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Ponder Over
Lot 244B
#018-332-30
GAAB-HD I
Gp--~ATER ANCHORAGE AREA BORO~'-GH
HEALTH DEPARTMENT ~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
ADDRESS
LEGAL ·DESCRIPTION ~ "~{'/~/~
DISTANCE FROM WELl
LIQUID CAPACITY
( ~)t"~ ~f~-'GALLONS.
MATERIAL
NUMBER OF
COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINF
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH.
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREAl
, LENGTH , DEPTH
BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
, TOTAL LENGTF~7~)
OISTANCE FROM WELL ~J '~ / , FOUNDATION ~"~ , NEAREST LOT LINE ./~7 ~ , OF LINES. '/ '-
DEPTH: TOP OF TILE TO FINISH GRADE '~ DEPTH OF FILTER MATERIAL BENEATH TILE //~ IN. ABOVE TILE
~ ~f,(,~o./ DISTANCE FROM / WATER
WELL: TYPE ~_1-,'1 l~ , DEPTH ,BUILDING FOUNDATION /~ SAMPLE
~)'l~/ NEAREST /~xx.,..S E[ .SEPTIC /~ SEEPAGE ~ ~'7
SEWER LINE ~-"d~ , I~.NK ~:~ SYSTEM_
DIAGRAM OF SYSTEM
LOT LINE
DISTANCES:
DATE
. CESSPOOL.
HEALIH AU[HORI[Y
NEAREST
OTHER
SOURCES ?
..... 'OROt GU
GREATE :'ANCHORAGE AREA
HEALTH DEPARTMENT
Eagle St. Anchorage, Alaska 99501 g79-2511
Case No. '7]~'~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~j. ~, K'~J/~'~ MAiLiNG ADDRESS~,~,
20'7/
RESIOENCE
ADDRESS
EEGAL DESCRIPTION ......
APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT / ,DRAIN FIELD .,OTHER
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ~¢-~
PERCOLATION TEST RESULTS
TO BE I,STALLED BY M'*~-~%-
ANTICIPATED DATE DF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE [(~)1~) TYPE SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
DISTANCES:
~// -. ~' H"lth-AuthorityI
· ' withI cerhfy that I am famd~a the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLICANTS SIGNATU RE.
: NotaRY ACKNOWLEDSEMENT
NOTARY ACKNOWLEDGEMENT
ATE
Subscribed end sworn 1o before me this ~.~ doy
~ CHUGACH ELECTRIC ASSOCIAT,ON, loft
~ 50 ft wlde va,et,ti ..... eening
NOTE
ALASKA DEPARTMENT OF TRANSPORTATIO. AND PUBLfO
TAX CERTIFfCA T/ON
LEGEND
(~ EXISTING MONUMENT
MONUMENT SET TH)S SURVEY
VfCINITY MAP SCALE
DTI001316
PLAT OF
PONDER OVER SUBDIVISION
JAMES B. RODGERS
R o. Box i9- 6577