HomeMy WebLinkAboutT13N R3W SEC 28 LT 19 S2 E100'
GR~:-~TER ANCHORAGE AREA
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~,~'~7'-' /-~'~.~,~--~
SEPTIC TANK: ,,4//.,~%---
NUMBER OF
DISTANCE FROM WELl MATERIAL COMPARTMENTS.
LIQUID CAPACITY
PHONE.
INSIDE WIDTH
GALLONS. INSIDE LENGTH
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINF
SEEPAGE PIT:
/ OUTSIDE DIAMETER
~ , LENGTH DEPTH
DISTANCE FROM WELL'/~'~r~'~''~' ~'g:'~:~ ' , BUILDING FOUNDATION~c~ /'~',
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ,~.~/~ SQ. FT.
DISTANCE FB:O/M WELL I , FOUNDATION_ / , NEARI~ST LOT LINE / , OF LINES
NCH WlD[H / IN. TOJAL EFFECTIVE
AB/ORPTION AREA ~ LENGTH OF EACH LINE \~
D/EPIH: TOP OF TiLE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
~ DISTANCE FROM WATER ,'"'~/¢~ , NEAREST
WELL: TYPE ~*.,'(//-/~"~'~ _, DEPTH , BU LDING FOUNDATION ~J . SAMPLE
SEEPAGE '~'~ .~'~'?/'?~?"~' OTHER ~
LOT LINE / ~: z~.., SEwERNEARESTLINE ~, TANKSEPTIC ~ SYSTEM ~J~;~ ~' , CESSPOOL ~ SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
GREATEY ',ANCHORAGE AREA?DROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~-~2,~ZJ~'?YJ ~4%.~-'-
RESIBENCE ABDRESS ~':.~} T-~~
LEGAL DESCRIPTION .('~_/-¢-/~//'-~,~- ~.:g~ ,/~L-/'~
APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT ~>/~DRAIN FIELD , OTHER.
TO SERVETHE FOLLOWING FACILITY ~ ,~"~c~
FINANCED THROUGH -~:~ · TO BE INSTALLED By~7~,T
PERCOLATION TEST RESULTS ~~-~ ANTICIPATED DATE OF COMPLETION-~
/~EL0~LED OUT aY HEALTH DEPARTMENT
MAILING ADDRESS>~'"~%'~,~~ ~&'--~- PHONE NO.
LOCATION OF INSTALLATION .,~?~ ~- -- '- '~/'~'
THIS IS TO SERVE AS
· SEPTIC TANK SIZE.
~.~',-/--~'.-~.~-~ , PERMIT TO INSTALL A _ ,~~.x'_~'~'~/?
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~
~' SEEPAGE AREA
~ .TYPE ~--'
DIAGRAM OF SYSTEM
DISTANCES:
TYPE
LICENSED DESIGNER
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.
APPLICANTS SIGNATURE ~ / ''