HomeMy WebLinkAboutLAZY ACRES LT 14
GR' ~R ANCHORAGE AREA BOROU
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
__PHONE
LOCATION
SEPI'IC TANK:
DISTANCE FROM WELL. _c~,,~,,'''2~/'/~, /-*¢/..,~/~'
LIQUID CAPACITY__ /'&2 [~'~ GALLONS.
NUMBER OF ~
MATERIAL_ ¢- r~C' '~-.'"'~"/~'~-~' ~..-'''~'~- .COMPARTMENTS
INSIDE LENGTH ~--~"q-NSIDE WIDTH ~:. ...... DEPTH
SEEPAGE SYSTEM: SEEPAGE
NUMBER OF PITS /~ __OUISIDE DIAMETER
LINING MATERIAL ./'~?~¢'~'"~--S: //""~""
NEAREST LOT LINE~_:~:' ~'~''~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
/'~"~ OR WIDTI-I.___.~/_'~_ ..... LENGTH /"~" , DEPTH_ __,
DISTANCE FROM WELL_ ~/"r'~'./~._.~ ./'~__±_/''''/~','''~ ___, BUILDING FOUNDATION __,
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~ F,,...~g_.~.N.D~~ , NEAREST LOT LINE
LIN~.,'/ DISTANCE BETWEEN LINES '~ TRENCH WIDTH
NUMBER
OF
ABSORPTI.~C~AREA SQ. FT. LENGTH OF EACH LINE ~
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MA1ERIAL BENEATH TILE
_IN. ABOVE TILE
DISTANCL- FROM WATER
WELL: TYPE ~'~/'.~,,Z.~/~/.,:.'/,~.,,~_, DEPTH ~ , BUILDING FOUNDATION ..... ~"'-"'- _SAMPLE ~'"~, NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE ~ SEWER LINE ~ , TANK ~""'"'~' SYSTEM ..... ~ CESSPOOL ~ SOURCES
DIAGRAM OF SYSTEM
DISTANCES: '~ ~,~' ' ~
- G,A.A.B,
DATE
GAAB-HD-2
GREATEF
327 Eagle St.
_NCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
ROUGH
279.2511
Case N 0.
SEWAGE DISPOSAL SYSTEM -. APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION.
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ~'~ .~-' g--/~'
PERCOLATION TEST RESULTS /oc~
LOCATION OF INSTALLATION__~: ~ ~)¢:~ ~/< 0'~/-~
~., SEEPAGE PIT. ~ , DRAIN FIELD , OTHER_
TO BE INSTALLED BY_ ~/~C~/C~
b ~/~ ANTICIPATED DATE OF COMPLETION ~~ ~/~~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED '~--Z~t~)~-'~~ "'---
SEPTIC TANK SIZE _._~'~"'0~ TYPE '~e:~'~ SEEPAGE AREA TYPE
/ DIAG~
I ce:t'ti£y that I am £amilJar with the requh'ements o£ Greater Anchor'/ge Area Borough OrDinance' 't'~o. 28-68 and that the
DATE . APPLICANTS SIGNATURE '/'''' ' ::~ ,, /~ /' ~/: ,:,,,~-~ ~. , ~,/'
_ MUNICIPALITY OF ANCHORAGE ~AU~,_.,~,~,'-" ~E AuetOm'~G~
~ 825 L Street, Anchorage, Alaska
~A~. r,~'
9
9
5
0
2 6 4 - 4 7 2 0
~e~uesg [o~ Approval o~ Zn~LviduaZ SeNe~ a~d Nate~ 2acLZLtie~. _..~ i~
3o
Mailing Address:
Name of Buyer:
Mailing Address:
Lending Institution:
Mailing Address:
Realtor/Agent:
Mailing Address:
Legal Description:
Street Location:
Phone:
/
Number of Bedrooms:
Number of Bedrooms:
Single Family Residence:
Multiple Family Residence:
Water Supply: *Individual Well ( )
If Individual Well, well depth
If Community System, name of system
Public/Conm]unity System
Sewage Disposal System: On-site System ~' Public System ( )
If On-site System, date of installation:
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
MUNICIPALITY OF ANCHORAGE
DEPARTMEN.. JF HEALTH AND ENVIRONMENTA
,~2 ~ 825 L Street, Anchoraa~. Alaska
~- ~ ~~-- ~ ~ Da~e Received:
~1: Time ll~a.m. ~2: Time
Date 10-~-77 Thur~y ~
PROTECTION
99501
October 25, 1977
#3:
Time
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: State of Alaska Veteran's Administration
Mailing Address: Phone:
2. Property Owner: Robert J. Furlong
Mailing Address: 8301 Pokey Circle
Phone: 344-7776
Legal Description: Lot 14 Lazy Acres Subdivision
8301 Pokey Circle
4: Single Family Residence: (x)
Number of Bedrooms: Three
Multiple Family Residence: ( )
Number of Bedrooms:
Well System:
Permit #
Construction
Individual well ( ) Community/Public System ( ~
Depth of Well Well Log on File
Bacterial Analysis
Sewage Disposal System: On-site System Sx)
Permit # -- Installed 1971
Public Utility ( )
Installer
Septic Tank Si. me ) 0~0 Manufacturer '~,'~c~
Absorption Area ~ Soils Rate ~ 00~ Material
Di~ances: Well to Septic Tank (~. to Absorption Area
to Sewer Line ~ Nearest Lot line
to Nearest Lot Line
Absorption Area
Fage Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description:
Comments:
Lot 14 Lazy Acres SubdiVision
r/ /
Approved: ~. C~ ~0~
Disapproved:
Date:
Department Worksheet:
Department of IIealth and Nnvironmen-kal Protection.. ,,
~/{~i~5%2:~'Il 825 L Street, Anchorage, Alaska 99501
':~:'::Nequest for Approval of Individual Sewer and Water FacJ_lities
Pro2ez~y Owmer:
Hailing Address: Phone
5 o
Single Family Residence: (: Number of Bedrooms:
Hu].[Jple l!'ami]_y Residence: ( ) Number ef Bedrooms:
8 o
WaLer SuPl>ly: * Individual Well ( ) Pub]_ic/CommunJ_ky System
i/if Individual ~.4el!, well depi:h
Sewage Disposal System: *%)n--sJie System ~) Publi_c System ( )
If On-site System, date of installation: /~.~_ ~: .......
*NO'PEr A well log is required on A/[,i~ wells drilled s:[nce 6/75.
** if on-site sewer system is over' two(2) years el.d, an adequacy
test is required by this depar-tmenh~
A fee of $25.00 musk accempany each request before precessing
can be inihia'ked.
3/'? 7
o Robert/_Deggy Furlon~ AT 8301 PokeV Circle 99507
SUBJECT Lot 14 La~v Acres DATE 11~30~.77
This request has already been d. one and approved, A copy was sent to
. the S'kate Veteran's Administration on November 17, ].977, I am enclosinc~
_you a copy of the ~epo:ct for your records or hanf/ca~r~y.
Sewer and Water 264~4720
DATE
Redi~orm ®
SIGNED
4S 469 SEND PARTS 1 AND 3 WiTH CARBON INTACT
PolyPak(~osel,14P469 PART 3 WILL BE RETURNED WITH REPLY
DETACH AND FILE FOR FOLLOW-UP