HomeMy WebLinkAboutT12N R3W SEC 9 E2 SW4 SE4 NW4 Address No Longer Exists!?
GF"~,TER ANCHORAGE AREA BORO,~'~H
HEALTH DEPARTMENT
327 EAGLE ST, ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
,(~_:~,,~g..~ ~' NUMBER OF
DISiANCE FROM WEL ~_~,, ~x) --MA]ERIAL--~' ~' c~--<"/, COMPARTMENTS
LIQUID CAPACITY ~..-~_~Z? GALLONS. INSIDE LENGTH. '~ .INSIDE WIDTH
LIQUID
SEEPAGE PIT:
SEEPAGE SYSTEM:
NUMBER OF PITS .... ~_ OUTSIDE DIAMETER
LINING MATERIAL
NEAREST LO! LINE_
· _OR WIDTH_ ~::~" /
DISTANCE FROM WELL~',~r~'.~ ~?~' '~ , BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) /~ ~ SQ. FT,
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELl .~, OUNDADON , NEAREST LOT LINE , OF LINES
NUMBERABsOR~ '~'~"/~OF LI ~EA DISIANCEs ~/BETWEEN LINESF EACH/.~TR~HLiNE WID~(.~// IN. ~-TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: TYPE .~ ,~./¢ ·~/////////,~/'~:~'-~zz'~¢' DEPTH__ b~-'~¢ DISTANCE FROM ~.~-----~ WATER
, · BUILDING FOUNDATION .... SAMPLE NEAREST
NEAREST / SEPTIC /- SEEPAGE OTHER
DIAGRAM OF SYSTEM
DISTANCES:
,,~ ,~,~=//, '
,,~;,-~ ~' =-.~ ?"
GREATEI
327 Ea~le St.
ANCHORAGE AREA-
ItEALTIt DEPARTMENT
Anchorage, Alaska 99501
9ROUGH
279-2511 q,' ~¢
SEWAGE DISPOSAl. SYSTEM - APPLICA?ION & PERMIT
NAME OF APPLiCANT 2~._,)&~ &w,'-"c~J--.- MAILINGADDRESS~?.:'7":~ ~>'c'/YX' PHONENO v¥-,..~ ,~,,
RESIDENCE ADDRESS_~'~-4~c° LOCATION OF INSTALLATION I; '~'~',/~'
APPLICATION TO INSTALL: SEPTIC TANK ¢ , SEEPAGE PIT_ .Y __,DRAIN FIELD ,OTHER_
TO SERVE THE FOLLOWING FACILITY dL ~
7
FINANCED THROUGH_ .~,d~ TO BE INSTALLED BY. ~'~
PERCOLATION TEST RESULTS /~'~ ~'~- ANTICIPATED DATE OF COMPLETION 9L/ /~' '~z~%~
BELOW TO liE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS '~'''~ {~>~'>~'&' PERMIT TO INSTALL A
_AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVE[] ~ ~'
. SEPTIC TANK SIZE/~ TYPE ~g~'~ SEEPAGE AREA~J~'~ __TYPE.~~
~( DIAGRAM OF SYSTEM
DISTANCES:
1 certify that I am familia' with the requh'ements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
OATE __// }/ /