HomeMy WebLinkAboutT12N R3W SEC 15 LT 61A
Gr'~ATER ANCHORAGE AREA BOR(
HEALTH DEPARTMENT
,'" 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
· ,. INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAT,ON
MAILING
LEGAL DESCRIPTION~,~O'J
SEPTIC TANK:
DISTANCE FROM WELl I~5 MATERIAL ~/t/~,
LIQUID CAPACITY__ ~_~ ~ (~ GALLONS. INSIDE LENGTH
NUMBER OF /
COMPARTMENTS
INSIDE WIDTH ,'~ LIQUID
DEPTH __
SEEPAGE SYSTEM:
NUMBER OF PiTS
LINING MATERIAL
NEAREST LOT LINE_
SEEPAGE PIT:
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
BUILDING FOUNDATION /.,G !
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LtNES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
FOUNDATION_ , NEAREST LOT LINE
DISTANCE BETWEEN LINES TRENCH WIDTH_
_.__SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
__IN. ABOVE TILE__
WELL:
LOT LINE
DISTANCES:
TYPE__ ~l~ ~ (~ ..~. ~_, DEPTH__
~Qb~i NEAREST .~-~E ' SEPTIC
, SEWER LINE , TANK
DISTANCE FROM ~ 5~ WATER
· BUILD NG FOUNDATION. SAMPLE
SEEPAGE
DIAORA~M/OF SYSTEM
. CESSPOOL
· NEAREST
___ OTHER
, SOURCES
DATE
APPROVE[)
GAAB-HD-2
GREATEr. ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
3ROUGH
279-2511
Case No. x,~_/~)
SEWAGE DISPOSAL SYS?EM - APPLICAIION & PERMIT
NAME OF APPLICANT. "J~. L,
RESIDENCE ADDRESS_ q"'-~
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK_
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS__
MAILING ADDRESS ,~_~,X d5~z;~/F'
LOCATION ()F INSTALLATION_
,SEEPAGE PIT_ v'__,DRAiN FIELD
PHONE N 0.._?,V'/
, OTHER.
TO BE INSTALLED BY '~ cF- / ,'
ANTICIPATED DATE OF COMPLETION__.
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS - /"]4~ /~//'/~-//:-~ -~ _, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE
(--/~/""~//~ SEEPAGE
SEPTIC TANK SIZE. /(")~)().-~_TYPE ')' '
" ) '- '-/~7~'~-DIAGRAM
SYSTEM
__TYPE.
,. O/c
DISTANCES:
,? /
H0alth Authority
I certify that I am familiar with thc requh'ements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE : ~ APPLICANT8 81GNATURE_ .... ~>, -:
~REATER ANCHORAGE AREA BOROUGL
HEALTH DEPAkTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE
Performed Fop '~',~£ ~..~_~. Date PePfommed
Legal Description: Lot~lock__ ~ubd~v~s~on~~l~X
This Form Reports a: So~].s Log_ ~__~ ........ '__-~ercolatlon Test Depth
Feet Soll Characteristics Location Sketch
Was Ground Watem Encountered?__~___.~.w~
If Yes, At What Depth ......
Reading
Date
Gross 'rime
Net Time
Prop)sad Install-~o~. Seepage Pit
Net Drop
Depth Of Inlet_
COMMENTS:
Teat Performed
Certified By:~