HomeMy WebLinkAboutWILLIAMSON BLK 2 LT 6
C-"'!.ATER ANCHORAGE AREA BORO';GH
HEALTH DEPARTMFNT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 2/9-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSI'EM
SEPTIC 'rANK:
!
DISTANCE FROM WELI'r-/t~ 'f~
__GALLONS. INSIDE LENGTH c~' /
NUMBER OF
COMPARTMENTS
LIQUID
INSIDE WIDTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATER IA,
NEAREST LOT LINE
OUTSIDe DIAMETER Or WIDTH__ , LENGTH ~/~' , DEPTH ~' /
/ /
_. DISTANCE FROM WELl. '/~'~ , BUILDING FOUNDATION~_-~s~-'
~ TOTAL EEFECHVE ABSORPTION AREA (WALL AREA) SQ. F~.
TILE DRAIN FIELD:
DISTANCE FROM WELL
TOTAL LENGTH
FOUNDATION ., NEAREST LOT LINE _, OF LINES
__SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF EILTER MATERIAL BENEATH TILE
IN. ABOVE TtLE__
WELL: t Y p E ~,},,~/~z.~-./~ DEPTH
/ NEAREST
SEPTIC
LOT LINE /(~ '/" , SEWER LINE
, TANK_
DISTANCE FROM ~' WATER ~
,BUILDING FOUNDATION.. ,/~ '~:~__SAMPLE /~Z' _, NEAREST
t'~ ,~ / SEEPAGE ,/ / OTHER ~
· 't" , SYSTEM <J~) [~, CESSPOOL / . SOURCES__
DIAGRAM OF SYSTEM
DISTANCE:S:
DATE __
GAAB-HD-2
GRE " E
327 Eagle St.
ANCHORAGE AREA
HEALTIt DEPARTMENT
Anct,orage, Alaska 99501
;OROLTGH--c :e
279
SEWAGE DISPOSAL SYSTEM - APPLICAT,!~N & PERMIT
NAME OFAPPLICANT~ ~ ~ MAILINGADD~ES~}' :~ ~-/ PHONENO
APPLIgATIO~ TO INgTALL: SEPTIg TANK_ /., SEEPABE PIT /', B~AIN FIELD , OTHE~_
TO SERVETHE FOLLOWING FAClL. ITY_~,~/Y~ ~;~{~' ,
THIS IS TO SERVE AS '% ., PERMIT TO INSTALL A
_AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
_. SEPTIC TANK SIZE ~ C .TYPE~, f~SEEPAaE AREA
I / DIAGRAM OF SYSTEM
DISTANCES:
ALTH AUTHORITy
OR
2ENSED DESIGNER
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__ --4~7~' ~ APPLICANTS SIG NATU R E ----~:,~~/'
~ GREATERANCHORAGEAREA BOROUGH
~/'~ ,. Department of Environmental Quality
· 3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received / o ~,6'
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAl. SEWER & WATER FACILITIES
FOR
/ ~ /
Mailing Address: /-"~ (? ?i:by,/ ~/- -~,:, ~ o Phone:
2. Property Owner: /'~ ,~ ~,,~ ~(' ~ f~ ~ ''
''' ,'~ ~ ,'~ Phone: ..'z/ ~/~ /),~ 5
Mailing Address: ~?,/.i /.~, /~-// '/~? ~
3. Legal Description:
4. Location:
5. Type of facility to be inspected
No. of bedrooms -.~
Wel 1 Data:
A. Type ~_ ^//>/~ .
C. Construction ~" '~,~,, ~
B. Depth _ ,);~ /
D. Bacterial Analysis
Sewage Disposal System:
A. Installed ~-/~/_ ~/L2 B.
C. Septic Tank: 1. Size /'~-~ ' ~
D. Seepage Pit: 1. Absorption Area
Installer
2. Manufacturer 7:~L/: Z',
2. Material _/~,___~,: ,:' }~',
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank ~,'~ /'
_, Absorption area
, Sewer Lines
Nearest lot line
, Other contamination
B. Foundation to septic tank
Absorption area
C. Absorption area to nearest lot 'line
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Re st for Approval of Individual ~ 'er & Water Facilities
Legal Description ~?
/
Comments
Approved ~,~, ..... ~ '" · ' Date
/~.
Approval~Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily,
SIGNED Date
EQ-034 (1/74)
333O
GREATER ANCitORAGE AR[:,', aORO[JGtl
Department of Environmental Quality
"C" St., Anchorage, Alaska 99503 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of inspection: CMRO VA .. /__ FHA __. CONV
' ..... - c/ __ , ~ :?,'~ :::
Nailing Address:
Name of Realtor or Agent:
Nailing Address: .~
. yer. , __ ZZ~___~ r- tl .............. cL .
l'ia i 1 i n9 Address
Phone
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings
If Individual, dep,:t o'F well (~[/~,
Sewage l)i sposal. System
Type .of S~steln: Public Ui;ili'ay
If Individual,
__ ~-(~ L~L,%C..E~__ No, Bdr;,msz _,%
Individual v/
presently served .../__
Individual (on-site)
date of i nsi;allation