HomeMy WebLinkAboutAL CROSS BLK 2 LT 8
GLOATER ANCHORAGE AREA BOROU"~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
MAILING
LEGAL OESCRIP.ON
PHONE
DISTANCE FROM WELL.
LIQUID CAPACITY
MATERIAL '~' )r'"z~' NUMBER OF
COMPARTMENTS
...~' ~"--'~_..~-L,... /'"~ 7~'~ LIQUID
GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM:
SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH /~,,.. i /~-- ! ~,~ !
, LENGTH , DEPTH
LINING MATERIAL C¢.-'~[/;2e~_. DISTANCE FROM WELL ~7~ BUILDING FOUNDATION /c9'
NEAREST LOT LINE i ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ 7~ SQ. FT.
TILE DRAIN FIELD:
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL: TYPE DEPTH '~ DISTANCE FROM .~,. . ~
- "' BUILDING FOUNDATION. SAMPLE NEAREST
,C.~) NEAREST SEPTIC ,~7' SEEPAGE 9"7' OTHER
LOT LINE ~ , SEWER LINE. ~ ., TANK ~ SYSTEM , CESSPOOL ~ , SOURCES I
DISTANCES:
DATE
APPROV HEALTH A uZ~o RI TY
GREATE~
327 Eagle St.
ANCHORAGE AREA ~,OROUGH
HEALTH DEPARTMENT
Anchorage, Alaska 99501 279-2511
Case No. ~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS
~./,~ ~,~,~ LEGAL DESCR,PT~ON
~/~ ~,,~ ~
MAILING ADDRESS /'~-o~ ~j.~.,c PHONE NO.~¢ y-.,7,..~/~
LOCATION OFINSTALLATION~ ~ ~'~J'',~ ~
APPLICATION TO INSTALL: SEPTIC TANK ~(' , SEEPAGE PIT ~' ,DRAIN FIELD ,OTHER
~o s~.w ~.~ ~o..ow,.~ ~,,c,.,~.~ .~ ~. ~..~., %~, /,.. ~ ~.~
~ BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~"~/~/"-' 7~'*~
Health Authority
DISTANCES:
PERMIT TO INSTALL A ~'¢,,'/, ~ '"~4~~"
AS DESCRIBED BELOW. SIZE OF UNITTO DESERVED ,~ ~"~-~
/¢c~,,,~2 .TYPE ~St'~/ SEEPAGE AREA ~
SEPTIC
TANK
SIZE
. /- ,
DIAGRAM OF SYSTEM
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.
DATE APPLICANTS SIG NATU R E ./