HomeMy WebLinkAboutT13N R3W SEC 32 N2 SE4 SW4 NE4 SE4
G~"~.TER ANCHORAGE AREA BORO~qH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? 506
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~--
SEPTIC TANK:
DISTANCE FROM WELL
uQU~D CAPACITY /
MATERIA[
GALLONS.
MAILING ~. ~
~--~ O ~-F~t~ NUMBER OF J
COMPARTMENTS
~ ~',/~/,/") ~ ~ ~ LIQUID
INSIDE LENGTH / INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
DISTANCE FROM WELL /' ~) c~- !
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH // ~'7 ,DEPTH
, BUILDING FOUNDATION
~ ~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES /
ABSORPIION AREA
FOUNDAIION
· NEAREST LOT LINE
.SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES
DEPTH: TOP OF TILE TO FINISH GRADE
WELL:
TYPE. _, DEPTH
NEAREST
LOT LINE . SEWER LINF
DEPTH OF FILTER MATERI~L BENEATH TILE
IN. ABOVE TILE
DISTANCE FROM WATER
l ,BUILDING FOUNDATION SAMPLE-- I , NEAREST
SEPTIC '~.)/ SEEPAGE //____~"' / OTHER
, TANK , SYSTEM CESSPOOl ~ , SOURCES
DISTANCES:
6 = '7o
DIAGRAM OF SYSTEM
GREATEFANCHORAGE AREA r~gROUGH C~seNo. //~/
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~'rt ~ J'P/, /-~')l(tq MAILINGADORESS ~-~TL~ ~' PHONENO.
RESIDENCEABDRESS~ G~' ~[/J~ LOCATION OFINSTAL~TION ~
LEGAL BESCRIPTION'~)~ ~ ~'~ ~.~2~ ~)~)~%) 5~
APPLICATION TO INSTALL: SEPTIC TANK ~,SEEPA6EPIT ~.~DRAINFIELD. ,OTHER
~~ST RES~TS '~>~/ fe~, ~C~P~EO 9~TE OF COmET~O~ ~F~.. ~b~e.
~[( BELOWTOBE FILLED OUT BY HEALTH DEPARTMENT ~ ~'~n~/ i~/.eC~/~
THIS ISTO SERVE AS_/'~/'* Le'7'/'/~/~ 'F ,PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNITTO BESERVED 2
. ,SEPT C. TANK SIZE ~TYPE ~'~oI~SEEPAGE ~c . ~/ TYPE
~ .[W~]~'i~,~/ , . ,z /~ DIAGRAM OF SYSTE~
-~.~; /'~/~l,c wet/
DISTANCES:
HEALTH AUTHORITY
OR
LICENSED DESIGNER
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.w~k
/-'~GR~ATER ANCHORAGE AREA BO~{O~G?
II[iAbTIi DEPARI'HENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
Legal Des¢~ipt~'-~-~.i~{' 'Lot ~c~ SubdiviSi0n ' '
This Form Repomts a: So~s Log ~ ' ";~e~¢olation 'rose ......
Depth Legal Description: N~, SE¼, SW¼, NE¼, SE¼, Section.32, TISN, R3%V.
Soil Cha~'&¢tePistios
Location Sketch
Readlng Date GPoss Time ~et Time DePt.h' To ~20. Net Drop
F~oposed Instal~Seepage Pit Dmain "' "
Depth Of Inlet . Depth .To Bottom Of Pit O~ Tmenc~ .....