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s�-HD�/ ~l ~~�~ANCHORAGE AREA �~~��H
Dr-PARTK3ENT OF ENVIRONMENTAL�UAL|�Y �-L^�`
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3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
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NAME =- A000sss pnumE
U][xT|ON DESCRIPTION
SEPTIC TANK:
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NUMBER OF
DISTANCE FROM WELL MATERIAL compxmwswnn
LIQUID CAPACITY— GALLONS. INSIDE LENGTH ^--- |N3|DE WIDTH "---- DEPTi[__����
SEEPAGE SYSTEM
NUMBER OF PITS -
SEEPAGE P[[
OUTSIDE DIAMETER
nxWIDTH Lcws7*_______'DEPTH
_-_____
DISTANCE FROM w . BUILDING FOUNDATION _'
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
STANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
EAREST LOT LINE
ENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
osrm. Top opTILE noFINISH GRADE ospTa OF FILTER MATERIAL nsws4rnTILE _________IN. ABOVE TILE
WELL:TYPE �� DEPTH ,~-~~~ DISTANCE FROM w4Te»
BUILDING mAnVw. ^-- — NEAREST
__._ wEAxssr ~_ SEPTIC~_ c _ ssspAGs ^____ OTHER °--
LOT LINE SEWER LINE .sYslew-________''[EsspooL_____--_'SOURCES—
DIAGRAM OF SYSTEM
DISTANCES
DATE APPROVED
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
r
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE. ALASKA 99502
TELEPHONE 279-6686
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT ��"J/�'✓ /��-rT`�y�� MAILING ADDRESS L���` �` "` •T'!` PHONE
INSTALLATION LOC T101fN I1 _2
LEGAL DESCRIPTIQLJ/�,.f�
INSTALLATION OF: SEPTIC TANK �"'SEEPAGE PIT DRAIN FIELD OTHER ,
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
TO BE INSTALLED BY
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
' '� - /�y `� SEEPAGE AREA SIZE - �'��//t/l'
SEPTIC TANK SIZE - '��_f ��=// TYPE � / TYPE a�-�1�=-✓-
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK.SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK ' SEEPAGE PIT
DRAIN FIELD
1
SEPTIC TANK, ? l2_, SEEPAGE PIT
TO RIVER, LAKE, STREAM.
DRAIN FIELD-�
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
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. //
DATE �f �'T /'T— APPLICANT'S SIGNATURE-�'" e, X-/,"'�-%��J /
i
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
1 . APPROVAL REQUESTED BY:
ADDRESS
PHONE:
2. PROPERTY OWNER: - PHONE:
i
3. LEGAL DESCRIPTION:
4. TYPE FACILITY TO BE INSPECTED: !"STREET:
NUMBER OF BEDROOMS:
5. WELL DATA:
A. TYPE
B. DEPTH
C. SIZE
D. CONSTRUCTION
E. BACTERIAL ANALYSIS
6. SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK (IF HOMEMADE„ SHOW DIAGRAM ON BACK)
1. SIZE
2. AGE
3. MANUFACTURER-_-,
4. INSTALLER
7.
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
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 :�C=
COMMENTS:
APPROVED:- -,z f, DISAPPROVED:
DATE : �l.`.p� DATE
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY
NUISANCE COMPLAINT FORM
f
Complainant's Name:
Street Address:
Phone No.
Box No.
Description of Complaint:
Name of Person Against Whom Complaint is Made:
Owner of Property inhere Nuisance Exists:
Owner's Address: ��?%,S" S(� � � ei'���0.
Location of Complaint: -��
Street Address:
Person Receiving Complaint: 's�,�c�' —�..' Date
I certify that such statemen, of facts is true to the best of my be-
lief and knowledge. I request that the foregoing matter be investi-
qated and that appropriate action thereafter be taken. I am willing
to testify to the facts stated in the foregoing complaint in court
if necessary.
i�'"
Complainant
REPORT OF ACTION TAKEN
Investigator:
Date Investigated:
Action Taken:
DATE COMPLAINANT WAS CALLED REGARDING DISPOSITION OF COMPLAINT:
September 19, 1974 9/
Si
Billy Perkins
257 Patterson
4-idiorane. Vkt�;; n
A. I I I le
SEN R: Be sure -,-o follow insfrueions on oNier side
PLEASE FUIRNiSH SERRVICE(S) INDICATED BY CHECKED SLOCK(S)
(Additional charges required for these services)
❑Show to whom, date and address Deliver ONLY
where delivered 1:1 to addressee
19/74 RECEIPT
nurnoerea GiTicia C105cl
SIGNATURE OR NAME OF ADI
�PPERTIFIED rhhn17
00 r4o./Ru
LJUJ
740381 ko SIGNATURE OF ADDR 3SLE
INSURED NO.
0 NAS'
DATE DELIVERED SHOW WHERE DELIVERED (0j1y if requested, and i
illancdat-or.,y sewc,,r hookup - Lot 5 Parcel bf), Si las 1,3-1, '7r— �. Q 'i
Dear Mr. Perkins:
19, 1071A.
6'lj
• L
Los Buchholz, R.S.
Sanit-arion RECEIPT FOR CERTIFIED MAIL -304 (plus postage)
POSTMARK
'SENT To OR DATE
STREET AND NO.
11'eeid rtiflAo. 7403321 V-4 - —
00 P.O., STATE AND, ZIP CODE
CD CD OPTIONAL SER L FEES
-
1 Shows to whom and date dell ered ........... 154
RETURN With delivery to addressee only ............ 650
RECEIPT 2. Shows to whom, date and where delivered :. 350
ti SERVICES
With delivery to addressee only ............
CE 85#
DELIVER TO ADDRESSEE ONLY ......................................................
Q SPECIALDELIVERY(extra fee required) ....................................
PS Form 1 3800 NO INSURANCE COVERAGE PROVIDED— (See other side)
Apr. 1971 NOT FOR INTERNATIONAL MAIL * GPO : 1972 0 - 460-743
701
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CpvAT,-- T,-!rjVU',RAft' AREA DOR041G[j
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Departm,ent of Environmental Quality
A E 14 01 11, TI. f -A D U
'Iomm! rr 1974
TO Prosecutor
F Q, 0, L e S llt u C h tho I z S,
Sari i 4?,- a r i a r i
SUBJE,"T: I'Ally Perik-Ins - f",Iandat-ory conmect.-Io-n to Public 'Sc-i"fer
Lot 3", Parcel 50, Silas JacL Sparks SWAHvision
Pu'lic infomed this departmont., that P-OwMins ncorn
available
IGLrII---IA Time period for connection expired.
� ij 1) 1) L.1 .1 i,
'--")--74 PLO lic in-Forjiiad th4s department no conricction naiadby Tlr-rkins.
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