HomeMy WebLinkAboutLot 148Lo'
Gp'~TER ANCHORAGE AREA BORO?~'H
b.,AflTMENT OF ENVIRONMENTAL QUALJ, .-
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ' ,
ADDRESS '7./~' J~'//'~/4'cz)~/~)&~(:- //~z...)'/;': PHONE
LEGAL DESCRIPTION ~:'/ /~? <-~
SEPTIC TANK:
DISTANCE FROM WEL[
uQUlD CAPAaT¥
.GALLONS.
MATERIAL t/~ ~;'/?~'/~-/~'//~ NUMBER OF
COMPARTMENTS /
~/~//'/'~ ['///~/('~ LIQUID
INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS_ /~ OUTSIDE DIAMETER
LINING MATERIAL ~'~/~ '-':' '" ~//~J~'~
NEAREST LOT LINE
OR WIDTH_ / ~--" !
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
., LENGTH ~"~)' , DEPTH
, BUILDING FOUNDATION
.f -)/('~ SQ. FT.
TILE DRAIN FIELD:
TOTAL.LENGTH
ABSORPTI / · ~ ......
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN, ABOVE TILE
WELL: TYPE ~ '/ '~ uEPTH/~] ./..z~.* ,¥1 BU LDING FOUNDATION. SAMPLE NEAREST
NEAREST /l~.~/f.~'i~&¥; ~(:', SEEPAGE ., 1 OTHER
LOT LINE . SEWER LINE ~-ANK . SYSTEM //~/~/ , CESSPOOl . SOURCES
DISTANCES:
~ AGRAM OF SYSTEM
DATE
GAAB-HD-2
GREATE: NCHORAGE AREA ' ROUGH
HEALTH DEPARTMENT
327EagleSt. Anchorage, Alaska99501 279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
MAILING ADDRESS PHONE NO.
LOCATION OF NSTALLATION.
NAME OF APPLICANT
RESIDENCE ADDRESS
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH.
PERCOLATION TEST RESULTS
LEGAL DESCRIPTION
, SEEPAGE PIT
, DRAIN FIELD ., OTHER
TO BE INSTALLED BY_
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY FIEALTH DEPARTMENT
THIS IS TO SERVE AS ' , PERMIT TO INSTALL A : ~,.
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED,
, . SEPTIC TANK SIZE ' ; TYPE ' SEEPAGE AREA TYPE DIAGRAM OF SYSTEM
DISTANCES:
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordfl~ance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLICANTS SIGNATURE
327 EAGLE ¢'v
ANCHORAGE ~ ~
.... ~,,~,,K¢~ 99501
* ........... :,,~ ..... ~'ercolat:on Test
Was Ground Watez, E~cou~te~,ed? ff~.j Xo /~
~ead~f~g Date Gross ~ime ~e~ ~;~e berth To H20 Net Drop
Test Perforwed By:..~D
O~ta Certified