HomeMy WebLinkAboutT13N R3W SEC 13 Lot 3 of Lot 89LOT,.
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GP~' ~TER, ANCHORAGE AREA BORO.I~' -~H,.
~ HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA . 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION /
SEPTIC TANK:
DISTANCE FROM WELL MATERIAL
LIQUID CAPACITY "~- :~' ] GALLONS.
MAILING /'~/q/ //,/ c~ ~'/' "~ ~ 7~ ~'~'~'~'~
ADDRESS ~C~i ~C/I ~ ~ D~
/
CO PA T TS
INSIDE LENGIH INSIDE WIDTH DEPTHs__
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH / ~ . LENGTH / ~ ~ DEPTH
DISTANCE FROM WELL ~~ BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) t~-~ SQ. FT,
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
· NEAREST LOT LINE
TOTAL LENGTH
OF LINES
TRENCH WIDTH
-IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILL
IN. ABOVE TILE
WELL: TYPE~?/ ~'~ , DEPTH
NEAREST
LOT LINE . SEWER LINE
SEPTIC
.. TANK
DISTANCE FROM WATER
· BUILDING FOUNDATION SAMPLE NEAREST
SEEPAGE OTHER
SYSTEM . CESSPOOL. , SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
GREATEK ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage,.Alaska 99501 279-25
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS ~)' A.~-~d?--. LOCATION OF INSTALLATION '7
LEGAL DESCRIPTIO"~ ~07~ ~ ~ ~ ~
APPLICATION TO INSTALL: SEPTIC TANK ., SEEPAG
FINA~.~ED ~H~OUGH ~'~ / TO BE INSTALLED BY ~/
~~TEST RESULTS ~t~. ~/O~ANTICIPATED DATE 0F COMPLETION
BELOW T0 BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~. ~/~9 , PERMIT TO INSTALL A ~
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
.SEPTICTANKSZE ~.~-~"(~ TYPE '~-/-/ SEEPAGE AREA /7C)~' TYPE
DIAGRAM OF SYSTEM
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~//~//~fin accordance with said code. ~ ~
DATE ~ ,~ /~ / APPLICANTS SIGNATURE '
/ /
Y~%,REATER ANCHORAGE AREA BOROUGH,/~
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE #
Legal Descript~'on: Lot~..~__~l°ck~Subdi~l°n - '
This Form Reports a: So~ls Log - ~/~ -~, .Percolation Test_ ....
Depth
Feet Soil Characteristics Location Sketch
Was Ground Water Encountered? bj ¢9~ ¢¢~e4~'--J' .l' bJ~_" .....
! I /
Prop ~sed ' ' ·
-~nstallatzon: Seepage Pit Drain Field
Depth ~f Inlets__ Depth 'To Bottom Of Pit Or 'French .....
~OMM ....... · ~ ' ~ ' ~ '' ^ ' ~ ~ ' .........
Test Performed By:~ .........
Data Certified By:~.~ --
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