HomeMy WebLinkAboutT13N R3W SEC 13 Lot 98
GAAB HD-I ~
G,P-r-~,TER ANCHORAGE AREA BORO'~'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK: ,~,'~
DISTANCE
LIQUID CAPACITY
GALLONS.
MATERIAL
INSIDE LENGTH.
MAILINg :~/~.~" /
ADDRESS ~ ~-~.'~ PHONE
z ' L,OU,O
INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
/ /
,LENGTH /~ , DEPTH ~
BUILDING FOUNDATION
OR WIDTH
DISTANCE FROM WELL
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
, FOUNDATION NEAREST LOT LINE
DISTANCE BEIWEEN LINES TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATER AL BENEATH TILE.
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE __
WELL: d.~", ~./-~
TYPE
LOT LINE
DISTANCE FROM ~_~
, DEPTH , BUILDING FOUNDATION. ~ f ' SAMPLEWATER
NEAREST SEPTIC SEEPAGE
· SEWER LINE TANK ~ , SYSTEM ~ , CESSPOOl
NEAREST
OTHER
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
G,~AB~-2~GREATEK ANCHORAGE AREA ~"~ ~)ROUGH
ItEALT" DEPARTMENT
327 Eagle St. AHchorage, Alaska 99501 279-2511
Case No. 07
./
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
/J O- "~.~a£ MAILING ADDRESS '..~o~. 3,~_q PHONE NO.
4 LOCAT,0N OF,,STALLAT'DN' 'Z~"g~ ~"~- '9~
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH //
~ PER CO LATION TEST HESU LTS ~//fi///~ /~/ ANTICIPATED DATE OF
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
/, SEEPAGE PIT J~, DRAIN FIELD ;:, .,OTHER.
TO BE INSTALLED BY
COMPLETION
THIS IS TO SERVE AS , PERMIT TO INSTALL A ':~"
.,AS DESCRIBED BELOW. SIZE OF UNIT T0 BE SERVED
., SEPTIC TANK 81ZE TYPE SEEPAGE AREA TYPE DIAGRAM OF SYSTEM
DISTANCES:
Health Authority
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 APPLICANTS SIGNATURE
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~'~, , ), 7~5'~"~¢~ MAILING ADDRESS /~°X ~'~"-~ PHONE NO.
RESIDENCE ADDRESS ~0~'-~{2o-$o/'/<J '~- ~ LOCATION OF INSTALLATION
LEGAL DESCRIPTION ~
APPLICATION TO INSTALL: SEPTIC TANK ¢-'/' , SEEPAGE PIT P/ , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY 4 '~ ~-.oo~; /,'~/
FINANCED THROUGH ~ ~L (r"-- .TO ~E INSTALLED BY ,~ff
-~-F~RCOLATION TEST RESULTS~ /Y/0~ ~NTICIPATED DATE OF COMPLETION ~'~1~- ~ ~,'~U~'Z,~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS ISTO SERVE AS ~,~, T.~ ~3 c/~ t~-~, PERMIT TO INSTALL A ~'~--4.4.J~4 ~t'~-_~. .~
AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED ~ ~¢_ ,~'~c,~-~ 5
· SEPTIC TANK SIZE '?, -~ ~ TYPE SEEPAGE AREA TYPE
DIAGRANI OF SYSTENI
DISTANCES:
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that tho
above described system is in accordance with said code.
DATE APPLICANTS SIGNATURE