HomeMy WebLinkAboutT14N R1W SEC 7 Block 4 Lot 3
GAAB-HD-I
GR.~:.~TER
ANCHORAGE AREA BOROU-~H_
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279J2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
SEPTIC TANK:
MAILING
ADDRESS
DISTANCE FROM WELl J
LIQUID CAPACITY /+.'~ (m-~
LEGAL DESCRIPTION
MATERIAL
GALLONS. INSIDE LENGTH
PHONE.
NUMBER OF /
COMPARTMENTS
INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAl ~
NEAREST LOT LINF
OR WIDTH / 2' , LENGTH q.~r , DEPTH ~'~ ' ,
· DISTANCE FROM WELl ~ /'/"'~( , BUILDING FOUNDATION /'~v/7~ ,
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) (~ C/~) SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE F OM WELL FOU ATION , N~T LINE OF LINES ,
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE.--
~ DISTANCE FROM WATER
WELL: TYPE~bo , DEPTH ., BUILDING FOUNDATION.. SAMPLE , NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE · SEWER LINF TANK . SYSTEM . CESSPOOL , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
HEALTH AUIHORllY
GAAB-H D-2 ~
GREATEt~ ~.~NCHORAGE AREA ~ ~)ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case N o. /~r~,'~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
EEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
SEEPAGE PiT
TO SERVE THE FOLLOWING FACILITY ~
PERCOLAT,ON TEST RES, LTS '2Z'7,£' C,PATEO DATE OF
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
TH'S IS TO SERVE AS ~ ¢~ PERMIT TO INSTALL
,~,,,x~d,,[ ~,,~,~ DESCRIBED BELOW. ' - V
'.SE~PTiCTANKSiZE /2,~¢~d TYPEd~',>~Z'~ SEEPAGE AREA ~"?~"~) TYPE~
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