HomeMy WebLinkAboutSOUTHWOOD PARK BLK 3 LT 44
GAAB HD I
G~:-~TER ANCHORAGE AREA BORO~U.(~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
iNSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
MA,.N° v,_5
ADDRESS
~:~ 7 'm~ LEGAL DESCRIPTION~7~'~L~-'
PHONE.
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID C A PA C IIY _ ~/~'~") ~-----)
MATERIAL /~ -('~,~g///~'~ NUMBER OF
-- .COMPARTMENTS
GALLONS. INSIDE LENGTH INSIDE WlDIH
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS__
LIMING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT: ~X ,5j.~'7-,/~.~
i
OUTSIDE DIAMETER OR WIDTH_
DISTANCE FROM WELl
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
· LENGTH . DEPTH
BUILDING FOUNDATION
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
FOUNDATION__
DISTANCE BETWEEN LINES
, NEAREST LOT LINE
TRENCH WIDTH ·
TOTAL LENGIH
, OF LINES
IN. TOTAL EFFECTIVE
ABSORPTION AREA__
SQ. FT. LENGTH OF EACH LINE.
DEPTH: TOP OF TILE TO FINISH GRADE
.DEPTH OF FILTER MATERIAL BENEATH TILE
.IN. ABOVE TILE __
WELL: TYP~ /~ DEPTH
NEAREST
LOT LINE . SEWER LINE
SEPTIC
. TANK
DISTANCE FROM
, BUILDING FOUNDATION.
SEEPAGE
. SYSTEM
· WATER
SAMPLE
CESSPOOl
NEAREST
OTHER
SOURCES
DISTANCES:
,-s,e =
DIAGRAM OF SYSTEM
DATE
APPROVED
HEALIH AUIHORllY
GAAB HD I
GP~ATER ANCHORAGE AREA BORO~-'~GH
:' " HEALTH DEPARTMENT I
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCAT,ON 'r-5 C----
SEPTIC TANK:
DISTANCE FROM WELl.
NUMBER OF
MATERIAL COMPARTMENTS_
LIQUID
LIQUID CAPACITY GALLONS, INSIDE LENGTH INSIDE WIDTH. DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF P,TS / OUTS'DE D'AMETER__ '~ ORW~DTH ,/~ .LENO'H,/ . DEPTH__(,"
£
~, ~ z, ,../
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE F, OM WELL , . NEAREST LOT LINE / OF~..~LINES
NUMBER /,.-'"~ISTANCE BETWEEN LINES TB~I~K~ IN. TOTAL EFFECTIVE
ABSORPTION ARE ~A~ SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GR DE DEPTH OF tILTER MATERIAL BENEATH TILE hL ABOVE TILE.
~U ~ DISTANCE FROM WATER
WELL: fY DEPTH . BUILDING FOUNDATION. SAMPLE NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE .. SEWER LINE . lANK . SYSTEM CESSPOOL . SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
GAAB~FID-2
GREATE " ,,ANCHORAGE AREA DROUGH
HEALTH DEPARTMENT
327EagleSt. Anchor~e,A~&a 99501 279-2511
Case No. '~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~.'~:CL
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY_
FINANCED THROUGH
PERCOLAIION TEST RESULTS
, SEEPAGE PIT
MAILING ADDRESS ~'~
LOCATION OF INSTALLATION
, DRAIN FIELD , OTHER
TO BE INSTALLED BY, 5~-
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 UNIT TO BE SERVED
· SEPTIC TANK SIZE .TYPE SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
DISTANCES:
I certify that i am familiar with the requkements of Greater Anchorage Area Borough Ordnance No. 28-68 and that the
above described system is in accordance with said code.
APPLI CANTS SIG NATU R E ,~' ~'~,,
DATE
REQUEST FOR BPPROVAL OP
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fiji out in Triplicate)
'~ Name .of person requesting ~proval ......... _. ~
2, Name of property,,owner ~, ~,~ _, ,
3, Legal descriptioR .....
4. Number of ]~edrooms in house 3
5, Water Analysis: ~ ~ ~[
a. ~aetemial .
b. Deter~en~
5. Well data:
Type
b. Depth.
c. Casing Size
Distance from well to closest existing or proposed:
1. Sewer line
2. Sept J c tank
3. Seepage Area
Cesspool'
5. Property Line
6.
Other sources of possible eontamination~ i.e., creeks~ lakes,
houses, barn~ ~ralnage ditch, etc. ·
Sewage disposal system.
b. Septic tank capacity in gallons .......
c. Name of septic tank manufactu~e,r
1. If "home made" show diagram on reverse side of this form,
d,' Disposal field OF seepage pit size and type
1. Distance to property line
to house foundation .........
e. Percolatio~k T~st '~sults
f. Percolation Test performed by
Use the reverse .side of this form to show diagram. Diagram should include
"X%he foJ_l.o~ing info~mation: p~operty lines~.well location~ house location,
~t~:~c tank location, disposal area location~ location of percolation test,
a~. direction of ground slope.
The ~r[o~o~ on Ykis form is true and correct to the best of my knowledge,
%~gnature of Applicant ~ Date Signed
\
~O BE FILLED OUT__BY HEAqTH DEPART~.JENT PERSONNEL,
above described sanitary facilities are hereby approved, _su_bject to t~he_
rollowzng cond~ions:
The above descPibed sanitary facilities are disapproved for the following
reasons:
owing he date of approval.
.- CPJ:cw
December 3~ 1968
Mr, Dan Rapalee
Local KepPesentative
Veterans Administration
Box 139§
Anchorage~ Alaska 99501
SUBJECT: Sewer and Water Facilities
Serving Residence at 2501 West 67th,
Lot 1;~, Blk. 3, Southwood Perk Subd.
Dear Mr, Rapalee~
Personnel of the Greater Ancherage Area Borough Health Department have
inspected the subject residence and found that the water supply is
from an approved community system. The sewer system presently is a
cesspool°
This Department will grant conditional approval to this system until
July 1~ 1969, at or before which time a 1,000 gallon septic tank is
to be installed in the system.
This Department re¢onm~ends that sufficient funds be put in escrow for
the installation of the septic tsnk.
S~ncerely,
DAVID R. Lo DUNCAN, M. D.
Medical Director
BY~
Sanitarian
RRS/srr