HomeMy WebLinkAboutT14N R1W SEC 6 Lot 6
GAAB-HD-I
GR~TER ANCHORAGE AREA BOROU-~H
/ HEALTH DEPARTMENT ~1
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING
ADDRESS ~'~?'~"/-~_,~/ ~'- ~- PHON[~:~"/~'
LEG A L D E S C RI p TI O N ~ ~ ~ :~:~'-../-/'-~..~'-~'
DISTANCE FROM WELL '~"~:J~
LIOUID CAPACITY
NUMBER OF
.MATERIAl .~c'"/..~,~-~"'-,~/~_.. COMPARTMENTS
GALLONS. INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH___
SEEPAGE SYSTEM: SEEPAGE PIT:
LINING~ ~ · .BUILDING FOUNDATION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ, FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL ,~ ~ / , FOUNDATION "'~/ , NEAREST LOT LINE-~'~ 4~ /'"'/" , OF LINES
NUMBER OF LINES ' ~'"' .DISTANCE BETWEEN LINES ~:' /
TRENCH WIDTH ..~ /
IN. TOTAL EFFECTIVE
ABSORPTION AREA-~ ~'~ .SQ. FT. LENGTH OF EACH LiNE?~// j:~..~ !
DEPTH: TOP OF TILE TO FINISH GRADE ~'~ / DEPTH OF FILTER MATERIAL BENEATH TILI~ .~ // IN, ABOVE TILE
WELL: TYPE ~,~/(-~".~-/~'~ DEPTH '-~/ DISTANCE FROM WATER
BUILDING FOUNDATION ,,.~'~.,~ /
-, . SAMPLE ~/'~ NEAREST
NEAREST SEPTIC SEEPAGE .~ OTHER
LOT LINE ,/',..~ /'~ . SEWER LINE ~ ' ., TANK J~,:~"'/ SYSTEM /~"~'/. CESSPOOL . SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
GREATEI'--'ANcHoRAGE AREA ' )ROUGH No.
,~' HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ,¢.,F'-/V /~2/)~,~.,~.,/~ MAILING ADDRESS (,~,X' /,?? /~1 PHONENO.
RESIDENCE ADDRESS/A.7~ ~/~ ,~/~, ~ LOCATION OF INSTALLATION
LEGAL DESCRIPTION ~/~/ ~///~ ,F~;, ~ /~ ~/~ ~ ~
APPLICATION TO INSTALL: SEPTIC TANK l~'/., SEEPAGE PIT , DRAIN FIELD /'~ ....... , OTHER
TO SERVE THE FOLLOWING FACILITY ~ /~.~. ~4/~ ~ ~'
FINANCED THROUGH g"~ / ~ TO REINSTALLED BY,~¢ ~>"~ ~Fd~/~
PERCOLATION TEST RESULTS/~ ~[ VOL~ }~)~ ANTICIPATED DATE OF COMPLETION 2~/zz. .//~/.,~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ./Y~.~ A~"'~zx.~'r PERMIT TO INSTALL A ,,~z"zc ,~/<' ~'\/-¢~-'"'~' :
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~.~ _/¢~-~2 ~
.. SEPTIC TANK SIZE ,/,',~_Z'~ ~ TYPE ,f/~/-'~- / SEEPAGE AREA TYPE.j~/F'A/~'/~/'~Z/)
DIAGRAM OF SYSTEM
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.
DATE. APPLICANTS SIGNATURE
,2REAT~R ANCHORAGE AREA BOROUGH/-']
HEALTH DEPARTMENT
32? EAGLE STREET
ANCHORAGE~ ALASKA 99§01
CASE
~ 'al Descri,otioh: I,ot Block Subdivision ' / /~ ~--~m~'r ~-'
This Form Reports a: Soils Log /~~ ,-~e~coiat~on 'rest
Depth
Feet Soil Characteristics
Was Ground Water Encountered?/_~_~
If Yes~ At What Depth ·
Reading
Date
Gross Time
Net Time
Location Sketch
Depth To H20
Drain Field
Net Drop
e r c°la~ ~' ~
Proposed Instal~Seepage
Depth Of Inlet
Test -Performed
Data Certified
Dat~~
