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HomeMy WebLinkAboutSEACLIFF BLK 1 LT 5AQII -2z1 -D (o _Opo mu LOCATION_ SEPTIC TANK: V '%ILK AIM%.19VKAVC AKCA DVKV yn HEALTH DEPARTMENT �� NO 407 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING n �g L S cCU! AnnDGcc 3 ,-t .PHONE'q S`j ESCRIPTION 4/5 t - b//4 l - ` c ��Arl C �j �L��FC r��%,� NUMBER OF DISTANCE FROM ELL �`—�P� MATERIAL ��' �,j�/� COMPARTMENTS UID LIQUID CAPACITY 7�% p GALLONS. INSIDE LENGTH i 7 e 5_71L_ y NSIDE WIDTH—DEPTH- SEEPAGE/vIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS O OUTSIDE DIAMETER OR WIDTH, LENGTH , DEPTH LINING MATERIAL � L�� �— i � • DISTANCE FROM WELL BUILDING FOUNDATION NEAREST LOT LINE 15 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) z © z SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL_ NUM ER OF LINESS-- ABSORP NEA_ TOTAL LENGTH UNDATION , NEAREST LOT LINE OF LINES ISTANCE BETWEE NES _ T�EI3lClf7t H IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: mea c- /; f / 4 L 11/c DISTANCE FROM WATER TYPE , DEPTH BUILDING FOUNDATION. SAMPLE NEAREST NEAREST r— SEPTIC SEEPAGE OTHER LOT LINE '� SEWER LINE—, TANK , SYSTEM , CESSPOOL , SOURCES DISTAr pv+ca A c1 `11 Xc 3 ,fin_ -_3 B D=46 DIAGRAM OF SYSTEM I DATE ✓31 11V APPROVED HEALTH AUTHORITY l GAAB-HD-2 GKLA'1'Ll, X1'NU11U1tAt_vh AHEA 01tU U UH Case No./" HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM — APPLICATION & PERMIT FINANCED THROUGH TO BE INSTALLED BY �3�L✓/'.?%/i PERCOLATION TEST RESULTS 5 ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS` ZZ -2 1- -3c PERMIT TO INSTALL A n AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED SEPTIC TANK SIZE TYPE crxPl✓e,%<�-SEEPAGE AREA L'ee,C TYPE /yl� DISTANCES: 0 Z HEALTH AUTHO OR LICENSED DESIGNER 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. DATE `'�G/ APPLICANTS SIGNATURE _�_>�' — NAME OF APPLICANT MAILING ADDRESS PHONE NO. RESIDENCE ADDRESS /—Lal,' l LOCATION OF INSTALLATION LEGAL DESCRIPTION l07 -.5 1&_%�Cli/�=- APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT DRAIN FIELD OTHER �— TO SERVE THE FOLLOWING FACILITY S/// 1z' , '5 11& FINANCED THROUGH TO BE INSTALLED BY �3�L✓/'.?%/i PERCOLATION TEST RESULTS 5 ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS` ZZ -2 1- -3c PERMIT TO INSTALL A n AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED SEPTIC TANK SIZE TYPE crxPl✓e,%<�-SEEPAGE AREA L'ee,C TYPE /yl� DISTANCES: 0 Z HEALTH AUTHO OR LICENSED DESIGNER 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. DATE `'�G/ APPLICANTS SIGNATURE 1. N EATER ANNMORAGE AREA 30ROUGH PF.ALTH DEPART ENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 279-2511 DATE RECEIVED 71 INSPECT: n TIME: < o REQUEST FOR APPROVAL OF INDIVIDUAL SELVAGE AND WATER FACILITIES FOR Approval Requested By Address_ -1 %oC)X- Phone j Property Owner ( �� � � � � �� hone (5 -5679 3. Legal Description 4. Type of Facility to be Inspected Number of Bedrooms S. Well Data: A. Type B. Depth C. Size D. Construction E. Bacterial Analysis 6. Sewage Disposal System: /z ALL -L am" jC , STREET: <-9 Z�/ JA)ft— / ,4- A— A. Septic Tank (If homemade, show diagram on back) 1. Size 2. Age 3. P9anufacturer= _ -:_ G „��j 4. Installer Approval Request for Sewa & Water Facilities Page Two s B. Seepage Pit 1. Size f, X—? >! iii`✓ 2. Lining /.-r - -✓ljcr ✓ ✓ ' :: i ✓. C._ Disposal Field 1. Number of Lines -- 2. Total Length 7. Required Measurements A. Well to Septic Tank B. Well to Seepage Pit C. Well to Sewer Line D. Well to Property Line E. Well to Other Possible Contamination F. Foundation to Septic Tank i G. Foundation to Seepage Pit H. Seepage Pit to Property Line l 8. COMMENTS: APPROVE `UY4 A . DISAPPROVED: DATE: , AtA 16, 1,vw DATE; VALID FOR ONE YEAR FROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT ED1170 5 ;(ZL•'ATER ANMORAGE AREA BOROUGH PEALTH DEPARTHENT 327 EAGLE STPFET ANCHORAGE, ALASKA 99501 279-2511 DATE RECEIVE INSPECT:, 7) TIME: 3 REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES FOR f f 1. Approval Requested By Address !% C/, 2. Property Owners 3. Legal Description L A4 'r'J a /e- ( 4. Type of Facility to be Inspected �CSTREET: Number of Bedrooms S. Well Data: A. Type B. Depth C. Size D. Construction E. Bacterial Analysis 6. Sewage Disposal System: A. Septic Tank (If homemade, show diagram on back) 1. Size i9 ) cjgA 2. e A bT (1✓ 7 3. Manufacturer 4. Installer����� -d? i c Page Two B, Seepage Pit � � 7 2. Lining C.__ Disposal Field Q 1. Number of Lines 2. Total Length 7, Required :v,easurements A. Well to Septic Tank ,* I , 1 ZZ B. Well to Seepage Pit " C. Well to Sewer Lite D. Well to Property Line E. {'sell to Other Possible Contam-nfU-Ion F. Foundation to Septic Tani: G. Foundation to Seepage Pit H, Seepage Pit to Property Line B. COMENTS: A?PROVED: f % "l IiTSAPPROVE-D: _- --- PATS _--�—l�—�--G� %� nXrL Jj?PROVAL VALID FOR ONE. YEAR 1 R0'ii DATE STGAir GREATER ANCHORAGE AREA BOROLMIi RUALTH DBPAR"IENr ED1170