HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 3 LT 13
~l~~ ~IER ANCHORAGE AREA BOROPO, H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 9950] 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELl
LIQUID CAPACITY ¢~")tO
GALLONS. INSIDE LENGTH
NUMBER OF /
COMPARTMENTS
INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
NUMBER OF
LININO MATERIAL
NEAREST LOT L'NE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH__ / ~.
P~SlANCE BROM WELL //O /
TOTAL EFFECTIVE ABSORPTION AREA [WALL AREA}
, LENGTH--~} ,DEPTH
., BUILDING FOUNDATION
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE fO FINISH GRADE
FOUNDATION , NEAREST LOT LINE
__DISTANCE BETWEEN LINES __TRENCH WIDTH
SQ. Ff. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
, OF LINES
IN, TOTAL EFFECTIVE
IN. ABOVE fiLE
WELL: TYPE
LOT LINE ,O'?~)~ NEAREST /! .~ I SEPTIC
, SEWER [INE~' ~, TANK
DISTANCE FROM Z'I t'~- / WATER
· BUILD NG FOUNDATION._ I ~])__ SAMPLE NEAREST
/,~o' SEEPAOE //~)
, s~s~m _, c~ss~oo~ . sources_
DISTANCES:
C,': 35 ~
DIAGRAM OF SYSTEM
D 0 t.o c.
/¢ao,.s e.
DATE
GREATEk
327 Eagle St.
AN(;HOIIAGE AE. EA ORO1UGH
ItEALTIt DEPARTMENT
Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMII'
NAME OF APPLICANT~/:/; ' :-/A ~ /)' /) ;~"~')-'~//y,~'/~M;~,II. ING ADDRESS._~'~c'-~; ."~ ' ~
~//~/~ ,.~)z~ PHONE NO.~ -~.~-
RESIDENCE ADDRESS ~ , ' ~ -'
D. /,~z~ ~[. _ LOCATION OF INSTALLATION ~/ ~/:
x~.-~,,~ ~I. EGAL DESCRIPTION ~6'~/~,'./~
APPLICA'rlONTO INSTALL: SEPTIC TANK ~- , SEEPAGE PIT__ ~'- ,DRAIN FIELD ,OTHER
TO SERVE THE FOLLOWING EAC . TY.
FINANCED THROUOH__ '
PERCOLATION TEST RESULTS
TO BE INSTALLED BY_~;~'4 ~,'~
ANTICIPATED DATE OE COMPLETION
BELOW TO BE FILLED OUT BY HEALI'Ii DEPARTMENT
THIS IS TO SERVE AS , PERMIT TO INSTALl. A
.AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
.. SEPTIC TANK SIZE TYPE .SEEPAGE AREA__ _TYPE
DIAGRAM OF SYSTEM
Health Authority
t certify that I am familiar with the requkements of Greater Anchorage Area Borough Ordinance No. 28-68 and titat the
above described system is in accordance with said code.
CR~rt;~ AN~,,.u~,R,",',%'E AREA BOROUGH
HEAl. TH DEPAkTHEHT
327 EAC~LE ~IREET
ANCHORAGE, ^LASKA 99501
Depth
Soil ChaPact epistics
Location Sketch
If Yes.~· ;~':~t Deplh
1
Pit _-~- D~ain Field
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: CMRO
2. Property Owner: _ :r~/?>
Mailing Address: _~
3. Name of Buyer:
Mailing Address:
VA
FHA CONV ~/f
Day Phone
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address: :~n~
Phone
6'. Legal Description:
Location:
7. Type of Facility to
8. Water Supply
Type of Supp.ly:
If Individual,
If Individual,
g. Sewage Disposal
be inspected: ,//~.~7.~,,~,~" No. Bdrms.../2/ _
Public Utility _. Individual
number of dwellings presently served
depth of well
System
Type.of S~stem: Public Utility
Zf Individual, date of installation
Individual
(on-site)
06-1220(a) Rev, 1973
DATB
ALA' DEPARTMENT OF HEALTH AND SOCIAL SE' ",ES
DIVISION OF PUBLIC HEALTH
INOIVIBUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS
INDIVIDUAL E] SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
CITY ~' : ' i ZIP CODE
ADDRESS i~? ,, j
Lab No.
OFFICE
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
El Questionable
[] Sample too long in transil; sample should not be over dR
hours old at examlnation fo indicate reliable results. Please
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY "':
SOURCE:
LOCATION~
Well - ~ Dug J~ Driven [] Drilled J~ Bored
El Spring [~] Cislern O OtBer ....
~Tile Brick br
Yes [] No
~] Of Well [~ Other
PURPOSE OF EXAMINATION: Illness Suspecled? [] Yes
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
[] Yes J~ No Signoture ,:
(]6-1220 (b)
go,,. 1973 ~ BACTERIOLOGICAL WATER ANALYSIS RECORD
lose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc 1,0¢c
24 Hours
48 Hours ,
lianl Green
24 Hours
48 Hours
Absent
Presenl
Lot 13 ~loc.:k 3 ~:odi~k ~{anor
99507
~tr. Clifford Spohnholz
i!A¥:i:D ~1. !,, J;IiL,'CA;I, 1;o D.