HomeMy WebLinkAboutNEVILLA PARK LT 83
I/EATER gNCHOR~.GE AREA BOROUGIt
!!EgL'HI DEP~R~ENT
327 EBGLE STREET
~NCHORAGE, ALASKA 99501
279-2Sll
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND I7ATER FACILITIES
FOR
Approval Requested By .... ~_o/'/ O,
Address
Phone
Property Owner
Legal Description
Phone
Type of Facility to be Inspected__~.~c/, //o~
Number of Bedrooms {~)
Well Data:
A. Type
B. Depth
C. Size
D. Constrtlction
E. Bacterial Analysis
Sewage Disposal System:
A, Se tic Tank' (If homemade, show diagram
1. Size
2. Age ~'/6
3.
4,
Installer
Approval Request for Se~ .~ ~ Water Facilities
Page Two
Seepage Pit
1. Size
2. Lining
Disposal Field
1. Number oJ~ Lines
2. Total Length
IZ.×)z,
Required ~easurements
A. Well to Septic Tank
B. Well to Seepage Pit
C,
D.
E.
Well to Sewer Line
Well to Property Line
Well to Other Possible Contamination
F. Foundation to Septic Tank
G, Foundation to Seepage Pit ~ /!
H, Seepage Pit to Property Line Z.~'--~
8. COMMENTS:
-' ,.,y' _:': ' ..!~,'-- / -
APPROVAL VALID FOR ONE YEAR FRO~I DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMEN"I'
EDll70
Gm" 'TER ANCHORAGE AREA BOROI'n.H
HEALTH DEPARTMENT
:327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
£7--
DISTANCE FROM WELL__ ~/'~'Z'~~''~ MATERIAL C~-~'~/~I''
LIQUID CAPACITY ,.~c~-c~) _GALLONS. INSIDE LENGiH
NUMBER OF
.COMPARTMENTS
INSIDE WIDTH
LIQUID
DEPTH ____
SEE!PAGE SYSTEM:
NUMBER OF PITS /
LINING MATERIAL Z-
SEEPAGE
OUTSIDE DIAMETER
OR WIDTH
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH , DEPTH_
BU~LD~NG FOUNDATION ,'~ /,
.ff o so. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER OF LINES
ABSORPTION AREA
FOUNDATION_
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
, NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL:
TYPEr Z'),/~...'/¢.V , DEPTH.
NEAREST
LOT LINE ., SEWER LINE.
DISTANCE FROM WATER
,BUILDING FOUNDA'rlON. _SAMPLE_
SEPTIC SEEPAGE
., TANK , SYSTEM. . CESSPOOL
DIAGRAM OF SYSTEM
· NEAREST
OTHER
, SOURCES__
DISTANCES:
DATE
APPROVED
GREATE[ aNCHORAGE AREA
HEALTIt DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279.2511
SEWAGE DISPOSAL SYSTEM - APPLICA'i'ION & PERMII'
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY ~
FINANCED THROUGH
PERCOLATION TEST RESULTS
NAME OF APPLIgANT c/-~//'/2~'. /.) ,r,~/O~,~./~/),'g¢/'Z/-- MAILIN6 ABBRESS~/~ ~<~//~ PHONE
REglBENGEABBRESS ~-~ ~¢&/'~¢ .-¢'~%LOCATION OF INSTALLATION.
~ , SEEPAGE PIT , DRAIN FIELD. , OTHER
ANTICIPATED DATE OF COMPLETION ~)/
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS_ ~ff/~ /~&' ~6F],"2/9 ' J', PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNITTO BESERVED~
SEPTIC TANK SIZE ~'~¢~0 ..TYPE ('Old, .SEEPAGE AREA(~/S'~/~g) TYPE DIAGRAM OF SYSTEM
DISTANCES:
/4o0.;£ 7
Health Authority
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.