot 1~ Blogk 5,
Subdivision, (~ner: Elsie
[)oar Sirs:
3~ inspection was made of the subject preaises on Ueco~nber 17,
1969 by porsonncl of tim Greater J~nchora:¥.~ Aret~ gorough Health
i!ator is furnished bM Ce~trai Alaska Utilitios and is therefor~
satisfactory.
'I'i]c sewer sy:~t~a cousists of t',~'o in-line standard size log
ccsspoe.ls. Since ~mnicary sea,ers will net bo available in
tank and a seepa~ie pig, trill be needed. '1%0 present cesspools
canaot be used as tho7 are too close to tho house.
In order 'to socore approval by this Deport~¢nt, fu~,ls should
bo placed in escrow for the inst(~llati~m of a ne~,~ stayer system
no la, er ghan July i, 1970,
CLIFFORD P. J[iDKIN.%~ R.S.
Ad:niuist~a~ivo Director
Sanitarian
Elsie Il. Cornell
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
Number. o~edmooms in house.,,,
a. T~e , .
b. Depth · - ~-~
c. Casing Size
d. Distance from well to closest existin proposed:
.
1. Sewer line
2. Septic tank__ .
3. Seepage Area
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 3
b. Septic tank capacity in gallons
c. Name of septic tank manufacturer ........
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,~ /~F,,, , ,'
e, Percolations, Test ~esults
f. Percolation Test performed by
Use the reverse side of thi~ form to show diagram. Diagram should include
~he o] lowing information: ~.~operty lines~ .well looatlon, house location,
=~ptlc tank location, disposal area location, location Of percolation test,
an~ direction of ground slope,
The ~for~ratlon on this form is true and correct to the beet of my knowledge.
Signature of ppllcant
~ ' ~ate signed'
T_~O BE FILLED OUT BY HEALTH DEPART~ENT PERSONNEL
~'T~e above described sanitary -acilltles are hereby approved, subject to the
r~ollowmng cond~.~ons: .
The above described sanitary facilities are disepproved for the following
reasons:
.... Date ~i-' ~'
· Approval is valid for one year following the date of approval.
CPJ: cw
2.
REQUEST ROVAL OF '
I~f[VIDUAL SEWAGE AND WATER FACIBITZ~S .~/~
'ama .of per.on requesting ~pprov.1
a. Bec t~,~a 1.
b. Deter~ent '" ' .
data:
b, Depth
c. Casing Size
d. Distance from well to closest existing or proposed
3. Seepage Area
Cesspool'_~
5. Property Line
6. Other sources of possiq le contamination~ i,e., creeks, lakes~
houses~ barn, drainage ditch, etc.
Sewage disposal system..
a. Age of system .~ ~7~.
tank ~ ' ~
b. Septic capacity in gallons... ~
Name of septic tank manufact~m~m
1. If "home made" show diagram on reverse side of this form.
Disposa! field or seepage pi[ size and type .....
1. DzstDnce to property lineg to house foundation. ./~/
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
..... ~ ~ ~ ~ ~ (Fill out in Triplicate) ~~_~) ~7o1~z~..~
1. lla~ of person requesting approval
2. ~ %lnme of p~ope~y~ owner
~. Numb~r~ b~drooms in house ~
a. Bacta~al
h. Detergent__
6. Wel~ data:
a. Yyp~
b. Depth__
c. Casing Size
d. Distance from well to closest existing or proposed:
1. Sewer llne
2. Septic tank
3. Seepage Area
4. Cesspool'
5. Property Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses~ barn, drainage ditch, etc.
Sewage disposal system.
b. Septic tank capacity in gallons,,,,
~~ c. N~me of septic tank manufacturer ~,~ 7"~J
~~ If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type
1. Distance to property line~ to house foundation
Percolation. TeSt ~mesults
f. Percolation Test performed by
Use the reverse .side of this form to show diagram. Diagram should include
~Xqhe following info~matlon: ~opert¥ lines~.well location, house location,
~ic tank location, disposal area location~ location of percolation test,
an~ direction of ground slope.
The lr~fc~.tlon on this form is true and cormect to the best of my knowledge.
k ~g~a~ure o~ Applicant Date Si~ned
TO BE FILLED OUT BY HEALTH DEPART~-~ENT PERSONNEL
~--~'~he~ above described sanitary facilities are hereby approved, subject to the
.......... ~61~owing con~onsi '
Conditions:
'" ~ a ow ng the date of approval.
The above described sanitary, facilities are disapproved for the following
reasons:
CPJ:cw