HomeMy WebLinkAboutBROWNS RESUB LT 37(PLAT P-498) LT 9 T13N R3W SEC 22
GF'~.TER ANCHORAGE AREA BOROI'"~H
· , HEALTH DEPARTMENT _~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N.°
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
MAILING --~ --
ADDRESS rz~'~7~/ _~,~/'~r..~'~ PHON~~---
LEGAL DESCRIPTION ,.~,~L~-~...~.~,..
DISTANCE FROM WELL
LIQUID CAPACITY //~ ~-) ~/ GALLONS.
NUMBER OF /
MATERIAL _~_~/~/_~__~.~r--~ COMPARTMENTS
,~,.~ /~'..~) ~j~'~___~,~il~ LIQUID
INSIDE LENGTH ~NSIDE WIDTH ~ DEPTH~
SEEPAGE SYSTEM: SEEPAGE PiT:
/ OUTSIDE DIAMETER ~ OR WIDTH /~:~' / LENGTH /~ / / /
, , , DEPTH ~/
NUMBER OF PiTS ( ~ ,~'/'.x~ ~--~,'~ .~'".4~---~.,,) '
LINING MATERIAL '~-~.~/'~'~-~ ~'/'~'~ DISTANCE FROM WELL"I,/_~-"~'~~ , BUILDING FOUNDATION/---~-~ /
NEAREST LOT LINE 3 ~) /' '/--------~"'~--'"'
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ, FT.
TILE DRAIN FIELD:
~ ~ TOTAL LENGTH
DISTANCE FROM WELL ~ , FOUNDATION ~ , NEAREST LOT LINE OF LINES
ABSOI~ION AREA SQ. FT. LENGTH OF EACH LINE \
P~TH: TOP OF TILE TO FINISH GRADE DEPiH OF FILTER MAT~T BENEATH T~.~/''''/~ IN. ABOVETILE
WELL: TYPE'~ '-'''~.~/]7-/--4,/~z~-.~ DEPTH ~ DISTANCE FROM
, BUILDING FOUNDATION. / WATER
· . . SAMPLE , NEAREST
LOT LINE /./ NEAREST SEPTIC / SEEPAGE
SEWER LINE f.--'~, TANK , SYSTEM ~, CESSPOOL , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE APPROVED
-- ' ' HEALTH AUTHORITY
G[.-m~TER ANCHORAOE AREA BOROI,~H
' HEALTH DEPARTMENT '
327 EAGLE ST. ANCHORAGE, ALASKA 99501 27' ,q~511
N.o
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME /Z~'-O'/'/ '~
LOCATION ~---/0~, ,'~/7
SEPTIC TANK:,
MAILING
ADDRESS
LEGAL DESCRIPTION
NUMBER OF
DISTANCE FROM WELL ~/7"~' ~//~f('~ MATERIAL ~~-- COMPARTMENTS
LIQUID CAPACITY /~/)~ GALLONS. INSIDE LENGTH ~SIDE WIDTH
LIQUID ~' .
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
~ //~/ LENGTH //'~// DEPTH
f OUT~J~DE DIA~METER OR WIDTH
~,,~s~ LO~ u.~ , ~ / TOT*L EFF~CnVE *BSOR,.O~ *~E* (W*LL *~*~ ' ~ ~ SO. ~T.
TILE DRAIN FIELD:
DISTANCE~FROM WELL ~ON ,~EST LOT LINE
NUMBE~ DISTANCE BETWEEN LINES /IRENCH WIDTH
ABSORPTION AREA SQ. FT. LENGTH OF EACH(/ //'/'~
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF~FILI~'ATERIAL BENEATH TILE
TOTAL LENGTH
IN. ABOVE TILE
WELL: TYPE(~/,~ ~'~[~'~/~' DEPTH ~ DISTANCE PROM / WATER ~
· BUILDING FOUNDATION.. SAMPLE NEAREST
OTHER
NEAREST SEPTIC ~ SEEPAGE ~ CESSPOOL ~ SOURCES
LOT LINE ~ , SEWER LINE ~ lANK , SYSTEM . .-,
DISTANCES:
DIAGRAM OF SYSTEM
DATE
GAAB-H D-2
GREATEI
327 Eagle St.
ANCHORAGE AREA'
HEALTH DEPARTMENT
Anchorage, Alaska 99501
9ROUGH
279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
FINANCED THROUGH
-I~,F~~T EST RESULTS
NAME OF APPLICANT ~~~ Z~'~ ~ MAILING ADDRESS34~/ //~f-//,;'Z~ PHONE NO.
APPLICATION TO INSTALL: SEPTIC TANK ~,~'", SEEPAGE PIT. ~ , DRAIN FIELD , OTHER
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED DUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~,~. ~-~'~'~'~ PERMIT TO INSTALL A
AS DESCRIBED BELOW· SIZE OF UNIT TO BE SERV - ~~,~
SEPTIC TANK SIZE ~ ~<C"?
· TYPF~~-Z~- SEEPAGE AR
/(..,,~2~ DIAGRAM OF SYSTEM
'/.7/
3"
.,_/
-
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough ~}rdinance No. 28-68 and that the
above described sy. stem is~in accordance with said code. ~/~ /~!/~ ~¢/'~ ~_,~/~ ~'
DATE APPLICANTS SIGNATU R ~t~' 7_ ('"J/ "'--~