HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 4 LT 8LOT"
GAAB HD I
GI~:ATER ANCrtORAGE AREA BOROI'GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2§!1
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
ADDRESS
.LEGAL DESCRIPTION
4- PHONF
SEPTIC TANK:
DISTANCE FrOM WELL
LIQUID CAPACITY
.MATERIAL ~'t¢' "¢d¢'¢' '4/7~ NUMBER OF
COMPARTMENTS
GALLONS. INSIDE LENGTH. INSIDE WIDTH DEPTH____
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
TILE DRAIN FIELD:
SEEPAGE PIT:
OUTSIDE DIAMETER OR WIDiH , LENGTH__ , DEPTH
DISTANCE FROM WELL .~ ~- / __ BUILDING FOUNDATION.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)~.~~--~ SQ. FT.
DISTANCE FROM WELl
TOTAL LENGTH
FOUNDATION. , NEAREST LOT LINE , OF LINES
NUMBer OF LINES
DISTANCE BETWEEN LINES
TRENCH WIDTH
IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEAIH TILE
IN, ABOVE TILE
WELL: TYPE__'~i~-///e¢/ , DEPTH ~)0~'
LOT LINE ~' / NEAREST .1¢~ ! SEPTIC
, SEWER LINE ., TANK
DISTANCE FROM / WATER
, BUILDING FOUNDATION. /~ SAMPLE ///'.~2 , NeArESt
7.,,~ / SEEPAGE ¢: /' ,__ OTHER
, SYSTEM___/~'2 '~ , CESSPOOl __, SOURCES'---
DIAGRAM OF SYSTEM
DISTANCES:
,9;6 7z
..T)_? o,.
DATE
SF~?E DISPOSAL SYSTEM- APPLIC Iq'~,.PEP~IT ."'-
. , , / ~J~
. . : .. -,. . . ·
Application to Inst~l: S~ptic tu~_t~, ~e~e pft~, ~a~ field,
To S~ve'the [p~o~ing racii' ~ ' ' '
nn~ced Th~u~ .~ ~. , ~. To b~ Inst'aXle~ by .,/~H ..
Percolation Test R~s~ts~ , , -, ':,, .',,'~%iclPated Date
' ~ . ~ ,' % ,
~ ~sn0..T0 ~S: ~Xn~ '~m .~ ~TH .~p~f~ . '.. '
~is is to se~e as . : , ~ ~.
~ ~0~ 'si~ " 'o'. : ":
~ , ..... as desc ed be , e off ~[t t be'se~e
',- · ~Ptmc 't~k size' ~e ~ePase
DISTilS: DIAG~H- OF ~S~M.
./6j, ~ o '
.' ~ ~~ ' .' *..
· ;~'~aith Authority
,/g'
I certify, that I am' familiar with the ~equi~ements of G~eater Anchora[e Amea Borough
Ordinance No. 28-68 and that the above desc~.~bed system is' in accordance with said code.
,.1~. Du Ra~a~ee
· P.O. ~ox. Xsgg
The .eff. r eyetem had .a XO00 ~ 8aptS~ tank a~ded to
the exirLLng seep.asa area'. -',
DAV]:D lq, L, DU~CA~.o,H, '1)o
lled~ca~. M~e~to~
eel R, L, Xvlno££
~' .('Flll :ou% in .' Triplicate)
· of person .requesting._ approval-
. '...` . . _~ ' ~. . . -
.b.
do
.Distanc~ from well' tO closest existing or ~oposed.
1'.- ,~ewer line.
.2; sept~.c tank
3..Sehpage -Areai
~ ~ '..."CessPool.
5 i Property Line
Age.of system
Septic tank capacity in gallons .
~Na~e of septic tank manufactu~%
._.:, If "__..~hn~o made" 'show --c&agram on 'reverse side of this form.
DisPosal field or seepage pit size and type,
Distance to property., line
to house foundation .
· Sewage disp'6sa'l:system~ . ..
a.
C.
~'""'Other sources of:'~ossible conta~in~-tion i.e'.', c ;eks, lakes, · h6uses', .ham ~ ~ai~-~ge' ditdh, etc. '
· e, Percolatlo~ Te~T'~esults
f. Percolation Test p~rformed by. .-
Use the ~revePse side of this form to show ~iaEram. Dia~ra~ should.include
'~he foll0wing informatiOh: ~operty lines;.well location, h6use location,
~eptlc tank tocatlon,'disposal area location, location of pePcolatlon test,
and direction of ground slope,
®
The lnfor~ation on this fo~'m is tmue and correct to the best of my knowledge.
%iEnature..~f Applicant · - Date"Si~ne~
' 'TO BE :FILLED oUT BY HEALTH 'DEPART.qENT .RERsO}iNEr,
' above desc.ribed sanitarY facili~ies are hereby approved, .Subject ~O the
The ab'Oge..describ'ed .sanitary facillt~s are disspproved 'for the following
.... FSignature 'of
· . .,..., ..,... -,~, ~!~!.~?
Approval is ..Valid· for one year fOlAlOWing..the date of approval.
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