HomeMy WebLinkAboutNEWTON LT 3
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 ~)-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
ADDRESS PHONE
DISTANCE FROM WELL '7 7 / ~_~.~:~__~ NUMBER OF /
MATERIAL COMPARTMENTS.
LIQUID CAPACITY 7 ~""~ GALLONS. INSIDE LENGTH INSIDE WIDTH. DEPTH __
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF pITS / OUTSIDE DIAMETER '-- OR WIDTH / ~ /
LINING MATERIAL ~.~'~4~'~..o ~",'//L~ ~ DISTANCE FROM WELL /~'~/
NEAREST LOT LINE ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
., DEPTH
BUILDING FOUNDATION ,
sQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL. FOUNDATION j, NEARESTLOT LINE .
NUMBER OF LINES DISTANCE BETWEEN~,,/' TRENCH WIDI~H
ABSORPTION AREA SQ.~TH OF EACH LINE
DEPTH: TOP OF TiLE TO FINISH GRADE
TOTAL LENGTH
, OF LINES
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
,,,//~¢ ~ DISTANCE FROM
WELL: TYPE 4~/"/ , DEPTH * , BUILDING FOUNDATION.
~ NEAREST ~ 7 / SEPTIC 7 / SEEPAGE
LOT LINE * , SEWER LINE , TANK '~ , SYSTEM
~-~ ~.~ WATER
: SAMPLE /x/~ ., NEAREST
/~/~./ ' OTHER
~' , CESSPOOL ~ , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED
HEALTH AUTHORITY
GREATE1,.,.ANCHORAGE AREA . :)ROUGH C. No.
HEALTH DEPARTMENT
327, .. Eagle St. Anchorage, Alaska 99501 279-2511 /[[ ~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT f/'u////~;t~ !./~/~)-~tD/~L~,.,. 'MAILING ADDRESS ~,~× 6Z PHONE NO
RESIDENCE ADDRESS ',." ' r ' LOCATION OF INSTALLATION .~c~.~;¢>~,~ / h/~?
· ' , - .-. Z ~ ~ ~(~ ~ -~u ~zd~
APPLICATION TO INSTALL: SEPTIC. TANK , OTHER
TO SERVE THE FOLLOWING FACILITY"
FINANCED TH ROUGH ~ ~ ~ ~ ~z~iUA '/~
~o~ ~
~~-TEST RESULTS · ANTICIPATED DATE OF COMPLETION` ~z~ kv~ ~?~6~-_
' BELOW TO BE FILLED ~UT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~)?, k)a[/) '~ :' , PERMIT TO INSTALL A ~<~: ,' ,
~'/, SEEPAGE PIT ~ .,"DRAIN. FIELD
. . '"'"'""
TO BE'INSTALLED.BY
AS DESCRIBED BELOW. : SIZE OF UNIT TO BE SERVED
. SEPTIC TANK SIZE '~'?.) 'TYPE(?~;/C'~fU /SEEPAGE AREA /~ ~./L TYPE DIAGRAM OF SYSTEM
DISTANCES:
-IOo/
~, /
Jthority
I 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.
'~ APPLICANTS SIGNATURE
DATE
· / ¢/