HomeMy WebLinkAboutLAZY ACRES LT 12
GAAB-HD-I
~'ER ANCHORAGE AREA BORG
DIEI'~RTMENT OF ENVIRONMENTAL QUALI1,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL. SYSTEM
NAME.
LOCATION
MAILING
.__.ADDRESS ~"~:~?-.~'¢'.,~.~,,'~¢~ ¢"~/___.,~.~-¢*-U~,~'~ PHONE
LEGAL DESCRIPTION. ,'"~'~P~'~
SEPTIC TANK:
NUMBER OF
DISTANCE FROM WELL ~ ~'~,"'~" /-,~,/-.-" __MArERIAL ~ ~/~~ COMPARTMENTS ~
/ ~ ~/~- ~¢' ~ LIQUID
LIQUID CAPACITY /~' .__.GALLONS. INSIDE LENGTH ~ .... INSIDE WIDTH ~ __DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
R WIDTH
DISTANCE ~
, LENGTH__ , DEPTH__
,--B~LA~G FOUNDATION_
NEAREST LOT LINE
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
.SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL C~)/"~/~--~' ~,/..~,/,x , FOUNDATION__
NUMBER OF LINES DISTANCE BETWEEN LINES
ABSORPTION AREA c'~/)~'~'~ SQ. FT.
DEP1H: TOP OF TILE TO FINISH GRADE ~ "'~ ~'~
// / TRENCIt WIDTH ,,-~ ~'
LENGTH OF EACH LINE.,,*""~z~r'~..~'¢,~-~-'~_!_._~''~ .~z'?<_~'Z)~'_2 J
DEPIH OF FILLER MATERIAl. BENEATH TILE
NEAREST LOT LINE. "~'~ / TOTAL LENGTH
OF LINES .~"~ ~ '/
__._IN. TOTAL EFFECTIVE
~'"'"-IN, ABOVE TILE
WELL: Ty p E d-~/_)/<~. ,,.8-' ~,,,,,~/.,;z¢,,.~-, ,. DEPTH ~-~-~' , DISTANCEBuiLDiNG FOUNDATIoNFROM ~ _SAMPLEWATER c___ .. NEAREST
~ NEAREST /..,_._ SEPTIC SEEPAGE c:.~- OTHER
LOT LINE , SEWER LINE ____ TANK. '?'"~ , SYSTEM___ , CESSPOOL '~ , SOURCES_
DIAGRAM OF SYSTEM
DISTANCES: ....
G.A.A.B.
GREATE tNCHORAGE AREA 9RO'UGH
HEALTH DEPARTMF, NT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Casa N o.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS LOCATION OF INSTALLATION_:5 "'/ Ii_. O((' / F, c';I I,;5
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH '-, ~' I. i:
PERCOLATION TEST RESULTS
SEEPAGE PIT ~- , DRAIN FIELD
TO BE INSTALLED BY_ (",'
/~?O ~ i//~D~MANTIClPATED
DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
,OTHER
T.,S,ST0SEBVEAS 5" a PE.M,TTO.NSTALLA
AS DESCRIBED BELOW. SIZF_ OF UNIT TO BE SERVED
SEPTIC TANK SIZE ..Zd'..~ TYPE ~/D~..,-AJ'7'-~EEPAGE AREA TYPE
DIAGRAM OF SYSTEM
I certify that I am familiar with the requh'ements of Greater Anchorage Area Borough Ordinance No, 28-68 and that the
above described system is in accordance with said code.
DATE ~O APPLICANTS SIGNATURE ~:~
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "¢" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
5. Type of facility to be inspected
6. Well Data: 7~.-~.,--~/-_~
A. Type
Phone: .~,~- ~ ,/-/%
No. of bedrooms
C. Construction
Sewage Disposal System:
B.~epth
D. Bacterial Analysis ,/-/?t2-,~)~: _
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
_/,? 7/ B. Installer
1. Size ~m m x'~'e- 2. Manufacturer ~'.~'~.,,,~,'o
1. Absorption Area .... 2. Material
Total 'length of lines ~%~ ~r/~.L/~ ~
J
Distances:
A. Well to: Septic tank(~,~/~ Absorption area
Nearest lot line ~"- , Other contamination
B. Foundation to septic tank./2 c~ ~ , Absorption area
C. Absorption area to nearest lot line ~
Sewer Lines
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Req.~st for Approval of Individual S....er & Water Facilities
Legal Description
Approved. ~LL~x/L,~ -- :'~,d ~ ~ "~?/"~- Disapproved D a t e ~-'~"~ - ?2z~[
~'~/~ ~(/~A~R.roval: Va l id for one. year from date .signed
Greater Ancho~e 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
EQ-034 (1/74)
'GREATER ANCHORAGE ARb/, BOROUGH
Department of Environmental Quality
3330 "C" St., Anchorage, Alaska 99503 - 274-45~.
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
Type of InspectiOn: CMRO
VA x FHA CONV
Property Owner: BURKES~ Samuel ,
Mailing Address: 8261 Pokey Circle, AnchorageDa~ Phone 344-6419 ~,
3. Name of Buyer: STARNER, Del Ray
Mailing Address: Box 8976, Anchorage, 99508 OaS Phone 344-9661
Name of Lending Instit~ltio.:- Alaska NATIONA~ Bank
Mailing Address: Pouch 7010, Andh0rage, AK Pt~one 277-5511
5. Name of Realtor or Agent:
Mailing Address:
N/A Phone N/a
Legal Description:
Location:
Lot 12, Lazy Acres Subdivision
8261 Pokey Circle
Ancho~rage, AK
7. Type of Facility to be inspected: Sewer
8. Water Supply
Type of S~pply: Public Utility x Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal'System
Type ,of S~stem: Public Utility
If Individual, date of installation
No. Bdrms. 3
Individual (on-site)
1971