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HomeMy WebLinkAboutWENTWORTH BLK 1 LT 26 GAAB-HD-I GR~:~,TER ANCHORAGE AREA BOROUr"-H HEALTH DEPARTMENT '~_,~ .. · 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION ADDRESS SEPTIC TANK: DISTANCE FROM WELL uQUlD C^PACm' b ' MATERIAL ~/t~"~¢~- &cCJ~ COMPARTMENTsNUMBER OF GALLONS. INSIDE LENGTH ~7' L"J~! INSIDE WIDTH '~' ~'1 DEPTHLIQUID SEEPAGE SYSTEM: NUMBER OF PiTS LINING MATERIAl NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER. "~? OR WIDTH · LENGTH / ~ , DEPTH. DISTANCE FROM WELl BUILDING FOUNDATION TOTAL EFFECTVE ABSORPTION AREA WALL AREA SQ. FT TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA_ DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION NEAREST LOT LINE DISTANCE BETWEEN LINES TRENCH WIDTH SQ. FT. _ENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH ., OF LINES IN TOTAL EFFECTIVE ABOVE TILE WELL: LOT LINE · ,~ .~z'.~L~'/D IST A N C E FROM [YPE_ ¢~lv,~/,(,~,~ DEPTH ~ /~ . BUILDING FOUNDATION. NEAREST SEPTIC ~ SEEPAGE SEWER LINE TANK ~ ~ ! , SYSTEM WATER SAMPLE · CESSPOOL_ NEAREST OTHER · SOURCES DISTANCES: DIAGRAM OF SYSTEM ~.~' ' ~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE ,~UNICtPALITY OF ANCHORA PF, PT, ©F ~:'qTH ENVIRONMENTAL MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION  B2B L Street- Anchorage, Alaska 99501 f~U8 2 6 /980 ENVIRONMENTAL SANITATION DIVISION Telephorte 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTION'S: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. I OPERTY OWNER MAI LING A~ID~E~S PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAiLiNG ADDRESS 4. ,BEALTOR/AGENT PHONE MAILING ADDRESS TREET LOCATION ( 6, TYPE OF RESIDENCE [] SINGLE FAMILY /~ MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ~-- Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY  INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. 1~ PUBLIC UTILITY 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 [~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY E~ TWO [] FOUR [] SIX 2; WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INBTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ARSORPTION AR EA MATERIAL 4. DISTANCESwELETO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS I~/~PP ROV ED FOR Z~ BEDROOMS [] CONDITIONAL APPROVAL (letter must acco/mpa~y certificate) []DISAPPROVED 72-010 (Rev. 6/79) 825 c S:REE'r / ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M, SULLIVAN MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION August 29, 1980 Roger C. Shaw 330 L Street Anchorage, Alaska 9950~ Subject: Lot 26 Block 1 Wentworth Subdivision Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report be delivered to this' department from Chem Lab, 5633 B Street, for our review. (2) Locate and expose the well for our inspection to determine proper construction. This will need to be re-inspected by this department. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw APPROVAL ADDRESS: PHONE: GREATER ANCHORA'GE. AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 DATE RECEIVED: INSPECT: TIME: REQUEST FOR APPROVAL OF INDIVI'DUAL SEWER AND WATER FACILITIES FOR //,'o 0 REQUESTED BY: 2. PROPERTY OWNER: 3. LEGAL DESCRIPTION: 4. TYPE FACILITY TO BE NUMBER OF BEDROOMS: WELL DATA: B. DEPTH D. E. SEWAGE DISPOSAL A. SEPTIC TANK SIZE ~ s/ CONSTRUCTION ~~ · BACTERIAL ANALYSIS SYSTEM: (IF HOMEMADE, SHOW DIAGRAM ON BACK) 1. SIZE 2. AGE 3. MANUFACTURER 4. INSTALLER APPROVAL REQUEST PAGE TWO '~,~ FOR SEWER & WATER FACILITIES B. SEEPAGE PIT 1. SIZE 2. LINING C. DISPOSAL FIELD 1. NUMBER OF LINES 2. TOTAL LENGTH REQUIRED MEASUREMENTS A. WELL TO SEPTIC TANK B. WELL TO SEEPAGE PIT C. WELL TO SEWER LINE D. WELL TO PROPERTY LINE E.. WELL TO OTHER POSSIBLE CONTAMINATION F. FOUNDATION TO SEPTIC TANK G. FOUNDATION TO SEEPAGE PIT H. SEEPAGE PIT TO PROPERTY LINE COMMENTS:= APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY ~;REATER ANCHORAGE AREA BOROUGH L~AL?~I DEPARtmeNT 527 EAGLE STREET PoNCHORAGE, ALASKA 99501 279-2Sll REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES FOR - M. - -' ' . ~- Number of Bedrooms ~ Well Data: A ?ype B. Depth D. Construction E. Bacterial Analysis 6. Sewage Disposal System: Septic Tank (If homemade, show diagram on back) 3. Manufacturer ~~ M 4. Installer~ff~ ~ dApproval Request for Ser~_? ~ Water Facilities ~_ P~ge Two B. Seepage Pit 1. Size 2. Lining C. _ Disposal Field 1. Number of Lines 2. Tota Length 7. Required Measurements A. Well to Septic Tank to Seepage Pit Well C. Well to Sewer Line /~ ~- D. Well to Property Line E. Well to Other Possible Contamination / Foundation to Septic Tank G. Foundation to Seepage Pit H. Seepage Pit to Property 8. CO,~4ENTS: APPROVED:~~, ~' DATE:~ DISAPPROVED: DATE: APPROVAL VALID FOR ONE YEAR FROBI DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT EDll70