HomeMy WebLinkAboutJESSE D NICHOLS LT 3A
,_~, HEALTH DEPARTMENT .....
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS . _ PHONE
LEGAL DESCRIPTION ~-'~,~ ~ ~//~Z~,~/..2~'' ~"~
SEPTIC TANK:
DISTANCE FROM WELL ~."~~t~/~ / MATERIAL '~'
LIQUID CAPACITY /OOO GALLONS. INSIDE LENGTH
NUMBER OF /
COMPARTMENTS
INSIDE WIDTH LDEPTH ~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS .OUTSIDE DIAMETER OR WIDTH
LINING MATERIAl "~¢ DISTANCE FROM WELL
NEAREST LOT LINE
l~J LENGTH ~ DEPTH
Z~O ~ '/ BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'~'~2¢1¢/~~-~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE.
NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
SQ. FT. LENGTH OF EACH LINE
WELL: Ty~J~J
DEPTH
,BUILDING
FOUNDATION.
NEAREST SE"TIC SEEPAGE
LOT LINE , SEWER LINE , TANK. , SYSTEM
DEPTH OF FILTER MATERIAL BENEATH TILT'
'/ DISTANCE FROM WATER
IN. ABOVE TILE
SAMPLE
CESSPOOL
, NEAREST
OTHER
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATE~ ANCHORAGE AREA'~OROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-25
Case No.
SEWAGE
DISPOSAL SYSTEM
- APPLICATION
& PERMIT
RES,OENCE ^0CRESS //y~/z'/¢'~ / ~" LOCATION OE ,NSTALLAT, ON
APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PiT. ,DRAIN FIELD
~ SE.VE ~HE .O~W,~. FA~,~,TY ~ b~/~/d
FINANCED THROUGH
PERCOLATION TEST RESULTS
,OTHER
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS //~,~ '/~/ , PERMIT TO INSTALL A ~ '~'?¢".~"~-."~¢~'""
As OESCmEO ~ELOW. SIZE OF UNiT TO ~E SERVEO
~'-~'/-- /TYPE
SEPTIC TANK SIZE ~'~ TYPE -,~ ....... '-'- SEEPAGE AREA
DIAGRAM OF SYSTEM
DISTANCES:
lealth Authority
y 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.
2.
3.
4.
5.
REQUEYT-~0-J APPROVA~~ OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in T~iplif~e)
Number'of bedrooms in house
Water Analy~sls:
a. Bacterial
b. Detergent
Well data:
a. Type
b, Depth
c. Casing Size
d.
Distance from well to closest existing or proposed:
'!
1. Sewer line '
3, Seepage Area
4, Cesspool'
6 Other sources of ib ' u ' '
· p le contamination, z.e., creeks, lakes,
houses, barn, drainage ditch, etc. "/t
Sewage disposal system.
a. Age of system .
b. Septic tank capacity in gallons .
c. Name of septic tank manufactu~gr
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type
1. Distance to property line to house foundation
Percelatlon~?~st ~'rasu~ts
f. Percolation Test pemformed by
Use the reverse side of this form to show diagram. Diagram should include
,~he fo~%owing information: ppoperty lines~.well location, house location,
~ptic tank location, disposal area location, location of percolation test,
a~ direction of ground slope.
9. The lnforw~tion On this form is true and correct to the best of my knowledge,
'S,ignature 'of Applicant bate si~ne~'
\
T_00 BE FILLED O?r BY ~HEALTH DEPARTMENT PERSON..NEL
~he above described sanitary facilities are hereby aPproved, subject to the
The above described sanitary facilities are disapproved for the following
reasons;
S~ n ,-
Approval is valid for one year following the date of approval.
CPJ: cw
June 15~ 1968
Mr~. Roberts Potter
P. O. Box 85
Eagle Rivers Alaska
99577
Factllties Servfag Lot 2~
J. D. Nichols iubdivisio~ No, 1
This notice ls to rem$nd you of the condltioaal approval of
the subject system by this office, The Conditional approval
expires on July 31, 1968,
Please contact ~his office ~o schedule Ethel inspection of
the vequf~ed modifications prio~ ~o backfilling,
If we have not hesrd from you pv/~r ~o the above ~entloned
expiration date, the syste~ ~ill automaticall~ be disapproved.
DAVID Ro L. DUNCAN, ~. D~
~Y~
Cc~ Civilian Mtlitat~y Referral Office