HomeMy WebLinkAboutELMRICH #1 BLK 5 LT 11EL. MI ICH
ADDN
G"'CATER ANCHORAGE AREA BORO'"~'H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N°. 261
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
MAILING
ADDRESS~ ·
LEGAL DESCRIPTION,-
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY_ '* '
NUMBER OF /-
', ~, MATERIAL · ', ,4 ~; "' ' F ,' COMPARTMENTS_
LIQUID
.GALLONS. INSIDE LENGTH ~. .INSIDE WIDTH_ ~ DEPTHs"
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL_'
NEARESt LOT LINE
SEEPAGE PIT:
,/ OUTSIDE DIAMETER ~' OR WIDTH~ ~ ~ J { _, LENGTH~, ,~: ' _, DEPTH
,~' ,L' . " ': 'i ?'; '' '
· ~ ~ ,,' '~. ' .' ' ' ' BUILDING FOUNDATION
' . / .' t~, · DISTANCE FROM WELL~_
- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~,' ' .- · SQ. FT,
TILE DRAIN FIELD:
DISTANCE FROM WELt
NUMBER Of: LI~ES___
A B SORp, TJ'~D N AREA
DEPTH: TOP OF TILE TO FINISH GRADE
, FOUNDATION ~ , NEAREST LOT LINE·
DISTANCE BETWEEN LINES_ ~_ TRENCH WIDIH__
SQ. FI, LENGTH OF EACH LINE ~
.DEPTH OF FILTER MATERIAL BENEATH TILE__
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: TYPE._~_'*.,, -" , DEPTH
NEAREST
LOT LINE ~ , SEWER LINE
DISTANCE FROM WATER
':' , BUILDING FOUNDATION, SAMPLE
SEPTIC SEEPAGE
, TANK ~ , SYSTEM. , CESSPOOL_
~ , NEAREST
OTHER
" , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
/
APPROVED ' --" ' ~' ' "/ "~ '
HEALTH AUTHORITY
DATE
GAAB~HD-2
GREATE
327 Eagle St.
4NCHO AG_,
HEALTH DEJ~AETMENT
Anchorage, Alaska 995(H
¢)ROIJGH
279-251!
SEWAGE DISPOSAL SYSTE~ ~ AP~[~CAlqON & PERMIT
NAME OF APPLICANT : : '>/ / PHONE NO.
," I?IAILING ADDRESS__'__: ~
RESIDENCE ADDRESS LOCATION OF INSTAI_.I_ATION / ' LEGAL DESCRIPTION ....... ~_~' ] : .... / "
APPLICATION TO INSTALL: SEPTIC TANK ,SEEPAGE PIT : ..... DRAIN FIELD ~,OTHER
TOSERVETHE FOLLOWING FACILIFY ........... : ...... ; u ................. ., ~ / :,: ,
FINABCEB TH~OUBH ....... ~ ....... TO BE I~STAI.LEB BY , , ' ,''
PE~COLATIO~ TEST ~ESULTS__ ANI-IClPATEO ~ATE OF COMPLETIOn_ ,
BELOW TO BE FILLED OU'I' BY HEALTH DEPARTMENT
THIS IS TO SERVE AS-L____ '2 ............ ~ .....[, PERMIT 'l'O IIMSI'AI.I_ A
AS DESCRIBED BELOW. SIZE OF UNITTD BE SERVEO ! ' '
SEPTIC TANK SIZE ............... /'YPE .... ,......_.,:.... SEI!PA[:iE AREA._:C .... _:_ > , ' TYPE
DIAGRAM OF SYSI'EM
DISTANCES:
I certify that 1 am familiar with thc requirements of (;r~atm' Anch0ragc Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE_ ,; , ., APPI,ICANTSSIGNA'FO . _~< .