HomeMy WebLinkAboutEAGLE RIVER MID HEIGHTS BLK 4B LT 12
GP' 'TER ANCHORAGE AREA BOROI"~'H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 9950! 279-251
N? 177
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILINGADDRESS
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS.
NUMBER
OF
MATERIAL -/~ ~¢~/(---,~
COMPARTMENTS
INSIDE LENGTH / '~ INSIDE WIDTH J l~ .,'
LIQUID
DEPTH__
SEEPAGE SYSTEM: S E E P A G~..P-I..T..~----...~
TILE DRAIN FIELD:
DISTANCE FROM WELL .~.~ '" . FOUNDATION '..~ . NEAREST LOT LINE
NUMBER OF LINES "~ DISTANCE BETWEEN LINES ~ .TRENCH WIDTH
ABSORPTION AREA /~'--~-~"~ SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE.
TOTAL LENGTH . -'
OF LINES ~'~'/' ,
I'~'. TOTAL EFFECTIVE
,N. ABOVE T,LE~
/ DISTANCE FROM WATER
WELL: TYPE ,~,,,~'//--~ , DEPTH /~/--) BU LD NG FOUNDATION, ~) SAMPLE /I/'~ , NEAREST
., NEAREST / SEPTIC ~,¢~ ' ,~ SEEPAGE j~,,~//,z~,~/.~ OTHER
LOT LINE /~) ~ , SEWER LINE . TANK // ,~ , SYSTEM ~'-~'" , CESSPOOL ~ . SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
G'.\~B-H D:2
GREATE}, NCHORAGE AREA.,
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
)ROUGH
279.2511 J'
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT FTC" /"~~
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
SEEPAGE PIT.
TO BE INSTALLED BY /"~/
ANTICIPATED DATE OF COMPLETION
MAILING ADDRESS~/ ~-" ~'-'~/'~'~ PHONE NO.
LOCATION OF INSTALLATION
"~ , DRAIN FIELD , OTHER.
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS '~
,PERMIT TO INSTALL A ~
AS DESCRIBED BELOW. SIZE OF~.~UNI~ TO BE SERVED ~'~ ~"Z~
SEPTIC TANK SIZE /'75-/2 TYPE ~ SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
DISTANCES:
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. '-~d~ ff~J b~/t'~c'Z2t ~
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d ~ or ' ) '~ ' ' '
- ~ ~~S Led
..~ . . i,oc~ticn Sketch
....... ~ T~e ~m
~/th ~ IOw
eo. te~t. The~
Was G~o~n~ Wate~ g~countere~?__~~ '"<~ ~~
Drain Field
Fret, o: e,7 inst.~i~F:eePage ~'i~ -
. , Dei:,~5;~it Or Trench--,,
Drop