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Home My WebLink AboutTIMBERLUX #1 BLK E LT 11LeT II OAAB HD- I GRrATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-251 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: MATERIAL ADDRESS GALLONS. iNSIDE LENGTH /-- NUMBER OF COMPARTMENTS NSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PiT: NEAREST LOT LINE. TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA.) SQ. FT. TiLE DRAIN FIELD: / I ~.,) / TOTAL LENGTH .~ DISTANCE FROM WELl /J~'~ , FOUNDATION '*'~¢~ '~- , NEAREST LOT LINE '~ ~ IN. TOTAL EFFECTIVE NUMBER OF LINES 4D DISTANCE BETWEEN LINES ' TRENCH WIDTH ABSORPTION AREA //~ ~' ~'~ SQ. FT. LENGTH OF EACH LIN~ / (~' I~ '~ ~ / '~ ~ (~ ;~ ~/' / / / / DEPTH: TOP OF TILE 10 FINISH GRADE'' '~ DEPTH OF FILTER MATERIAL BENEAiH TILE ~ '~ IN. ABOVE TILE r'/.~/ '~? D STANCE FROM 7/~, WATER /.~/ WELL: TYPE~ /Z'~?) DEPTH r/~ ~7 ,BUILDING FOUNDATION. . SAMPLE ~ JqEARES1 JEAREST SEPTIC ~/, SEEPAGE // ~, .~ OTHER LOT LINE /"~ ~' SEWER LINE ~ , TANK SYSTEM , CESSPOOl . SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE GAAB-HD-2 GREATEI, ,ANCHORAGE AREA L,) ROUGH CsseNo. 327 Eagle St. Anchorage, Alaska 99501 279-2511 ¢~'~fD, 3 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT ~AMEOF APPLICANT Z~T~l,{) I/~') ~,¢~C~'~ MAILING ADDRESS ~)~ ~Z~. ~9~ A&[ LOCATION OF INSTALLATION ~1 RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~- L- F PERCOLATION TEST RESULTS SEEPAGE PiT TO BE INSTALLED BY -~¢--)--- ANTICIPATED DATE OF COMPLETION , DRAIN FIELD ~J , OTHER BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS ]Y~t~' -~ a ~-.~: , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED . SEPTIC TANK SIZE ~-'-~'Z~) TYPE ,~'tZ'-~¢- & SEEPAGE AREA TYPE DIAGRAM OF SYSTEM DISTANCES: I cert~f' y that I am familiar with the requirements of Greater Anchorage__Area Borou3~hz.r Orflinance }Io.// ./ , . --28'p8 and that.t~he/i. // above described system is in accordance with said code. ~.44~ ,-F~'~'L-~';//~ dt'y~~g~ 4~t~;t~t~' DATE ? 9~ APPLICANTS SIGNATURE ~/ ~d~ _ SREATER ANCHORAGE AREA BOROU~H~ HEALTtt DEPARTMENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 ,CJ ~/~ ' Date Performed 7- i0~7~ ~ This Form Reports a. bozAs ~og ..V . Depth ~ eet So.il Characteristics Location Sketch Was Ground Water Encountered? If lYeS, At What Depth Reading Date Gross Time i Net Time Depth To ~20 Net Drop ereola~lon Late ~"/ M~n~te Proposed Instal~Seepage Pit,, ~ i iDrain Field Depth Of Inlet' ' Test Performed Bye Data Certified By Date: ~, DATE .~ RECEIVED ' INSPECTION APPOINTMENTS TIME TI M E/~t~) MUNICIPALITY OF ANCHORAGE D~PT. OF H~ALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~NMENTAL PROTECT[ON ' ~ ENVIRONMENTAL SANITATION DIVISION MAY 2 8 1981 Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~ER FACILITIES MAILING ADDRESS $~ 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS /~ [] One [] Four SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY .~ Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A is required for all we[Is drilled log [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) [] Other SEWAGE DISPOSAL SYSTEM ~ INDIVlDUAL/ONISITE** '-73 [~ PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE ~J THREE [] FIVE [~] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX 2. WAT/ER/SUPPLY PERMIT NUMBER ~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED NED AGE DISPOSAL SYSTEM PERMIT NUMBER [VI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY '~' ~/7 ~') Connection Verified INSTALLER E~Septic Tank or [] Holding Tank Size: /~b-'~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line,, Absorption Area to nearest Lot Line ii, COMMENTS [~APP ROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-o10 (Rev. 6/79)