HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 6 LT 1LOT
GAAB-HD- I
GR'=~TER ANCHORAGE AREA BOROU~i.L'!
HEALTH DEPARTMENT i
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
SEPTIC TANK:
MATERIAL
LIQUID CAPACITY 4;_-/~'~Z~'~ GALLONS.
MAILING ~
ADDRESS /'~ (~ PHONE
DESCRIPTION ~'~- / ~ ~r '
LEGAL r' r' ,,t
2-z'9 NUMBER O,
. COMPARTMENTS
INSIDE LENGTH ~ INSIDE W~DTH DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
/
OUTSIDE DIAMETER
OR WIDTH / ~ ,LENGTH / ~ , DEPTH
TILE DRAIN FIELD:
DISTANCE FROM WELL
N UM~ES
ABSORPTION AREA
TOTAL LENGTH
FOUNDATION . NEAREST LOT LINE , OF LINES
TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE--
WELL: TYF~'~_/~, DEPTH
NEAREST
LOT LINE , SEWER LINE
DISTANCE FROM WATER
· BUILDING FOUNDATION. SAMPLE , NEAREST
SEPTIC SEEPAGE OTHER
TANK , SYSTEM , CESSPOOL , SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
=rs'
DATE APPROVED -- H~LTH '~ L~ORITY ~ ~
GAAB-HD-2
GREATEI
327 Eagle St.
,NCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
)ROUGH
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT /~/Tt~/,¢-/~
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
MAILING ADDRESS /-~"~' [ o.~y PHONE NO.
~OC~T,O. o~ ,.s~,o. 5~/. ~
~ , SEEPAGE PIT ~ ,DRAIN FIELD ,OTHER
~ ~..~.~..~ ..4, Z_. ~
TO BE INSTALLED BY ~-~z( ~-oe~w~7~,~
/~o~1~ ~ ANTICIPATED DATE 0F COMPLETION ~ /~ ~
BEL~ T~E FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ¢~,.~¢e"'¢7 ,PERMIT TO INSTALL A :'j''''~7/''-'
AS DESCRIBED BELOW. SIZE OF U~J,T cT0~_~B. E2y;~V..E~ ·: 1,~,:~,.~,
/ ~ ~,,[ DIAGRAM 0F SYSTEM
DISTANCES: ~ ~ J
Health Authority
I certify that I am famJlia~ with the req-uYements of Greater A~chorage Area Borough O~dina~ce No. 28-68 and that the
above described system is in accordance with said code. ~
DATE 7- ¢" ?' APPLICANTS SIGNATURE ¢~¢ ~/~-~. '~/
/