HomeMy WebLinkAboutDRAKE BLK 2 LT 6
GAAB-HD-J
Gpr'~.TER ANCHORAGE AREA BOROf'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
NUMBER
OF
!
DISTANCE FROM WELL .MATERIAL ~-,,.,~,,,.~-.c ~',,--
,COMPARTMENTS
LIQUID CAPACITY /~)c)O GALLONS. INSIDE LENGTH ~t LIQUID ~ !
INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM:
SEEPAGE PIT:
NUMBER OF P~TS OUTSIDE D~AMETER 't OR W~DT, LENGTH , DEPTH
UN,NO MATERIA~ Q~.~.'~ DISTANCE FROM WELL BUILDING FOUNDATION__
NEARESI LOI LINE IOIA[ EFFECIIVE ABSORPlION AREA {WALL AREA) SQ. FI.
TILE DRAIN FIELD:
DISTANCE FROM WELL
I TOTAL LENGTH
FOUNDATION ~ NEAREST LOT LINE OF LINES
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
DISTANCE BETWEEN LINES TRENCH WIDTH
SQ. FT. LENGTH OF EACH LII',J~ -,-~, -,' rr'"tr'?
, ~'"PTH (~ FILTER MATERIAL BENEATH TILE'
WELL:
TYPE 1_~1,,~ ; DEPTH
NEAREST
LOT LINE SEWER LINE
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
DISTANCE FROM
BUILDING FOUNDATION
SEPTIC ~ ~-- ~ SEEPAGE
., TANK ~ SYSTEM
WATER
~ SAMPLE
CESSPOOL
NEAREST
OTHER
, SOURCES__
DISTANCES
b-o =
DIAGRAM OF SYSTEM
DATE
APPROVED
HEALTH AUTHORITY
GAAB-HD-2
GREATEIt. ANCHORAGE AREA ..OROUGH)if'CassN0.
HEALTH DEPARTMENT
T
327 Eagle St.Anch. orage, Alaska 99501279.2511
O F /: ~ c ~ ~. ~ 7 ¢~ 0 ? 7.a- ~-~1 ~
SEWAGE DISPOSAL SYSTEM- APPLICATION &
NAME OF APPLICANT~/~,~ ~/~tt/~-N
LEGAL DESCRIPTION_
APPLICATION TO INSTALL: SEPTIC TANK,
TO SERVE THE FOLLOWING FACILITY
_.~'¢
MAILING ADDRESS/~'-; Z.. ~~ PHONE
O AT,O OF, TA AT,
SEEPAGE PIT '~' , DRAIN FIELD
FINANCED THROUGH ~'~f-~'-" TO BE INSTALLED BY
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION_
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ ~~;~ / '
.SEPTIC TANK SIZE /~/yTYPE 53[E~0 SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
DISTANCES:
i 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 -,,/ , ~