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Home My WebLink AboutYALE BLK 1 LT 4s/o 0 LOT' 151¢& GP~ATER ANCHORAGE AREA BOROI~H HEALTH DEPARTMENT 327 I"AGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N? 459 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ,/f,// LOCATION SEPTIC TANK: MAILING . ,~ ~.... ADDRESS ,~/~Z;).f? ~'~f~'~ /~J/~;~ PHONE-~'~' -X'~/ ~-~/~AL DESCRIPTION ~-~,;g' DISTANCE FROM WELL // ~' LIQUID CAPACITY ,:~-~,'/~"~-) GALLONS· NUMBER OF M A T E R I A L ../~'/)~'~:~r~.~' ~'/~,/~,~,~'~-'~'~' ' ' COMPARTMENTS INSIDE LENGTH ~---~ ~" / ~'" INSIDE WIDTH. ~/~ DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF FITS // OUTSIDE DIAMETER. / / / LINING MATERIAl r/~''~ ~-~ -' ~ .~/1~"/J~r~ , LENGTH /'~/~ , DEPTH DISTANCE FROM WELl , BUILDING FOUNDATION "~ / NEAREST LOT LiNE TOTAL EFFEC11VF~ ABSORPTION AREA (WALL AREA) ~::/f ;~:'~ SQ, FT. TILE DRAIN FIELD: DISTANCE FROM WELL ABSO? A EA .... - ............... ~ TOTAL LENGTH ~-~'~' , FOUNDATION ~ , NEAREST LOT LINE , OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH_ ~ ,N--~FFECTIVE SQ. FT. LENGTH OF EACH LINE "~ .//- DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE ~'2./Z./'/--Z~-'~ , DEPTH ./.~/t./ / LOT LINE ~//'? /.~,.~ NEAREST .~ / SEPTIC , SEWER LINE .~--~/2 T/~, TANK DISTANCE FROM ~'/~ /./,..:. WATER BUILDING FOUNDATION SAMPLE /b/~ ,<9 ' SEEPAGE ~.~ x ~ .~ ~ '2~, SYSTEM ~;<- ._"2z.: :7', CESSPOOL /~ · NEAREST OTHER , SOURCES /~ DISTANCES: // :"://=/?~ h DIAGRAM OF SYSTEM GA, ~-HD-2 GREATEr' 327 Eagle St. ANCHORAGE AREA HEALTH DEPARTMF. NT Anchorage, Alaska 99501 SEWAGE DISPOSAL SYSTEM - APPLICATION PERMIT RESIDENCE ADDRESS__ LOGA/~ION~OF INSTALLATION APPLICATION TO INSTALL: SEPTIC TANK ,SEEPAGEPI~ ,DRAIN FIELD .~OTHER TO SERVE THE FOLLOWIN6 FACILITY F~NAUCEa T,a0UOH_ T0 aE ~,SVA~,~Ep aY PERCOLATION TEST RESULTS ~) , ANT~CmTa9 aA~a ~F COmPLETiON BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS iS TO SERVE AS · ~-(~-- _, PFRMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED. DISTANCES: y that I am fa niliar with the reqt re nents of Greater Anc ~orage Area Boroulth Ordj~ya ice No. 28-68 o,a(ldlha~the/ above described system is in accordance with said code. ,,~¢x~)~"~ rT~U~y DATE t APPLICANTS SIGNATURE __ / GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ua~e Kecelve~ Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SE~ER & WATER FACILITIES FOR 4. 5. 6. Mailing Address: 2~L~/O "~ ~--~t~/ JPhone: / Property Owner: _/~/~ ~__~--'>~-~.~-/ Phone: Legal Description: ~ ~ X~Z~ ~XZ~ Type of facility to be inspected ~ff No. of bedrooms Well Data: A. Type ~:- B. Depth / ~o / C. Construction 7. Sewage Disposal System: A. Installed D. Bacterial Analysis , - ~ ' _'~ ~.'~ ~ ~ .~ , ;' C. Septic l'ank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Distances: Total length of lines 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 Page 2 of two pages - Re t for Approval of Individual · r & Water Facilities Legal Description Comments Approved ' ~k ~ . ~-/Yz-~..~D~ a p p r o v e d [)ate ~/- -~- ¢"?: ~ Aneroval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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) GREATER ANCHORAGE AREA BOROUGH_ Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: 2. Property Owner: _ Mai.ling Address: e CMRO VA //f FttA CONV Name of Buyer: _~IC~ A, ~'~/~ ~ai~n~ A~r~ss: F~3.~Sm~)~.. ~,v ~no~ Name of Lending Institution: ~ -~ Mailing Address: ~C~o~2~.~/~ Phone 9.~-~]~// Name of Realtor or Agent: ~~' Mailing Address: ~] ~ffWl~ Phone 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms. Individual presently served Individual (on-site) / EQ-037 (!/74) GREATER ANCHORAGE ARL:I, BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAl. SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA ~ FHA CONV 2. Property Owner: ~_~2~_._.__Z: ...... L¢~<_/.~/_ ~/~/~/ Mailing Address: ~ ~'17-~/~Day Phone 3. Name of Buyer: ~¢¢¢~ Mailing Address: . ~ ~/ ~iy Phone , 4. Name of Lending Institution: ~/~ ~/* Mailing Address: ~ Name of Realtor or Agent: Mailing Address: ~ ~ L'"', -,("~'""]' P h o n e '2.- ;72 7. Type of Facility to 8. Water Supply Type of Supply: be inspected: Public Utility No. Bdrms. ~/ Individual If Individual, number of dwellings presently Individual, depth of well ~/5'~ If Sewage Disposal. System Type .of S~stem: Public Utility If Individual, date of installation served Individual (on-site) INDIVIDUAL [] ALA~ BACTERIOLOGICAL WATER DEPARTMENT OF HEALTH AND SOCIAl. SI ',ES : DIVISION OF PUBLIC HEALTH Lob No INDIVIDUAL AND SEMI.PUBI.IC ';' ' ANALYSIS SEMI-PUBLIC [] CHLORINE RESIDUAL PPM REPORT RESULTS TO ZIP CODE ADDRESS OF SOURCE COMPLETI-' THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY ' ' ~" DATE COLLECTED '" . TIME COLLECTED [] LOCATION~ []In Yard [] Olher MATERIAL: Building Sewer- [] Cast Iron [] Wood [] Tile [] Fibre [] Asbestos GENERAL: Does Water Become Muddy or Discolored? [] Yes [] No When? Diameter of Well Depth Feht. Well Caring Material Diameter Depth J~ Of Well [] Olher PURPOSE OF EXAMINATION~ Illness Suspected? [] Yes [] No OFFICE SANI'rARIAN'S REMARKS READ INSTRUC'rlONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE o6-1~2o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. J973 48 Hours '- - 48 Hours . 48 hrs, AGAR This analys~s Jnd[cales Coliform Organisms lo be~ r/' Absent~'~ _.{Most probable No. per lOOcc) Analysis shows 'thls Water SAMPLE lo be: ~]/Satisfactory ~ ~] Unsatisfactory ' [] Questionable [] Sampio too long in transil; sample should not be over 48 hours old at examination fo indicate reliable results, Please send new sample. ~J Botlle broken in transit, please send new sample. GRI~AT~R ANCHORAGE AREA BO,'IOU(;H 3500 EAST TUDOR RD, ANCHORAGE, AK 99507 PHONE: BILLING 279-0541 SERVICE: 279-4771 01122309-00101 I 10-01~:75 EXPLANATION AMOUNT CHARGES FOR OCT NOV L DEC 22.95 12-31-75· 22.95 FOR SEWER SERVICE AT 9400 EMERALD PLEASE PAY WITHIN 20 DAYS OF BILLING DATE LEGEND · Set Rebut O Found Rebut ~ Drainage Arrow [] Found Hub & Tack Found Iron Pipe Found Brass~Cap It is the responsibility .of the owner, prior to construction to verify proposed building ~ocation on lot, grade, and utility connections, also determine the existence of any easements, covenants, or restrictions which do not appe~r en ~he ~ecorded {~l~tt. I hereby ;ertify that a survey of ~,? ~ z~Z~a- ~, ;Y~m~-", _:~/~: was made by me or under my direct supervision and the property corners marked as indicated. CONTRACTING ENGINEERS &~ASSOC. Datet_~ ,:~.~, i~?~? 212 E. International Ai~P0rt Ro~ / ~ Anchor~e, Alaska' 99502 278-3773 SEAL