HomeMy WebLinkAboutCREEKSIDE PARK #1 LT 1A
6AAB-HD-I
G£" TER ANCHORAGE AREA BOROI' t
~'~rARTMENT OF ENVIRONMENTAL QUALI~-,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
" MAILING
NAME -/'""~/~"'~.~'~,~"~/J/',~;~ f_~,~,,/l/'f~T". ~_.,~,,,~,,~V",/~ ADDRESS,_,~.~.2'/__;2Z.~ _.~,~.-~Z~.~,,~--f~:~ ,.,~./~'_,, __PHONE__
LOCATION ,/~u"~-~'d)L-~,"~" ,,~L-',-~g~___ LEGAL DESCRIPTION~ ~~/~~. ~ ~/
SEPTIC TANK: ~: ~ /~
¢ ~_~-;...~,,~'-'/'~,,"~---
DJ'STANCE FROM WELL
L,/QUID CAPACITY,-~ ~ ~ ~" GALLONS.
NUMBER OF
.MATERIAL ~',~'~-'---~/---- COMPARTMENTS ~
INSIDE LENGTH ~ INSIDE WIDTH ~ DEPTH "---
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / CUT3',D[- DIAMETER '~ /' J':"~'~' OR WIDTH ~ LENGTH -'~, DEPTH
LINING MATERIAL,,,'~,,,~'~ --~/,,,~',,.,'~..4-'-7".~--- ~' D~STANCE FROM WELL /-~'..~"/~-..--,~'-/~¢' . BUILDING FOUNDATION
NEAREST LOT LINE ~0 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) _/~,~rJ'J~"~~' SQ. FT.
TILE DRAIN FIELD: /~/,/'.~
DISTANCE WELL
FROM _~c"~ATION ~ , NEAREST LOT LINE
NUMBER~OF LINES~~~~NCE BEIWEEN LINES ~IRENCH WIDTH
ABSOR~A~ SQ. FT. LENGTH OF EACH LINE _~_.__
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER
MATERIAL
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE__
WELL: c~-7~',~'~,~- ~, /--~/~,,'~.~=:-~'" DISTANCE FROM
TYPE .,,~:/'~"~---- DEPTH ~'j/~ , BUILDING FOUNDATION
NEAREST SEPTIC SEEPAGE ~
LOT LINE ~),~_ , SEWER LINE ~/~ , TANK c~)~ , SYSTEM_~._,~
DIAGRAM OF SYSTEM
WATER
SAMPLE
CESSPOOL
NEAREST
OTHER
SOURCES
DISTANCES:
DATE
APPROVED
G.A.A.B.
I'-z./(~['7~- iPL)lbt~ %ewP_Z_ IS /uO-( AVA(L. ABLE.
GAAB-HD'7~_ GREATE! ANCHORAGE AREA
.k~i~k '~ HEALTH DEPARTMENT
' ~t'~ 327 Eagle St. Anchorage, Alaska 99501
ROUCH
279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT "i
RESIDENCE ADDRESS
MAILING ADDRESS . ~ .,'~' ~':
LOC~TION OF INSTALLATION
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK ,DRAIN FIELD ,OTHER
TO SERVE THE FOLLOWING FACILITY (') / 'ii~:~
FINANCED THROUGH < :h, Z ~- TO BE INSTALLED BY ' (' l:'k
PERCOLATION TEST RESULTS fi- (). ANTICIPATED DATEOF COMPLETION
' ' ' :BE~Ow TO BE FILL~D OUT BY HEALTH DEPARTMENT ~ '/'~;:~¥~, /-4
' " '
THIS IS TO SERVE A$ -)¥'~1 . :'~:~:" , PERMIT TO iNSTALL A '
AS DESCRIBED BELOW. SlZ¢ OF UNIT TO' DESERVED .~
· SEPTICTANKSIZE..~;,.~I~¥'Aiil TYPE
DISTANCES:
-'
.... . .:sEEPAGE :~ .-. .
/ -'" :>'~: ;' / A'REA .~ "> ':: '< TYPE
· %t~ <- ~__, ; DIAGRAM OF:SYSTEM
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system isin accordance with said code. '
DATE z -' // .(,.
-' APPLICANTS SIGNATURE $/, /.,_ , .// ,,., ,S"~
~ordo~. A. lilrtlatb