HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 2 LT 30
G~'"~"~,'R ANCHORAGE AREA BOROt ~U"~-U~
HEALTH DEPARTMENT
327 EAGLE ~T. ANCHORAGE, ALASKA 99501 279-2511
'N? 817
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY ] '~
MATE.A, :~f .UMBEROF :~
COMPARTMENTS
GALLONS. INSIDE LENGTH~ INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
"N'NG MA.ER,Al C'~"/~
NEAREST LOT LINE
OR WIDTH. / ~ .,LENGTH / ~ , DEPTH ~:~
· DISTANCE FROM WELl. / / ~ · . BUILDING FOUNDATION.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '~ ~ ~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl , FOUNDATION , NEAREST LOT LINE.
ABSORPTION AREA .SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
.. OF LINES
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
~i//-'~ff D,S,ANCEFROM Z~' WA,ER
WELL: TYPE DEPTH , BUILDING FOUNDATIONSAMPLE , NEAREST
LOt LINE /O ~'~ NEAREST sEPtIc ~:~'~" sEEPAGE//..~ ' OTHER
SEWER LINF . TANK , SYSTEM /'f* · CESSPOOl , SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
GrEATEr ANCHOraGE AREA BOrOUgh
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
PHONS
OTHER
FINAL INSPECTIONs 24 HOUR NOTIGE REQUIRED· BACKFILLING OF ANY BY~TE:M WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL, BE; SUBJECT TO PROSECUTION.
DIAGRAM OF BYSTEM
MINIMUM DISTANCES. RE;QUIREMENT$
FOUNDATION TO SEPTIC TANK J~'/
FOUNDATION TO BEEPAGS PITi ~ / DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALl. /~"~'
WSLl- TO SEPTIC TANK SEEPAGE PiT
DRAIN FISLD ALSO CONSIDER AREA WELLS.
~WATSR MAIN TO SEPTIC TANK SEEPAGE PiT
GRAVEL. BACKFILL
/ / "'AI-TH?OR,TY
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA E~OROUGN ORDINANCE NO, 28*68 AND THA~ THE ABOVE
DESCRI SYSTEM IS IN ACCORDANCE WITH SAID COD~.
I ·
Fcbm~ry 3~ lg?~
File Ho.: 4-1
G.T.
~0
River,
Dear
R ha~ be,~n brought to our attesto~ that l~blie sewer is ~vallnble to
Lo! ~0, Block ~, l;agJe ~h'or llei~hta Subdtvlakm.
According to the A~el~rage C~de e~ Oe~tna~eea "3ow~ge Diqx)sel Prlartlo~",
Chapter 18. A~'tlele 16.~. Seeflom 1~.4~.~:
The Municipality of A~ehor~ Depa~tme~ ~ ~blic Wo~8 hms
has ~ ~.
You must sppl~ ~ a eoan~elton pstadt from ti~ ~R ~ f~ ~
.. ~~ ~e. ~ do ~ ~ ~ ~ ~ ~t ~ at
Y
RECEIPT FOR CERTIFIED MAIL---30~' (plus postage!
~[8~O~OHLY .......................................... 50~
PS Fo~ 3800 NO INSURANC[ COVERAG~ PROVIOEO~
· ~r. tg?l HOT FOR INTERNATIONAL MAIL
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 11!1~./7~
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address: F?~ ~. ~, Av~. ~ch~r~ne Phone: ~77_n,~
2.Property Owner: ....
Mailing Address: ~ex t~.
3. Legal Description: Eot ~9~ ~lec~'
4. Location: tou~ ~f %r~or
5. Type of facility to be inspected
6. Well Data:
A. Type ~rtlled
C. Construction Sta~a~!
7. Sewage Disposal System:
A. Installed
C. Septi~ Tank: 1.
D. Seepage Pit: 1.
E. Disposal Field:
8. Distances:
B. Depth t7o'
D. Bacterial Analysis
FuSltc Sc~er Syste~
B. Installer
Size
Absorption Area
Total length of lines
2. Manufacturer
2. Material
A. Well to: Septic tank
Nearest lot line
, Absorption area
, Other contamination
, Sewer Lines ,
B. Foundation to septic tank
C. Absorption area to nearest lot line
, Absorption area
EQ-034 (1/74) Page 1 of two pages
Page 2 of t~ pages - Re~,for~ Approval of Individual '~"'~&
~ater
Facilities
m. egal escriptJon Lct~.~ Llc¢1. ~. F~,:le P, Jvcr ti~J~,hts c,, ~...~ · ,.
Comnents
~//_ Approval kValid for one year from date'stgned
Greater Anchorage Area Borough, Department of £nvtronmental Qualtty
DIAGRAM OF SYSTEM ~:
I 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" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
VA
, / ,
Mailing Address: 5Z3 ;! ~t~ Ave. f~chorage Phone:
Property Owner: .. Frank bi Ostrmlski Phone:
Mailing Address: Box 30, EAgle River AK 99577
Legal Description: Lot 30, Dlcck £, Eagle River Heights Subdivision
Location: South off ~aranof and Caribou.'
Type of facility to be inspected Single
Well Data:
A. Type
C. Construction
Sewage Disposal System:
A. Installed
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
116176
277-0543
No. of bedrooms 4
B. Depth
D. Bacterial Analysis
Public Se~r Systo~).
B. Installer
2. Manufacturer
2. Material
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines
EQ-034 (1/74) Page 1 of two pages
..~_p~e.2 0f~.two pages - Re. or Approval of Individual Water Facilities
l~gal Description Lot 3g. :,loc.; Z. la,lc River tlal~.::s Subdivision
Comments A~proval f,~r s~',~:r ~ystc:rl anl¥.
Approve~~ i~ ~,~, Disapproved
Date
Approval ~Valtd for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
/, /i/o ~. DIAGRA~ OF SYSTEH
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) ' '
Tax Code:
IATER AN~CIIOR~GE AREA BOROUGH
'-DYE TEST
Date:---//
ii/,
Ma/ling Address:..,
Property Address:
S~bd, vision,
/". z:
TEST:
[] Positive
,[]. Negative
~OD/TIQNAL iNFORMATiON.'.
Office: ~'/,,: ,,. .~-' :
Field:
Adm/nisfered
FHA Eofm 2S73
MOETGAGOR OR SPONSOR
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART L---TO BI: COMPLETED BY FHA
MORTGAGEE
I NattonalBank 0~' Alaska
Yes [] No
[] Community system
[] Public system
]Community system
Ea~le R{ver
New installation
F~-m Approved
Budget Bureou No. 63-R0296
~ Yes ~ ~o
Individual 4 Y~ ~ Nc
PART II.~TO BE COMPLETED BY HEALTH DEPARTMENT
REPORT OF INSPECTIONtlNDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PIIMAIY TIIATMINT consls(s of I-1 ~l~ic ~znk. I-I C~ss~.
Distance from well, feet. Material
Toul liquid capacity..
Inside length f~'~. Inside width.
Disur~e
Inside dbmeter..
gallons. CapaGty inlet compartment.
fort. Liquid delxh., feet.
feet; f,,undach,fl.., f~"~; nearest I,,~ llne ac r-{ front. I--I side. I-I rent.
~}Jl' f(~' Liquid capacity., gallons. Lining material
{-{ Seepage pits. Other.
gallons.
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIV,~.'.
INS.E~,./
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES~~.
FOR
Ge
APPROVAL
ADDRESS:
PHONE:
PROPERTY OWNER:
PHONE:
LEGAL DESCRIPTION: ~0~",.~'~/
TYPE FACILITY TO BE INSPECTED:~,/¢~/_~ ~,~'y/~TREET:
NUMBER OF BEDROOMS:
WELL-DATA:
A. TYPE
B. DEPTH /"2.'~
c. SIZE ~,'~' ~~
D. CONSTRUCTION .~ ~
E. BACTERIAL ANALYSIS .~ /~ :Z?- 7F
SHOW DIAGRAM ON BACK)
SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK (IF HOMEMADE,
1. SIZE
2. AGE
3. MANUFACTURER ...rT/2cz
4. INSTALLER
.APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
e
B. SEEPAGE PIT
SIZE
C. D~SPOSAL F~LD
1. NUMBER OF LINES
2. TOTAL LENGTH ~'
REQUIRED MEASUREMENTS
/
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT, //Y/
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE
E. WELL TO OTHER POSSIBLE CONTAMINATION
F. FOUNDATION TO SEPTIC TANK
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
COMMENTS:
DATE. /2.--/'~ 7/ DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BDROUGH DEPARTMENT
OF ENVIRONMENTAL
QUALITY