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GRr~TER ANCHORAGE AREA BOROU',H
~ HEALTH DEPARTMENT ~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAT,ON '~ L~
SEPTIC TANK:
LEGAL DESCRIPTION ~:)7-- lB
DISTANCE FROM WELL
LIQUID CAPACITY
~'~ ~/' MATERIAL ~")~J~4'/~- COMPARTMENTsNUMBER OF
GALLONS. INSlD5 LENGTH INSIDE WIDTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
/.06-
t
._~(/) , TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
OR WIDTH / ~-/ LENGTH I 'J~ /, DEPTH
· DISTANCE FROM WELl /~ O / BUILDING FOUNDATION
'--~3~) ' SQ. Ft.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
, FOUNDATION , NEAREST LOT LINE
DISTANCE BETWEEN LINES. TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
DISTANCE FROM ~ I ' WATER
WELL: TYPE J~O'~ ~' /A~, DEPTH ,BUILDING FOUNDATION SAMPLE /~/~) , NEAREST
~ NEAREST /_~/ SEPTIC ~/ SEEPAGE /~ / ~ OTHER
LO~ LIN~ I. :SEWER LIN~ ~_ ,TANK. ~/ ~ - , SYSTEM - /~._ ,CESSPO0~ -- :SOURCE~
DIAGRAM OF SYSTEM
DISTANCES: .... ' .... ' ....... : ..........
~-~ :/~ .... . ......... ~ ........... ~
E_~=los, .'. ,~ :.":: :- [ ~ .~::" :.. :. ::~' ,.::. ::'
-". .... ::': '1
~-~-//~ ........................... t-~--I :--~--<~ ...... ~.----.--~-~1--~-~---~,- -
GREATE[ ANCHORAGE AREA / )ROUGH
ItEALTll DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case Ho.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS LOCATION OF INSTALLATION
LEGAL DESCRIPTION ~'~ ' '
APPLICATION TO INSTALL: SEPTIC TANK ["/ . SEEPAGE PIT z.-'"' . DRAIN FIELD . OTHER
TO SERVE THE FOLLOWING FACILITY "~ ,~"0~-'
PE,CO~TIOH TEST ,ESULTS ~ ~~ ANTICIPATED DATE OF COMPL~O~
BELOW T0 BE FILLED 0UT BY HEALTH DEPARTMENT , /
THIS IS TO SERVE AS ~ . PER~IT TO IHSTALL A ~,~
. SEPTIC TANK SIZE
AS DESCRIBE~ BELOW. SIZE OF UNIT TO BE SERVED
SEEPAGE AREA
DIAGRAM OF SYSTEM
?~/TYPE
TYPE
Health Authority
! certify that ] am familiar with the requirements of Greater Anchorage Arco Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLICANTS SIGNATURE
PERMIT NO.
RPPLICR~T
LOCATION
LEGAL
MUN I P.. PAL I TY OF A~I~4ORAQE
DEPARTMEi.o OF HEALTH AND EN¥IRONHENTRL PROTECTION
825 'L' STREET~ ANCHORAGE, AK.
264-4720
~ P~IT
( 8e~0~9 )
LOIS L. HURD
BO.ERr LnND SP#
~ISNRi~.S..e'LOT ~6'1
LOT SIZE
¢88-2845
D0000 SQUARE FEET
tIINIHU~I DISTAtICE BETWEEN R HELL n~D RNY Ot'~-$ITE SEWAGE DISPOSRL SYSTEH IS -
~.00 FEET FOR R PRIVATE WELL OR 150 TO 20~ FEET FRO~ R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
'HINIHU~ DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET RND
TO R COMNLINITY SEWER LINE IS 75 FEET.
HELL LOGS ARE REQUIRED AND ~UST ~E RETURNED TO THE DEPRRTHENT WITHIN DO DAYS
OF THE WELL CO~IPLETIO~.
OTHER REQUIREMENTS HAY APPLY. SPECIFICRTIO~S AND CONSTRUCTION DIRGRRHS RRE
RVRILRBLE TO INSURE PROPER INSTALLATION.
PEArl I T EXP I RES DECEMBER ~l. l~Ae
I CERTIFY THAT
l: I RM FRHILIRR WITH THE REQUIREMENTS FOR ON-SITE ~EWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I HILL INSTALL THE SYSTEM IN RCCORDRNCE HITH THE CODES.
..............
APPLICANT ~ L. ~URD
by
E)OC Co. dba
SULLIVAN WATER WELLS
P. O. BOX 272. CHUGIAK, ALASKA 99597 .* TELEPHONE 688-2759
OWNER OF LAND
ADDRESS " .... ;'"'f '/
DEPTH OF WELL ', ~ '5'
STATIC LEVEL OF WATER FT.
LEGAL DESCRIFflON ~' ' ~'''' /~'~ ~'
DATE - Started .... ' ~ Ended
PERMIT NUMBER
~-,: ~_ - 4. o I DRAW DOWN FT. ,
,t', · . GALS. PER HR '' '
KIND OF CASING ?- ";/;
KIND OF FORMATION:
From " Ft. to ~ ' Ft.~
From ' Ft. t Ft. , ' ' ~ ' /
From Ft. to.~.Ft.
From Ft.
From Ft. to_~F/.
~rom Ft. to Ft.
Fr~ Ft. to Ft.
From Ft. to Ft._
From Ft. to Ft.
From Ft. to Ft.
Fr~ FL Io Ft..
From Ft.
From--Ft. to Ft,
From Ft. to___Ft.
From Ft. to Ft.__
From Ft. to F[~
From__Ft. to Fl
From Ft. to Ft.__
From__.Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From__.Ft. to Ft..
From Ft. to FI
From Fi. to Ft.__
From Ft. to Ft
From Ft. to Ft
From__Ft. to Ft.
ANCHORAGE
From Ft. lo. MI.~glPALITY CF g,
DEP1. GF ~ '-
From Ft. to ~j..,J~ONM~:~I."L ; :.~: .CTtON
MISCL INFORMATION
I/lAY 8 1980
RECEIVED
DRILLER'S NAME