HomeMy WebLinkAboutPROSPECT HEIGHTS BLK 2 LT 2A::
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53-
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GR; ER ANCHORAGE AREA BOROU~~''~,
HEALTH DEPARTMENT ~
327 EAGLE' ST. ANCHORAGE, ALASKA 99501 279~2.~',11
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
ADDRESS
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY /~2
MATERIAL ~T~F-'~F~/-- NUMBER OE /
COMPARTMENTS
GALLONS. INSIDE LENGTH //"~ ~'' '~ / LIQUID "~ '~'~ /
INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
OUTSIDE DIAMETER OR WIDTH J~
. DISTANCE FROM WELl /~/
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
,LENGTH /'~/ ,DEPTH ~
, BUILDING FOUNDATION '~.~'/,
,,~ ~'J~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL~ FOUNDATION , NEAREST LOT LINE
NUMBER OF LINES. .DISTANCE BETWEEN LINES TRENCH WIDTH
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
ยท J 17~" DISTANCE FROM ~// WATER
WELL: TYPE ~'t'l//~ DEPTH , BUILDING FOUNDATION. . SAMPLE
NEAREST
OTHER
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
APPROVED
DATE
-~ SEWAGE DISPOSAL SYSTEM APPLICATION g PERMIT
Name of Applicant D.(/, ~C~,o,~ ,~ ........ Mailing Add~ess~'40 5F~3~3;
Residence Add~ess ~f4-/~ , ~ Location of Installation~dF~_
~~Legal Description_
~'~&~ th~ ~owing Facility i~es~J~. ~
~ ~ ~- ~ - . _ ......
'~:..~'o'f~Z~ Results_//~//~- ~' ///~ ~ticipated Date of Comple~ion
~a~ ~ BELO~ TO BE FILLED O~ BY HE~TH DEPARTMENT
This is to serve as
.... :. permit to install a
_ .~_~as described below; Size oft[nit to be served
. Septic tank size .... Type ,,, Seepage Al-ea
DISTANCES: _ , DIAGRAM O~,SYSTEM,
he'alth 'Authority
Type
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.
