HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 2 LT 27
G'~-~ATER ANCHORAGE AREA BOROUGH
I ~ HEALTH DEPARTMENT ' I
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N°. 556
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ,-~"".~'"~.~/'~/~"/~ '~'
LOCATION
SEPTIC TANK:
NUMBER OF /
DISTANCE FROM WELL ~'~2 / MATERIAL~"~'--L~,.4~.~ ~'~-~".,,(/~'~"'~ COMPARTMENTS
LIQUID
LIQUID CAPACITY //z~' g'~'.) GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
~c-.,C~. ,~,~c~. ~':.~'~--
SEEPAGE SYSTEM: SEEPAGE PIT=~./c~x~,/~?/~ /c~.~ ~ ~~- ~~
NUMBER OF PITS / OUTSIDE DIAMETER / OR WIDTH /~ '. LENGTH /~ ' , DEPTH ~ /
LINING MATERIAL~~ ~ ~/~ , DISTANCE FROM WELl . BUILDING FOUNDATION ~,, /
NEAREST LOT LINE ~ I , IOTAL EFFECTIVE ABSORPIION AR~A ~ALL AREA) ~/~ .SQ. FT.
TILE DRAIN FIELD:
~OT LINE
DISTANCE FROM WELL N
NUMBER ~ DISTANCE BETWEEN LINES TREN(~H
ABSORP~ON AREA SQ. FT. LENGTH OF EACH LINE
/
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
. OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
· ~,"~,,~-'-*':~'~'-.""' ~-~- g~....~,~ ~
WELl.. ~E ~~ , DEPTH //~
LOT LINE /~ , NEA"EST ~ _ ~ SEPTIC
SEWER LINE ~ TANK
DISTANCE FROM WATER
,BUILDING FOUNDATION ~'~-'~-' ~' SAMPLE ~'"~/~:~ , NEAREST
~,.~. J SEEPAGE /~.) / OTHER
, SYSTEM . CESSPOOl "'"J//"~ , SOURCE,~'~'*/'.'.'.'.~
DISTANCES:
DIAGRAM OF SYSTF. M
DA, E _ ./~>?/_ APFROVED .,.,,..u,.o,,,.
o**..?..2 GREATE!~%ANCHORAGE AREAf'OROUGH C~,eNo.?/ ~
IIEALTll DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
M- // . //.4/7 , ..,~'/~ze ~'~'¢-r<
NAME OF APPLICANT~¢. '~~"f~ MAILING ABDRESS~ ~t /~g ~/g~ .PHONE
. / - / ~ ....
PERCO~TION TEST RESULTS '" ANTICIPATED DATE OF COMPLETION -~-- /~[
BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT
.J
-7
DISTANCES:
I c~ertify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
ab6ve described system is in accordance with said code.
INSPECTION APPOINTMENTS
MUNICIPALITY OF ANCHORAGE ~UNICIP~ OF AN~GE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~O~EPT' OF HEATH &
~) ENVIRONMENTAL SANITATION DIVISION MAR ~ 1981
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AN
~. PROPERTYOWNER I PHONE
Steve Cod~nI 337-~752
MAILING
* ' 248-
Re[eh ~Je~ce
.2202 RooseveLt ~2, ~cho~a~e, ~ "
3. LENDING INSTITUZlON I PHONE
I
T.te~e altT_IncZ_Kris. Ab sh ire ~m_~05[.[~ _~ ...... ~c~/~272-0571
724 ~- ~rh Ave.. Anchoraee. ~ 99501 ~--~
S. LEGAL DESCRIPTION
Lot 27, S[ock 2, Easle PJ. ver Heights
SZREETLOCATION
Caribou
TYPE OF RESIDENCE
~'~ SINGLE FAMILY
r-1 MULTIPLE FAMILY
7. WATER SUPPLY
INDIVIDUAL'
I-3 COMMUNITY
PUBLIC UTILITY
I-1 O.e F-I Four [] Other__
[_-] Two [] Five
:[~ Three I--I Six
· ATTACH WELL LOG. A well log is required for all wells drilled
del)th (at ach log if av;~ilable.)
8. SEWAGE DISPOSAL SYSTENI
[] INDIVIDUAL/ON-SITE''
~ PUBLIC UTILITY
ON-SITE SYSTEM WAS INSTALLED.
NOTE: Tile INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
o,o iR... . ./ilt
THIS SIDE FOR OFFICIAL USE ONLY
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
r-'l SINGLE FAMILY
r-I MULTIPLE FAMILY
2. WATER SUPPLY
[~3 INDIVIDUAL
i--1 COMMUNITY
r-I PUBLIC UTILITY
Connection Ver~ f~ed
3. SEWAGE DISPOSAL SYSTEM
I-'IlNDIVlDUAL/ON -SITE
/-'1pub LIC UTILITY
Connection Verified
I-'lSeptlc Tank or [--]Holding Tank
Size: I f Tank is homemade
give dimensions:
TYPE OF TANK
i--1 ONE i-'l THREE [] FIVE
[] TWO L-'J. FOUR [] SiX
[] OTHER
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALL£11
SOILSItATING
MANUFACTURER
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
5. COMMENTS
MATER, IAL
DA'~ E
[~/~APPROVED FOR -- "~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accolnpm~y
[] DISAPPROVED ~
7;2.010 (Rev. 6/79)
GREATER A. NCI]ORAGE AREA BOROUGH
~':~. DYE TEST
Yox Code: .~.., .~ ~ Dote:
'" - ('-;I >
Property Address:
DYE TEST: [] Pos/f/re
[]' 'Negative
ADDITIONAL
Off/ce:
INFORMA T/ON:
Administered By:
pW-062 (7-74)
· CHEMICAL & GI~.,LOGICAL LABORATORIES ~'-" ALASKA, INC.
'TELEPHONE,. 274-3364(907)'279'4014, ~ ANCHORAGE56331NDUSTRIALB Street CENTER,,.:
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
,~"~ : ;~,..~-J~L,~.~~' t.O.~O. ,
Water System Name Phone No.
Mo. Day Yea~'
SAMPLE TYPE:
cI Routine
n Check Sample (for routine sample
with lab ref. no.
E] Special Purpose
[] Treated Water
(:::] Untreated Water
SAMPLE
NO.
I
2 I
3 I
, I
LOCATION
Time Collated
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
/~] Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
D~i~ Received
Time Received
Ar~alytlcal Method:
[] Fermentation Tube
,~ Membrane Filter
Lab Ref. No. Result* Analyst
I r-~
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (III
Rev. ]g78
BACTERIOLOGICAL WATER ANALYSIS RECORD
htr. Stephen Oodmin
P.O. ~ 80
Eagle River. AlAska
Mr. Godwin:
RECEIPT FOR CERTIFIED MAIL~30~' (plus postage]
pOSTMARK
PS Fora 'HO IMSURANC[ COVER~E ~OVIDED~
Apr, ~97L 38~ NOT FOR INTERKATtOHAL
' It hu bee~ brm~fht to om* attention that publto sewo~ is avallabb to
River Jletwhta Subdivision'.
a,2~ to Or~itm' Anehm'age Area Gorough Orm-m~, C~ 18.
A~e 16.45. S~ 1O.~.0~:
av~ wi~ ~v~ (70) f~ ~ the n~d 1~ ~e ~
The ~ ~e~ra~ A~a ~ ~ ~o~o ~~ ~
h~ ~ ~e.
You must apply for a conn~ p~t from th~ pormit office- f~ ~
· n~ ~ ~ J7~4561, e~n 141.
~ lliver l)ist~ic~ S~mlUu'i~n
Aprtl ~{, 29'r$
Mr. S~pheu Godwin
P.O. 3]o~: 80
{~agl,2 River, Alike
File ~o.:
l~fzr ~r. Godwin:
It hu been b~ought to our attention that pub{Ac sewer is syllable to
L~t ~?, l~lo~k m, ~q~te River lleights Subdivision.
According to the AnchoF~ge Code of Ordtnencee eSewege DlslMsal Pralines".
CheWer 18,
I~ we do not he~r fFom you within ~ (?) days, we viii auwn~ that
~r r~s are ~rre~. We, ~o~e, ~ Y~ ~ ~Y ~d
~1 s~ ~d~ ~ t~ s~J~ p~ to ~blte s~er by .
July ~0, l~J.
LI~~ ~An~e, 3~ E~ ~r R~. If~ have ~ ~
~ga~g the a~e, ple~e do ~t h~t~e to ~a~ t~ ~t o~r
RECEIPT FOR CERTIFIED MAIL~O¢ (plus postage)
SEN! FO POSTMARK
OR DATE
:STREET AND NO.
· PS Fom~ 'l OO lid INSURANCE COVERAGE PRC~VIDED--
Apr. 1911 .8 liOT lrOR INTERNATIONAL MAIL