HomeMy WebLinkAboutT13N R3W SEC 33 LT 14-i¸
GAAS-HD.I
G,P'~'\TER ANCHORAGE AREA BORO~.~H
HEALTH DEPARTMENT
~ 327 EAGLE ST. ANCHORAGE, ALASKA 99501 23'~-2511
.. INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LEGAL
DESCRIPTION
LOCATION
SEPTIC TANK:
D,STANCE ROM WELL
LIQUID CAPACITY '~-
MATERIAL '~ >~'~ / NUMBER OF
COMPARTMENTS
GALLONS. INSIDE LENG INSID~ WIDTH DEPTH_--
SEEPAGE SYSTEM: SEEPAGE PIT:
NEAREST LOT LINE
,/ , DEPTH
IDTH/~~. ./
DISTANCE FROM WELL_ BUILDING FOUNDATION--
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
SQ. ET.
TILE DRAIN FIELD:
DISTANCE FROM WELl
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
FOUNDATION , NEAREST LOT LINE , OF LINES
DEPTH OF FILTER MATER AL BENEATH TILE
IN. ABOVE TILE __
WELL:
LOT LINE
I J/~./"
~-~'~" "~ DISTANCE FROM
TYPE '~'lllil/VY4 DEPTH '~'..c/..F~ ~', ,BUILDING FOUNDATION.
NEAREST ~t~/. C_j/ SEEPAGE
· SEWER LINE , TANK C~ ,~ , SYSTEM
WATER
SAMPLE
, CESSPOOl
NEAREST
OTHER
, SOURCES
DISTANCES:
DIAGRAM .OF SYSTEM
I
DATE
~^~-~-~ GREATE'~NCHORAGE AREA~' 3ROUGH C~No. 1~-,/~
~ HEALTH DEPARTMENT
. 327 Eagle St. Anchorage, alas~ 99501 279.2511
·
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME 0F APPLICANT~q ¢/AA~.~., ~t)~q¢lf~L~MAIklNG ADDRESS ~
RESIDENCE ADDRESS ~ 6 8N~ LOCATION OF INSTALLATION
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWm FAC~UTY
mAnCED T.ROU0" ~e., '~
PERCOLATION TEST RESULTS
,SEEPAGE PIT_ /' ,DRAIN FIELD .,OTHER
TO BE INSTALLED BY [) ~L~t~,¢ZM
ANTICIPATED DATE OF COMPLETION 2g//~ ¢~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW.~--SIZE OF UNIT TO BE SERVED ,~Ag'j~'~
· SEPTIC TANK SIZE ~TYPE t!~/'b~*¢/~ SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM C~ .¢~.,,~;~?
DISTANCES:
qEA LTH AUTHORITY
OR
LICENSED DESIGNER
I certify that I am familiar with the requirements of
above described system is in accordance with said code.
DATE ~' ,&,., APPLICANTS 81flNATURE