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HomeMy WebLinkAboutROSELAND LT 10000 G~ATER ANCHORAGE AREA BORO~='~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N.o INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ADDRESS LEGAL DESCRIPTION ZD7 '~ 77'- PHONE SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY GALLONS. NUMBER DE MATERIAL ,~' ~ COMPARTMENTS INSIDE LENGT~ ~ ~N~IDTH. i DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAl NEAREST LOT LINE OUTSIDE DIAMETER OR WIDTH , LENGTH ~. 0 , DEPTH DISTANCE FROM WELL C ;'~/'-/,/ ~/~..~L~/. , BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~/F ~ ~'~ sq. FT. TILE DRAIN FIELD: , FOUNDATION ABS~O~ AREA SQ. FT. TRENCH WIDTH~ LENGTH OF EACH LINE. TOTAL LENGTH , OF LINES DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE LOT LINE ~.&/~-e DEPTH - NEAREST , ~;'EWER1]NE- .... D IST AI',,J_CE E R O/~-- WATER ~-~B~[DiNG FOUNDATION, ~'~,MP~E .... , NEAREST SEPTIC SEEPAGE OTHER · TANK .... , ·SYSTEM. CESSPOOL , SOURCES DISTANCES: DATE GAAB-HD-,~ GREATEkl ANCHORAGE AREA .OROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT Case No. NAME OF APPLICANT '~--L-k&' ,'--4'r' % t~'~.~c~ MAILING ADDRESS ."~>- ~:~/aL~PHONE NO. RESIDENCE ADDRESS ~ ~ ~k ~ LOCATION OF INSTALLATION ~' ~- ~ ~ LEGAL DESCRIPTION ~"~ /~ ~ L--~ ~ (~ APPLICATION TO iNSTALL: SEPTIC TANK , SEEPAGE PIT. ,DRAIN FIELD ,OTHER TO SERVE THE FOLLOWING FACILITY ~[~ ~ ~ ~ FINANCED THROUGH ~ -~ TO BE INSTALLED BY PERCOLATION TEST RESULTS ' /~ f~ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE /C"~) ~~) TYPE~-~--',-i,L ~.~.~%EEPAGE AREA ~?~5-/'J' TYPE DIAGRAM OF SYSTEM DISTANCES: ~ 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. SlaNATURE DATE ' R.r'.QU~ST FOR APPROVAL OF INDIVIDUAL SSWER & WATER FACILITISS FOR 1. Approval Requested By: , ~/~)~¢ Address: GRBATBR ANCHORAGB AR~A BOROUGH Department of Bnvfronmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received 4/4/ ~ '3 Time of Inspection ~Y//'/~>O /~/~ Date of Inspection ~/~7~i~ Phone: 2. Property O~;ner: 3. Legal Description: ,~-f I©) ~. Location: 4~i Z~ ~ U~%0 5. Type of Facility to be Inspected: ~ Number of Bedrooms: ~ A. Type Bo Phone: Depth C. Construction Sewege Disgosel System: Septic Tank: 1. D, Seepage Pit: 1. Disposal Field: D. Bacterial Analysis B. Installer Size'~©Cs<>o~L2 Manufacturer~ 2. Uateriel Total Length of Lines Distances: A. Well To: Septic Tank , Absorption Area , Sewer Lines , Nearest Lot Line , Other Contamination B. Foundation to Septic.Tank ~ ~'~ Ab'~°rption Area ~.~ Absorption Area to Nearest Lot Line -~/ Page Two 9. Comments: R~quest for Approval of iividual Sewer & Water Faciliti, ~ · Ap?ro'~/~2r~lid for One Year From Date Signed Greater Anchoraae Area Borough, Decartment of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and sccurate represeotation of the subject sewer and water facilities located et: Signed Date