HomeMy WebLinkAboutT12N R4W SEC 2 LT 26 SE4E2LoT'
GAAB-HD-I
GREATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
ADDRESS
LEGAL D~SCRIPTION
SEPTIC TANK:
D,STANCE EROM WE.-
LIQUID CAPACITY ~7 0~"0 GALLONS.
INSIDE LENGTH
NUMBER OF
COMPARTMENTS
INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
OUTSIDE DIAMETER
OR WIDTH
DISTANCE FROM WELL ~2
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
/
,LENGTH ~) ,DEPTH
· BUILDING FOUNDATION
~ ~ g SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
, FOUNDATION_
DISTANCE BETWEEN LINES_
SQ. FT. LENGTH OF EACH LINE
, NEAREST LOT LINE
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
TYPE / , DEPTH
NEAREST SEPTIC
LOT LINE , SEWER LINE . TANK
DISTANCE FROM
,BUILDING FOUNDATION
SEEPAGE
. SYSTEM
WATER
SAMPLE
. CESSPOOL
, NEAREST
OTHER
· SOURCES__
DISTANCES:
z
DIAGRAM Off SYSTEM
DATE
APPROVED
HEALTH AUIHORIIY
GAAB~HD-~
GREATE_. ANCHORAGE ARE3~OROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Casa No. 32/~
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
~TEST RESULTS
LOCATION OF INSTALLATION
SEEPAGE PIT , DRAIN FIELD.
TO BE INSTALLED BY "~/~-'~t~)~'-
ANTICIPATED DATE OF COMPLETION
,OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
_/
THIS IS TO SERVE AS ??~"~ ~'~-~, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE ~ ~ TYPE C"7~/~'~/U/~EEPAGE AREA
DISTANCES:
Health Authority
TYPE
DIAGRAI~I OF SYSTEIVI
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 APPLI CANTS SIG NATU R E
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
b. De~e~en~ .... .
/
data: ? /
b. Dept~ ,/d0 / * · . '
,. Casing . GM
d. Distance fPom well to closest exis%in~
Cesspool~ , .
5. Property Line /~r~
6. Other sources of poss~le contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc.
Sewa~ d~mposal system.
a, Age of syste~~~
b. Septic tank capecity in gallons ?:~'--~
C. Name of septic tank manufactu~P ~C~_AA~
1. If "home made" show diaFram on reverse side of this form.
Disposal fi~eld or seepage pit size and type (~
, ~ / ,/ / / -- ,~
1. Distane~ to p~pe~.llne ~/ . to house fo~datzon ~8
e. Percol~tiom. 'Te~t h~esults
._..~he foilowing inf?mation: ~,~ope~ty lines.; ,well lo.cation, house location;
~t~pTic tank locatmon, disposal ares location, location of pemcolation test,
a~,~ direction of ground slope.
9, The information on this form is true and correct to the best of my knowledge.
Siena%ute of Applicant'
Date S~gned
TO BE FILLED OUT BY HEALTH DEPARTMENT PERSONNEL
~e above described sanitary facilities are hereby approved, sub~ec~ .~,o. the
......... :~6'll~owin ~ cond~fons
Conditions:
The above described sanitary facilities are disspproved for the following
reasons:
., ,,/. //f). f ,q f; .... .,
'--Approval f~s valid for one year following the ~te of approval.
..~ CPJ: cw
:..RA§~BEI~RY
W. SEVENTIETH AVE.
I."TELECOMM. & [LEE" IS AN ABBREV-
IATION FOR TELECOMMUNICATIONS
AND ELECTRICAL EASEMENTS.
,~==~---~x '"'"" sITE ' '
D11002584
BLM LOT 27A
CENTRUH ~. ' -.
CERTIFICATE TO PLAT H-179 LA S;~5~ -. ~'