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Home My WebLink AboutBRUCE #2 LT 17OlZ.- 3"t Z-lO GAAB-HD-I GP. rATER ANCHORAGE AREA BOROIf~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELC~'~t~ - MATERIAL LIQUID CAPACITY GALLONS. ADDRESS PHONE SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS. / OUTSIDE DIAMETER Li N iN G MATE Ri A L ~/~/~/'~?'~"'' //~~g-' , NEAREST LOT LINE ,~"~ / ~ .... OR WIDTH /~' / D,STANCE EROM WELL . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) , LENGTH , DEPTH , BUILDING FOUNDATION. ~"~ ~ SQ. FT. TILE DRAIN FIELD: DISTANCE F.,~ WELL NUMBER OF LI SAL~.~~/DISTANCE BETWEEN LINES TRENCH WIDTH TOTAL LENGTH IN. IOIAL EFFECIIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE OF E TO FINISH GRADE WELL: DEPTH DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE LOT LINE ~ ~ NEAREST SEWER LINE DISTANCE FROM BUILDING FOUNDATION SEPTIC ~;-,%., / SEEPAGE , TANK Ol:''/ "/~ , SYSTEM ,_..._. WATER . SAMPLE ,., / ~ "'/~', CESSPOOL , NEAREST OTHER , SOURCES DISTANCES: DATE DIAGRAM OF SYSTEM APPROVED GAAB-HD.2 GREATEr/ NCHORAGE AREA HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 )ROUGH 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~L~ PERCOLATION TEST RESULTS ~a THIS IS TO SERVE AS BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT .~. ~-~, r~~)~, PERMIT TO INSTALL A DISTANCES: AS DESCRIBED BELOW. · SEPTIC TANK SIZE HEAl ~,UTHORITY LIC DESIGNER ~,¢.L"O:~JMA,L,NG ADDRESS] ~D! 'J-/.]~ PHONE NO. LOCATION OF INSTALLATION ~/..I (~ ~"~ ' SEEPAGE PIT ~ ,DRAINFIELO ,OTHER. ANTmmATEO OATE OF COMPLETIo~ ~.~ SIZE OF UNIT TO' BE SERVED TY,E SEEP* E *RE* mRAM O, I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the J],sys'~~~s ir~ accordance with said code. ~~d ,~ ~~~~t.~ above described em i ~, DATE .~//7/7D APPLICANTS SIGNATURE ~ f , ! APPLIC -' IT FILLS OUT UPPER HAl ' Property Own~,r /-'~'d Ca/a' V" ~ ~ ~ [~ IV ~ Phone Mailing Addre~ ~ ~' ~ / ~ ~ ~Y~ /~/~ C F Zip Code ~ ~ ~ ~ ~ F~ ',/~ Buyer ~~ Address . Zip Code Lending Institution ~ ~ ~ Phone Address Zip Code {~"~ ,,' ..~{ '~' Realty Co. & A~nt / _ ~;~ '"" '~ ' Phone Address Zip Code LegalDesorlpt~n ~'~C ~,'~,'~,'0~ ~/0~ ~ ~u~ /7 Ty~ Resi~nce ~ Single Family ~ Multiple Family No. of Bedroo~ ~ ~ Other W~r Supply~h~ ~ ~ O ~ Individual ~- A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. ~ Community ~ , ~ For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal pndlvidual Year Indlv~ual Installed: ublic Utility When Connected to Public Utility: /~ ~ ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Date Date Date Date Inspector Inspector ~. Inspector Inspector Field Notes: w! ,%~ /~'7~"~ (~']~ .... ~ ~ , (~- (-,° -c~'7''- --~'~ ~. ~ CJ ( ~ APPROVED BEDR~O*MS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) C(~IDITIONAL APPROVAL* DATE ~ ~_ ~Q~'~ ~ Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023 (3/82) /~ CHEMICAL & G ~,OGICAL LABORATORIES ,~ ALASKA, INC. ' TELEPHONE (907)-279.4014 ' ANCHORAGE INDUSTRIAL CENTER /~~ 274-3364 5633B Street ~ ~.o ....... ~ Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Water System Name Phone No. Mailing Address City State · ?_. Zip code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. ) [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. 3 4 LOCATION · : Time Collected Collected By TO BE COMPLETED BY LABORATORY Analys~s shows this Water SAMPLE to be: .~ Satisfactory -]Unsatisfactory [] Sample too long ntransit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: [] Fermentation Tube ,El' Membrane Filter Lab Ref. No. Result* Analyst ~ ~ ,,- ,~,,' . _ i-T'I i-]"-I I I F-I-I wNo of colonies/lO0 mi or No. of Positive Dort~ons READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source a.m. Date Received Time RecelVl(I -- P.m. Lab. No. Presumptive 10mi 10mi 10mi' 10mi 10mi 1.0mi 0.1mi 24 Hours 48 HOURS Confirmatory 24 Hours 48 Hours EMB Broth 24 hours: Broth 48 houri:. Multiple Tube Report: 10mi Tubes Positive/Total 10mi Portlonl Membrane Filter: Direct Count Collform/lO0ml Verification: LTB BGB Final Membrane Filter Results Collform/lOOml Reported By . r* , Date , , ,- - 'i' Time: ", . ~ I.m. pomo Anchor ¢ PL,~. JH 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4'111 TONY KNOWl MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Edward S. Barno 8991 Vernye Place Anchorage, Alaska 99502 Subject: Lot 17 Block 2 Bruce Subdivision Surface water is presently draining to your well casing and pooling around the casing. Fill will need to be brought in and placed around the casing and the surface water drained away so that water will not stand around the casing. ® k , This item will need to be corrected prior to our approval. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw