HomeMy WebLinkAboutT13N R3W SEC 28 N2 Lot 30
Gl? ~\TER ANCHORAGE AREA BORO?'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
/
DISTANCE FROM WELL
LIQUID CAPACITY / ~-~'~'~ GALLONS.
MATERIAL
INSIDE LENGTH
..... s /
INSIDE WIDTH ~ ~ DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTHS'
DISTANCE FROM WELl
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH DEPTH
· BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
, FOUNDATION
DISTANCE BETWEEN LINES_
, NEAREST LOT LINE.
TRENCH WIDTH
TOTAL LENGIH
· OF LINES
IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH; TOP OF llLE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILl
~,r//~, o/ °,STANCE EROM ,,,Z~,SZW'ATER
WELL: TYPE , DEPTH , BUILDING FOUNDATION ~ SAMPLE
LOT LINE o'~O /' NEAREST ~,~'~,O~''/ SEPTIC j~,.~(' SEEPAGE /Z.;~'~
, SEWER LINF "~"'~' ·TANK SYSTEM /~"
CESSPOOL
IN. ABOVE TILE.--
NEAREST
OTHER ~
SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
APPROVED
REQUE ST --f~-~0VA L OF
(F~ll out in T~ip~e)
~x~. Name .of pemson meques~ing app~oval~~~
2." ~e of prope~y~owner .
B. Nu~eP~o~ ~ooms in house,
~a~e~,Anal~ is:
a. BactemiaA
b. Detergent .....
Well data:
b. epth / FO.
e. Casing Size
S~wage disposal system.
a. Age of system ~ .
b. Septic tank capacity in gallons
c. Name of septic tank manufactum~r
Distance from well to closest existing or proposed:
1. Sewer line ,/~ -~ ,~ ~
3, SeepaEe /,=~, 6
~. Cesspool',., .
/
5. Property Line ~O ·
6. Other sources of possible contamination~ i,e., creeks, lakes~
houses, barn, drainage ditch, etc. ~
dt" o
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type
1, Distance~ to property line to house fo.undation
~-~ Percoiati~,T~st ~r~sults ,.
f. Percolation Test performed by
Use the reverse.side of this form to show diagram, Diagra~ should include
'~he foJ].o-,~Jng info~mation: p~operty lines;.well location, house location~
~'-~:{c tank location, disposal area location, location of percolation test,
nd d~ction of ground slope.
9. T~e ~'~r~>'~',~t~on On tkis form is true and correct to the best of my knowledge.
S,ignature of Applicant Dante Signed
FILLED OUT BY HEALTH DEPARTMENT PERSONNEL
~ above .escrlbed S. anltary facll~t~es are hereby approved, subject to the
The above described anmtary facilities are disapproved for the following
reasons:
'"Signature of ~f,~i'e~?l,4
Date '-, ·
Appro'~al is valid for one year oltow~ng the date of approval.
f
CPJ: cw