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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 RWR/ljw VAcA N T , '9(/~- L L L~A :Il '1 ItlC VACA N'F I',-I , 'Y/ELL IIIC ,% E ~-l-h A