HomeMy WebLinkAboutT13N R3W SEC 13 LT 111A
GR~>'~.R ANCHORAGE AREA BOROUgh,
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY /~20
GALLONS.
MAILING
ADDRESS
LEGAL DESCRIPTION
MATERIAL
INSIDE LENGTH
PHONE____
NUMBER OF
COMPARTMENTS
INSIDE WIDTH_ ~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PitS /
LIN/NO MATERIAl ~1~!
NEAREST LOT LINE ~ 0 p
OUTSIDE DIAMETER OR WIDTH. ] ~ , LENGTH /~/~ , DEPTH
DISTANCE FROM WELl BUILDING FOUNDATION
TOTAL EF~ECUVE ABSORPTION AREA (WALL AREA) ~~ 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 BETWEEN LINEE .TRENCH WIDTH
· SQ, FT. _ENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES~
~N TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
TYPE ~Ek"~AREST' DEPTH
LOT LINE . SEWER LINE
DISTANCE FROM
. BUILDING FOUNDATION.
SEPTIC SEEPAGE
TANK . SYSTEM
WATER
SAMPLE
· CESSPOOl
NEARES1
OTHER
. SOURCES
DISTANCES:
47
DIAGRAM OF SYSTEM
DATE
Residence AddPess ~0~ ~. ~--~ Location of Installation
Legal Description Z~Or /i .
Application to Install: Septic t~k~, Seepase
pl~__, omalnrleld~ ~he~ _
To Semve the Following Facility ~ ~F~/~_ ~ .........
Financed Through...~~ To be Installed by..
Pemcolation Test Results ~tlcipa~ed Date of Completion
~: ......... BELOW TO BE FELLED OUT BY HEALTH DEPART~NT
-- ~__ , pePmi~ to install a
........... ~P~ic tank siz .,, -a e
' -- Y~ . ~
DIST~CES: ~ DIAGRAM OF SYS~M
I cemt~fy that I am familiar 'w~th ~he
~ ' of G~eateP ~choPaEe ~ea BoPouEh
9 '
mdln~ce No. 28-68 ~d ~ha~ ~he ~ove descPlbed s~te~ ~$8 in aceoPd~ce with sa~d code,
'
NU,,N ICI PAL ITY OF~SNCHORAGE
DEPARTMENT OF HEALTH AHD ERVb..,~ENTAL PROTECTION
oTRE~T~ ANCHORAGE~ AK 99501
264-4720
ON-SITE WELL PERMIT
PERMIT NO: 860187
DATE iSSUED: 06/20/86
APPLICANT:
ADDRESS: 75D9 E.6TH AVE.
ANCHDRAOE~ AK ~504
CONTACT PNDHE:
LEGAL DESGR1P: SUBDIVIDIOH: N/A GT: i11A
SE~TION:
LOT SI~E:, 2~000 ISQ.FT. Ha A£RES) .~
BLOCK:
cer[iI¥ that:
I a~ ia~ilia~ ~ith the D~gmirements Imf mn-site seue~s and~ls as set
forth by the Municipality of Anchoraae (MOAJ~a~ the~State~laska.
! .ill insLmll Ehe syste; in accerd~c~ .i~taj MgA'~edes'~d Pegolatienm,
and in compliance ~ith the desiqn crf~ria orihis permit.
I ~ilI adhere ts alt MOA and State st Alaska reqai~ementm ~mr the set back
distances from any existing mell~ nastewate~ disposal system or public
sewerage system on this or any adjacent mr nearby lot.
SIGNED DATE:
APPLICANT: C.R. KRON
Mumc pa. ty
t 071
Anchorage TO~YKNOWLE ,
MA YOR
~X 19665O
ANCHORAGE, ALASKA 99519-6650
4744
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 22, 1987
C.R. Kron
7529 East 6th Avenue
Anchorage, Alaska 99504
Subject: ! Ti-~N R3W SEction 13 Lot lllA
On-site Well Permit #860187
T12N R3W SEction 13 N½ Lot 110
On-site Well Permit ~860186
A permit(s) issued by this Department for an indivual well
and/or on-site sewer system has expired as of December 31,
1986.
Permits are issued on a claendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
In addition to the expiration of the permit, the
subject permit(s) were not paid nor the permit(s)
the applicant.
fees for the
signed by
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the on-site
sewer system, the original as-built inspection report(three part
form) must be sent to this office for review and approval, and
for documentation.
The fees for the permit will need to be paid and the permit
signed by the applicant if any or part of the installation
has been installed.
Program Manager
On-site Services
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