HomeMy WebLinkAboutT12N R3W SEC 8 NW4 SE4 Now John Wells S/D0_.
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HEALTH DEPARTMFNT
327 EAGLE ST. ANCHORAGE, ALASKA 9950] 279-95]]
INSPECTION REPORT ON-SFrE SEWAGE DISPOSAL SYSTEM
MAILING
A D D R E S S ~/~'~'~
LEGAL DESCRIPTION~J,
SEPTIC TANK:
DISTANCE FROM WELL__
LIQUID CAPACHY .J '-'g' ~-~
GALLONS.
NUMBER OF
MATERIAL /~- COMPARTMENTS
INSIDE LENGTEI ' INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS i OUTSIDE! DIAMETER_
LI NINO MATERIAL_~.~ ~/~,1~('~ ~'-~:
NEAREST LOT LINE_~
OR WIDTH
DISTANCE FROM WELL [
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREAJ
LENGTH , DEPTH
· BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
FOUNDATION_
LINES
DISTANCE FROM WELl , . NEAREST.~.~LOT..L~E
NUMBER OF L~NES _DISTA..L~A~.E~ff~RT'Cg~N~'~INE'~'~''''''-~ TRENCH WIDTH_ IN. tOTAL EFFECTIVE
ABSORP~ SQ. FT. LENGTH OF EACH LINE
DEPTH: tOp OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
DISTANCE FROM '~./~j I WATER
WELL: TYPE '~J/411_LI_~D . DEPTH_ , BUILDING FOUNDATION. SAMPLE NEAREST
NEAREST ,.~, SEPTIC I ~ J t SEEPAGE OTHER
LOT LINE ¢) ~,~ , SEWER LINE~- , lANK , SYSTEM_ I[ ~-O ~ , CESSPOOL ~' , SOURCES
DISTANCES:
.- --
DIAGRAM OF SYSTEM
GAAB-HD-2
_)ROUGH Ce~.No. --
GREATEI ANCHORAGE AREA '
HEALTti DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMI'r
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCmPT~0N A~4'Vdy 5'£
APPLICATION TO INSTAl_L: SEPTIC TANK / ., SEEPAGE PIT
TO SERVE THL: FOLLOWING FACILITY_ ,~/'~ ~'
5e~ ~ T /~ N
__, OTHER _ __
FINANCED THROUGH cS
PERCOLATION
TEST
RESULTS
BELOW TO RE FILLED OUT BY HEALTH DEPARTMENT
T,,s ,s To SERVE AS _/dC/z/
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
~,.~
· SEPTIC TANK SIZE ~,5~ TYPE ~m~Y~/~EEPAGE AREA,
DISTANCES:
/ Health Authority
~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./~P)/,'53t~/~(~'z~?/~,<'? Z/~,,.,5~~ APPLI CANTS SIGNATU RE ~,~/~.~'~--" (' ~ :/
DATE / _/ /