HomeMy WebLinkAboutT13N R3W SEC 13 LT 14 LESS S150' (2)
GR,,~,,ATER ANCHORAGE AREA BORO~U'~H
' HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAT'ON V o6T'
SEPTIC TANK:
DISTANCE FROM WELL /O '~-
LIQUID CAPACITY /L~) ~) GALLONS.
ADDRESS
LEGAL DESCRIPTION_ /J'//'~- /--~"sT/'~
NUMBER OF
MATERIAL. ~ ~~ COMPARTMENTS.
INSIDE W~TH DEPTH_~
INSIDE LENGTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH_
DISTANCE FROM WELL_
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH DEPTH_
BUILDING FOUNDATION.-
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES_
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
LOT LINE
EOUNDATION NEAREST LOT L'NE
DISTANCE BETWEEN LINES-- /Q / '~ j
TRENCH WIDTH
SQ. FT. LENGTHOF EACH LINE
~, ~ / ZDE~TH O~ ~LT~. ~A~R~AL ~m~ATH T~L~_
~ DISTANCE FROM '~ / WATER
DEPTH * , BUILDIng FOUNDAiJON SAMPLE
NEAREST ~(/ SEPTIC /~ SEEPAGE /~ ~ESSPOOL
, SEWER LINE ~ ,TANK SYSTEM '
TOTAL LENGTH
, OF LINES
+IN. TOTAL EFFECTIVE
IN. ABOVE TILE
NEAREST
OTHER
SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
.~o t.._z~O 6U~I-b
APPROVED
GAAB-HD-2 ~
GREATEK ANCHORAGE AREA )ROUGH C,s. No.
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT -
kOgATlON OF INgTALLATION
, DRAIN FIELD , OTHER
, SEEPAGE PIT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ~
PERCOLATION TEST RESULTS '-~'
TO BE INSTALLED BY --~'~C ~- ~'~
ANTICIPATED DATE OF COMPLETION ~>~/~//'
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /F~) ~ ~'f,/V/, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SiZE ~,~,,,7~:9 ,TYPE ""?~/)I'/~,,'~7"-SEEPAGE AREA
DIAGRAIVI OF SYSTEM
TYPE~' ~
DISTANCES:
¢/g~z -/~/
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 in accordance with said code. ,./
DATE APPLICANTS SiGNATUR