HomeMy WebLinkAboutDOWLING LT 29A
GAAB-HD-I
GRr~TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MATERIAL
INSIDE LENGTH.
NUMBER OF
COMPARTMENTS
/f' ?o , QU D
INSIDE WIDTH DEPTH_
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
OUTSIDE DIAMETER OR WIDTH
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH , DEPTH
BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER OF LINES
ABSORPTION AREA
FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
NEAREST LOT LINE
TOTAL LENGTH
OF LINES
TRENCH WIDTH
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE.
IN. ABOVE TILE
WELL: TYPE/,~~' .,~ , DEPTH
NEAREST
LOT LINE SEWER LINE
SEPTIC
, TANK
DISTANCE FROM
BUILDING FOUNDATION
SEEPAGE
SYSTEM
WATER
SAMPLE
, CESSPOOL
NEAREST
OTHER
SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
APPROVED
HEALTH AUTHORITY
GAAB-HD-2
GREATE
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
9ROUGH
279-2511
Case No. '~q,7
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
LEG~C RIPTI 0 N '~-~'~:~'~~
APPLICATION TO INSTALL: '~I~TANK , SEEPAGE PIT
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
,/-/,,'/,~/-,,~ ~ ,~,~, .~?-~
,,~.,~i~,~/v' MAILING ADDRES,%,/.~-~_-~;/~__~.~/~5~ PHONE NO.
LOCATION OF INSTALLATION ~.~'~'~
BRAIN FIELD , OTHER
T 0 B E I N STA L L E D B Y _
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
PERMIT TO INSTALL A .,~'¢,r.,t/~,4 ~
THIS IS TO SERVE AS /~'/~'~-~
: AS DESCRIBER BELOW. SIZE OF UNIT TO BE SERVER J~-~---
.sEpTI-C.TANK ~'IZG. ~ TYPE .~ SEEPAGE AREA ,"~'."~ ,TY;~~''~/
DISTANCES:
DIAl 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