HomeMy WebLinkAboutT15N R1W SEC 9 LT 73
G I~TER ANCHORAGE AREA BORO' ~H
HEALTH DEPARTMENT NO. 553
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
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NAME
LOCATION
SEPTIC TANK:
MAILING '' /~'d . ~2/~" PHONE_
ADDRESS/~?,/'1, /(~j( '" ('A (,:(' ~
DISTANCE FROM WELL ~.~Z'
UQUID CAPACITY X~'(%C: gALLONS.
(. /~( c'l "~'6'/~'~ ~~'- NUMBER OF
COMPARTMENTS
MATERIAL
INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
OUTSIDE DIAMETER
LINING MATERIAL ("~?IUC/("J='~II~ ~c)X)'I"('~ ~' ·
NEAREST LOT LINE '~ ~ '~ ~'( ~? TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH / ~/ , DEPTH
OR WIDTH
DISTANCE FROM WELL
BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl . ,-~-'-" , FOUNDAT NEAREST LOT LINE
~ TRENCH WIDTH
TOTAL LENGTH
,/I/N. TOTAL
EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE.
IN. ABOVE TILE --
.~ DISTANCE FROM ~,
WELL: TYPE/',~,c~/~/Z: ~ DEPTH . BUILDING FOUNDATION.
z ? , NEAREST SEPTIC ~ ~ I SEEPAGE
LOT LINE · ~' ~ ~'- , SEWER LINE .... ,TANK , SYSTEM
WATER
SAMPLE /(~/~';~,~,2 , NEAREST
--. OTHER ~'/'
CESSPOOl , SOURCES
,";~-~ .~,
DISTANCES:
DATE
DIAGRAM OF SYSTEM
(i}~EA'I'ER ANCHO~ASE AREA BOROUGH
HEALTH DEPAkYr',~ENT
327 EAGLE F:TREET
ANCHORAGE~ ALAf'KA 99501
CAS£ ,i
Depth
Feet
uega! bescr*p~on, l, ot 73 ~Jock . °'dDfllvl:;iO~, ~)f' O /
~h.~s form Reports a: So~2s Log ~ ~~ Tes't
oozl Cha~ut:ter'istic8 Location Sketch
Reading
Ground Water Encountered?
Date
Depth To H20
Net Drop
GREATEI~ ANCHORAGE AREA ,~OROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
casa No. -~_~ D
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT{~)~ ]~¢'/~'~ F ~'~'/~'"~ 0 .~.
RESIDENCE ADDRESS
'--/~i'~'/~6
MAILING ADDRES~(-~/~/~ t,'~/~/-~ . PHONE NO.
LOCAT,ON OF ,NSTALLAT'ON // ?,? ?
LEGAL DESCRIPTION.
SEPTIC TANK_~.-, SEEPAGE PIT ,/'~ ,DRAIN FIELD ., OTHER.
APPLICATION
TO
INSTALL:
TO SERVE THE FOLLOWING FACILITY ,g~'' -,(/~_~c..//L./~z,~-~r"~_ J ~,.x~"'~"-~-"O------'""~.d '
FINANCED THROUGH ~'~.%~¢'~"~.. TO BE INSTALLED//BY ~"~"/--'f~d~
ANTICIPATED DA'~OF COMPLETION .'.~g~c~.~_._...-~. ,-
PERCOLATION TEST RESULTS ~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS _ . PERMIT TO INSTALL A .,~e~,,m_..-~t~"
_-~~'/ _AS DESCRIBED BELOW.,,~SIZE OF_ .UNIT TO BE SERVED ri//</-~--~ -/~-~'~"-'~.~'~ ~"~"~¢~'("~
· SEPTIC TANK S ZE, /gr~9.~'ffTYPE ~EEPAGE AREA TYPE ~
DIAGRAM OF SYSTEM
DISTANCES:
Health Auth~
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.
DA //~; APPLICANTS SIGNATURE_ ~ =~,, ~ ..s .... .. /
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J
J
3AI~JO N~3~IO
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