HomeMy WebLinkAboutWAKEFIELD Lot 3
Gr-~,TER ANCHORAGE AREA BOROI'"~H
H EAL'rH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? 147
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
MAILING ~,,~.,~
ADDRESS~
PHONE
LEGAL DESCRIPTION ~" ~r'
NUMBER OF /
DISTANCE FROM WELL ~'~'.~/~ MATERIAL~/~'~'~/-~J~ COMPARTMENTS.
LIQUID CAPACITY /~), ~ GALLONS. INSIDE LENGTH. ~ / INSIDE WIDTH ~'"' ~ LIQUID
DEPTH __
TILE DRAIN FIELD:
DISTANCE FROM WELL~, FOUNDATION_
NUMBER OF LINES --~ DISTANCE BETWEEN LINES
ABSORPTION AREA ~)d~ SQ. FT. LENGTH OF EACH LINE
/
DEPTH: TOP OF TILE TO FINISH GRADE
. NEAREST LOT LINE
TRENCH WIDTH__ ~'~
DEPTH OF FILTER MATERIAL BENEATH TILE ~
TOTAL LENGTH
OF LINES.
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: Typ E~¢~, ./~ DEPTH /
LOT LINE ~ NEAREST SEPTIC
, SEWER LINE. ~'"~'., TANK
DISTANCE FROM ~...~WATER
· BUILDING FOUNDATION.. SAMPLE. ., NEAREST
OTHER
~ SEEPAGE ~ ~/ , SOURCES
, SYSTEM__ . CESSPOOL
DISTANCES:
DIAGRAM OF SYSTEM
~ z=
DATE
HEALIH AUJHORI]Y
GAAB-HS-2
GREATEF
327 Eagle St.
NCHORAGE AREA ?")ROUGH Case No. 7'J/
HEALTIt DEPARTMENT
Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAMI-' OF APPLICANTS~~- .~-(ff.4~v~ MAILING ADDRESS/~''0~ ~/ ,~'~ PHONE NO.~']'~ ~ (~'6~;~
..... LEGAL DESCRIPTION.
GELOW TO GE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BI:_ SERVED ,~ ~'~
" / f~"f.7'~ ~ ~7--I]IAGFIAM OF SYSTEM
DISTANCES:
I ~
tify that t 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 "' ' ·
DATE ~ APPLICANTS SIGNATU~
Pate
REQUEST FOR ^PPROV^L OF
INDIVIDUAL SEW^GE AND WATER FACILITIES
(Fill out in T~iplieate)
5. .Wate~.~.y~ls.
a. Bacterial .
b. Detergent, ...... ,
Well dar a:
b, Depth, .........
Casing Size ...... . /~j~ ,
f.:;;;].l to ~&oses, e×isting or p.opose
Dist.ance
.
1. Sewer line._________ ~
2. Sept~ c tank , .
3, Seepage Area___,,._.,.__,
4, Cesspool'
5. Property Line
6.
Other sources of possible contamination~ i.e,~ creeks, lakes,
houses, barn~ drainage ditch, etc._
Sewage disposal system,
a. ^ge of ~ys~e,, / ¢ 7 ~
b. Septic tank capacity in gallons
c, Name of septic tank manufactures, r_ . = . ..... ,
1. If "home made" show diagram on reverse side of this form,
d.' Disposal field o~ seepage pit size and type .... ~ ~/ ,
1, Distance to property..line
to house founda~ion.~_____i
e. Percolatio~ Te-stYesults_ ......... ,
f. Percolation Test performed by ................ ~ ....... . ..... ,
Use the meverse.slde of this form to show diagram. Dzagram should include
..'~he foilowing information: p~operty lines;.well location, house l?oation,
'~ptio tank location, disposal area location, location of perco].atlon test,
a~ direction of ground slope.
The ~for~atlon on this form is true an(] correct to the best of my knowledge,
TO. BE ¥IIi!~,D OUT B,,Y ,HEALTH, ~D?.P~AP. TMENT
~he ab.ove described sanitary facilities are hereby approved, s__ubje?~__to t~he
Conditions
The above described sanitary facilities are disspproved for the following
reasons:
._~, ~ / ~
· '/t,~ , ~ ,': a' .--.(.'./("/ fl_
/~, /" ,,," ,. ,. , ._..~ (~'1/ ~
.... ~pp~o~ is va~id fo~ one yea~ ~olZowLa8 the date o~ app~ovaZ,