HomeMy WebLinkAboutELMORE #1 BLK 3 LT 104+
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAnON /~/??~;r/~h? £//~=
SEPTIC TANK:
DISTANCE FROM WELl ~'~ !
LIQUID CAPACITY /~. Z') ¢) GALLONS.
INSIDE LENGTH
NUMBER OF /
·COMPARTMENTS.
'~'~ :~"~ '~ Z'~m' 'J-) LIQUID
INSIDE WIDTH__DEPIH
SEEPAGE SYSTEM: SEEPAGE PIT:
/
NUMBER OF ElIS OUTSIDE DIAMETER ~ OR WIDTH.~__~, LENGTH. ., DEPTH
L'N'NG MATER,A, ~/,~'*',--/r~ 2".''."'jF.~ . D,STANCE FROM WEU //~' ' BU,LD,NG FOUNDAT,ON
NEAREST LOT LINE '~'-~"* ~ f TOTAL EFFECTIVE ABSORPTION AREA ('WALL AREAL --~°~)' SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPIION AREA
~ ' U~ TOTAL LENGTH
, FO , NEAREST LOT LINE , OF LINES
DISTANCE BETWEEN LINES TRENCH WIDTH__IN. IO,~,L EFFECIIVE
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: Type [')/,., ~ I ~,_ T.~ DEPTH ~tO~' DISTANCE FROM
. BU,LD,NO FOUNDA.ON.
LOT UNE 4£~/~ 4) NEAREST -- SEFT,C 9.5' ' SEEPAGE
, SEWER LINE .. TANK , SYSTEM
4~' · WATER
SAMPLE JL}OA)/-:-' ,, NEAREST
'~ OTHER
//~ , CESSPOOL, '"' , SOURCES
DISTANCES:
£/,6'7-
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATEI kNCHORAGE AREA T. "?ROUGH
IIEALTli DEPARTMENT
327 Eagle St. Anchorage, AlaSka 99501 279-2511
Ca~ No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~'/z~/',ff,.-4
LEGAL DESCRIPTION ~/~,7 X¢~/~ ~
APPLICATION TO INSTALL: SE~IC TANK / , SEEPAGE PIT / , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY -~ ~ ~.~
FINANCED THROUGH ~/~ TO BE INSTALLED BY
/~ ~O~ BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT
MAILING ADDRESS/~,'j/_~3',~
LOCATION OF INSTALLATION/q//'~'~"~
THIS IS TO SERVE AS ,PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED- ~ ~t/~'~ ,~lj~,,~,~,-
.SEFTICTANKSIZE /~ ~'/ TYPE~,~'-,~a"~'r~ SEEPAGEAREA,i-~ X.~.? ~YPE ,~*~,'~,~'~
DIAGRAM OF SYSTEM
Health Authorj~ g
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
/
· . RE^TER ^,C,ORA E AREA
· .~k,~flIl~'/7 Department of Environmental Quality
.~~ 3330 "C" St., Anchorage, Alaska 99503 - 274-4561
J/~/ ~ ~ REQUEST FOR APPROVAL OF
I~ ~ ~.)~- INDIVIDUAL SEWER & WATER FACILITIES '
~/~Type of' Inspection: C[,IRO VA ' FHA CONV~
2. Property Owner:
Mai.lin9 Address: ~'~, ~, ~ Day Phone
3. Name of Buyer:
Mailing Address:
Name of Lending Institution:
Day Phone
Mailing Address:
Name. of Realtor or.Agent:
Mailing Address:
Phone., ~ /~ . / \
Phone ~--Y ~/~GII
Legal Description:
Location:
7. Type of Facility to be inspected:
8. Water ~upp)y
Type of Supply: Public Utility
No. Bdrms.
Individual
If Individual, number of dwellings presently served
If Individual, depth o~ well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual
(on-site)
EQ-037 (1/74)
Department of Environmental 'Qualtty
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
1. Approval requested by:
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Mailing Address:
Property Owner: 7'~ ~
Mailing Address: ~ ~ 5
3. Legal Description: ~.~/J ,~/~3
4. Location: ~ /~~
$. Type of facility to be inspected
6. Well Data:
A. Type ,J~~
C. Construction ~ ~ ~
Sewage Disposal System:
A. Installed.~.
e
Phone:
Phone:
No. of bedrooms
B. Depth /l:z./
D. Bacterial Analysis,~'~j~7~,~
C. Septic Tank: l. Size //~j~JTi/ 2. Manufacturer .
D. Seepage Pit: 1. Absorption Area~F/~z)~' 2. Material
E. Disposal Field: Total length of lines
Be
Distances:
A. Well to: Septic tank '~ ~ , Absorption area
Nearest lot line ~, Other contamination
B. Foundation to septic tank
C. Absorption area to nearest lot line
/_//~'~, Sewer Lines
, Absorption area ,.~/
EQ-034 (1/74) Page 1 of two pages
· Pag~ 2 of two pages - Re It for Approval of Individual .~'~)r & Water Facilities
Legal DescriPtio~
Cm~nents
Approved ~ -~ ~-~/~i sapproved Date ~'
Approval ~Valid for one year from date signed
Greater Anchorage Area Borough, Oepartment 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)
