HomeMy WebLinkAboutSOUTHWOOD PARK BLK 2 LT 4
GAAB-HD. I
GR-~..~TER ANCHORAGE AREA BOROp-GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
MATERIAL ~/'~r~/. ~.~ ~ NUMBER OF /.
COMPARTMENTS.
~'"~ '~'~"~ ~, ,',',',',',',',',',~' '/;' ~ /~,~ LIQUID
GALLONS~ INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
NUMBER GE PITS
LINING MATERIAl
NEAREST LO] LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH /'~' , LENGTH //'~ , DEPTH
DISTANCE FROM WELL BUILDING FOUNDATION
IOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) "~'~--~ SQ. ET.
TILE DRAIN FIELD:
~..~r.--)~ ~ TOTAL LENGTH
D STANCE FROM WELL .,-:'""~ , FO DATION AREST LOT LINE , OF LINES
ABSORPTION AREA .SQ. FI. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILT.
IN. ABOVE TILE
WELL: DISTANCE FROM WATER
TYPE DEPTH , BU LDING FOUNDATION · SAMPLE__ NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE , SEWER LINF . TANK SYSTEM ~ CESSPOOL , SOURCES
DISTANCES:
E-F-,-=
DIAGRAM OF SYSTEM
DATE "~'~.~ /,~/~/¢~ APP ROVED(.~ '~ ~
HEALTH AUIHORIIY
GREATEI " ANCHORAGE AREA "gROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS/'~ ~' ~,~--~t./~'~-,~. ~A~)../.4 LOCATION OF INSTALLATION ~ ?~ ~' ~A- -
APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT ,DRAIN FIELD ,OTHER
TO SERVE THE FOLLOWING FACILITY .~'~¢~
FINANCED THROUGH ~ ~:~ ,~-~TO BE INSTAkkED By.~ ~r.¢' '¢
PERGOLATION TEST RESULTS A.TIC'PATED DATE O~ SOMPLETIO"
BELOW TO BE FLEXED OUT BY HEAkTH DEP~RTMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SEBVED ~ ~,~-~
.. SEPTIC TANK SIZE. /'~ TYPE &c~d~'¢& SEEPAGE AREA TYPE
THIS IS TO SERVE AS 'q~(~ ~'~/'~)
'7-
.!
DISTANCES:
DIAGRAM OF SYSTEM
Health Authority
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.
DATE _(~h~ /'~'~., //f(f APPLICANTS SIGNATURE
2.
3.
4.
REQUEST FOR APPROVAL OF
INofVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
Name .of person requesting approval, /~,/z)~, ~F~--~ g/~'
~a~ 6f prope~ty~ owne~ . , ~. .
l~umb~x~'c,~ bedr, ooms in house
Watez~ Analysis: ~l
a. Bacter, ia], .
b. Detergent__ "' ' .
data:
a. 'i'Tpe
b. Depth__
c. Casing Size
d.
Distance from well to closest existing or proposed:
1. Sewer line
2. Septic tank
3. Seepage Area
~. Cesspool]~
5. Property Line
6. Other sources of ~ossible contamlnation, i.e., creeks, lakes,
houses~ barn~ drainage ditch, etc., ...... ~ ,.
Sewage disposal system.
b. Septic tank capacity in gallons ..... /~P~ k~-~-~[,Zf ~--~e
c. Name of septic tank manufact~
d,' DisposaZ f~eZd o~ saepa~e pit size a~d ~e,
1. Distance~ to p~pe~y. ~ne ~/~ to house ~dat~on' / ~ .
· a. P ercaLat ion.. T~st ~reaukts.
f. Percolation Test performed by
Diagram should include
Use the reverse .side of this form to show diagram.
~[.~qhe following information: p~operty lines~.Well location, house location,
m~i,t~c tank location, disposal area location, location of percolation test,
a~d direction of ground slope.
9. The >~o~on on this form is true and correct to the best of my knowledge.
'~,ignature of Applicant ..... Date Signed
~O~_~E__FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL
'T ~e above described sanitary facilities are hereby approved, subject to the
fpllowing condi,~ions:
Conditions:
The above described s ' f · ' ·
an~tary acxl~tzes are disapproved for the following
~easons:
'"'~ At~P'~oval is valid for one year following the date of approval.
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