HomeMy WebLinkAboutLot 13
GIt""TER ANCHORAGE AREA BOROI'"H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILINGADDRESS 3
LEGAL DESCRIPTION
DISTANCE FROM WELI
LIQUID CAPACITY
GALLONS.
MATERIAL
INSIDE LENGTH
NUMBER OF /
COMPARTMENTS
~IDTH DEPTH __
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAL
NEAREST LOT LiNE
OR WIDTH /'"~
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA
LENGTH /4 ,DEPTH
BUiLDiNG EOUNDAnON
sa. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION
NUMBER OF LINES DISTANCE BETWEEN LINES
ABSORPTION AREA SQ. FT, LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
WELL: TYPE "' DEPTH
NEAREST SEPTIC
LOT LINE SEWER LINE , TANK
DISTANCE FROM
BUILDING FOUNDATION.
SEEPAGE
, SYSTEM
WATER
SAMPLE
, CESSPOOL
NEAREST
OTHER
, SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
~ ~'~ - .. /Ix
DATE
APPROVED
HEALTH AUTHORITY
GAAB-HD~A
GREATEr_ ANCHORAGE ARE .,
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
_OROUGH
279-2511
Case No. /-7~-
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
---'- /~/ (,,/c'- ,~, PHONE NO.
NAME OF APPLICANT~C )~..~2 ~ MAILING ADDRESS ~ //~ / ' ' ~
RESIDENCE ADDRES~ /)
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
LOCATION OF INSTALLATION
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS ~ '"'~'
, SEEPAGE PIT , DRAIN FIELD
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
, OTHER
THIS IS TO SERVE AS iL//;._" ,~
AS DESCRIBED BELOW.
_. SEPTIC TANK SIZE
DISTANCES:
/ I~;Ith Authority
PERMIT TO INSTALL A . ~? ,~',?'"?"~" ~,'7,'~' ,,
/_:'
SIZE OF UNIT TO BE SERVED ?'~'"
(
TYPE'S, ~'"£"f _~7~'/ SEEPAGE AREA TYPE ....: .-
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 SIGNATURE .t'~--~'~.~- ~.'/~,~ .... ,;L,'- ~--~<.~'