HomeMy WebLinkAboutJOHN WELLS 1952 BLK 3 LT 10A ABBOTT WOOD TOWNHOMESLo'T'
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 9950'1
279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
_PHONE.
SEPTIC TANK:
DISTANCE FROM WELL_
LIQUID CAPACITY__4
GALLONS.
,NSIOELENOT, d'4:" ' 'NSIDEW'DT' DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT:
..~ , BUILDING FOUNDATION__ ,
LINING MATER ..L~ ~-- ..... ~"~
NEAREST LOT LINE____ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE . Z '
FROM WELL
ABSORPTION AREA ~ '~ c~-~
DEPTH: TOP OF TILE TO FINISH GRADE
!
, FOUNDATION__ ~---- --~ , NEAREST LOT LINE
DISTANCE BETWEEN LINES '~7' ~- jTRENCH WIDTH :'~
_SQ. FT. LENGTH OF EACH LINE/'(f( /.U~
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH~ .... · ,/ /
· OF LINES
IN, TOTAL EFFECTIVE
IN. ABOVE TILE '~'~ ~:~
t NEAREST ! SEPTIC
LOT LINE *~Z.~.'~ ~' SEWER LINE ~'~'~'i
, , TANK
DISTANCE FROM /' WATER ., /'
,BULDING FOUNDATION,_ 7 SAMPLE__~" ~ ~ NEAREST
.~? ~? j SEEPAGE t ..... OTHER -.
,) ~) , SYSTEM /~'T.~' , CESSPOOL , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
GAAB-H D-2 Case No ....
GREATEI
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 9950]
279-25 ] 1
SEWAGE D~SF~OSAL SYSYE~ - AFPL~CA?~ON & PER.g?
NAME OF APPLICANT( ({~7~ ;!:i, ~
.... i~ ~ ~ %
RESIDENCE ADDRESS ,../0.~ ;~. 5/~
LEGAL DESCRIPTION_ g.o
APPLICATION TO INSTALL: SEPTIC TANK/~'~?z~ , SEEPAGE PIT_ ,DRAIN FIELD
T0 SERVE THE FOLLOWING FACILITY_
FINANCED THROUGH
PERCOLATION TEST RESULTS
MAILING ADDRESS,~J~ LC q~_v*.~ PHONE N0.'~7,Z ~f'~c~{
LOCATION OF INSTALLATION ~z/~Z~ Z~/.~ /.~.~/...~>~,_,~
, OTHER __
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS //¢t
?/~u:.~ , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNITTO BE SERVED__
SEPTIC TAN K SIZE ~LY~: TYPE ~'~ u,
DISTANCES:
.SEEPAGE AREA )d:e:' ___TYPE
DIAGRAM OF SYSTEM 2~ / ?~ .- /~'~/~
//f ~ealth Authority
I de)~tify that I am familiar with the requh'¢ments of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE 4 )/ ] APPLICANTS SIGNATURE
INDIVIDUAl, SEWAG]:: AND WA3t~]~ FACILITIRS ( t-'iLL OUI' .tN TRIPLICA']}:)
h, Nt.u~)e~ of bedrc~ in house
d
W,:tLaP 7~anlw~is :
b o f~al:epgent
Well data:
d. Distance frxom we],l 'l:O c1¢' ;'"oeot.~' ' existing or pno~x)sed:
..... ~ S(,we~ t.Lne
~-'SepTic
5~ ~ ~)~ t:v llne
6, Other sot.mces of [mssJ. ble cont~md.t~ation, ie~ creeks,
housea~ barn dr'ainape ditch~ etc, t~, ~[2. ~ _ .
Sewage disT.,al sCat'em. ~/3 '~
]., Distahce 1:o p're~Pt:y Ii.ne ........................ ~o house founda't:Lor
e,~ ?eP(nO].a'lion Tes/: pesults ......................................
f~ Percolation Test perfoPmed by
8. Use the peveI¥;e side of this fopm to show diagl'am0 DiaF, pam should include
the foll~i, ng info~2tion: ppo~Pty l]nes~ well location~ house location~
septic -ta~ lc~ation~ disposal a~a. location, location of ~molation test~
and di~ction of w~und sl.o~
The inforw~tion on this forth is 'hme and co~ecl; to the best of my kmowleck~e~
TO ['~E FILLED OUT BY I~A~711 ILI A!d]*ILNF PERSONNEL
~-lhe above described sanitary facilitSes ar~ herebv approved, subject 'to the
fol]_owin[{ condit [OhS:
Conditions:
/
The alx}ve described sanitary~ facilities are disapproved for the following reasons:
ApNx2val is valid fop one year followin~l the date of apppoval~
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