HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 4AEAGLE RIVER VALLEY
RANCHE-TTES
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GAAB-HD_,. R".. "IER ANCHORAGE AREA LF — 4
WEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING fF'x
NAME _'r &L,
= ADDRESS ; PHONE
LOCATIONXL DESCRIPTION"�
SEPTIC TANK: I
DISTANCE FROM W
LIQUID CAPACITY f? GALLONS
SEEPAGE SYSTEM:
SEEPAGE PIT:
f'
` NUMBER OF
\TERIAL f COMPARTMENTS
CIc ID
INSIDE LENGTH INSIDE WIDTH DePTH.
NUMBER OF PITS —OUTSIDE DIAMETER OR WIDTH Z Z ,LENGTH ` DEPTHS,
LINING MATERIAL ( 1 C` DISTANCE FROM WELL �` BUILDING FOUNDATION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL
FOUNDATION NEAREST LOT LINE
OF LINES
NUMBER OF LINES
DISTANCE BETWEEN LINES TRENCH WIDTH
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: C-
e 7
DISTANCE FROM
WATER
TYPE
DEPTH
BUILDING FOUNDATION.
SAMPLE NEAREST
NEAREST
SEPTIC SEEPAGE
OTHER
LOT LINE
SEWER LINE
, TANK SYSTEM
CESSPOOL , SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
f
-
DATE
,., .:-
� .^
,�-APPROVED
��
,__HEA1TH
AUTHORITY d*
15�_')
NAME OF APPLICANT. 0 Ade A0 J;. MAILING ADDRESS PHONE NO.,
RESIDENCE ADDRESS LOCATION OF INSTALLATION em
LEGAL DESCRIPTION 19 6a 46 L ,I, ()O�Cz4 AIJt4--d_j4=-�
APPLICATION TO INSTALL: SEPTIC TANK , SEEPAG� PIT , D RAN FIELD—, OTHER
TO SERVE THE FOLLOWING FACI,�ITY 9 1 /b& a4,,6zV-?n - Z
FINANCED THROUGH TO BE INSTALLED BY
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT -(,,- ML -11A ral
THIS IS TO SERVE AS Q, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED.
MOO YPE Ad -SEEPAGE AREA C49 )-9
SEPTIC TANK SIZE �/ - DIAGRAM OF SYSTEM
TYPE
0
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATELA 6% APPLICANTS SIGNATURE q P2�
0
1'77 7 1 11
F',
GAAB-HD-2GREATEh -tNCHORAGE AREA
Atb'UGH
case
HEALTH DEPARTMENT
i -
oul
"
327 Eagle St. Anchorage, Alaska 99501
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
15�_')
NAME OF APPLICANT. 0 Ade A0 J;. MAILING ADDRESS PHONE NO.,
RESIDENCE ADDRESS LOCATION OF INSTALLATION em
LEGAL DESCRIPTION 19 6a 46 L ,I, ()O�Cz4 AIJt4--d_j4=-�
APPLICATION TO INSTALL: SEPTIC TANK , SEEPAG� PIT , D RAN FIELD—, OTHER
TO SERVE THE FOLLOWING FACI,�ITY 9 1 /b& a4,,6zV-?n - Z
FINANCED THROUGH TO BE INSTALLED BY
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT -(,,- ML -11A ral
THIS IS TO SERVE AS Q, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED.
MOO YPE Ad -SEEPAGE AREA C49 )-9
SEPTIC TANK SIZE �/ - DIAGRAM OF SYSTEM
TYPE
0
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATELA 6% APPLICANTS SIGNATURE q P2�
0