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GP"ATER ANCHORAGE AREA BOROJ'GH
~,~ .... HEALTH DEPARTMENT .... ,~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
ADDRESS J.. ?o ~ /~ PHONE.
LEGAL DESCRIPTION ~'~ ~"7~ ~;~Z~ ~ ~ ~,~.z' ~ ~ ~."
SEPTIC TANK:
DISTANCE FROM WELL MATERIAL ~'"~'"~'"'~':¢~ NUMBER OF
COMPARTMENTS /
LIQUID CAPACITY "~ ~'""'C) GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS i OUTSIDE DIAMETER OR WIDTH l~ , LENGTH J "7, DEPTH
LINING MATERIAL . DISTANCE FROM WELL BUILDING FOUNDATION
NEAREST LOT LINE '~'~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~-~'~'" SQ, FT.
TILE DRAIN FIELD:
-, TOTAL LENGTH
DISTANCE FROM WELl FOUNDATION. , NEAREST LOT LINE OF LINES
'1 ........ \--' :
ABSORPTION AREA ~ /,-/ SCL FT~L'r~N'~fTH OF EACH LINE. _~ -
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE; IN, ABOVE TILE
WELL:
DISTANCE FROM WATER
TYPE ~:~.:.~"~,uz~, DEPTH ., BUILDING FOUNDATION, . SAMPLE , NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE , SEWER LINE ,TANK , SYSTEM , CESSPOOL , SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
,GR, EATEI, ANCHORAGE AREA ,_,OROUGH CaseNo.
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
i/:;:,,~ H-,~,, ~,- ~ '; _ ,~,~,.~
NAME OF APPLICANT ~lt--t~, [~iO&4~&~MAILINGADDRESS ~) ~ff~/ .
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACJLITY
SEEPAGE PIT. , DRAIN FIELD. , OTHER
TO BE INSTALLED BY_ /:'~ ~: ~7: ?~:~
FINANCED THROUGH
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~1'~' P' W~'~JJ/~J~'r"~/;'/(-) , PERMIT TO INSTALL '~"- (~.)
Y
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE ~-'~ TYPE SEEPAGE AREA
DIAGRAM OF SYSTEM
DISTANCES:
I ~I~EALTH ~UTHORIT¥
I certify that I am *miliar with the requ*ement, of Gre%r An~orage ~r~yorough Ordinance No[ 28-68 and that the
above described sysyem, is i¢ accordance with said code. ~k)_(%'1-~ ' tkjCj[ ~i, ~ ,.--[ i,a~ j ~ ~"l/lJ/~- 4..' ~ 97" .¢Obl~ z '
GREATER ANCHORAGE AREA BOROUGH.
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
per. formed For ~Y,'I I Yl~ ,Pm~ o ~DD ~'P,, ~Oqf~'~ _pate Performed ] ~ /~T&~ /~ 7~
Depth
Feet
3--
Soil Characteristics
Was Ground Water Encountered?__~
If Yes. A~ What Depth
Location Sketch
Reading Date Gross Time
ereolatioh~' ~e ~"--~/ ~ ......
Net Time Depth To H20
Net Drop
Proposed Instal~Seepage Pit ~ Drain Field
~ . .~ ~~~~. De?th Of Inlet___~ _Dep~it Or TPenc~
Test Performed B
Data Certified
RECEIPT FOR CERTIFIED MAIL--~!us----TF~a~p°stage)o.
I --STREET AND NO.
~ . 1. Shews.to ~',~,',~,v to addressee only...,...*;"* ~=~ )
~ RETURN ~ . With u?-~-~te ~nd where deUverea .. ~ t
~pter 1G~ A~,~le 18.45, Se~/im
~ ~n~ed to the ~
~rds to ~ ~ the ~u~is)
noti~ u~ i~~y i¢ y~r
all ~l~u~ue~m ~at~d m~ the ,s~,~e~ p~:~*~ to publie ~.~e~ ~
Jui~ -~, 1976.
~u~eip~lt~ ~ Anc~a~, ~' ~t TU~ ~. ~ y~ have
GREATER AN,CHORAGE AREA BOROUGH
RETURN RECEIPT
Tox Code: ~' .: Dote:
Owner:
Moil/nE Address:
User/TenonA. .....
Property Address:
, > ; /: ....-,!!!:.~: ~ .:- :.
Subd/v/s/on: ( ...
DYE TEST:
[~ Positive
~ Ne~ative
.ADDI TIONA£ INFORMATION:
Office:
Field:
Adrn/n/stered By..
· SENDER: Complete items 1, 2, and 3.
Add your address in the "RETURN TO" space on
1. The following service is requested (check one).
~Show to whom and date delivered ............ 15¢
[] Show to whom, date, & address of delivery..
[] RESTRICTED DELIVERY.
Show to whom and date delivered ............. 65¢
[] RESTRICTED DELIVERY. "-.
Show to whom, date, and ~ddress of delivery 85~
2. ARTICLE ADDRESSED TO: JK/lw
W.G. Thompson & D.C. Hooper--~'
2701 Raspberry Rd.
~. AhTicLE bESCRIPTION:
REGISTERED NO. / CERTIFIED NO. I INSURED NO.
40261
. (Always ob~ln signature of add~ssee or agent)
~ bare received the a~de desc~bed above.
SIGNATURE ~ Addr~see ~ Authorized agent
6, UNABLE TO DELIVER BECAUSE: ~
~R~ALS