HomeMy WebLinkAboutT13N R3W SEC 33 LT 44A
G,?-~TER ANCHORAGE AREA BORQ!-C~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N°. 382
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
NUMBER OF
MATERIAL ~~ COMPARTMENTS
GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH __
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUtS,DE D,AMETER
LI N, N a MATE RIA L-~ ~4~'' ~,)~c~>~ /
NEAREST LOT LINE ~'~ /
~ OR WIDTH /~/ , LENGTH /'~' , DEPTH ~
DISTANCE FROM WELl /~-'~ ~ BUILDING FOUNDATION ~L.~.~,
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'~'~' SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~/,FOUNDATION , EAREST LOT LINE. .,T~O_ ;~..LE~oFTiiNL~NGTH
DEP'TH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
">~'~'7/'~"/'~'~" ~r/~ ' ' DISTANCE FROM WATER
WELL: TYPE -~.~'~. DEPTH /~ ~ . BUILDING FOUNDATION. /~ x SAMPLE ~ , NEAREST
LOT LINE /~ ~ NEAREST x SEPTIC ~ SEEPAGE x OTHER
, SEWER LINE ~ ~- . TANK , SYSTEM /~ , CESSPOOl /~SOURCE~
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED .~"~ ~~'~/-- ~
HE,~LTH AUTHORITY
GAAB-HD-2
GREATE[' 'ANCHORAGE AREA <'gROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
casa No. ,/~?-- f
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLiCANT ~) riC/[/(,'fim lie?l/ MAiLiNfi ADDRESS //7/ ~f5 //~,~'/?)'~/. PHONE N0.
RESIgENCE ABB~ESS LOCATION 0F INSTALLATION ~
/'
APPLIgATIONT0 INSTALL: SEPTIC TANK ~t, SEEPAGEPiT ~ ,BRAIN FIELD ,0THE~
~0 SERVE THE FOLLOWING FACILITY , ~ , d~- g,( .
FINANCED THROUGH TO BE INSTALLED BY /)~'/~
A.TIC~PATE~ hATE OF CO~PLET~O= ~?-
PERCOLATION TEST "ESULTS -~/'/ ~5 ~ / '
TNIS IS TO SERVE AS ~5) ~":~:/~./,.~5 PERMIT TO INSTALL A f'~.z.~.-'~
AS BESg"IBEB BELOW~ SIZE 0F UNIT T0 BE SE"VEB d'~'~ ~ '
. SEPTIC TANK SIZE /~ TYPE [~rF~~SEEPAGEAREA TYPE
DIAGRAM OF SYSTEM
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described syste~n is in accordance with said cod~sf/~./
OATE. ~ 7 ' '' /
ANCHORAGE A!.:i;:
~,~.. I, ).~,A ....... T C~o~,
32? EAGLE STREET
ANCHORAGE ~ ALASKA
Location
Yes, A~ What De
~ Date{ Gross Time
Reading
Ne~ Time
Depth To H20 !. Nez Drop
..... ~-'.' .....
~'~'co~_a ~zon i~a~'~' / ~'~;'e '
2top, seal Instal'i~'io.~: Seepage Piz Drain Field
:)ep~h' Of inlet l)epth~' To B~'Ztom O'f' P'it O~ Trench '