HomeMy WebLinkAboutDEARMOUN #2 BLK 2 LT 9 REMOnsite File
Block 2
Lot 9 REM
-Y = "Im" I$) IWP
a te
Formerly
T12N R3W Sec
28 Parcel
#5.
There is
evidence
that this
file
is
related
to
this
current
property.
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GAAB-HD-I GF"OiTER ANCHORAGE AREA BOROP"M
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON -SITE SEWAGE DISPOSAL SYSTEM
MAILING,�
ADDRESS Z `A/ HONE
NAME- 4, x
EGAL DESCRIPTION,Z/_Z:_-,_Z,
LOCATION C
7
SEPTIC TANK:
DISTANCE FROM WELL
MATERIAL
NUMBER OF
COMPARTMENTS
LIQUID
LIQUID CAPACITY __Z,,
% GALLONS.
INSIDE LENGTH
INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:.
SEEPAGE PIT;
OF PITS /—OUTSIDE
DIAMETER-----
NUMBER
OR WIDTH
LENGTH, DEPTH
LINING MATERIAL
FROM WELL BUILDING FOUNDATION -7
DISTANCE FR
NEAREST LOT LINE
TILE DRAIN FIELD:
DISTANCE FRCIM WELL
NUMBER OF LI
ABSORPTION AREA
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
I FOUN
(STANCE BETWEEN LIN
SQ. FT. LENGTH OF EACH LINE
NEA
TRENCH WIDTH
aJ, C', SQ. FT.
TOTAL LENGTH
OF LINES
—IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH,GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN, ABOVE TILE
WELL:
TYPE
DISTANCE FROM WATER
DEPTH
IL
-,BUILDING FOUNDATION. SAMPLE
/ NEAREST
LOT LINE
NEAREST
SEWER
R LINE_�2�
SEPTIC SEEPAGE
TANK__, SYSTEM
TANKL-24 M CESSPOOL—,
OTHER
SOURCES
., ,
DISTANCES:
DIAGRAM OF SYSTEM
-4,
DATE APPROVED
HEALTH AUTHORITY
NAME OF APPLICANT. 7�A 10- e_' L aE 4- XJVIEA�ILING ADDRESS PHONE NO.
RESIDENCE ADDRESS 5- 4 11
��
APPLICATION TOINSTALL: SEPTIC TANK____��_''SEEPAGE P|T___��__.DRAIN FIELD -
TO SERVETHEFOLLOVV|NGFAC|L|TY
FINANCED THROUGH c~TOBEINSTALLED BY -
PERCOLATION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
'OTHER
THIS IS TO SERVE AS PERMIT TO INSTALL
AS DESCRIBED BELOW. SIZE OF UNIT SERVED
.8EPT|CTANKG|ZE PE SEEPAGE AREA TYPE �~c/
DIAGRAM DFSYSTEM
DISTANCES:
^Hx"�
�*~
�
c^crx^urvomry
OR
cs"scoocs/sws°
I
lcerfifythat lumfamiliar with the requirements ofGreater Anchorage Area Borough Ordinance No.28-68 and that the
above described system iyin accordance with said code.
DATE .— APPLICANTS S|GNATURE
V-1
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
Ea -me of person requesting /ap roval.
2. NaTfte of property; owne
3. -reFal, descriptio
4. Numbel- of,
in house
5. Water,, Analysis:
a- Bacterial
b. Detergent
6. Well I data:
a
b
c.
Type
Depth
Casing Size lop
rI
Casing
from well to closest existing or proposed
1 Sewer line
2. Septic tank lec '-o-.
3. Seepage Area
- � Cam• ,!�/! �- ..
4. Cesspool,
5. Property Line
6. Other sources 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
—45
c . Name of septic tank manufacturer
1. If "home made" show diagram on reverse side of this for
d., Disposal field or seepage pit size and type
�J
1. Distance to property line to house foundation
r•
e, Percolation, Test 'results
f. Percolation Test performed by ,
Q. Use the reverse side of this form to show diagram. Diagram should include
the fo]l.o•,iing information: ppoperty lines; .well location, house location,
tank location, disposal area location, location of percolation test,
ar:d direction of ground slope.
9. The ion on this form is true and correct to the best of my knowledge.
SiF,nature of Applicant Date Signed
"0 BE FILLED OUT BY HEALTH DEPARTITENT PERSONNEL
The above described sanitary facilities are hereby approved, subject to the
7011owin7 conditions;
Conditions:
,
The above described sanitary facilities are disapproved for the following
reasons;
.. �;
Sign tur of1f�ea Date f
Approval is valid for one year following the date of approval.
CPJ:cw
44RO
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
of person requesting approval
2. ?1;11- of proper-
3* des ,cr,ipt
4. Numielnf bed -rooms in house
5. Water. P-n;qly.Fis:
cguc
a. Bacterial
b. Detergent
6, Well data:
a. Type
b. Depth
c. Casing Size
d. Distance from well to closest existing, or proposed:
I 'T�- /
1. Sewer line
2. Septic tank () r
3. Seepage Area_
g
4. Cesspool,
5. Property Line
6. Other sources Of Possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc.
7. Sewage disposal system.
a. Age of system
At
b. Septic tank capacity in gallons
c. Name of septic tarik manufacturer
1. If "home made" show diagram on reverse side of this form.
d. Disposal field or seepage pit size and type
dl
1.
Distance to property line to house foundation L/ C,
------ L—
0
t•
e. Percolation, Test '!esult.s
_ f. Percolation Test performed by
Use the reverse.side of this form to show diagram. Diagram should include
-the following information: property lines; well location, house location,
r�,<rllc tank location, disposal area location, location of percolation test,
and direction of ground slope.
9. The 1-11-F T-1-1tion on this form is true and correct to the best of my knowledge.
Signature of Applicant Date Signed
TO BE FILLED OUT BY HEALTH DEPAP.TIIENT PERSONNEL
CaThe above described sanitary facilities A
k~� Y ties are hereby approved, subject to the
;ollowing conditions:
Conditions: art r
The above described sanitary facilities are disapproved for the following
reasons:
Signa ure_`of"1ea1.
Date a:?
Approval is va 'd for one year following the date of approval.
CPJ:cw