HomeMy WebLinkAboutSOUTHWOOD PARK BLK 3 LT 36
GR~:-~.TER ANCHORAGE AREA BOROI>.~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279~2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS ~'~ ]'~'~ ~ PHONE_
LEGAL D ESC RI PTIO N '~'~" ";~
DISTANCE FROM WELL
LIQUID CAPACITY
NUMBER OF ~.~
./'~"'~) MAT ERIAL -~"-7'~.-~'~ COMPARTMENTS - '
,.~,~L.,~'/,~ ..~.7:'-',,~"~ ~,".~,~9 LIQUID
GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH____
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAL
NEAREST LOT LINE
OR WIDTH /'~ / /'~'( /
"-'"-" , LENGTH , DEPTH
DISTANCE FROM WELL ~ /~ , BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl FOUNDATION
NUMBER OF LINES ISTANCE BETWEE S
DEPTH:~ff'OP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE'
. NEAREST LOT LINE_
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE --
.,/~,~.~ DISTANCE FROM ~ WATER .~l~/'.~:~ NEAREST
WELL: TYPE ~'~ ~ ~ /~DEPTH '~' . BUILDING FOUNDATION._ SAMPLE
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE . SEWER LINE -- . TANK -- . SYSTEM ~ CESSPOOL -- SOURCES'~'
DISTANCES:
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATEF-'ANCHORAGE AREA ?"gROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
/Z~"O~-~'~:;)L2/~,,,-'>Z ~J/J~;NI~ILING ADDRESS ~'
RESIDENCE ADDRESS
APPLICATION TO INSTALL: SEPTIC TANK ~SEEPAGE PIT DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ,/' '/~/,~5'/~') ~
PERCOLATION TEST RESULTS
TO BE INSTALLED BY GLG ~-
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF, U.N[T,T? BE S_ERVED ,'~ ~,
/~)~)f .~d¢-~ DIAGRA~ OF SYSTEM
· DISTANCES:
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. ..~--~-. . ~( -
APPLICANTS SIGNATURE
GREATER ANCHORAG[ AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
o
Itt
APPROVAL REQUESTED BY:
ADDRESS:
LEGAL DESCRIPTION: )[~p ,.~ /
TYPe FACILITY TO BE INSPECTED:
NUMBER OF BEDROOMS: ~
WELL DATA: /]/~ /~'~E~
A. TYPE
B. DEPTH
C. SIZE
D. CONSTRUCTION
E. BACTERIAL ANALYSIS
SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON
1 . .S I Z E ~ ~> ,5 (_9 //~//~)~
2. AGE / ~ ~'
3. MANUFACTURER /~p~"t//'c~ ~'~'~
4, INSTALLER
APPROVAL
PAGE TWO
l
REQUEST FOR SEWER & WATER FACILITIES
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE
E. WELL TO OTHER POSSIBLE
F. FOUNDATION TO SEPTIC TANK
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
COMMENTS:
CONTAMINATION
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF
ENVIRONMENTAL
QUALITY
October 19, 1973
Mr. George Foster
2617 ~. 67th Avenue
Anchorage, Alaska
99502
Public Sewer Available to Block 3,
Lot 36, Southwood Park Subdivision
Dear l,ir. Foster:
Borough sewer is now available to you. Your present sewer
system is located too close to the community well which
serves you. Due to the location of your sewer system, you
will need to connect to borough sewer by May l, 1974.
You will need to obtain a sewer connect permit from sewer
maintenance at 3500 Tudor Road before the connection is
made.
If you ))ave any questions concerning this matter, please
contact me at 274-4561, extension 137.
Sincerely,
Robert C. Pratt,
Environmental Control
RCP/ko
Officer III
Certified #740191
RECEIPT FOR CERTIFIED MAIL--30(~ (plus postage)
STREET AND NO,
P,O., STATE ARD ZIP CODE
OPTIONAL SERVICES fUR ADDITIONAL FEES
~N ~k. 1. Shows to WhOm and date delivered ........... 15¢
With delivery to addressee only ............ 65¢
RECEIPT p 2. Shows to whom, date and where de]ivered .. 35¢
SERVICES With delivery to addressee only ............ 85¢_
DELIVER TO ADDRESSEE ONLY ......................................................
SPECIAL DELIVERY (extro Ieee recl~i,rec~) ....................................
POSTMARK
OR DATE
PS Form
Apr. 1971 3800
NO INSURANCE'COVERAGE PROVIDE8-- (See other
NOT FOR INTERNATIONAL MAIL . GPo :]9~ o-4e~?~
/q
· tar. Geottge gostei'
o?o?
You w.i11 need to ob{ain a Sewer connect permi~ from se
nalntenance'&'t 3500' Tudor· Road. before-the co:nnect.ion
made,
~ . 4 nc'ernin "this ~at,ter.; please
If you have any quest!OhS Co - g . ,
con~act me at 274-4561, extension .13'7.
Sincerely, '
Robert C.' Pratt
Environmental Control Officer III.
lb
RECEIPT FOR CERTIFIED MAIL--30c (plus postage)
SENT TO
197~,____ NO INSURANCE COVERAGE
PROVIDEO--
Apr.
POSTMARK
OR DATE
(See ofher side)
NOT FOR INTERNATIONAL MAIL