HomeMy WebLinkAboutBAKERS LT 1
G~.T~R ANCHORAGE AREA BORO~Ht
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 2'79-2511
108
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
N AM E /-~ ~ / C7-/t//~- ,~"~' _~-
SEPTIC TANK:
MAILING
ADDRESS
LEG A L DES C RiP TI
DISTANCE FROM WELL ~'?_~'_/~"~
LIQUID CAPACITY / :'~ ~ ~-~' GALLONS.
NUMBER OF /
MATERIAL ~ ~:-?/(_./~_~/~ z~_.'~ COMPARTMENTS
INSIDE LENGTH ~-~ INSIDE WIDTH ~ DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PiTS / OUTSIDE DIAMETER.
LINING MATERIAl ~:~'/~'~-,~'~'~:>~-Z'?~
NEAREST LOT LINE
OR WIDTH _ J/~fl)/ j r /
, LENGTH -~' ~-' , DEPTH
DISTANCE FROM WELL -~/")/~z~'~J/~ยท .//~--~.~ ~'~' , BUILDING FOUNDATION~'~') ~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'~ SQ. FT.
TILE DRAIN FIELD_____Z ~
//' '~ TOTAL LENGTH
.
NUMBER OF ~S DIlAtE BETWEE~ LINES ~RENCH WIDTH ~ IN. TOTAL EFFECTIVE
Q EACH
OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL:
LOT LINE
DISTANCES:
./~'~? DEPTH /. / DISTANCE FROM ~_/ WATER
, BUILDING FOUNDATION. SAMPLE ~/~ NEAREST
NEAREST /SEPTIC ~/ SEEPAGE ~/ ~/ OTHER
SEWER LINE ~ , TANK SYST~ , CESSPOOL , SOURCES~
, ~'~I~ ~,~
DIAGRAM OF SYST~
DATE
APPROVED
GAAB-HD-2
GREATET
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
)ROUGH
279-2511
Case N o./O ~--" 7
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
/ ,/..~ ~ ~-,~_'..~'_,~ MAILING ADDRESS
RESIDENCE ADDRESS /Y/~~ LOCATION 0 F ,NSTALLATION~/~
APPLICATION TO INSTALL: SEPTIC TANK /~-~-, SEEPAGE PIT /i.,,.~-
TO SERVE THE FOLLOWING FACILITY /~ ~./-~.,,,~/~"~~ 7)t,~,..-/',.,,
PERCOLATION TEST RESULTS t/.~T~O /-1~.~, ~'"'2_. ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THiS iS TO SERVE AS ~ ~.~/& :Z.--~ , PERM IT T0 INSTA LL A _-d~-_---~':~-~ ,.,.4~Z:'Z .-. /z%~-'~ 2--~ ~
...~_~,.,/~ ..-.__ AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
~ SEPTIC TANK SIZE /'~?~ t) TYPE ,--;. ........ :.~ SEEPAGE AREA
DIAGRAM OF SYSTEM
DISTANCES: ~:)~../.._
HEALTH AUTHORITY
LICENSED DESIGNER
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 ~'~-- ,,/C~ ~ /~ APPLICANTSSIGNATURE~--'~,.'/~'/~--~- . . . ~
