HomeMy WebLinkAboutSUNSET HILLS WEST BLK 3 LT 20
GAAS.HD I
GRI;~,TER ANCftORAGE AREA BOROUGH
HEALTH DEPARTMF!NT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILINGADDRESS ~.~0/ ~/'~':~./~'/~--'~'~'-~. PHONE,~g':b~'~,
DISTANCE FROM WELl
LIQUID CA PA C ITY_~/~'~- ~-~'-O GALLONS.
NUMBER OF
MATERIAL ~_,~-"~ ~=C-., COMPARTMENTS
INSIDE LENGTH_ ~ .INSIDE WIDTH ~'DEP~H
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS .// __OUTSIDE DIAMETER_
LINING MATERIAL
DISTANCE FROM WELl /~> ~) , BUILDING FOUNDATION~_[2
TOIAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~7~-'2'~'2~' SQ. Fl.
NEAREST LOT LINE__~' ~
TILE DRAIN FIELD:
1'O I'AL LENGTH
WELL:
I'YPE ~-,'~/~'- ~- '~, ~:~ DEPTH
NEAREST ~/ SEPTIC
LOT LINE ., SEWER LINE , TANK
DISTANCE FROM /_ WATER /
BUILDING FOUNDATION.?'//~ ',~ ~SAMPLE~., NEAREST
· SEEPAGE ~ OTHER
//~-'~ ~2 , SYSTEM__/~') ~Z2 , CESSPOOL ~ SOURCES__
DISTANCES:
DAle
DIAGRAM OF SYSTEM
-.:.;, ..? ru '. ?,: ~.~, .: i!~
I' I? .,.:
,
APPROVED.
HEALTll AUTHORITY
GAAB-H D-2
GREATEI"
327 Eagle St.
ANCHORAGE AREA
tI~ALTI1 DEPARTMENT
Anchorage, Alaska 99501
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~ ~'-~'~ MAILING ADDRESS~':'},:U ,')/'~;//~q' PHONE NO.
RESIDENCE ADDRESS ,~'~ LOCATION OF INSTALLATION~-~e~ /~'~'
APPLICATION TO INSTAl_L: SEPTIC TANK_ , SEEPAGE PIT ,DRAIN FIELD_ ,OTHER_
TO SERVE THE FOLLOWING FACILITY 7~g-, ~/~¢¢~.-,
FINANgEBTHROUBH flTO BEI~TALLEB BY_ ~7" ~'~ g~"~¢
PERgOLATION TEST RESULTS.~z~/ '~7~ ANTICIPATED DATE 0F COMPLETION
BELOW TO BE FIt. LED OUT BY HEALTH DEPARTMEBT
THIS I$ TO SERVE AS -2U,f,,L,¢ ~;~ PERMIT TO INSTALL A
~/~/~ --
_AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
SEPTIC TANK SIZE ~-rU .TYPE ~'~:(~' 8EEPAGEAREA
DIAGRAM OF SYSTEM
I certify that I am familiar with the requirements of Gre~ter Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
/::::
DATE AP~L CANTS SIGNATURE ?' - .
, . :~ -.:,>-- -:_y.
GREATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
32? EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE
T~= :'c~' ~ooz~ts a So,Is Log ~ '~-6~lat=.on lest
Depth
Feet Soil Chamacteristics
Z_] ~/~/, ~ /~ f~
Reading
If Yes, At What Depth .................
Date
Net Time
Location Sketch
Depth To H20
Drop
Pmoposed Inatal'l-~To-~?~eepage pit .... ~ Dpain Field
Depth Of Inlet _
~ __~L.~...__..___j)epth
COMMENTS: (~/~, ~
Test Pemfommed By: ~ ·
Certified By :~ z.~ '7-7~.z//
APPLI('*N'T FILLS OUT UPPER HAl
Address ~) ~ / ~J~ ~"~{pI;-4] ~'.~-~
Lending Institution ' ~. / . /~ ~ ....... ~ '~ ~ ,
Address . O~
'ONLY
Zip Cod~
Zip Code
Realty Co. & Agent
Legal Description
Type of Residence
- .Single Family
~-Multlple Family No. of Bedrooms
[] Other
Phone
Phone
Water Supply
[3 Pub!lc Udllty
Sewer Disposal
[] Public Utility
[] Holding Tank
ATTACH WELL LOG. A well log Is required for all wells driIled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
Year Individual Installed: ~/ ~
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Date
Inspector
Time
Date
Time
Date
Inspector
Inspector
Field Notes:
'CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received /~//~ ,
Septic Tar, k Size I__~._~ 0 '
dune 21, 19L',3
814
J. 402U ,Jarvi })rive
fmchora(/e, Al.< 99502
Subject.- Lot 20, i31ock 3, f.hanset Hills
Ai)proval i~o¥ th(~ iildividt]a.L ,,1(2wer and water faciJLitJ.,q~s
}30 (j'~OII~LG(] UBI:il. the fc)J.J, owil~g it~e:[~l,% ]k~vo })eon
o J~xpoaed eJ. ectr~cal wire,q 'co the well head ar(~ in violation
~f the Municipality of Anchorage codes and Lm~t b~ encased
'l'he ~4o})tic t. itnk l)l.l~flk)e(] with i.l r(~ceipt ~ubiail, ted to t;hJ.s
ciepal: t~acr~ t,
Please notify t, hi,~.; Depart;~ent ~ol:' ~ rei/~sl)c'ction ,;./he~ the
noted di~screl)ancies have been corrected. If the~;e a]:e any