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~~