HomeMy WebLinkAboutSewer Information (2)
GAAB HD I
GPCATER ANCHORAGE AREA BORO"'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
NAME F ''~ L
LOCATION. fl~////'"*~
SEPTIC TANK:
DISTANCE FROM WELL
?,..LIQUID CAPACITY
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
7~j MATERIAL ~"'C~ k,J C I'~'~ J~-~ NUMBER OF
COMPARTMENTS
I LIQUID ,~
INSIDE LENGTH ~ INSIDE WIDTH DEPTH
GALLONS,
SEEPAGE SYSTEM:
NUMBER OF PITS
LJNING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER OR WIDTH "~ , LENGTH ~> , DEPTH
I1 '
~'/ ~)~'"~' DISTANCE FROM WELL , BUILDING FOUNDATION.__
/oo' .-F- 2.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA} SQ. FT,
TILE DRAIN FIELD:
DISTANCE FROM WELL
TOTAL LENGTH
FOUNDATION. , NEAREST LOT LINE , OF LINES
NUMBER OF LINES
DISTANCE BETWEEN L~NES
TRENCH WIDTH
IN. TOTAL EFFECTIVE
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
SQ, FT.
LENGTH OF EACH LINE
.DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE T}LE__
WELL:
LOT LINE
DISTANCES:
TYPE
:DEPTH /O'Z"
NEAREST SEPTIC
SEWER LINE , TANK
DISTANCE FROM WATER
BUILDING FOUNDATION SAMPLE NEAREST
'~/. I SEEPAGE i/ ~ ~ OTHER
SYSTEM , CESSPOOL , SOURCES
DIAGRAM OF SYSTEM
DATE
APPROVED
HEALTH AUTHORITY
GREATE.-- ANCHORAGE AREA ,.-tDROUGH
HEALTH DEPARTMENT A /~1 ~C27~,~4/J,~,~
Anchora e, Alaska 995"1 /fl~$~"] 1/~7t4-~5'ii '~
SEWAGE DISPOSAL SYSTE~vAPPLICATION & PERMIT
NAME OF APPLICANT ~rL ~ l (-~ Y~
RESIOENCE ADDRESS ~L ,~ '~ k
LEGAL DHSGRIPTIDN
APPklCATION TO INSTALL: SEPTIC TANK ~ ., SEEPAGE PIT~ ~.-, DRAIN FIELD_
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH-
case No.-~& ~,
PERCOLATION TEST RESULTS
..- MAILING ADDRESS gz
TO BE INSTALLED BY ~:;7 Z 1'~-:
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
., OTHER.
THIS IS TO SERVE AS
, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT,TO BE SERV
SEPTIC TANK SIZE /0(~0 TYPE ~.OIk~, SEEPAGE Al
-' IAGRAM SYSTEM
DISTANCES:
I > o
Health Auth0dt¥
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. ~ ~