HomeMy WebLinkAboutHYATT ESTATES BLK 2 LT 40147 lol coo
.~AAB-HO-, GR,r~TER ANCHORAGE AREA BOROUGH 6//
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELl
LIQUID CAPACITY
GALLONS.
MATERIAL
INSIDE LENGTH
· -,,-:-'. ?z?.
MAILING
ADDRESS .'~/''t/~2 / PHONE
LEGAL DESCRIPTIONZ~ ~2-~5'~'7/~//~'~~
COMRARTME~TS
INSIDE WIDTH - DEPTH~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
· ,~ ,~, ........... . ~:, , ~
LINING M A T E R I A L ~ '~/~-",~'~', ~'~:/:' ~.. ~
NEAREST LOT LINE "~ ' '~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
/ /
OR WIDTH /7 , LENGTH /~//' , DEPTH
· DISTANCE FROM WELL {e"~ (.~ BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES ~-~_
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
~ , FOUNDATION ,~L~, d - . NEAREST LOT LINE '~'(-'~ ' d--'
DISTANCE BETWEEN LINES ~/, ~ / ~'
TRENCH WIDTH /~:~ /
SQ. FT. LENGTH OF EACH LINE '~ ~/ /
~ DEPTH OF FILTER MATERIAL BENEATH TILE 7/~? Zi
TOTAL LENGTH
, OF LINES .,
IN. TOTAL EFFECTIVE
IN. ABOVE TILE /~/~ j/
.~.5/,,~(-.~' '~ DISTANCE FROM ~" WATER
WELL: TYPE -~//dZ[L~ DEPTH· , BUILD NG FOUNDATION. SAMPLE
LOT LINE /~ r NEARESt ~, ~_ SEPTIC - ' [ SEEPAGE /~/ ('
, SEWER LINE . TANK ~ ~ , SYSTEM [ ~) ~'~ . CESSPOOL
· NEAREST
OTHER
, SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
APPROVED
HEALTH AUTHORITY
GAAB-HD~2
GREATEh ANCHORAGE AREA uOROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Ahska 99501 279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPi~ICANT /~-~,
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY ~'
FINANCED THROUGH
PERCOLATION TEST RESULTS
MAILING ADDRESS .~2q&[ ///t/~"~. . PHONE NO.
LOCATION OF INSTALLATION
SEEPAGEP~T ~ ,ORA~N FIELD ,OTHER
TO BE INSTALLED BY ~-~-~
ANTICIPATED DATE OF COMPLETION ~ /'~: ~'~ 7~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /~'~ ,/~./r_~,~.&~,.~ , PERMIT TO INSTALL A ~"~'"¢'" /'~k'~''~''~ ......
.AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED 7 Z~'v
.. SEPTIC TANK SIZE / ~-~'-~ TYPE ~<~.~4~. .. SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
DISTANCES:
.I//.. ,~ealth Authority
I~ertify 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,
~-~]REATEt~ ANCHORAGE AREA BOROUGH
HEALI'H DEPA~TMENT
327 EAGLE STREET
ANCHORAGE~ ALASKA 99501
CASE #
Performed For ~(~J, ~6,5C'~m .......... __Date
This Fo~m Eepomts a: So,is Log____._~ ;~Test..___--- ....
Depth
Feet Soil Characteristics
Location Sketch
Was Ground Water Encountered?
tf Yes, At What Depth~ _
Reading Date Gross Time Net Time Depth To H20
Proposed Instal~Seepage Pit~~_ Drain Field
Depth Of Inlet ,~-z Depth To Bottom Of Pit Or 'P~'~enc~~
:e Oee
T~s~ Pemfommed
D~<a Cer~ified~~
Z 'Z /o '/v /.~¢
Z 6