HomeMy WebLinkAboutKLUANE TERRACE TRAILER EST #1 LT 10
GREATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 Eagle Street
Ancho~age~ Alaska ggso1
Phone 272-§457
June ~3, ~968
Mr, Bobby PennfnEton
610 KLm
Anoho~age, Alaska 9950~
SUBJECTi Sewage Disposal System
Serving Lo~ lO, Kluane Terrace
Dea~ Mr. Pennin&d:on ~
This notice is to remind you of the conditional appPoval of
· 1-,9 subject system by this office. The conditional approval
expires onJu~y ~, ~968~
Please contact this office to schedule final inspection of
the required modifications pPiom to backfilling.
If we have not heamd fmom you pmlom to the above expiPation
date, the system will automatically be disapproved.
Sincemely,
DAVID R. L. DUNCAN~ M. D.
Medical Di~ectom
BY:
D~H/sr~
cc~ Civilian MlltCaz.7 l~fe~ral Office
'-1~ Name .of person requesting approva~ ....
2. Mann Of property owner
3. LeEal descmiptio~ LOt
4. Number'of. bedrooms in house
5. Water Analysis:
~0~0 V A L OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
. .,. . 7 -..
a. Bacterial
b. Detergent
Well data:
a. Type
b. Depth
c. Casing Size
d. Distance from well to closest existing or proposed:
1. Sewer line
Other sources of possible contamination, i.e,, creeks, lakes,
houses~ barn~ drainage dltch~ etc. .
3. Seepafe Area
4. Cesspool'
5. Property Line
Sewage disposal system.
a. Age of system 3
b.
Septic tank capacity in gallons
Name of septic tank manufacturer
1. If "home made" show diagram on reverse side of this form.
seepage pit size and type ~~
Disposal
field
or
1. Distance to property line to house foundation
e. Pereo]~tio~.Test'r.esults
f. Percolation Test performed by
Use the reverse side of this form to show diagram, Diagram should include
%he foilowing information: ~poperty lines~.well location, house location,
n~.otic tank location, disposal area location, location of percolation test,
and direction of ground slope.
The l~for~tion on this form is true and correct to the best of my knowledge.
S~nature o~ Applicant ~ ' Date~$i~ned
\
TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL
~T~e above described sanitary ae~l~tmes are hereby approved, subject to the
........... ~$'llowing con~]ii'ions: ' '
! I
The above described sanitary facilities are disapproved for the following
reasons:
'g ~fre of ~f_'~'ic~i~ ~'~'/~,'" ~. Datel~".
Approval is valid for one year following the date of approval.
CPJ:cw
'" REQUEST FOR APPROVAL OF ~
INDIVIDUAL SEWAGE AND WATER FACILITIES,
(Fill out in Triplicate ). ~ ~'~ ~: .. ~..-~>'~
~. 1,!ama .of person requesting approval ~2.;~ /~7.~A,,_~
2. ' ~an~ off property~ owner
b. Detergent
6, Well data:
a. Type
c. Casing Size
d. Distance from well to closest existing or proposed:
1. Sewer line
2, Septic tank
3, Seepage Area
4. Cesspool'
5. Property Line
6. Other soumces of possible contamination, i,e., creeks, lakes,
houses, barn, drainage ditch, etc. ,
7, Sewage disposal system·
a. Age of 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 or seepage pit size and tsrpe ' ~, .... ~ I' : ,~ ~
1. Distance to property line to house foLkndation
Percolatior~ Te-st 'leesulJcs
f. Percolation Test performed by
~ Use the reverse,side of this form to show diagram. Diagram should include
· '~,~he roi_lowing information: ¢~operty lines;.well location, house location,
~t~c tank location, disposal area location, location of percolation test,
an~ direction of ground slope.
9, The 2-n'[o~on .on this form is true and correct to the best of my knowledge,
Signature '6f Applicant
Date Signed
~O BE FILLED OUT BY HEALTH DEPARTf4ENT PERSONNEL
~he above described sanitary facilities are hereby 8pproved subject to the
......... '_~'l!owing cond,l~ions i ' ' .....
The above described sanitary facilities are dis8pproved for the following
reasons~
Approval is valid for one year following the date of approval.
CPJ:cw
2.
3.
4.
5.
REQUEST FOR APPROVAL OF
IN DI VI D~iS1E~I~E inAiq~rl~I[~[eA~ I L IiInS
Numb er'of, bedro0ms in house
a. Bacterial
b. Detemgent "'" '
C. Casing Size
d. Distance from well to os ' ' g r proposed:
2. Septic tank ..
3. Seepage Area ~? .... :'
5. Proper~y nine .... . .....
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, bamn~ drainage ditch, etc.
Sewage disposal system,
a. Age of system
b. Septic tank capacity in gallons .
c. Name of septic tank manufactu~.~r
1. If "home made" show diagram on reverse side of this fomm.
d.' Disposal field or seepage pit size and type
1. Distance to property line to house foundation
e, ?ercolatlo~, Test
f. Percolation Test performed by
Use the reverse side of this form to show diagram. Diagram should include
-~he foilowing information: p~operty lines;.well location, house location,
~ptic tank location, disposal area location, location of percolation test,
and direction of ground slope.
9. The ~formation on this form is true and correct to the best of my knowledge.
'Signature 'of AppliCant
Date Signed
TO BE FILLED OUT BY HEALTH DEPARTNENT PERSONNEL
T e above described sanitary facilities are hereby approved, subject to the
........... ~6'llowing conditions:
Conditions:
The above described sanitary facilities are disappl~oved for the following
reasons ~
of
Approval is valid for one year following the date of approval.
CPJ:cw
INDIVIDUAL SEWAGE AND WATER FACILITIES ~
(['ill out in Triplicate) ~-~
Name of property o~f. er
Number'o£ bedrooms in house
Water Analysis:
a. Bacterial
b. Detergent
6~ Welt data:
b. Depth
c. Casing Size
d.
Distance from well to closest existing or proposed:
1. Sewer line
2. Septic tank
3, Seepage Area
4. Cesspool'
Property Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc.
Sewage disposal system.
a. Age of system .
b. Septic tank capacity in gallons
c. Name of septic tank manufactu~gr
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type
1. Distance to property line to house foundation
f. Percolation Test perfermed by
Use the reverse side of this form to show diagram. Diagra~ should include
~he foJ~owing information: p~operty lines~.wetl location, house location~
~ti¢ tank location, disposal area location, location of percolation test~
a~ direction of ground slope,
9. The in-formation on this form is true and correct to the best of my knowledge.
Signature of Applicant
DAte Signed ....
TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL
[--~r'The~ above described sanitary facilities
.......... ~llowing con~ions:
Conditions:
are hereby approved, subject to the
~The above descr/~b~e~d .sanitary facilities
reasons: , /~~ ~
are disaT~ov~ed for the following
Signatur. of ~f;f.'iei:AK.~: :~"'.~: ,, '- i ' 'Date '~"
Approval .is valid for one year following the date of approval.
CPJ: cw