HomeMy WebLinkAboutJESSE D NICHOLS Lot 3 Now Lot 3A
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
DISTANCE FROM WELL // ~
LIQUID CAPACITY /~2'5~'~-~
GALLONS.
MAILING ~?~,y',J ~j~-/ ~-' ~'~
ADDRESS ~ 4 ~ PHONE
~ t/,~~,/i~/~>~'''''~'2~ NUMBER OF
COMPARTMENTS
MATERIAL
INSIDE LENGTH. INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER , LENGTH //~ DEPTH
~, ~';L.' L/'~:. BUILDING FOUNDATION__
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 'Z~'~'"~'3 SQ. FT.
DISTANCE FROM WELL
TILE DRAIN FIELD:
TOTAL LENGTH
NEAREST LOT LINE OF LINES
DISTANCE FROM WELL .- .." .- ,.~J~OUNDATION , ~~/N';'~'~' ?'
NUMBER OF LINES ' '~ D STANC BETWEEN LINES ~"~" T CH WIDTH -~" IN. TOTAL.E. PFECTIVE
ABSORPTION AREA SQ. ..LE~H*~ ~CH LINE
D~PTH; TOP OF TILE TO FINISH GRADE D~PTH OF FILTER MATERIAL BENEATH TIL~' IN. ABOVE TILE
DISTANCE FROM WATER
WELL: TYPE J ,. DEPTH .~ BUILDING FOUNDATI~, · SAMPLE , NEAREST
LOT LINE SEWER L NE ' . ~ , CESSPOOl. , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
? -
DATE
HEALTH AUtHORItY
GAAB-HD-2 Case No. __
GREATEI,.,.,ANCHORAGE AREA .... DROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAMEOFAPPLiCANT/L)'LT-o,/',/ ~ C'/~O~ .
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
MAILING ADDRESS ,'~. ~Z~ PHONE NO.
LOCATION OF INSTALLATION~-''~
~ , SEEPAGE PiT ~ ,DRAIN FIELD ,OTHER
TO BE INSTALLED BY
/O~/L~C~ ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS //~/~t ~'~,~ ~ ~'~ , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
., SEPTIC TANK SIZE /"~7.~ TYPE ~EEPAGE AREA
DISTANCES:
u, c
1'7 5
!alth Authority
~ 4 g/'4 z TYPE
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 ~ t '