HomeMy WebLinkAboutELDON BLK 1 LT 14
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HEALTH DEPARTMENT
· ' , 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
ADDRESS,''-,
LEGAL DESCmPnON7'- /"/
PHONE
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY /~C~ ~i GALLONS.
MATERIAL ~-~ '/~:~c '~ / NUMBER OF /
COMPARTMENTS
~~'s/~'~ /~ LIQUID
INSIDE LENGTH 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
DEPTH: TOP OF TILE TO FINISH GRADE
FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TIL~
IN. ABOVE TILE
WELL:
TYPE
LOT LINE ~
' .~ ~'/./,,//~ ~/. DEPTH
XlEAREST _~ -/ SEPTIC
SEWER ~ NE ¢
· . TANK
DISTANCE FROM WATER
· BUILDING FOUNDATION. '/'~"~ · SAMPLE .~"-'/c/~ NEAREST
~,~/ SEEPAGE /~..~ ~ OTHER
DISTANCES:
A
DIAGRAM OF SYSTEM
HOn.,SE
E
DATE
APPROVED
GREATER-i NCHORAGE AREA
HEALTH DEPARTMENT
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT)'/~4~' ~~--~r~ ~/.,/~o,~,~ILING ABBRESS/Y'~ ~/~ ~ ~ PHONE
RESIBENCE ABBRES~'~ ~- ~- ~~CATION OF INSTALLATION
APPLICATIONT0 INSTALL: SEPTIC TANK ~,SEEPAGE PIT ~ ,DRAIN FIELD ,0THER.
TO SERVE THE FOLLOWING FACILITY ~ ~ ~ ~
FINANCED THROUGH ~< ) ~ -., ' .~_BE INSTALLED~BY ~c~ ~.~ ~
F~'TEST RESULTS ~ ~'~ A~~}~ OF COMPLETION ~' ],~ ~~'
~~ ~'-/~BELOW TO BE F~LED OUT BY HEALTH B~ARTMENT
THIS IS TO SERVE AS ~v~ ~_ S ~(:31~ ~( PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVEO
.SEPTIC TANK SIZE ~5~ TYPp. SEEPAGE AREA
~0 ~DIAGRAM OF SYSTEM
DISTANCES:
-%'',
/
H~alth Authority
I certify that I am familiar with the requkements of Greater Anchorage Area Borough Ordnance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLICANTSSIGNATUR~/~' ~;~A"~)'~ ¢?':~?;~(q'"~ ~ /~' ~& ~