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GF-~TER ANCHORAGE AREA BOROI'~H
,
~*~' HEALTH DEPARTMENT '~,
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELl '(~ '~' ~'~ MATERIAL
LIQUID CAPACITY '~'~'!'":'~ GALLONS. INSIDE LENGTH
NUMBER OF
COMPARTMENTS
~ 1, r, LIQUID
6~ DEPTH
INSIDE
WIDTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL_
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
Co&S:
?
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH ~ , DEPTH
BUILDING FOUNDATION
OR WIDTH
DISTANCE FROM WELL. (~'/~
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
, FOUNDATION.
DISTANCE BETWEEN LINES
SQ. FT. lENGTH OF EACH LINE
· NEAREST LOT LINE
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: TYpE C~¢¢~' ~'
NEAREST
LOT LINE . SEWER LINE
DEPTH.
SEPTIC
l TANK
DISTANCE FROM
_, BUILDING FOUNDATION
SEEPAGE
· SYSTEM
WATER
SAMPLE
CESSPOOl
NEAREST
OTHER
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
HEALTH AUTHQRITY
APPROVED
)GREATEh ANCHORAGE AREA ' OROUGH
~,/ HEALTH DEPARTMENT
/ 327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME DF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH .~ -~ L ~' TO BE INSTALLED BY
PERCOLATION TEST RESULTS ~ // (v//M//A/~.~ ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
MAILING ADDRESS~-~-q .~o~ D/2.PHONE NO~?~-.5~'~.~
LOCATION OF INSTALLATION ,,L-~.~/¢
, SEEPAGE PIT ~ ,DRAIN FIELD ,OTHER
THIS IS TO SERVE AS /~"
, PERMIT TO INSTALL A
SEEPAGE AREA 3.~0 .~ / TYPE
DIAGRAM OF SYSTEM
AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE
TYPE
!
.2-o
I oo~
· [~;aitl; -Authority
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.
BATE i~ g ~ APPLICANTS SlfiNATUHE
ALASKA GEOLOGiCaL CONSULTANTS
2227 SPENARD ROAD
ANCHORAGE. ALASKA 99503
April 22, 1969
Mr. Dudley Rugely
2523 Brook Drive
Anchorage, Alaska
Re: Percolation Test, Lot on Friendly Street in Muldoon Area
Dear Sir:
Pursuant to your request we have Conducted a percolation test on
the above described property. The test was conducted at the bot-
tom of the test pit dug by yourself.
The test pit was conducted according to the requirements of the
Greater Anchorage Area Borough Health Department.
We conclude that the coarse glacial outwash gravels found approximately
two feet below the surface are excellent for a sewage disposal medium.
Very truly yours,
ALASKA GEOLOGICAL CONSULTANTS
HJM:js
Attach.
Very p~v,ou.s
Pe ~-co/,~ t'/or~ Tes¢/oe~-+~ot-rned here.
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND J>~ATER FACILITIES
(Fill out in Triplicate)
Name .of person requesting approval
2.' of property owner ,
4. Numbe~'~o~,bedrooms in house
5. Mate~Anals~sis:
a. Bactemial
b. Detergent
Well data:
a. Type
b. Depth..
c. Casing Size
Distance from well to closest existing or proposed:
1. Sewer line
2. Septic tank
3, Seepage Area
4. Cesspool'
5. Property Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch~ etc.
Sewage disposal system.
a. Age of system ~ /~,~'
b.' Septic tank capacity in gallons
1. If "home made" show diagram on reverse side of this form.
Disposal field or seepage pit size and type ~ ~ ~
/
1. Distance to property line to house foundation
Pereolatiork Test
f. Percolation Test performed by
~ Use the reverse .side of this form to show diagram. Diagram should include
~he foJ.].owlng information: p~operty lines;.well location, house location,
~i,t{c tank location, disposal area location, location of percolation test,
an~ direction of ground slope.
9. The ~n'~o~.~l~on on this form is true and correct to the best of my knowledge.
'Signature of Applicant ~ate Si~ned
T_O. BE FILLED OUT BY HEALTH DEPAP. T{-~ENT PERSONNEL
'~e above described sanitary facilities are hereby approved, subjec[ to the
......... ~l!owing cond~'ionsi -
Conditions:., p~OD'~
The above described sanitary facilities are disapproved for the following
Approval is valid for one year following the date of approval~
CPJ: cw
REQUEST FOR APPROVAL OF ~\=-?
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
~J Name .of person requesting approval;
2. · ~la~l,~. of property~owner ~ .
L~y.~l. deacriptio5 ~~--.
Numbem-oq bedrooms in house
~ate~.Analysis:
a. Bacterial ,%
b. Detergent ', .
6~ We3~l data:
a. Type
b. Depth,,,
c. Casing Size
Distance from well to closest existing or proposed:
1. Sewer llne
2. Septic tank
3. Seepage Area
Cesspool'
5. Property Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc.
7. Sewage disposal system.
a. Age of system ~ .
b. Septic tank capacity in gallons,
Name of septic tank manufactu~.r .......
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type, ,
1. Distance to property line to house foundation
e, Pereolaticm. Test~resuP~ts
f. Percolation Test performed by
Diagram should include
~.. Use the reverse .side of this form to show diagram.
- ix%he foJ.]~owlng information: p~operty lines;.well location, house location,
p~i~t~c tank location, disposal area location, location of percolation test,
aa~ direction of ground slope~
9. The h~o¥~!ion on this form is true and correct to the best of my knowledge.
Signature of Applicant
Date si~ned
T_~O BE FILLED OUT BY HEALTH DEPART!~ENT PERSONNEL
z -The above described sanitary facilities are hereby approved, subject to the
.......... cond ions i '
Conditions:
The above described sanitary facilities are disapproved for the following
'- Appz'oval is valid for one year following the date of approval.
· CPJ:cw
,_~;RBATHR ANCHORAGE AREA BOROU~
['~L~I DEP~R~NT
327 EAGLE ST~ET
~CHO~GE, AL~KA 99501
279-2511
DATE ~ECEIVED
INSPECT:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AMD WATER FACILITIES
FOP
Approval Requested
Address
2. Property Owner 2~d.x,~'/'~:7~-
5. Legal Description_. /~t~
4. T~e of Facility to be Inspected
Number of Bedrooms
Well Data:
A. Type
B. Depth
C, Size
D, Construction
E, Bacterial Analysis.
Sewage Disposal System:
A, Septic Tank (If homemade, show diagram on back)
Approval Request for Se~ e ~ Water Facilities
Page TWo ~-'
Seepage Pit
2. Lining
C. _.Disposal Field
1. Number of Lines
2. Total Length
Required Measurements
A.
C.
D.
F.
6.
H.
Well to Septic Tank
Well to Seepage Pit
Well to Sewer Line
Well to Property Line
Well to Other Possible Contamination
Foundation to Septic Tank ~ /
Foundation to Seepage Pit /~ /
Seepage Pit to Property Line/? ·
8, CO~MENTS:
.':
'APPROVAL VALID FOR ONE YEAR FR0~.! DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT
BDll70