HomeMy WebLinkAboutT13N R3W SEC 13 Lot 7 of Tract 97LoT
'7
GAAB HD I
Gp~TER ANCHORAGE AREA BORO~-~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
ADDRESS
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELl
LIQUID CAPACITY
GALLONS.
MATERIAL ~"~0,~
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
STANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA WALL AREA
LENGTH
BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSC RPTION 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 TIL[~
TOTAL LENGTH
OF LINES_
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
TYPE L- ¢r"6.,', DEPTH
NEARESI
LOT LINE SEWER LINE
SEPTIC
. lANK
DISTANCE FROM
· BUILDING :OUNDATIO~I.
SEEPAGE
· SYSTEM
WATER
SAMPLE
· CESSPOOl
NEARESI
OTHER
· SOURCES
DISTANCES:
/
1.5
DIAGRAM OF SYSTEM
DATE
APPROVED
/~ HEAL]H AUJHORITY
GAAB-HD-2~
GREATEL ANCHORAGE AREA ~ )ROUGH'~case.0.~F
· ~ HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED q~HROUGH '~ ¢P-[ ¢
~N TEST RESULTS
.... AOORESS ,/5//~ //Z'eP/~HONE .0.
LOCATION OF IN,,STALLATION , .
~., SEEPAGE PiT / ,DRAIN FIELD ,OTHER
TO BE INSTALLED BY ('~-/a E'/P~,
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
T..S ,S TO SERVE AS Crt.~../0~ '[S"-.._d. PERM,T T0 ,.STA'L A ~:¢;~e~x.~-.- ..~?~7~,~
. SEPTIC TANK SIZE TYPE ~-/SEEPAGE AREA TYPE
~ ~0 ~k-~ DIAGRAM OF SYSTEM
DISTANCES: ~ ~
Health Authority
I that I am familiar with the requirements of Greater Anchorage Area B~rough OrG~nance No. 28-6~8 and thai(the ~
above described system is in accordance with said code. ...~.-t.~,~r~.~ /~'¢',.~' /~¢'Y~%~/~ ~//D~L~
/ ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 . .
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
MUNICIPALITY OF ANCHORAGE ~ . · ...
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 90501
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10} days for processing.
1. PROPERTY OWNER I PHONE
I
MAILING ADDRESS
PROPERTY RESIDENT (If different from above)
PHONE
PHONE
2. BUYER
PHONE
MAILING ADDRESS
~, LENDING INSTITUTION
S7/~7b~ L/'.~
MAILING ADDRESS
PHONE
4. REALTOR/AGENT
MAILING A ESS
5. LEGAL DESCRIPTION
TR E ET /OCATI ON
6. TYPE OF RESIDENCE
~iNG LE FAMILY
o ULT,.LS
NUMBER OF BEDROOMS
[] One
[~] Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
[~1~ DIVI DUAL* * ATTACH WELL LOG. A well Icg is requ'ired for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC uTI LITY depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
[~ ~d(J~!~lC UTI LITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72~)10(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS '
TIME TIME I TIME
DATE DATE ~ DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~/'SING LE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MUL~!PLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[~J~ DIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECSIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~,f'q/DIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
I~]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
E~;-'~APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Titlo)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)