HomeMy WebLinkAboutHOLLY HILL BLK 2 LT 3L
GAAB-HD-I
G~,.r~TER ANCHORAGE AREA BORO~H
~ HEALTH DEPARTMENT ' ~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL. ~.~,- X
LIQUID CAPACITY ,/-.~/~'~- GALLONS.
MAILING
ADDRESS ~.~.~ '"'~-/'~"~'~='~---~'~ '~' PHONE~?~'"~"T'~
NUMBER OF /'
MATERIAL ~,,~'~~'''Z'~''~-' COMPARTMENTS
INSIDE LENGTH ~' j INSIDE WIDTH '-~ / LIQUID .~ ''/
DEPTH.
SEEPAGE SYSTE~M: ~
NUMBEROF PITS / OUTSIDEDIAMfTER ~ LENGTH , PTH
L,~~ ~ WELl BUILDING FOUNDATION
~EAREST LOTLINE ' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)- SQ. FT.
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
TILE DRAIN FIELD:
/ TOTAL LENGTH
/ ~ / ~ ~ OF LINES /"~"> '~
FOUNDATION ~'~'(--)' ~ , NEAREST LOT LINE. '
'~ / / ',~ /' IN. TOTAL EFFECTIVE
"~ DISTANCE BETWEEN LINES /'~"' //-':"? TRENCH WIDTH
3 ~ Y SQ. FT. LENGTH OF EACH LINE/d~')~ ~;/ ~ :~'~i~)' / _~-,~.~? '
DEPTH: TOP OF TILE TO FINISH GRADE '~ DEPTH OF FILTER MATERIAL BENEATH TILl
DISTANCE FROM WATER
SAMPLE ?"*"' '~ NEAREST
WELL: TYPE .~,~,¢"'/.~,~ DEPTH ~:~::~,~ / , BUILDING FOUNDATION. "
SEEPAGE J OTHER
NEAREST SEPTIC ~..~..' SYSTEM ../',~-~"~ , CESSPOOL ~ SOURCES
LOT LINE /~-"~"~ / , SEWER LINE ~ TANK
DISTANCES:
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATE~ANCHORAGE AREA~'~'gROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ~- ~/~'
NAME OF APPLICANT ,. 1~-~ /I~/~ !~,~
RESIDENCE ADDRESS ,,~
LEGAL DESCRIPTION ~..07' ~
, SEEPAGE PiT
TO BE INSTALLED BY ,,~.,~
!
PERCOLATION TEST RESULTS/'~0.~ 7~ ANTICIPATED DATE OF COMPLETION
BELOW TO BEFILLED OUT BY HEALTH DEPARTMENT
LOCATION OF INSTALLATION ~~ ~
, DRAIN FIELD , OTHER
T,,S ,S T0 SERVE AS A/ va/ PER ,TT0,NSTALLA &l.e .
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ ~'~)P---,~
SEPTIC TANK SIZE ~~ TYPE~~EEPAGE AREA ~ ~' TYPE DIAGRAM OF SYSTEM
DISTANCES:
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.
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