HomeMy WebLinkAboutBROWNS RESUB LT 37(PLAT P-498) LT 3 T13N R3W SEC 22Onsite 9%
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GAAB-HD-I GRr-'kTER ANCHORAGE AREA BOROU.rH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME � / � �� -Jc"f .f�.S
MAILING
ADDRESS010A 4?% /�d�1lC /.- PHONE O 1/
LOCATION
LEGAL DESCRIPTION/ -4r--2,
SEPTIC TANK:
DISTANCE FROM WELL
NUMBER OF
MATERIAL S E�'L COMPARTMENTS
/�` w&
LIQUID CAPACITY �� GALLONS.
--LIQUID
INSIDE LENGTH '-� INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
/ WIDTH, LENGTH, DEPTH
NUMBER OF PITS OUTSIDE DIAMETER
OR ,
LINING MATERIAL ��-C���✓��7�
DISTANCE FROM WELL C9 BUILDING FOUNDATION-Z� ,
NEAREST LOT LINE -� , TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)SQ. FT.
TILE DRAIN FIELD:
y
TOTAL LENGTH
DISTANCE FROM WELL
TION NEAREST LOT LINE OF LINES
NUMBER OF LINES DISTANCE BETWEEN LINES TR IDTH IN. TOTAL EFFECTIVE
ABSORPT AREA SQ. FT. LENG
OF EACH LI
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
W ELL:G!.
DISTANCE FROM 4
TYPE 2< 62 , DEPTH
---WATER
BUILDING FOUNDATION.SAMPLE NEAREST
NEAREST 4„ ----SEPTIC 4_---- SEEPAGE 4— OTHER j
L'�
LOT LINE SEWER LINE
, TANK , SYSTEM— CESSPOOL SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE ARRROVED
HEALTH AUTHORITY
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P
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DATE ARRROVED
HEALTH AUTHORITY
GAAB-HD-2 GREATEN. ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
.. JROUGH
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Case No, I 7G
1 I
NAME OF APPLICANTy� MAILING ADDRESS',Zd®
PHONE NQ.
RESIDENCE ADDRESS LOCATION OF INSTALLATION
LEGAL DESCRIPTION 67` teems 64 27 lv%r�
APPLICATION TO INSTALL: SEPTIC TANK_, SEEPAGE PIT__ , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY /elo�" l
FINANCED THROUGH
PERCOLATION TEST R
E INSTALLED BY
ICIPATED DATE OF COMPLETION
BELOW TO _U_ -F4 ED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS }"`�j14, PERMIT TO INSTALL A
DISTANCES:
a
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED 0 v
SEPTIC TANK SIZE 17S-0 TYPE ccr� C SEEPAGE AREA L+ TYPE
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance
No. 28-68 d that tM
above described system is in accordance with said code. Air
DATE /� APPLICANTS SIGNATURE
■■■■■■
■■■■■//■■■EI■■■■■
LICENSED DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance
No. 28-68 d that tM
above described system is in accordance with said code. Air
DATE /� APPLICANTS SIGNATURE