HomeMy WebLinkAboutELMRICH VILLAS #4 Block 4 Lot 19
G!,"~TER ANCHORAGE AREA BORO~,H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N°. 450
; INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
MAILING
ADDRESS ~q/'~ ~'~:(/~'~:'~ ~ ~/ .... ' PHONE~
LEGAL DESCRIPTION~ ~U
DISTANCE FROM WELl C /?' :('
LIQUID CAPACITY /,>< ~ - ~ GALLONS.
NUMBER OF ~ ~/~:'
,MATERIAl ~-'?~:-'-/-~-- COMPARTMENTS
INSIDE LENGTH ;~INSIDE WIDTH ~ DEPTH__
NUMBER OF PITS
LINING MATERIAL
SEEPAGE SYSTEM: SEEPAGE PIT:
// OUTSIDE DIAMETER.
. .A
NEAREST LOT LINE ,~:/,~/~" -
OR WIDTH :-'~:'
DISTANCE FROM WELL ('? /,~? -/,~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH · ,'~/~' , DEPTH
: BUILDING FOUNDATION~/
~-~'g SQ. FT.
TILE DRAIN FIELD:
LOT LINE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
,. - /~TILE
DISTANCE FROM WELL ~UNDATION .~N~AREST LOT LINE
NUMBER OF LINES ,/'~'~ DISTANCE BETWEEN LINES T~NCH WIDTH
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BEN~Aff-I.k-TILF
WELL: ~?/;~.z/~//~ /:'//~Z,.///,/) //,,2//~/h',~,/~ ~/- DISTANCE FROM ,~_~- WATER ~--
TYPE,/~,/:?/-/~ , DEPTH , BUILDING FOUNDATION SAMPLE NEAREST
OTHER
NEAREST /, _..SEPTIC ,~ SEEPAGE ~ .... ~ .... i SOURCES
~-~ ~ , SEWER LINE . TANK , SYSTEM , CESSPOOl
DISTANCES:
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATE?ANCHORAGE AREA ~'~ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT..) ,., yE MAILING ADDRESS PHONE NO.
RESIDENCE ADDRESS > ; LOCATION OF INSTALLATION
LEGAL S .,''O" :"
, ~.~ - t.,, ~ ,
APPLICATION TO INSTALL: SEPTIC TANK ~, SEEPAGE PIT , DRAIN FIELD , OTHER
TOSERVETHE FOLLOWING FACILITY .:: ~-7 ~f i ~
PERCOL~mN TEST ~ESULTS. ANT~CmYE~ OATE O~ CO~PLETmN ~ ~ ~":'-
BELOW TO eE F~LLED OUT BY HEALTH OEPARmENT
,AS DESCRIBED BELOW. SIZE OF UNIT TO.BE SERVED
DIAGRAM OF SYSTEM
DISTANCES:
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordi No. 28-68 and that the
above described systtm is in aTrdance with said code. (.---f "- _--~ ~
DATE k') ~-') "- '~ "'~/~' * '~'~':' '-~:'~""'---- -'
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEW RF& WATER FACILITIES
Approval requested by:
Mailing Address: 6~
Property Owner: ~~~
Mailing Address:
Legal Description:
! ! !
Phone:
Phone:
e
' ' '
5. Type of facility to be inspected_.~ ~ ~ s
6. Well Data: ~ _ ~._~.w-~ 7~- .~m~.
C. Construction
B. Depth
D. Bacterial Analysis
A. Installed '~/I/'7 0 '~
C..Septic Tank: 1. Size /2~-:,~ 2. Manufacturer .~-z_
D. Seepage Pit: 1. Absorption Area ~,~V 7r~,Y-~.~ 2. Material
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank ~- , Absorption area ~- , Sewer Lines
Nearest lot line .~----- , Other contamination
B. Foundation to septic tank ~ , Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
· Page~ 2 of two pages - Re~..~st for Approval of Individual . ~er & Water Facilities
Legal Description
Comments
Approv Disapproved , !
~ Approval .Valid for one year from date signed
Greater AnchOrage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and Water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)