HomeMy WebLinkAboutRACHEL LT 3
Q,GREA,FR ANCHORAGE AREA BOR~,~JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
~N REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LEGAL DESCR,P
LOCATION ~
SEPTIC TANK:
DISTANCE ·
FROM WELL ~573
,NS,DE LENGT,
MAN UFACTU R E ~~*
d COMPARTMENT5~"~.
MATERIAL _~~__~ NUMBER OF ~
INSIDE WIDTH
LIQUID DEPTH
.LIQUID CAPACITY/S/-) ~ GALLONS.
NUMBER OF PITS __ DIAMETER OR WIDTH LENGTH DEPTH
LINING MATERIAL
BUILDING FOUNDATION ~
~N
CRIB SIZE: DIAMETER~DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE~ ABSORPTION AREA (WALL AREA) SQ. FT.
WELL:
BUILDING
FOUNDATION ,
CONSTRUCTION
~, DEPTH DISTANCE FROM:
NEAREST NEAREST SEPTIC SEEPAGE
LOT LINE SEWER LINE TANK, SYSTEM .
CESSPOOL
, OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
PIPE MATERIALr '
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
MUNICIPALITY OF ANCHORAGE_M.I,~N C ............. Z'~,,*~
DEPAR~ENT OF H~LTH & ENVIRONMENTAL PROTECTION DEPT. OF H~ALTH &
~ L ;t~ - A~hom~, A~k. 99501 ~IRO~NTAL P~OT[~ION
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 2~720 NOV 1
OF INDIVIDUAL WATER AND SEWE~~
REQUE~
FOR
APPROVAL
~. Pfl~PERTY OWNER ~ PHONE
MAILING AODRE~
~0PERTY RESIDENT (If different a~) ~ PHONE
~ BUYER PHONE
MAILING ADDRE~
~ LE~DINQ INSTITUTION I PHONE
MAILING ADDRE~
MAILING ADDRE~
STREET LOCATt04
TYPE ~ ~IOENCE
[~ INDIVIDUAL*
I--~ COMMUNITY
I--I PUBLIC UTILITY
SEWAGE DISPOSAL $'~"FEIVl ~ INDIVIDUAL/ON-SITE"
[] PUBLIC UTILITY
NUMBE~ OF BEDROOMS
I-'1 One [] Four [] Other
[] Two J~ Five
[] Three [] Six
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
**If individual/on-site, give installation date
If system is over two. (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
~10(3178)
-: i THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
r-I SINGLE FAMILY I--I ONE [] THREE [] FIVE I'-] OTHER
[] MULTIPLE FAMILY [] TWO [~] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ~-~ \(~"~. (~
Connection Verified
I'-]Septic~Ta~k or [~] Holding Tank
Size: /3 ~-~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL__ /3
Absorption Area to nearest Lot Line
5. COMMENTS
[~'~P~RoVED FOR _~'"~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY ~q
LEGAtL ~)ESCRIPTION
72-010 (Rev. 3/78)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage~ Alaska 99503 274-4561
Date Received February 18f 1976
Approval requested by:
Mailing Address:
Property Owner:
Mailing Address:
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
COIIV o
Alaska Statebank
310 East Northern Lightg Blvdo Phone: 279:~7637
William & Rachel Smith
Phone:
Star Route A Box 1750f 99507
Legal Description: Lot 3. ,Block 25 Rachel Subdivision
Location: Off of O'Malley Road on Can% Drive
'Type of facility to be inspected Single Family Noo of bedrooms
Well Data:
Individual
Ao Type B. Depth
Co Construction
Do Bacterial Analysis
7o Sewage Disposal System:
Ao Installed
C~ Septic'Tank: l, Size
Do Seepage Pit:
Eo Disposal Field:
8o Distances:
A. Well to: Septic tank
Nearest lot line
B~ Foundation to septic tank
1o Absorption Area
Total length of lines
On-site system°
Bo Installer
2. Manufacturer
2o Material
, Absorption area
, Other contamination
~ Absorption area
, Sewer Lines __
C~ AbSorption area to nearest lot line
E0.~034 (1/74) Paae 1 of two Daqes
DEPARTMENT OF ENVIRONMENTAL QUALITY
· " ~1 ~) 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
~L~( ~)'INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO .VA FFJA CONV ~J"'
2. Property Owner: //~,/Z~-~/~,-~ ~/~_~/~'~
Mailing Address: _J/~W ~ /7~w? ' O~-~'-~"M~ ,Day Phone
/
3. Name of Buyer: ~-~*~ ~' . ,~./~:7 /~. ,
Mailing Address: q~? /~. ~/?~ ~'~ ~d.,J Day Ph0~e
4, Name of Lending Institution: ~-)~-~'~'_ ,~-~
Mailing Address: ~-~J/) ~. ~ _,~-/~- Phone
5. Name of Realtor or Agent:
... Mailing Address: Phone
6. Legal Description:
Location:
7. Type ot Facility to be inspected:
8. Water
'1 ~ ot Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
9. ~;ewage Disposal System
EQ-037 (1/74}
Type of System: Public Utility
If Individual. date'of
'
inaivid'Ual "~'"~
Individual (on-site)
P~ge 2 of two pages - Re, st for Approval of Individual ,~ ~r & Water Facilities
Lega~ Description Lot 3 .15lock 25 Rachel Subdivision
Comments
Approved
Disapproved Date
Approval Valid for one year from date s~ied
Greater Anchorage Area Borough~ Department of Environmental Quality
DIAGRAM OF SYSTEM
i certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily°
SIGNED
Date
E0-034 (1/74~
Depeztmont ,of[ Health
276-222!
4.1
Anchorage, Alaska 99503
~ub~ou~: Lo~ 3 ~lock 25 Rachel Sub~lvlsion
~earSir=
An Inspection of ~he sub}set ~oper~ev~aled the
1, ~he sMr system lacks a nopLtc tank which is za~ut~ed;
2. ~ e~ot d~c8 o~ ~e so~age aras to ~e'~ll cauls '
' ~t~de~o~nefl as r~r~ sta~pt~ is no~ In Fla~e.
the ~l~ m~t ~ te~ o~e ~e alsta~e f~ the~well, !s
~llsh~ as ad~ua~ a~ a sta~pi~ ins~lle~.
27t-2221, extension 2~3..
~e8 N. ~hbolz
~anitariam
cc: William Smith
Star Route A Bo~ 1750
Anchorage