HomeMy WebLinkAboutWENTWORTH BLK 5 LT 2
GAAB-HD-I
GR~6.TER ANCHORAGE AREA BOROI'mH
~r_,/ HEALTH DEPARTMENT ~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
LIQUID
LIQUID CAPACITY GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
NUMBER OF PITS J OUTSIDE DIAMETER OR WIDTH_ , LENGTH , DEPTH
LINING MAJERIAI ~' ~ ~ DISTANCE FROM WELl ,/O~ ,BUILDING FOUNDATION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL FOUNDATION . NEAREST LOT LINE OF LINES ,
'A~'SORPIION AREA SQ. FI LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO F NISH GRADE
DEPTH OF FILTER MATERIAL BENEAIH TILE'
ABOVE TILE
WELL: TYPE ~'//;//'~'~'/ ~'', ~'! /~' WAJER ~
DEPTH 8 DISTANCE FROM
. BU LDING FOUNDATION, SAMPLE. NEAREST
/ SEPTIC SEEPAGE /O,~ OTHER
LOT LINE /~ ~ NEARESI ~ ~ ~
. SEWER UNE TANK . SYSTEM , CESSPOOl . SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE '~A'I~F~ ~"I E~'~'" --
GAAB HD I
Gp=ATER ANCHORAGE AREA BORO'"~H
~? HEALTH DEPARTMENT '- ,
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS__
LEGAL DESC~,PT,ON
.PHONE
SEPTIC TANK:
DISTANCE
UI~C~PACIIY
GALLONS. INSIDE LENGTH
ER OF
LIQUID
INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT: ./x'/~2 ~
L D~/~- . DISTANCE FROM WELL
O!
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA).
LENGTH , DEPTH
w SQ. FT.
TILE DRAIN FIELD:
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF F LTER MATERIAL BENEATH TILL=
IN. ABOVE TILE
'.~ '. /W,-/ %:: D,STANCE EROM /0' WATE,
WELL: TYPE ~'~ ('~/"'~/ PTH , BUILDING FOUNDATION SAMPLE
> / NEAREST ~ SEPTIC SEEPAGE~
LOT LINE /~ '~ , SEWER LINE .TANK . SYSTEM CESSPOOl
°,'HER .
DISTANCES:
DIAGRAM OF SYSTEM
DATE
r,, RI . TEIr ANCHORAGE AREA . )ROUGH
~7 Eagle St. Anchorage, Ahska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT~.,~'/~ {../,',','~dz,~,z.g-
RESIBENCEADDRESS ~Z~
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY ~
FINANCED THROUGH /~ ~~
PERCOLATION TEST RESULTS
MAILING ADDRESS 9~2~'/~Z~ ,~
LOCATION OF INSTALLATION. ~-~/-'2'
PHONE
, SEEPAGE PIT ,)d , DRAIN FIELD. , OTHER
TO BE INSTALLED BY, ."~g'~ ~
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ,/~.////~ ,PERMITT01NSTALLA . .,.'~ ~.-~,,-~
.... AS'DESCRIBED BELOW. SIZEOF UNIT TO BE SERVED ~; ~ffz~/~>/~'
.SEPTIC TANK SIZE /~'t3¢ .TYPE~ SEEPAGE AREA~j~.~ TYPE
DISTANCES:
DIAGRAM OF SYSTEM
I certify that I am familiar with the requkements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE
APPLICANTSSIONATURE Y ~-/~'~ ~ ×/// ~'
/
;~GREATEI~NCHORAGE AREA ~:)ROUGH
HEALTH DEPARTMENT
//? 327 Eagle St. anchoraam,~Aaska 99501 / 279.2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Ca~e No.
~_OCAT~ON OF mSTA~.LAnON ~.~/;Z ~ ¢'~----
NAME OF APPkICANT
RESIDENCE ADDRESS
APPLICATION TO INSTALL: SEPTIC TANK__, SEEPAGE PIT ,DRAIN FIELD ,OTHER
To ~.w ~.~ ~o~o~,.~ ~.~ ,~,~ ~ &~. ~//~- ~: ,
BELOW TO BE FILLED OUT BY HEALTH DEPARTMEN~
Y~;".~ ~ ~fl~' PERMIT TO INSTALL A,~~I-
~_AS OESCRIBE~ BELOW. SIZE OF UNIT TO BE SERVED
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.
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF PUBI..[C WORKS
August 18, 1970
GAAB Health Department
327 Eagle Street
Anchorage, Alaska 99501
Gentlemen:
SANITARY SEWER SERVICE - WENTWORTH SUBDIVISION LOT 2, BLOCK 5
This is to confirm that the Greater Anchorage Area Borough Department
of Public Works has formed a lateral sewer improvement district in
the Wentworth Subdivision. These lateral sewers should be constructed
within the 1971 construction season.
The lateral sewers in this improvement district will service
Lot 2, Block 5 of the Wentworth Subdivision.
If further information is needed regarding this matter, please feel
free to contact this office.
Yours truly,
GREATER ANCHORAGE AREA BOROUGH
Robert H. Morriss, P. E.
Director of Public Works
Robert M. Hudnall, Jr.
Administrative Assistant
RMH/jt
cc: Les Polzin
John Jones
b, Detergent "' '
Well data:
a. Type ~
b. Depth ~i'"O~F~'
c. Casing Size
d. Distance from well to closest existing or proposed:
1. Sewer line
2. Septic tank ~! .
3, Seepage Area_ /00!
4, Cesspool'__
5. Property Line
6. Other sources of possible contamination, i,e,~ creeks, lakes~
houses~ barn~ drainage ditch, etc.
Sewage disposal system.
a. Age of system ~.
b. Septic tank capacity in gallons
c. Name of septic tank manufacturer
1. If "home made" show diagram on reverse side of this form.
Disposal field or seepage pit size and type., ~, , ,~7~
1. Distance to property line /D I to housefoundation' ,,~10'/!
Percolatio~ Te'st '~esultS
f. Percolation Test performed by
Use the reverse .side of this form to show diagram. Diagram should include
[.~<he foilowing information: p~operty lines~.well location, house location,
~utic tank location, disposal area location, location of percolation test,
~ direction of ground slope.
9. The h~£o~tion on this form is true and correct to the best of my knowledge.
~ignature 'of Applicant ...... Dat'e Signed
\
T__O~ BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL
~'£he above described sanitary facilities are hereby approved, subject, tqthe
.......... ~61lowing cond~ilons:
Conditions: ~/Jm~.~
The above described sanitaryfacml~tzes' ' ' are disapproved for the following
reasons:
Approval is valid for one year following the date of approval.
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