HomeMy WebLinkAboutSKOOKUM KNOLL TR 2Tr 2
051
Gn~,ATER ANCHORAGE AREA BORC"GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl,. SYSTEM
ADDRESSMAILING
p HO N G-~/~,/
SEPTIC TANK:
DISTANCE FROM WELL ,~-..~2 "~'
LIQUID CAPACITY
GALLONS.
,.~,,,~-~' '~.)'7'"' NUMBER OF
MATERIAL C£ ~")/~/~, ~.-'"*~" COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH ~-"-~-
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAl ~"~'
NEAREST LOT LINE
/ OR WIDTH /*dPX/L~-~, LENGTH '"~?-~ / , DEPTH
DISTANCE FROM WELL ,~'~ / ~' BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ SQ. FT.
TILE DRAIN FIELD:
"/~, FO ~ TOTAL LENGTH
DISTANCE FROM WELL -'~ UNDA NEAREST LOT LINE , LINE ~
AB~,,~,~ym /~t~:A SQ. FT. LENGTH OF EAC LINL~
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE____
DISTANCE FROM / ~ -'~ WATER
WELL: TYPF,~,,~,~....,~_..:,~,,,~,4/ DEPTH "~"~'~- ., BUILDING FOUNDATION. 4)~,',5.' ~-- SAMPLE ,..4../,~ , NEAREST
· NEAREST SEPTIC SEEPAGE OTHER
LOT LINE /~ ~ SEWER LINE ,~7...~ ~, 7..~',~) ~ y._~2 ~ ~-~'~'
, , TANK , SYSTEM , CESSPOOL , SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
APPROVED / ,', /1 ~-"--~.---.~'~.~-~- ~___,,.= .
HEALTH AUTHORIIY
GAAB-HD-2
GREATE
327 Eagle St,
ANCHORAGE AREA
ItEALTH DEPARTMENT
Anchorage, Alaska 99501
,OROUGH
279-2511
Case No./~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT~'~/L"(~/L''i/~/ 'r~' ~,'4,//~c'~ MAILING ADDRESS ~"~D,,,~.~-,~/' ~'?/~z[?/.,~AYPHONE NO,~~/
RESIDENCE ADDRES~/~ ~b/Z- C~/~ LOCATION OF INSTALLATION
LEGAL DESCRIPTION
APPLICATION TO INSTALL', SEPTIC TANK ~ ., SEEPAGE PIT ~', D~ ,~"~
TO SERVE THE FOLLOWIN~ ~C)~Y ~.~.~-~,_d
FINANCEDTH ~ .. .... - _~ .. - -
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS , PERMIT TO INSTALL A ~/~
~~4.-~'~-7' AS DESCRIBED BELOW SIZE OF UNIT TO.BE SERVED
. SEPT,C TANK S,ZE V': " PE ' EEPAGE AREA
DIAGRAM OF §YSTEM
DISTANCES:
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordh~ance No. 28-68 and that the
above described system is in accordance with said code.
oc~-ober 11, 1979
~3:hil lman ¥;allace
~?ost Offic, e Box 588A
Chugiak ~ Alaska 99567
Subject~ Ix~t B Skooku~]% Ifnoll Subdivision
Your water supply is (lrawn front a ~,reek on your property.
~l'his is not consid, ere~[ a protect~ water supply. Therefore~
befo.~ ~e may s~nd approval ~o the bank a w¢~11 will need to
be drilled..
A peri,it will need to be iss~led prior to th~ %~ell b~ing
~lrillad from this ¢].~partmen%
If there are any further q~-estions~ pl~aso contact this
offic~ at 26.~-4720.
S~ncc~r ely,
Robert C. I'rat't, RoS
Associate Specialist
Alaska ~utual Savings Bank
)?ost Office ~:]o× 106.~ 99577
DEPAHTMENT OF tlEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
RECEiV :O
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Comulete all parts on page 1. I,completa requests will not be procas~ed. Please allow te~ 110 days for processimj.
1, PROPERTYOWNER J PHONE
Thillman F. and Ella..~t Wallace ~88-2161
MAtLINGADDRESS
P.O. Box 588A, Chugiak, Alaska 99567
PHOPERTY RESIDENTllfdifferentfromabowd
Mile 19, Old Glenn Highway, Chugiak, Alaska
2. BUYER
~one
MAILING ADDRESS
PHoN~
3, LENDING INSTITUTION
Alaska Mutual Savings Bank
'~] PHONE
694-9572
MAILING ADDRESS
P.O. BOx 1068, Eagle River, Alaska 99577
4. REALTOR~AGENT
None
MAILING ADRRE$S
LEGAL DESCRIPTION
Lot B, Skookum Knoll Subdivision
STREET LOCATION
Mile 19, Old Glenn Highway~
6, TYPE OF RESIDENCE
I~ SINGLE FAMILY
LT_] MULTIPLE FAMILY
Chugiak, Alaska 99567
NUMBER
[~ One [--J Four
E"] Two [_] Five
~ Three I~] Six
F_.~J Other
7, WATER SUPPLY
INDIVIDUAL*
COMMUNITY
PUBI.IC UTILITY
' ATTACH WELL LOG A well log is required for all wells drilled
since June 1975. r-'or waits drilled prior to that date, give wall
depth (attach log if available,)
8. SEWAGE D~SPOBAL SYS'rEM
I-~ INDIVIDUAL/ON-SITE**
~ PUBLIC UTILITY
**if individual/on-site, give i.stallation date~ ....
If system is over two (2) yoars old an adequacy test is required
by this Depmtment
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72,010(3/78) .......
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