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G~~r~&TER ANCHORAGE AREA BORQI.L,GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 2 -2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ~'5/~'
~J~ ' I NUMBER OF l
DISTANCE FROM WELL /~).2 MATERIAL ~'~6~//~/~',,~'~-~ ~c,~' COMPARTMENTS
LIQUID CAPACITY '~/ZT'~'~ ~ GALLONS. INSIDE LENGTH /~;t t /
INSIDE WIDTH_ ~ .DEPTHLIQUID
SEEPAGE SYSTEM:
SEEPAGE PIT:
NUM EROFP,TB_ O OUTS,OED,AMETER ORW,DTH .LENGTH .OEPTH
NEAREST LOT LINE /~'~-~'~) ~ / 7 ~ ~
~O~AL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD
DISTANCE FROM WELL
NUMBER OF LINES
FOUNDATION , NEAREST LOT LINE
DISTANCE BETWEEN LINES TRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
ABSORPTION AREA
FT. LENGTH OF EACH LINE.
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
WELL: TYPE "~)~ I C-/~ ~'~?) DEPTH. ~"~/ DISTANCE FROM ! · WATER
-, BUILDING FOUNDATION 2(~ SAMPLE //~/(-~ , NEAREST
LOT LINE -/~ 't~ ~' NEAREST 4~?! SEPTIC ! SEEPAGE /,~Z / OTHER
SEWER LINE TANK ~'~: SYSTEM , CESSPOOL - , SOURCES~
DISTANCES:
~? Tm,u'K
DIAGRAM OF SYSIEM
DATE APPROVED
GREATEz 'ANCHORAGE AREA' OROUGH C eNo. '77
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT~¢~I~)~'~9%/'/O~J¢// MAILING ADDRESS .~)g~ ~'~ PHONE NO~'~
RESIDENCE ADDRESS LOCATION OF INSTALLATION
LEGAL DESCRIPTION ~,~ -~*~ ~'/Lf /~
FINANCED THROUGH e . ' TO BE ,.STALLE~ BY ~''~~ ~
A~TImPAT~O OA.E OF COMP~T O~ ~"~ '"~ ~~'
~ PERCOLATION TEST RESULTS (~ ~
BE~OW TO ~E ~EO OUT ~Y H~TH O~P~TMENT
THIS IS TO SERVE AS ¢~'~-~ r¢cc..-~ r - ~'/'~'<>~('/, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE ~Z3rl<~ SEEPAGE AREA -~?Y'~' ?~ TYPE
DISTANCES: ,,~/,,~'
Health ,~uthority ..
! c~fi~t~t ~ ~ [~mma~ wffh t~e
above described system is in accordance with Said code.
DAlE : .~ APPLICANTSSI~
DIAGRAM OF SYSTEM
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 1/29/74
Time of Inspection
Date of Inspection 1/30/74
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
FOSTER HOME
Division of FamilS & Children's Services
527 East 4th Aves Anchorage Phone:
Larry Carver Phone: ~
ll:O0 am
No. of bedrooms
B. Depth Pump set at
D. Bacterial Analysis
3. Legal Description: Lot 2~ Sect 35-36 TISN R1W
4. Location: Chugiak Christian Camp
5. Type of facility to be inspected $inqle
6. Well Data:
A. Type Drilled
C. Construction Standard
7. Sewage Disposal System:
A. Installed 1969 B. Installer
C. Septic Tank: 1. Size 4,750 gals 2. Manufacturer Chestnut
D. Seepage Pit: 1. Absorption Area 16x16x6 2. Material Log crib
95' , Absorption area
plqsOther contamination
132' , Sewer Lines
, Absorption area
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
Nearest lot line 20'
B. Foundation to septic tank
C. Absorption area to nearest lot line __
EQ-034 (1/74) Page 1 of two pages
,, P~e 2 of two pages - Req_~t for Approval of Individual ~ ,.~r & Water Facilities
Legal Description
Comments
Approve~ ~-~---~ Disapproved Date ~/~/?~,
~// e~:~ Approval Valid for one year from date signed
Greater Anchorage Ar6a Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
ccurate representation of the subject sewer and water facilities and these facilities
· i
are operating satlsfactor ly.
Date
SIGNED
EQ-034 (1/74)