HomeMy WebLinkAboutT15N R1W SEC 19 LT 44
GAAS-H0-I
GREATER ANCHORAGE AREA BOROIJ'~H
/ x HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING
ADDRESS
DISTANCE FROM WELL
LIQUID CAPACITY
i~E ~ z ,..~ . :x~ . , .~] NUMBER OF I
MATERIAL C~O~'~'~'~'~'~'~'~'~ ~Ll~ L~;~' 'Q- J ~ COMPARTMENTS
GALLONS. INSIDE LENGTH 7 F INSIDE WIDTH ~' LIQUID
DEPTH.~
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
/ OUTSIDE DIAMETER OR WIDTH
,i~-~ DISTANCE FROM WELL J60 /
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREAI
., LENGTH '~ DEPTH
, BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELT
FOUNDATION
. NEAREST LOT LINE
TOTAL LENG[H
OF LINES
NUMBER OF LINES
DISTANCE BETWEEN LINES.
TRENCH WIDTH
IN. TOTAL EFFECTIVE
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATER AL BENEATH TILE
IN. ABOVE TILE __
WELL:
NEAREST
LOT LINE , SEWER UNE
DISTANCE FROM ~,~ f WATER
, BUILDING FOUNDATION SAMPLE
SEPTIC ~..) SEEPAGE
_, TANK , SYSTEM ~ 'f~ ~) , CESSPOOl
NEAREST
OTHER
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE APPROVED
HEALTH AUTHORIIY
GREATEI. 'ANCHORAGE AREA ~,OROUGH Cas. No. /~'~'
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME
OF
APPLICANT
APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT ,DRAIN FIELD ,OTHER
TO SERVE THE FOLLOWING FACILITY
FINANCED
THROUGH
PERCOLATION TEST RESULTS ~/~,M~dANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS i , PERMIT TO INSTALL A .., -- .~.t/"~z~-,.-t~
~ AS DESCR,BED BELOW. S,ZE OF UN,T TO BE SERVED 4 ~Z~'~
· SEPTIC TANK SIZE /~=~.%-Z) .TYPE ~SEEPAGE AREA c*~?oddt/ TYPE
DIAGRAM OF SYSTEM
DISTANCES:
He 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. d';~ ~//~
DATE ~