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I~edi~rme 4S 471
Poly Pak 150 sel~) 4P471
SIGNED DATE / /
SEND PARTS I AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY
DETACH AND FILE FOR FOLLOW-UP
G~ ,TER ANCHORAGE AREA BORO H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
594
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
MAILING
ADDRESS /'-~ -/.~"'".~
DISTANCE FROM WELL_¢~-~/-2/'~//'./~. --'z~,-;z-,~
LIQUID CAPACITY //~'~ .2'~)~'d~ GALLONS.
NUMBER OF
M A T E R I A L,.~,~'~.~'~./~'~' ~,~'~ COMPARTMENTS ,'/
INSIDE LENGTH / INSIDE WIDTH ~ LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
,- /
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH ,~ , LENGTH , DEPTH
LINING MATERIAL ~ ~:':) ~ (:.~.,,,,4-,.z~' _ ~ STANCE FROM WELL ,~__r,~.~/..-/~,,.:..............~ ../~ . BUILDING FOUNDATION
NEAREST LOT LINE .=>~ ~ ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) / -~?'~- SQ, FT,
TILE DRAIN FIELD: ,/(/.~,/~
DISTANCE FROM WELl
NUMBER OF LINES
ABSORPTION,~
F.~QU N D/,cTIO~N
,.~'~DISTA~'~E BET WE EN LIN ES
SQ. FT, LENGTH OF EACH LINE
.,~E~,EST LOT LINE
.T~CH WIDTH
/
/
DEPTH.~P OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
IN, TOTAL EFFECTIVE
IN. ABOVE TILE
W E L L: ~.~;-,/,w~y~ ,~.4~.'/z.p
T Y P F ~'-*[~,,~:-~/~'z-- , DEPTH ,:d//~''
NEAREST SEPTIC
LOT LINE ,,,,,~/<~ , SEWER LINE z'~/~ , TANK
DISTANCE FROM
BUILDING FOUNDATION·
SEEPAGE
~"~,"~/' , SYSTEM
WATER
SAMPLE ~ .""~ , NEAREST
OTHER
CESSPOOL
DISTANCES:
DIAGRAM OF SYSTEM
DATE
HEALTH AUTHORIIY
GREAI"ER ANCHORAGE AREA BONtoUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
PERMITNO./ 4 /'S-'
INSTALLAT,ON LODAT,ON g/.¢~.
LEGAL DESCRIPTION /~ ~'~'~' ~d
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS ~/~
SEEPAGE PIT ., DRAIN FIELD , OTHER
NOTE= THIS PERMIT 1~ NOT VALID WITHOUT SOIL TE~T
~o~..~,o~ ~A~ A.~,~,.*~ /~/ ~ ~F
FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
¢
TYPE ~'J~'7-~'~' SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK
· SEEPAGE Pit , DRAIN FIELD
TO NEAREST lot LINE.
/
WATER Main TO SEPTIC TANK
DRAIN FIELD '~
SEPTIC TANK,
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURSED SOil.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WIth AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO ~OROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DATE
. APPLICANT'S SIGNATURE
.~EATER BNO'IORAGE N~^ BOROUGH
! 9:!AL?H DEPgRT]%NT
327 EAGLE STREET
NNCHORAGE, ALASKA 99501
279-2511
INSPECT:
REQUEST FOR APPROVAL OF
INDIVIDUAI, SEWAGE AND WATER FACILITIES
FOR
2. Property Owner., .~/,~:;
3. Legal Description
4. Type of FacilJ. ty to be Inspected
Number of Bedrooms
Well Data:
A. Type
B. Depth
C. Size
D. Construction
E.
Bacterial Analysis
Sewage DispOsal System:
A. Septic Tank (If homemade, show diagram on back)
1. Size
2. Age
Approval Request for Se~ & ~Vater Facilities
Page Two
Seepage Pit
2. Lining_
C. ~ Disposal Field
1. Number of Lines
2, Total Length
7. Required ,qeasurements
B...Well to Seepage Pit
C. Well to Sewer Line
D. Well to Property Line
B. [Sell to Other Possible Cont~Rnation~,,/
F. Foundation to Septic Tank
G. Foundation to Seepage Pit
H. Seepage Pit to Property
8. COUNTS:
APPR~
GREATER ANCHORAGE AREA BOROU~ HEALTH DEPARTMENT
HDll70
1970
Veterans Ad,~tnistration
P.O. Box 1399
~alchorago, Alaska 99501
SUBJECT: Sower Syste~a for Tract 23, Spenard
~ieigltt $ ,,ubdivisi on
This ~epartnleat would bo acceptable to giving approval
fo~ the subject sewer system pending tho escrm~ of funds
£o~- the tnstallatioa of an approved septic tank before
July 1~ 1971. The system as is should be adequate until
that time.
~ater is provided by (;ontral alaska Otilities ~hlch is
au apl)rOved source by thi~ Department.
Sincerely,
John R.
Sanitarian
t';illta~,~ J. Gamel
~Y~a~.x_, Nama .of
2. %Name' of
3.
4.
5. ~ate~.Analy$is:
REQUEST FOR APPROVAL OF ~[,._o {~ I~)
INDIVIDUAL SEWAGE AN~ WATER FACILITIES ~'
(~ill out in ~riplicate) ~/ .....
a. BacteriaJ. .
b. Detergent .
WeLl dar a:
a. Type_.
b. Depth~
c. Casin~ Size .
de
Distance from well to closes~ existing or proposed:
1, Sewer line .
2. Sept/.c tank
3, Seepage Area
4, Cesspool'
5. Property Line_ .
Sewage d~.sposal ~¥¢t~e~0 ,:' , :,
a. Age of system~.~)
b. Septic tank capacity in gallons[~ ,-/~,~5~3
Other sources of possible contamination, i.e., creeks, lakes,
houses, barn~ drainage ditch, etc. .............. .
1, If "home made" show diagpam on reverse side of this fo~m.
1. Distance to prope~y., line ~ / to house fo~dation ~ /
~,~~ Percolation Test performed by .~ .......... =~ .......... .
i%the reverse,side of this for,m to show diagram. Diagra~ should include
following lnfor~natlon: property lines;.well location, house location.
66pTic tank location, disposal area location, location of percolation
a~,, direction of ground slope.
The information on this form is true and compact to the best of my knowledge.
'~ Signature of AP~i'icant ' Date
TO BE FILLED OUT BY HEALTtt DEPART{~.ENT PERSO~,[NEL
~e above described ~anitary facilities are hereby approved subject to the
........... ~'l~,gying con~ion.s.: '
The above described sanitamy : acll~t~es are disapproved for the following
Peasons:
' Sign:i
.... "- .Approv:l~
..- CPJ:ew
valid for one yeap following the date of approval.