HomeMy WebLinkAboutBIRCH HILLS ESTATES ADDN 1 BLK 2 LT 1B 0 0
ir h Hills
E s
4-J6���
•r
I
EWOMMS MIN
GI~r~.~,,TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT '
327 EAGLE ST. ANCHORAGE, ALASKA 9950! 279.2SI1
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
ADDRESS HONE
LEGAL D ESC RI P TI O N '"~'~ ~'""/,,
NUMBER OF
DISTANCE FROM WELl ~ ~-.~D ~' ~ MATERIAL ~~ COMPARTMENTS
LIQUID CAPACIIY /~.~ GALLONS. INSIDE LENGIH. / I~SIDE WIDTH /
LIQUID
DEPTHS--.`.'
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PiTS
LINING MATERIAl
NEAREST LOT LINE
OUTSIDE DIAMETER / "~ ~'"'""'/
OR w? .--' . LENGT. /O DEPT.
~",.-~ DISTANCE FROM WELL'''''~'~''~ /' ~ , BUILDING FOUNDAIIO~
~ TOTAL EFFECTIVE ABSORPTION AREA ~ALL AREA) ~/~ SQ. FT.
DISTANCE FRO~'WELI , FOUNDA~'ION .. NEAREST LOT LIN~/
DEPTH: TOP OF TILE TO FINISH
·
p DISTANCE
WELL: type C~",~'J,'~ ./:/~-~'. tH ~ . BU~LmNG FOUN~At~ONFrOm watersampLe ~ Nearest
NEAREST /~ SEPTIC SEEPAGE
LOT LINE / ~ SEWER LINE ~, TANK / , SYSTEM CESSPOOl , SOURCES
TOTAL LENGTH
OF LINES
IN, ABOVE TILE
DIAGRAM OF SYSTEM
DISTANCES:
DATE ~'~J=-/~ //~0 APPROVED
GREATEf'"ANCHORAGE AREA . '"OROUGH C No.
327 Eagle St. Anchorage, Alaska 99501
· SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ~
PERCOLATION TEST RESULTS
SEEPAGE PIT y . .RAIN FIECe__. OTHER
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
DISTANCES:
/
~ with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
a~ove/3 _described system is in accordance with said code.
~"%GREAT£R ANCHORAGE AREA BOROUGH~
HEALTH DEPARTMENT
32? EAGLE STREET
ANCHORAGE, ALAF, KA 99501 -
CASE #
Performed For 7..ttO/c /?.~,//q ' Date Perforce, ed /x/./?~(4r /c/7(~.,
Legal Bescrlption{'L°t._~.~l°ck'~?,.Subdivisi°n /~/>c~ ~Y/~ ~,~(~ t
This rc~ Reports a: So~ls Log ~/ .... Percolation Test
~epth
Feet
Was Ground Water Encountered?
If Yes, At What Depth
Location Sketch
Reading Date Gross Time Net Time Depth To H20 Net Drop
Fropoaed Instal~Seepage Pit /r.~ Drain Field
Depth Of Inlet ~ ' Depth To Bottom Of Pit Or Trench
COMMENTS: