HomeMy WebLinkAboutHOLLIS LT 1I_1
GAAB-HD-I
GRF-~TER A.NCHORAGE AREA, BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY ~'~'.~
GALLONS.
MATERIAL_
INSIDE LENGTH
NUMBER OF
COMPARTMENTS.
/~..~..,~.,..*,,~*' / ~ '70 LIQUID
INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl.
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH
DISTANCE FROM WELl
TOTAL EFFECTIVE ABSORPTION AREA "WALL AREA,
LENGTH /,Z- '*' , DEPTH
BU .DING FOJNDATION
SQ. FT.
TILE DRAIN FIELD:
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN ABOVE TILE__
TYPE ")~/'~';P' ~7' f¢ DISTANCE ~ROM WATER
WELL: ~/~"J~" EPTH , BUILDING FOUNDATION. SAMPLE NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE SEWER LINE , TANK , SYSTEM , CESSPOOL . SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
!:~REATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE
Performed For ,~m~ ~meue Date Performed
L~al Descriotion: Lot ~ B~°ck . Subdivision ~l~i'~ ' - -
~ Form Re{orts a* Sol-fa Log~, Percolation Test
Depth
Feet
Location Sketch
Was G~ound Wate~ Encountered?
If Yes, At What
Reading Date GPoss Time Net Time Depth To H20 Net Dmop
P~op~sed tnstalla~16nf--~eepage Pit ~ D~ain Fi. eld
Depth Of Inlet ~Tq' , ])ep~ To Bo-~tom of" 'Pit 0P rmench~
COMMENTS: .~ ~.~ &'~. ZZ.~ ~{/~-~ Z _ ~5 _~'~z ~ /.
,Ou~ro ~, -- tu,5-~'/~,,~', ,,' _ , ...............
Test Pe~o~me~B~.~&~. ,
Data Certified By
Date ~..--/~ f/. ,>, ~, ~ ,.,.,
£OT ~
OWNERSHIP AFFIDAVIT
I hereby certify that I em the owner of the property sho~n anc
described hereon, I hereby request approval of this plah showing such
easements for publlc utilities, roadways and alleys dedicated by me for
public use.
Subscrlba~J and ..... bef ..... thi ........ ':-~ ~;:~?i ........ day of-
~:~`]~Z~-~-~`~~~-`-~~e .............. ~?0
Notar~ for Alaska My Commission expires
PLAT APPROVAL
Plat approved by the Borough, Planning Commission thb
......... _g_FA ........
.................... .,. ,..~ ~,-:~;~ ,:,
Authorized
ENGINEER'S CERTIFICATE
I, the undersigned registered engineer or surveyor, hereby certify that
land survey has been completed by me or under my direct supervision
end thet corners and monuments hove been Ioceted and established and
that dimensions shown hereon are true and correct.
HOLLIS SUBDIVISION
N~V I/4 SEC. 24, T/~N t~$W, S.M.
HEWITT V. LOUNSBURY & ASSOCIATES