HomeMy WebLinkAboutFYFE BLK E LT 6i 2,�
ATER ANCHORAGE AREA BORO)' :H
HEALTH DEPARTMENT NO 163
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON -SITE SEWAGE DISPOSAL SYSTEM
MAILING / �=-i, �'
NAME �% % ,�7%i�% /-'"�i//a/jam ADDRESS/! - i PHONE
LOCATION /� /� =�' LEGAL DESCRIPTION /-�'i'✓/��;
SEPTIC TANK: 'X /rt %/✓G
DISTANCE FROM WELL / / MATERIAL NUMBER OF r
COMPARTMENTS
LIQUID
LIQUID CAPACITY GALLONS. INSIDE LENGTH �/ INSIDE WIDTH ----DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT: �U'�' sue''/'%%' ✓'�i--x��yi�✓
NUMBER OF PITS f OUTSIDE DIAMETER �!� OR WIDTH LENGTH 1/ 1 DEPTH =
LINING MATERIAL DISTANCE FROM WELL ��- / BUILDING FOUNDATION=✓'
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) // x- SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM W
FOUNDA
NUMBER OF U NES DISTANCE BETWEEN LINES
ABSOfZ-PTION AREA
SQ. FT. LENGTH OF EACH LINE
NEAREST LOT
TRENCH W
, OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL: DISTANCE FROM WATER
TYPE���y'i-,l'i���=` DEPTH ���/� -,BUILDING FOUNDATION. `�� ;� SAMPLE Z �L NEAREST
NEAREST 4f SEPTIC / � SEEPAGE �, ..� OTHER
LOT LINE �� SEWER LINE , TANK / % SYSTEM CESSPOOL SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
�C
DATE .��1�"` "� �"= � /� �APPROVED- � �� ��
€ALTyd /p��' �L�THORITY'/
GAAB-HD-2 GRIEA7IEI �NCIllGRAGIE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
279-2511
SEWAGE DISPOSAL SYSTEAR - APPLICATION A PERPAIT
Case No. f/C/7
,/r/7;Yl7
NAME OF APPLICANT 11 ) } MAILING ADDRES 7 G� J f PHONE NQ.
RESIDENCE ADDRESS LOCATION OF INSTALLATIONe-Y�`<''`�
LEGAL DESCRIPTION 234/Y E
APPLICATION TA-i FjTA-6= SEPTIC TANK , SEEPAGE PIT
DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH F' �- F TO BE INSTALLED BY
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION l��• ✓ �%��
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS Mi�I ' k) 1 () ,j PERMIT TOTe A �E� k SiSFlAr6—
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
SEPTIC TANK SIZE _
DISTANCES:
141
,1
H AL H AUTHORITY
OR
LI NSED DESIGNER
TYPE SEEPAGE AREA
TYPE
DIAGRAM OF SYSTEMj, A
■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■
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.
C l
DATE / ��� APPLICANTS SIGNATURE �