HomeMy WebLinkAboutT15N R1W SEC 9 LT 17 REMOnsite File
T15N R1W SEC 9
Lot 17
#051-143-22
GAAB-HD-]
G,~ATER ANCHORAGE AREA BUR ~O~':'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SiTE SEWAGE DISPOSAL SYSTEM
LOCAT,ON
SEPTIC TANK:
MAILING
ADDRESS PHONE
DISTANCE FROM WELL /O~'~' MATERIAL ~""d'/Z~b~
LIQUID CAPACITY /'~' :~-~-) .GALLONS. INSIDE LENGTH
NUMBER OF f
COMPARTMENTS
LIQUID
DEPTH
INSIDE WIDTH.
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MAIERIAL
NEAREST LOT LINF
SEEPAGE PIT:
OUTSIDE DIAMETER_
DISTANCE FROM WELl
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)_
LENGTH ~.O , DEPTH
, BUILDING FOUNDATION ',~/ ,
~ S ~) SO. FT.
TILE DRAIN FIELD:
N~ ~ IOTA[ LENGTH
/'~/ TR NCH W~?' IN.~.TO~AL EFFECTIVE
NUMBER
OF
LINES
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE .
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE.
IN. ABOVE TILE.--
~.~ -~ J'/ DISTANCE FROM WATER
WELL: TYPE ~';. , DEPTH . BUILDING FOUNDATION (~ SAMPLE NEAREST
NEAREST ~/'(~) SEPTIC ~/~' SEEPAGE / '~~' OTHER
, SYSTEM ~ --~' , CESSPOOL
LOT LINE ~-- , SEWER LINE . TANK
DISTANCES:
DIAGRAM OF SYSTEM
A P PRO V,~?~'/~ ' HEALTH ~THORI~,,
OAAB-HD-2
GREATEi ANCHORAGE AREA DROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
CaseNo. /,~Y
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~'~,/~-z~///'A~' ,~.~,Y.~'/-)?.,,'C~'~.-~/IAILING ADDRESS
RESIDENCE ADDRESS LOCATION OF INSTALLATION ,/"~¢//,,~'
~.//J~;~' //~/~ LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PHONE NO.
SEEPAGE PIT ~ .,DRAIN FIELD ,OTHER
PERCOLATION TEST RESULTS,,~,,/~"¥"/~:/~~'' "~' ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS , PERMIT TO INSTALL A /~-~Y (~/~?~/'
.~k~ ~- ~ AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
[ .. SEPTIC TANK SIZE /~ .TYPE ~z~/~C~ SEEPAGE AREA~ /
DISTANCES:
Health Authority
TYPE
DIAGRAM OF SYSTEM
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 y-~ .~C9.'-- 2C~ APPLICANTSSIGNATU"E