HomeMy WebLinkAboutT12N R3W SEC 20 TR B REM P
GAAB-HD- i
GIr:'TER ANCHORAGE AREA BOROL i?1
DEPARTMENT OF ENVIRONMENTAL OUALII?
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME /~/~
LOCATION
SEPTIC TANK:
MAILING
ADDRESS ~-~'~ ~/~'~, ~/J'/"'///~"~,'~ PHONE
LEGAL DESCRIPTION ' ·
DISTANCE FROM WELL .:-~)
LIQUID CAPACITY /'~: ~2 (-2 GALLONS.
NUMBER OF ~
MATERIAL ->~'~"~-/-'~ COMPARTMENTS
INSIDE LENGTH / INSIDE WIDTH ~ DEPTH__ ~'~'
SEEPAGE SYSTEM: SEEPAGE PiT: ~)~,~z.~" ~--~,~j~/~-~ ~'~/-)/~--- ~..4J~.J-J-'~/~')J'~.=/'
~/~//~ ~ ~ LENGTH ~ DEPTH
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH ,
LINING MATERIAI~7~ ~~~/~ · DISTANCE FROM WELL /~ ~ ~ BUILDING FOUNDATION
NEAREST LOT LINE ~' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl
FOUNDATION
, NEAREST LOT LINE
TOTAL LENGTH
OF LINES
NUMBER OF LINES ,.~...-f~'ST~CE BETWEEN LINES T~"~%~ WIDTH
ABSORPTION ARE~'''~'''~ SQ. FT. LENGTH OF~ EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TiLE
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
TY P E ,,~¢~,,.'"'-~'/--~-.,~:~:~ , D E PT H.
LOT LINE ./~' // NEAREST SEPTIC
, SEWER LINE / ,TANK
DISTANCE FROM
-, BUILDING FOUNDATION. /~ '/~-' WATER
SAMPLE
- SEEPAGE --
~' "~"- , SYSTEM ./~'~'~ ~'~ CESSPOOL
NEAREST
OTHER
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
G.A.A.B.
GAAB-H D,:2 ~
GREATEr'"ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT /~/:',~;'/) /¢¢~f~/~. MAILING ADDRESS ~ay 6 ~fi7 '~/¢fie~. PHONE NO.
RESIDENCE ADDRESS ,~r/de~-! L~z~ ~-'/~f'~P~'l LOCATION OF INSTALLATION ~/~x,;':'/¢
APPLICATION TO INSTALL'. SEPTIC TANK ~/~ , SEEPAGE PIT , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY "~ '~¢'~'~"'~'~;
FINANCED THROUGH ,-'~ ,~ff~-~',/?--~;' TO BE INSTALLED BY_ /--~-~
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ¢g¢~ //~/~-~1 , PERMIT TO INSTAkk A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE /'~Z~'O TYPE '~/~- ~z. SEEPAGE AREA,~iai~ TYPE
¢.;~o,'~.¢.A.~..~ DIAGRAM OF SYSTEM
DISTANCES:
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.
APPLICANTS SIG NATU RE X' <:'~~
~..,MUNICIPALITY OF ANCHORr. .....
DEPARTMENi )F HEALTH AND ENVIRONMEN~'r-%PROTECTION
825 JL Street, Anchorage. Alaska 99501
264-4720
Date Received: September 27, 1977
#1: Time 10:10/a.m.
Date 10-~77 Monday
Insp Pr~t~
#2: Time 10:00 a.m. #3:
Date 10-4-77 Tuesday
Insp Bringle
Time
Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request:
Mailing Address:
Phone:
2. Property Owner: Forest Lawn Memorial Chapel Phone: 344-1497
Malting Address: Fred Kehl, Box 6187 Annex 99502 344-3314
3. Legal Description: T12N R3W Section 20 Parcel 25 Tract A
4: Single Family Residence: ( )
Multiple Family Residence: ( )
Number of Bedrooms:
Number of Bedrooms:
Well System:
Permit #
Individual well (x~ Con. unity/Public System ( )
Depth of Well 140' Well Log On File
Construction
Bacterial Analysis
Sewage Disposal System: On-site System (x)
See notes on white sheet.
Permit # Installed 1965
Public Utility ( )
Installer
Septic Tank Size
Manufacturer
Absorption Area
Soils Rate
Material
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: T12N R3W Section 20 Parcel 25 Tract A
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
Approved: Date:
Disapproved: Date:
~)epartment Worksheet: