HomeMy WebLinkAboutELMRICH VILLAS #3 Block 2 Lot 12 Public
GAAB-HD- I
GP, CATER ANCHORAGE AREA BOROU~'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
MAILING ~"~/~¢ ~7--/'/,~ "~"/ PHONE ,~T,.~- ~'~77
ADDRESS
LEGAL DESCRIPTION ~ /Z ~2~-~ Z Z~--~/¢/;/¢/ /~/~//~-4~ ~¢¢
SEPTIC TANK:
DISTANCE FROM WEE:
LIQUID CAPACITY / ,,~ "~ GALLONS.
~_~r~2. NUMBER OF
MATERIAL
COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH. .DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE.
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH , LENGTH , DEPTH
DISTANCE FROM WELL ~',/JC~J" /'J~ J~ BUILDING FOUNDATION r'~~')'.
SQ. FT.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
TOTAL LENGTH
/' , FOUNDATION , NEAREST LOT LINE , OF LINES
TRENCH WID.T*H"~'"'"~ IN. TOTA.~,~TIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL:
LOT LINE
TYPE
DISTANCE :ROM
DEP~F:t /,~ ,,,o ~ ,,~,~tJILDI~ FOUNDATION
NEAREST L *¢'//~'~S E P TI C/"~2 6// SEEPAGE
· SEWER LINE_ . TANK . SYSTEM
WATER
SAMPLE_
, CESSPOOL
NEAREST
OTHER
· SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
APPROVE~)
~--~4A LTH AUTHORITY
INSPECTION ~PORT, ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
Distance from well ~ Material n
capacity../;~.~C(> gallons, Inside len~h .
Number of compartments Liquid
Inside width Liquid depth
Seepage Pit: Number of pits,, /., ,Outside diameter,%~:K~ ,or width ,/~. , length ~, ~,
~" f ~ , .~ L¥~ ....
depth... ~;~., lining material, ~'>: ..::j.....j ..... . Distance from well/ ...... ' d , building
(wall
foundatlon...;.)~ , nearest lot line TOtal effective absorption area area) sq. ~
TILE DRAIN FIELD:
Distance from wail , foundation__ .
, nearest lot line ........ Total length
tile
WELL:
Type ......
sewer line
of lines_ . Number of lines ...... Distance between lines Trench width in.
Total effective absorption area ,sq. ft. Length of each line
Depth: Top of tile to finish grade_. , Depth of filter material beneath
inches, Above tile
~Distance from building foundation
__.__._, nearest lot line ..... . , nearest
.,, , septic tank
, seepage system , cesspool .... , other sources__
ealth A~ri~
SF~qE DISPOSAL SYSTEM - APPLICATIO~-'~ PERMIT
Residence Address Location of Installation
.... , ....... Leg,1 Description.. ~ar z~ ~o._ .~/,,./,e,~z
Application to Install: Septic t~k~ , SeepaEe p~t~, Dmain field
To Serve ~he ~ollowlnE Facility ~_~ ~~ ~ ~ ~= _ ......
Financed
Th~ouEh
Pemcolation Test Results'.$~.~~/~c~ted Da~e
as desePibed below. Size of =it to be se~ed_ ~
...... Septic tank siz~S¢ Type ...... ~epage
DIAGRAM OF SYSTEM
DIST~CES:
~ Debt,fy that I tm fire th the ~equ~m~nts of g~t~ ~ho~g~ ~ea Borough
O~din~c~ No. 28-68 ~d thlt the ~ov~ {es~ib~ system t, in te~o~{~ee with s~i4