HomeMy WebLinkAboutELMORE #1 BLK 6 LT 8
GRE/'"'h R ANCHORAGE AREA BOR !.GH
of Environmental
Department
Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRES5~
LEGAL DESCRIPTION ~'~ ,,~'~" ~' .~'",~" ~ ~'E~"./~' ~'~.,'d'~' '"~'~'"~'
SEPTIC TANK:
DISTANCE / NUMBER OF ~
FROM WELL ~:;~' MANUFACTURER ·.5''~'7~'~'~'' MATERIAL .,~'~ COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/~)GALLONS.
TILE DRAIN FIELD: ~ ' ~/~~ /~ c~~ ~/~ ~~
DISTANCE FROM WELL_/~ FOUNDATION ~ / TOTAL LENGTH
.NEAREST LOT ~INE ~ OF LINES
NUMBER OF LINES ~ DISTANCE BETWEEN ~INES ~ TRENCH WIDT~ IN. TOTA~ EFFECTIVE
A~SO~.T~ON n"[A/~~ S~. FT. L[~TH O~ [ACH L~N[ ~ ~ ~P~7 --~
~X, DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE ~' MATERIA~ BENEATH TILE IN. ABOVE TILE - IN.
WELL:
TYPE/ - CONSTRUCTION '~'~-~'~'-~ /~-~' ~'~"~'r/~'/K'" DEPTH
.BUILDING .. NEAREST /6~ /
~-, NEAREST ,~,~".~?,~'Y. SEPTIC j SEEPAGE
FOUNDATION ~..~d~'- o LOT LINE ¢~-"~-~' , 5EWER LiNF_.,~-~.-~ TANK ~-~c-- , SYSTEM
CESSPOOL .,~-~---~---, OTHER SOURCES ~t~O~'~" ~Dz'¢~'~ -
APPROVED
DISTANCE FROM=
DISAPPROVED
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
SEWER LINC DEPTH:
PIPE MATERIAL:
LOT SLOPE:
GrE;ATEr ANCHORAGE ArEa BOrOUgh
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION,
FOUNDATION TO SEPTIC TANK
SEPTIC TANK TO SEEPAGE PIT WALL
r l( , ~DO
DRAIN FIELD ALSO CONSIDER AREA WELLS.
£
WATER MAIN TO SEPTIC TANK /~ SEEPAGE PIT
/
SE~lC TANK, . SEEPAGE PIT /~ BRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
GRAVEL DACKFILL
CONFORM TO BOROUGH [GU ATIONS REGARDING INSTALLATION.
DIAGRAM OF' SYe:T£M
~'O.'N~ APPLICANT'S SIGNATURE ~ F~Jf 0~//!
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAl QUALITY
3330 "C" Street
ANCHORAGE, ALASKA 99503
Performed For -~t~mv Kr)m~
Legal Description: Lot ~Block
This Form Reports Soils Log.-
Soil Test Must Be Logged To 4'
Depth
Feet Soil Characterist4c~
Case
Dated Performed
~ Subdivision ~/mere
Percolation Test
Below Proposed Seepage System -
IIIII
_Lid.dj
II
Was Ground
If Yes, At
Water Encountered?
What Depth?
I,I t I I I I I
! I I I I I l.J i
RJading
Date
Gross Time
Net Time
Depth to H20
I
__1 I
Percolation Rate Minute
Proposed Installation: Seepage Pit
Drain Field
Net Drop
Depth of Inlet Depth to Bottom of Pit Or Trench
COM~'£NTS:~~tz r.,-~,,o,~.'"~_a~._~, ,~-r~. ~..,~g.~
Test Performed BY ~ ~~ .Date Certified BY.
~ Date:
:~ ' ~~Z.~:~..,;..'. ,-'"'~-': :', . · ....... ' · ',Z:~ · · · .. _ ." ~' v-.'. .... :-.': .
.~,'~ · ~ocation (addre~ o{: ~ow~hip, ~anse, Section, i~ tmown; or distance mare roa~ "· ' ' -.
· .~ . ...... .~....~ ..... ~.. ~ .... .,.~ ..... ~ · ,, . - ~/
. ~-. Stattc~vaterlevel V/ ~t. (above),' (below) land surface. Fm~sh of well (checkone) openend ( ~;~' ): '
.~,.e;~.. . , ;....~ ..... b~ : . . . ......... . . · . ...... .... ~,.-'..:~ ..t~..~..-
~:~]!. Well pumping test at' · 6 ~allo~ per (~E~ (minute) Jot I . hours wit~ 1~ ...... -: -'~.'~ f~.'
.'.- DepthlnfeetJrom -.:,~:'.v~ ..-.~,- .... ' '...:- .~ · , ~:.... . ~.- :.. . -. ~,,., ..i~.- .- .-., . , '.
. ~round surgace · .... ;, ~.,.~ Give details of formations penetrated, size of material, color and ~ardness . · -. ·...
~ .... ~6 TO--'.109'.-; :. 5mall aravel~ less sendy ~nd w~terbe~rin~ In lest five feet "~'~"
· ~' ?' ' · TO " ......... ~ -' ............. · '~' '~ ". '"'~"~ '~' ' '.~':.~ ' ':". "~-,~,~'~:""'
DAtE ECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME /
DATE DATE )ATE
MUNICIPALITY OF ANCHORAGE~,~ ~ ~ ANCO ---
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~;I'~F~;~TH&
~ 825 L Str.t - A~hora~, Al~a ~1 E~IRO~ENTAL
(~ ENVIRONMENTAL SANITATION DIVISION
MAILING ADDRESS
PROPERTY RESIDENT (If dilfe;ent from a~) ERONE
PHONE
4. RE~RIAGENT [ PHONE
MAI LInG ADDRESS
5. LEGAL DESCRIPTION
TREET LOCATION '
TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[~ SINGLE FAMILY [] One [] Four . [] Other
[]/Two I--I Five ,
[] MULTIPLE FAMILY [Ia( Three f-I Six
WATER S LY
7. ~INDIVIDUAL* * A'II'ACH 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 DISFOSAL SYSTEM
~/ INDIVIDUAL/ON-SITE** /~"~,~.~ YEAR ON-SITE SYSTEM WAS INSTAl.LED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72.010 (Re~. 6/79) "~ ~%'C>
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
r-I SINGLE FAMILY
i'-'l MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR : [] SlX'
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Co'nnection Verified '
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size:. 1 ~)O If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELLTO:
Absorption Area to nearest Lot Line
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
MATERIAL
JNearest
Lot Line
5. COMMENTS
DATE
[~'"~APpROvED FOR _~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 IRev. 6/79)
ALASKA ~nUIRO[Im~ITAL CO~ITROL S~RUIC~$, I[lC.
~n~jin¢~'in~i ~, ~nuironm~ntol $~uc~ies
MUNICIPALITY OF ANCHORAGE
DEPT. OF H~ALTH &
ENVIRONMENTAL p~',OT ECT ION
OOT 9, ~ lg80
RECEIVf:D
OCTOBER 21 1980
GENE
BOX 3-131
ANCHORACE AK 99501
SELLER GENE 0RI
SUE:DIV/SION-ELMORE SUBDIVISION BLOCK-6 LOT-9
THE TYPE OF ABSORPTION SYSTEM IS A DRAINFIELD WITH AN AREA OF 400 SQFT
S BEDROOM HOME
H
SEPTIC ' ANK
~ tUcst 25th Aucnu¢ · Ancho~e, Alaska eeoc3 · (907) 276-136t
Augus~ 3u, lS73
Alaska ~":utual Savings Bank
Sth & F Street
Auchorage, IQaskJ
g~SOl
ATTEfiTION: A. [~. Love
Lots 8 & 9, Block.6, Elmiore Sub.
Property O~vners: :Ir. ~, ~Irs. Eugene
Jr.
Dear :.lt. Love:
0~ ~ugust 26, 1973, this departc~ent inspected the on=site sekler
and twator facilities at the above location. The se~er is of ap-
proved construction consisting of a lOqO gallon septic tank and
dratnfteld.
~e did ~)ot obtain a water sanple fro~ the tmll as ~he ~ater was
not yet connected to the d~lelltng. The well is 106' dee~. Our
records indicate it should provide an adequate anount of potable
~ator.
Sincerely.
C. S. licKech~mte,
EnvtronG,entai Control Officer
esl,l/ko
cc: Eugene
