HomeMy WebLinkAboutNEVILLA PARK LT 35OdS
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GP~6,TER ANCHORAGE AREA BOROI'"~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N°.
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS ~ PHONE.
LEGAL DESCRIPTION z~'/ ?' -"~' /4~1,'///~ ~
SEPTIC TANK:
°,STANCE ROM WELL
LIQUID CAPACITY
~.~ / NUMBER OF
MATERIAL (~? COMPARTMENTS
GALLONS. IN~)E~LffN GTH- '~ ~W1D~T~' DEPTH ....
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PItS (/ OUTSIDE DIAMETER OR WIDTH / ~-~- /, LENGTH / ~'~' "' , DEPTH
LINING MATERIAL L :':~'/< DISTANCE EROM WELL C Xi~ . BUILDING FOUNDATION /;'
NEAREST LOT LINE / :; / l~/ ~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
~ ~ ~ TOTAL LENGTH
DISTANCE FROM W~--L¢ :~--. FOUNDATION / ~ NEAREST LOT LINE /'~ '~, OF LINES__
A~'~O~RPTION AREA --:(~.FT. LENGTH OF E~CH: - '
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
WELL:
LOT I. INE
DISTANCE FROM WATER
TYPE.~('~(J~ /~ J)£P.TH ............ TBUILDING-FOUNDATfON ....... SA.'~LP~L~_ , NEAREST
NEAREST ~.~9=~1~C. _ _ SEEPAGE ................ OTH ER
., SEWER HNE. ., TANK ~YST~ ........... ~CESSEQQI .... , SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATE[
327 Eagle St.
ANCHORAGE AREA
ItEALTH DEPARTMENT
Anchorage, Alaska 99501
9ROUGH
279.2511
Case No.~
SEWAGE DISPOSAL SYSTEM - APPLICATION &"PERMIT
NAME OF APPLICANT (-/'¢~.' -'~-' MAILING ,~DDREsS ~ ~,'~25' .. PHONE NO ....
RESIDENCE ADDRESS ... LOCATION OFINSTALbA~ION
LEGAL DESCRIPTION. (*~ -~' ~¢¢~'
~ "
APPLICATION TO INSTALL: SEPTIC TANK ,SEEPAGE PIT ~ jDRAIN FIELD ,OTHER
T0 SERVE IHE FOLLOWING FACILITY ~4~~E
FINANCED THROUGH ~ INSTAkkEB BY_
PERC0LATm TEST RESULTS / ~ ~ ANTIC~PATaU BATE 0F C0MPLET~0N.
BELOW T0 BE FILLED OUT BY HEALTH DEPARTMENT
, PERMIT TO INSTALL A __--
. ._AS DESCRIBED BELOW. SIZE OF U.~NIT TO BE SE
~.Z/z}¢:'~ ..TYPE-t~-~',, SEEPAGE ARE, ,TYPE~.,~---
DISTA~CE~: ~?
. # ::/,'//
I/ HEALTH AUTHORITY
OR
LICENSED DESIGNER
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 c°de'-'~//o~t~'~,
DATE , .2 ./¢'7