HomeMy WebLinkAboutCREEKSIDE PARK #3 LT 34
GAAB-HD-I
GP~:ATER ANCHORAGE AREA BORO~'~H
~.~E HEALTH DEPARTMENT ~/
327 E ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
ADDRESS
LEGAL DESCRIPTION
PHONE
SEPTIC TANK:
DISTANCE FROM WELL --
LIQUID CAPACITY / ~J~'
- .MATERIAL ~'~ ~'~'~:~'- NUMBER OF i
COMPARTMENTS
~_ ~.~'~'-~',~x~, ~r- /-'~l~j/~. LIQUID
GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM:
SEEPAGE PIT:
NUMBER OF PITS J OUTSIDE DIAMETER OR WIDTH /~ ' LENGTH /~'- ~, DEPTH (~ w
LINING MATERIAL ,~.O(~ DISTANCE FROM WELL ~' ~/' ~'~' BUILDING FOUNDATION ~""~ '~
NEAREST LOT LINE ,,,',,~O' ..,4- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~t,~ SQ. FT.
TILE DRAIN FIELD:
//~'~C ~~ TOTAL LENGTH
DISTANCE FROM WELL , NEAREST LOT LINE
NUMBER OF LINES ./' DISTAN ~ IN. TOTAL EFFECTIVE
ABSORPTIO SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE'
IN. ABOVE TILE
WELL:
LOT LINE
TYPE
DEPTH
NEAREST
SEWER LINE
DISTANCE FROM WATER
~1~ ,~..DING FOUNDATIOF, IsEEPAGE SAMPLE OTHERNEAREST
,TANK SYSTEM ,CESSPOOL ,SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
GAAB-HD-2
GREATEI ANCHORAGE AREA -- )ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case N o. ~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~/~.
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL:
MAILING ABBRESS ~ ,-~ -
LOCATION OF INSTALLATION
TO SERVE THE FOLLOWING FACILITY
SEPTIC TANK,/~Iff~!~ , SEEPAGE PIT, , DRAIN FIELD
FINANCED THROUGH
PERCOLATION TEST RESULTS
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
PHONE NO.2~/~/-~'
,OTHER
THIS IS TO SERVE AS HR 7./)u'--'(~-7. ~ , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
,,. SEPTIC TANK SIZE ~/~)0 TYPE ~¢¢~;Z'~,"' SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
DISTANCES:
Health Au o
I cerfi£y that I am £ami]hr with the requirements of C-~eat¢~ Anchora[¢ A~ea Bo~ou[h Ordinance No, ~$-~$ and that the
above described system is i~ accordance with said code.
99503 274-4561
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska
Date Received ~ -
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
VA
1. Approval requested by:
Mailing Address: J/q UC}~S+ .b-J6b-'/~u~. Phone:
2. Property Owner: J_/aL~t-On~6j ~hQr/6j /-/, Phone:
Mailing Address: ?~0o
Po.c,' ~'c, f'~o r--I--,g o_,g ~ Co mpo mo_e' o m
m 7~ -~S-o /
3. Legal Description: £o~.9~,
4. Location: A.
5, Type of facility to be inspected
No. of bedrooms ~_~
6. Well Data:
e
A. Type Pub/~'c, CZ-/-,'/~'/-u B. Depth
C. Construction D. Bacterial Analysis
Sewage Disposal System:
A. Installed /'~qO
C, Septic Tank: 1.
D, Seepage Pit:
E, Disposal Field:
B. Installer
Size /QO0 2. Manufacturer
1. Absorption Area /~,.X'/g ~/~. Material
Total length of 1 ines
8. Distances:
A. Well to: Septic tank
, Absorption area
., Sewer Lines ,
Nearest lot line , Other contamination
B. Foundation to septic tank J't~ , Absorption area
C. Absorption area to nearest lot line ~'~
EQ-034 (1/74) Page 1 of two pages
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" St., Anchorage,
Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
Type of Inspection: CMRO VA )<, FHA
Property Owner: ~.;~btlt~ne..~ ~J~L~' ~, N~..
Mailing Address: ~o OIL ~R~l~_ Day
Name of Buyer: ~":~to~., M~.~.E"r'~ ~.
CONV
Phone .q ? ?'- cl..s'K. I
Mailing Address: ?a~ Nu,.[J,,ao~q Koo. c:~--~. Day Phone
Name of Lending I~e.e.u.~,J~u ~,J~,[
Mailing Addres~~t~ .~ one
Name of Realtor or Agent: ~ -
Mailing Address: ---- Phone
Legal Description:
Location:
7. Type of Facility to be inspected: ~ro~ No. Bdrms. ~
8. Water Supply
Type of Supply: Public Utility __~ Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site)
If Individual, date of installation lY~~~ .
Pacific Merlga e Corporalion
:319 \VEST 5TII AVENUE
ANCI1ORAGE, ALASKA 99501
EQ-037 (1/74)
..... ~a~ 2 of two pages - Rec ~t.~Jr Approval of Individual ~ ~.~ Water Facilities
Approved
lDisapproved Date
id for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
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
/
APPROVAL
ADDRESS:
PHONE:
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
REQUEST FOR APPROVAL
INDIVIDUAL SEWER AND WATER
FOR
OF
FACILITIES
REQUESTED BY:
i- 7.2
TYPE FACILITY TO BE
NUMBER OF
WELL DATA:
A. TYPE
BEDROOMS:
B. DEPTH
C. SIZE
D. CONSTRUCTION
E. BACTERIAL ANALYSIS
SEWAGE DISPOSAL SYSTEM:
SEPTIC
1.
2.
3.
TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK)
SIZE -~,~F'l~&"g~t~ ~0~0 ~
AGE I q ¥ ~) - /'} ~'~ "~'~-":~
MANUFACTURER . O_ : (:1 CI~P~
4. INSTALLER
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
SEEPAGE PIT
C. DISPOSAL FIELD
1. NUMBER OFX~N[S
2. TOTAL LENGTH~x,,~
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 LO
H. SEEPAGE PIT TO PROPERTY LINE
COMMENTS:
APPROVE,/~//~/~/~.~,._DATE:f~ DATE:
APPROVAL VAL/ID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALIT