HomeMy WebLinkAboutT14N R2W SEC 1 E2 of SE4 Parcels 3 & 4
GAAB-HD-I
Gp~,~TER ANCHORAGE AREA BORO,P~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME ~'~ ~/~'~.~"~c]~-~-/'- ~,..,~'~.?,,~<'~'~ ~~ ADDR[SS
LOCATION.~~ ~/~ LEGAL DESCRIPTIO~z~
SEPTIC TANK:
C ~/fL.~ ~'.d.Z/.~--~ COMPARTMENTS
DISTANCE FROM WELL //'~,~ / MATERIAl ~ . : .,-- NUMBER OF
LIQUID CAPACITY ,,/' ~ ~-~ ~"' GALLONS. INSIDE LENGTH INSIDE WIDTH.
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATER~AL ('"~'/)./G/~--~.~j~j~' ~
NEAREST LOT LINE~,2 ~/'~c''~'~'~'~ ~
~ OR WIDTH / , LENGTH , , DEPTH
. DISTANCE FROM WELL ~J/,/~'~'~ ~ , BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~~ SQ. FT.
TiLE DRAIN FIELD:
. NEAREST LOT LINE_
TOTAL LENGIH
, OF LINES
DISTANCE FROM WELL . FOUNDATION
~-'~E'r'v~'E E N~'~"'~LINES '?~./ ......... H"'f~'~l ............. CH WI ' ............... EFFECTIVE
NUMBER OF LINES ~'- I~_ .----~'~ ................. IN. TOTAL
ABSORPTION
A~ SQ. FT. LENGTH OF EACH LINE
DEPTH: ~OP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILL
IN. ABOVE TILE--
WELL: I'YPE ~:~/' ~%'/~"~'--~ DEPTH,~,.~' 5~--~. ,,' DISTANCE ~ROM WATER -~
., . BU LDING FOUNDATION. ~ SAMPLE NEAREST
NEAREST SEPTIC / SEEPAGE ,//_~ / ~ OTHER
LOT LINE '~ , SEWER LINE , TANK //2 , SYSTEM , CESSPOOL , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
/
APPROVED
HEAL]H AU]HORIIY
GAAB-HD-2
GREATE[ 'ANCHORAGE AREA / iDROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No. //':~'~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT .~..~f'~.T ~(~z~.g~//~/47~/¢ MAILING ADDRESS/'r~/),X' ~% ~2 PHONE
RESIDENCE ADDRESS LOCATION OF INSTALLATION
LEGAL DESCRIPTION Z'-~
APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT ~ ,~A~,q , ......
TO SERVE THE FOLLOWING FACILITY .~
FINANCED THROUGH ~'~ TO BE INSTALLED BY
PERCOLATION TEST RESULTS ~ ~.~
BEIO~ TO BE FllLEO OUT BY HEALT~ DEPARTMENT
THIS IS TO SERVE AS/--~, ~jg)po/~l'''~'/t-'7''~'/2''~ ':PERMIT TO INSTALL A J~,~/I//'~J;: ..5'.F- ~,(JE:-./~ ,,
~,~' ~' T~//// AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~.'~ /_EZ: ~'O0/~.-,.t..~ #O/z~
' . SEPTIC TANK SIZE ,/d~) 5 .TYPE ~.~x/~',eeT~ SEEPAGE AREA ~5- TYPE ~o.~cAe;,~g
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