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HomeMy WebLinkAboutLot 026/b. I oH :i ©AAS-HD-J GREATER ANCHORAGE AREA BOROU(~H :'-~ HEALTH DEPARTMENT ' 327 EA~LE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY ~- '''~ ~:~'? GALLONS. MATERIAL. NSlDE NUMBER OF ] INSIDE WIDTH/'~z' DEPTH / SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS_ OUTSIDE DIAMETER LINING MATERIAl NEAREST LOT LINE OR WIDT~ D~BTANCE FROM WELL '/~ ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA} LENGTH '/~'~ / , DEPTH BUILDING FOUNDATION ~ (~") SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH NUMB~OF LINES ~, / DISTANCE BETWEEN LINES TRENCH WID[H IN. TOTAL EFFECTIVE ~BSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE. IN. ABOVE TILE ~" ~'~'"'~' / ' //,~(. j /" DISTANCE FROM //~)/-~ WATER WELL:-JP~'~I~pE ~)Y' (~ DEPTH / ~t /w~ -, ., BUILDING FOUNDATION SAMPLE NEAREST /:+/~ NEAREST SEPTIC ~:~b SEEPAGE /.,~> ' OTHER LOT LINE ,SEWER LINF ,TANK , SYSTEM , CESSPOOL ~ , SOURCES DISTANCES: DATE DIAGRAM OF SYSTEM APPROVED ' HEALTH AUiHORIIY GREATER' NCHORAGE AREA )ROUGH HEALTH DEPARTMENT 327 Eagle St. AncJ~orage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT/~/~5, /~/~/ -~-'?'~t/~-~ MAILINGADDHESS.~'~T ~ ~ PHONE RESIDENCE ADDRESS ~UFF~ LOCATION OF INSTALLATION / 0 LEGAL DESCRIPTION ~'T ~ ~~ ~U~' APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT ~ ,DRAIN FIELD ,OTHER TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS TO BE INSTALLED BY ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS '~/~-~' ~OV ~,z~ , PERMIT TO IN~TALI~ A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE DISTANCES: Health Authority TYPE~. SEEPAGE AREA: TYPE ~ 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 is in accordance with said code. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Date of Inspection 10: ~o ---//zOO Approval requested by: Mailing Address: Property Owner: Mailing Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 3. Legal Description: L,~'f~ ~/~~-~. ~~ ~~ 4. Location: ~ ~~ /~ ~~ ~~ 5. Type of facility to be ~nspoc~od ~ ~J/~ g~o~of bedrooms / 6. o Well Data: A. Type ~c~.- ,~O..~,-J--aJ'~ B. Depth /~0 " ~b'-v~ D. Bacterial Analysis C. Construction ~*~ ~, .,~ Sewage D i sposal System: ~//u~ ~'~/~ ~/~ A. Installed /o/~/~o B. Installer /~ ' ? C. Septic Tank: 1. Size ~ mm~J- 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank /~, Absorption area Nearest lot line ~0 /-A , Other contamination B. Foundation to septic tank ,s,-7/ , Absorption area C. Absorption area to nearest lot line ~0 /~ / /~-0 , Sewer Lines EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re~_.~st for Approval of Individual -x--~er & Water Facilities Le~gal Description ~- ~-' ~f~g~z7' ~/~q/~ ~/~Y~fi¢~P/~/~YYy~ Comments Approv Disapproved Date .~- Approval Valid for one year from date signed Greater Anchorage ArEa Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)