HomeMy WebLinkAboutRAYMOND TEDROW BLK 5 LT 4A
GF-~I'ER ANCHORAGE AREA BORO~, .~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME 6 c'E-~Z~
LOCATION ~.~' 5~*~
SEPTIC TANK:
DISTANCE FROM WELl
LIQUID CAPACITY
GALLONS.
MATERIAL ~-~"~'~%"~'~' NUMBER OF
COMPARTMENTS /
INSIDE LENGTH INSIDE WIDTH. DEPTH__
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH /~
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
·
, lENGtH /,~' , DEPTH
BUILDING FOUNDATION
SQ. Ft.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
, FOUNDAIION_ , NEAREST LOT LINE ~ , OF LINES
SQ. FT. LENGI ON...~..E~CH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__
WELL: DISTANCE FROM WATER
TYPE DEPTH· ,BUILDING FOUNDATION. SAMPLE , NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE ., SEWER LINE ., TANK , SYSTEM , CESSPOOl , SOURCES.__
DIAGRAM OF SYSfEM
DISTANCES:
DATE
GREATEK
327 Eagle St.
.NCHORAGE AREA'
HEALTH DEPARTMENT
Anchorage, Alaska 99501
ROUGH
279.2511
Case No._Z- -Z
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
,AMEOEAP,',_CANTYV', O . P.ONENO..
RESIDENCE ADDRESS ~ '""K~ ?! ,~"~.i¢;ZZ ~II/~OCATION OF INSTALLATION ~'~ ~Zg ~~/~
TO SERVE THE FOLLOWlNB FACILITY l~/, ~) F~"Fi" ~'' _
PERCOLATION TEST RESULT8 ANTI01PATEB DATE OF 00~PLETION
BELOW TO BE FILLER OBT BY HE~[TH BEP~RT~ENT
THIS IS TO SERVE AS , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
SEPTIC TANK SIZE .//~0o _TYPE ~'SEEPAGE AREA
.... TYPE
DIAGRAM OF SYSTEM
DISTANCES:
Health Authority
I certify that I am familiar with the requkements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
APPLICANTS SIGNATURE
~1: Time
'IUNICIPALITY OF ANCHORAGE
DEPARTMEN'; 3F HEALTH AND. ENVIRONMENTA- PROTECTION
825 L Street, Anchorage. Alaska 99501
~~ 264~720
~~ Date Received: October 14, 1977
1:30 p.m. tt2: Time !.L30 p.m. #3: Time
Date 10-~-77 wedneSday Date ]0m2~-77 Thrusday Date
Insp Nil 1 i_____~S _ Insp wi]_l ~ s Insp
, , ~ ~ ~0/,,0 ..
AP=O=m ,NDI= U
Lending Institution Request: Spokane Mortqaqe Company
Mailing Address' 3201 C strei%, suite 250 9950~hOne-
Property Owner: Johnnie Hill Phone: 694-9524
Mailing Address: 90 Echo Street 99577
3. Legal Description: Lot 4~Block~/
Tedrow Subdivision
4:
e
Single Family Residence: (x)
Multiple' Family Residence: ( )
Well System:
Permit #
Construction
Individual well ( )
Number of Bedrooms:
Number of Bedrooms:
Three
Permit #
Septic Tank Size
Absorption Area
Community/Public System (x)
Depth Of Well Well Log on File (
Bacterial Analysis
Sewage Disposal System: On-site System k~
Installed 1969
Manufacturer
Soils Rate
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
Public Utility ( )
Installer
Material
to Absorption Area
Absorption Area
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description:
Lot 4 Block Tedrow Subdivision
Comments:
Affadavit Attached: (') Letter Attached: ( )
Approved:
Disapproved
Date:
Date:
3330 "C" Si;reet~ Anchorage, A':aska oonn-~,.,u.,
!)ate Rece~vedqm.,-;.S -~0 ....
lime
......... ~.r, ~ ] L iT.,. ~-
FO2
Ap p'."O Va'! requested
ng Address;
Pro?r'W Owner:
ng Address:
Description:
~;., l_oca'u'ion:
1:] I o or: x{ u i s 'L ~>, ,~u~,.~ .... ~
~,::' '~,Yi~O o'? '?aci'i'rty,, to be inspected~-.'.-u~.u~c~ .... -~ No, DJ:' bedroo',;4 ............... ..'~
?!e'~ 'i Da-ca:
CO:$rZXITY
A, Type
C. Sonstruct'ion
7~ Sew~::ge O'sposa' System:
Depth ....................................
uc~ueric~l -la,~/S S ...................
Seepage Pit:
1970
'i. Size
'l, Bisoosai Field:
'i, Absorption Area
x~,a sq.f'~2. Mai:eriai -,,,;
8. 5is~;ances:
Total length of 1 ..... "
A, Wei'l to: Septic tank
~ Absorption area
n',aares-:: 1 ot 't i ne
Other contaFp, i i",ai;ioiq
~. ¢'L, una~u on to septic tank
Absorption are&
C, Absorpt-ion area to nearest lot line
c',",-' ~ty '[;h&'[; "'~lc~ iilfor:ila'i;'io~ coil'ha'i~,~ ...... -iii 'hh'[a ~eq,des'~ 'fop aoix'o\,'a] -~o
accu:~a-h~, 'rep?esen'~a'iiion o-ff 'hhe subjec'h sewe'c ar;d N..lateN 'f'ac'i]'i'aies and
ape a~}ei~a'i;'i ng sa'hi s-Facto'~'i 1 y.
