HomeMy WebLinkAboutT15N R2W SEC 13 S2SW4
GP--e.~TER ANCHORAGE AREA BORC~'~
HEALTH DEPARTMENT
,. 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
· ,:' INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~A"2, r~:/~.~/~:: /~:/ LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM
LIQUID CAPACITY
NUMBER OF ./'
~c_. MATERIAl r~/~- ~/~/~:' ''~ COMPARTMENTS.
~/,-'c"-'~"~"m-'~/z-"J~--~ ~'~:'~'~' // LIQUID
GALLONS. INSIDE LENGTH ,~'~ INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH ~--'~ , LENGTH .,/~' DEPTH
LINING MATERIAL ~,~(l~z~_~//~., ,DiSTANCEFROMWELL.~]g~ ~ BUILDING FOUNDATION
NEAREST LOT LINE ~ ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) // ~/ ~ SQ. FT.
TILE DRAIN FIELD:
~ ~ TO~ TAL LE~NG
NUMBER OF LIN~,~,/~-DISTANCE BET~;~TLiNc~; EACH LiNE '~C. WIDTH (~ IN. TOTAL EFFECTIVE
D TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL: TYPE .~'~,/¢L/~/~~' >' - ..... ._;-x~ . DEPTH , BUILDINGDISTANCE FOUNDATIoN.FROM WATERsAMPLE~~' ., NEAREST
, NEAREST -~. ~ ~ ,' SEPTIC ~ ) SEEPAGE ~. z ~HER
LOT LINE ~:~/~ ~ . SEWER LIN~'~ ~,TANK~-~/; ~ . SYSTEM ~-~:'9 ~CESSPOOL ~ , SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATEK .2NCHORAGE AREA ..!ROUGH
~IEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
C.,e No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT~cv-/~,-;~-"~'~-..///~¢f,~c~i,~ MALVING ADDRESS,./ /
RESIDENCE ADDRESS LOCATION OF INSTALLATION
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT ~ DRAIN FIELD ,
OTHER
ANTICIPATED DAY'OF COMPLETION
FINANCED THROUGH
PERCOLATION TEST RESULTS
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
, PERMIT TO INSTALL A,~/
.AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ,~ 7
THIS IS TO SERVE AS
· ,, SEPTIC TANK SIZE
TYPE
SEEPAGE AREA~'~''//~'~
DIAGRAM OF SYSTEM
DISTANCES:
Health Authority
I certif that I am familiar with the requkements of Greater Anchorage ,A, rea Borough Ordhn?nce No. 28-~8 and that the
above :dYescribed system is in acc°rdance with said c°de'
DATE
"'~"~ ~ CASE
327 !;Af-'??~ c'"R ....
ANC}ORAr:!'~ A~,~!KA 9~501
This Form Reports a: S~2'%,-.-, ~ ~rc,~,z~.~:~on Te~'t
Fee~ Sc:ii m,- ..... : .-
..... s, A~ ~'~a* Depth
Read
Depth To
Test Pe~for,~d
Data Cer~f~e~
G/r,'~,'~r.R ANCHORAGE AREA BORO'"~""~
~ HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N°. 211
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
LOCATION ~f"4~- ~../.~'/.?~...~//~.....z~.~' ~'/.~..z"_ · LEGAL DESCRIPTION
SEPTIC TANK:
NUMBER OF //
~ .~2 ~' / ~/~.~/~:~..//'~'..~:,'- COMPARTMENTS
DISTANCE FROM WELL r_.~-,~ /~ '~ MATERIAl
~ ~ ~ ~ ~) LIQUID
LIQUID CAPACITY /~ (~ ~ GALLONS. INSIDE LENGTH ~ INSIDE WIDTH ~-~DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
/ -
/
-- OUTSIDE DIAM TER · ,
('~ .'-' ~.~,:,~/~ OR WIDTH LENGTH '~ DEPTH
4Z~/~d~.~:'~///~;''. DIS]ANCE FROM WELL - ~> /~ BUILDING FOUNDATION~
~ ~" '~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ SQ, FL
TILE DRAIN FIELD:
.// ~ TOTAL LENGTH
DISTANCE FROM WEL[ , FOUND~A/=~I~-~'~'~. , NEAREST LOT LINE , OF LINES.
DISTANCE FROM WATER
WELL: TYPE ~(~/-~//-.~.=r.~ , DEPTH. ., BUILDING FOUNDATION SAMPLE ,/('/',~"~ , NEAREST
~.~ > / NEAREST .~-. .. SEPTIC -T) /..~._ SEEPAGE ._~ -
OTHER
LOT LINE ~-~ ~2 ;~z._ , SEWER LINF,-/' fM;-? ~/~, TANK ...~--~)/D , SYSTEM r_=~..~.~,~.)<'/Z~.,CESSPOOL
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE ~.~ . APPROVED
GAAB-HD-2
GREATEI .... NCHORAGE AREA ._., lOut;
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF ...... ANT~ ,-~:. ~ ---: ~ / . / ADDRESS
RESIDENCE ADDRESS LOCATION OF INSTALLATION
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK / .......,SEEPAGE PIT./~'' ...... , DRAIN FIELD , OTHER.
TO SERVE THE FOLLOWING FACILITY ~ :'>W~'/.~'j~'~-c' L-~'~'' ~/~ ~ '
FINANCED THROUGH TO BE INSTALLED BY ~ -
PERCOLATION TEST RESULTS,~~//';'~;' ANTICIPATED DATE~ COMPLETIO'
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DEscRIBED BELOW. SIZE OF UNIT TO BE SERVED ,.
TYPE ~--' SEEPAGE AREA TYPE d~'
DISTANCES:
DIAGRAM OF SYSTEM
Health Authority
I certify that I am familiar with the requirements f Greater Anchorage Area Borough.Ordinance No. 28-68 and that the
above described system is in accordance with said code. ~ ~ / ( A~ / '~ ~' /