HomeMy WebLinkAboutT13N R3W SEC 33 SE4 SW4 NE4 Lot 35
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
LEGAL DESCRIPTION
DISTANCE FROM WELL ~] '~/~
LIQUID CAPACITY /~' .~;' GALLONS.
NUMBER OF /
MATERIAL '~--~:~-~-- COMPARTMENTS
..~,~/~Z~ ~(~,~:_~:., ,,,~/~c.~/~,~-/~-;~ ~/"~LIQUID
~'~- DEPTH
INSIDE LENGTH //INSIDE WIDTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PiTS~ ORWIDTH ~ ~N
L,~ ................... 'TOTA LEF F~E~: ::~V~C' ,BUILDING
TILE DRAIN FIELD:
DISEANCE FROM WELL ./'~--~' S ~/~ .FOUNDATION ~z .~-. NEAREST LOT LINE
NUMBER OF LINES / DISTANCE BETWEEN LINES ~ TRENCH WIDTH
ABSORPTION AREA ~'~ ~' -~ sq. ET. LENGTH OF EACH LINE _/~
DEPTH: TOP OF TILE TO FINISH GRADE ~'~ ~ ~/ '/
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH .
OF LINES /,/~ ,
IN. TOTAL EFFECTIVE
IN. ABOVE TILE.
.-~',~--,~'/--/~'~%/~ DISTANCE FROM ,~ ~,~_ WATER
WELL: ~>~ ~ FOUNDATION, ~ ~'~ SAMPLE
TYPE ~'~/Z~z~'~ DEPTH , BUILDING
$ SEEPAGE .~.,
LOT LINE ~ /.~ NEAREST ~ SEPTIC ~' .~_- /~f~'~) CESSPOOL
SEWER LINE . TANK . SYSTEM
OTHER '/~-~')
SOURCES ~L~-
DISTANCES:
& ~.=/JM 9c
DIAGRAM OF SYSTEM
HEALIH AUJHORITY
GAAB-HD-~
GREATEr' 'ANCHORAGE AREA 'gROUGH
HEALTH DEPARTMENT
· .'~ 327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~'z//.~d/-~"~e ~ 7~.,~,,~,'Zz/ MAILINGA'DDRESS ~/'~,2'~o'Y//r'~2//
RESIDENCE AODRESS~7 ~ ~ ~ LOCATION OF INSTALLATION
LEGALDESCRIPTION_¢~ofif ¢,~ XO ¢
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
SEEPAGE PIT , DRAIN FIELD,//~ ,//% OTHER
TO BE INSTALLED BY..
ANTICIPATED DATE OF COMPLETION ~"'~77~", ,,,.~.,?.~ /.~'7~'
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
DISTANCES:
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 SIGNATU RE