HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 5 LT 14B0 91 47
GAAB-HD-I
Gr" '~TER ANCHORAGE AREA BORO~ ' "~
D='I~ARTMENT OF ENVIRONMENTAL OUALI/Y
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS
LOCATION .//~"/,,/~,,*¢'~.,~-~" .~¢ '"/;'~,/~-¢"~"~-.~.¢'~ LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELL ¢~'~ //~
LIQUID CAPACITY /~,_i~..¢, '~ GALLONS.
NUMBER OF
MATERI.~L C ,¢¢,/(/~'r'.~.z:¢7-----,~ COMPARTMENTS.
INSIDE LENGTH ~ INSIDE WIDTH
LIQUID
DEPTH __
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER / OR WIDTH /'~ ., LENGTH..~'/_.z.~_.., DEPTH
DISTANCE FROM WELL /'/~'~ / ("'""'~'~'~'~¢¢'"~' "¢¢'~":~¢'¢¢¢ ~'/
BUILDING F 0 U N D A TI 0 N"¢¢~'¢¢¢~/'?~.~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
SQ, FT. ~
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION ~
~E BETWEEN LINES
SQ. FT.
DEPTH: TOP OF TILE TO FINISH GRADE
W E L L:/~/"~'~//~"~:'/~"~'
TYPE -,.~.,~/'/~5,~,~-~ , DEPTH
LOT LINE ~-,/'~ /::~'' NEAREST /_~.__ SEPTIC
., SEWER LINE ,//'~) ~ . TANK.
LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE.
TOTAL LENGTH
· NEAREST ~ ,OF LINES
TRENCH WIDTH 'x~ IN, TOTAL EFFECTIVE
IN. ABOVE TILE__
DISTANCE FROM WATER
BUILDING EOUNDATION.~';~,`'¢''~¢¢.~' _SAMPLE , NEAREST
~,~,.~/~,~._ SEEPAGE /
, , CESSPOOL/~?/)/~ ,
DISTANCES:
DIAGRAM OF SYSTEM
/
I
GAAB-HD-2
GREATE -ANCHORAGE AREA" 'OROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No. --
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
MAILING ADDRESS
LOCATION OF INSTALLATION
PHONE NO..
, SEEPAGE PIT , DRAIN FIELD , OTHER
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS iS TO SERVE AS
.AS DESCRIBED BELOW.
· SEPTIC TANK SIZE.
DISTANCES:
, PERMIT TO INSTALL A
SIZE OF UNIT TO BE SERVED
TYPE SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
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.
DATE APPLICANTS SIGNATURE