HomeMy WebLinkAboutNORTON PARK #2 BLK 4 LT 9i ar
2ll,
GP~.TER ANCHORAGE! AREA BORG"
HEALTH DEPARTMENT
327 '~GLE ST. ANCHORAGE, ALASKA 99501 279.2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL, SYSTEM
NAME
MAILING 7/..,/'.,/ A'~/~//~//~.//~,Z/,.~../.~ PHONE
ADDRESS./' / ~-
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS. INSIDE LENGTH
NUMBER OF /'
/-~--~ (.,~ _COMPARTMENI'S
/.,/ t LIQUID
iNSIDE WIDTH -- DEP1H
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS // OUTSIDE DIAMETER --" OR WIDTH ,/ '~/ !
~ LENGTH /' ~' , DEPTH
LINING MATERIAL /~,' /'~/~/~ ~7-//'~'''~'~ ~J~. DISTANCE FROM WELL /~ ~ , BUILDING FOUNDAHON
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
FOUNDA ON ..~.~.~..~.~7"KIEAREST LOT LINE
.DISTANCE BETWEEN LIi~IE'S'~' TRENCH WIDTH
GTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE__
WELL: TYPE _~/'~ ~Z_.~Z.~-~ DEPTH ~ ~'~'
LOT LINE 1~.., F NEAREST SEPTIC
~ SEWER LINE ~-~"' , TANK
DISTANCE FROM WATER
, BUILDING FOUNDATION -~/' SAMPLE
.~ ~' (' SEEPAGE ~,~ S.-~" ,"
· SYSTEM ,CESSPOO[
DIAGRAM OF SYSTEM
· NEAREST
OTHER
, SOURCES
DISTANCES:
DATE
APPROVED
AUIHORI[Y
GAAB-H D-2 Case No.
GRE.ATI~ ~.
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
9ROUGH
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~.k.~[~
RESIDENCE ADDRESS
,Kraft ~'i~ LEGAl_ DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
MAILING ADDRESS lq2(~ ~/AJgl/q'lJJ~l~ONE NO
LOCATION OF INSTALLATION
, SEEPAGE PIT. , DRAIN FIELD , OTHER
TO SERVE THE FOLk0WING FACILITY ,~-
FINANCED THROUGH ~'i~ TO BE INSTALLED BY
PERCOLATION TEST RES~bTS ~
~ ~ BELOWTO BE FILLED OUTBY HEALTH DEPARTMENT
T.,S ,S TO. SERVE AS ~ C~k , PERM.T TO ,NSTALL A
AS DESCRIBED BELOW. SIZE OFiUNITTO BE SERVED
DIAGRAM OF SYSTEM
DISTANCES:
I/ /
'- ~ealth Authority -
q certi£y that I am £amiliar with the requirements of Greater Anchorage Area Borough Ordh~ance No. 28-68 and that the
above described system is in accordance with said code.