HomeMy WebLinkAboutRAVEN WOODS BLK 1 LT 2
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
DISTANCE FROM WEU ~ ¢~f
LIQUID CAPACITY ~ GALLONS.
ADDRESS
LEGAL DESCRIPTION ~)~ /-,/~- (L/~YOX ~/'~
PHONE_
,d,c
MATERIAL ~)~j' ~.~'~'T'~?' NUMBER OF
COMPARTMENTS J
INSIDE LENGTH 7 I INSIDE WIDTH ~" DEPTHLIQUID ~"/
SEEPAGE SYSTEM:
NUMBER OF PHS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
/ OUTSIDE DIAMETER OR WIDTH //"~' , LENGTH /.~"~' ' , DEPTH
L/'~(~ DISTANCE FROM WELL /'~"'" f BUILDING FOUNDATION
~/'J" TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) t,."~/,~ SQ. FT,
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
, NEAREST LOT LINE , OF LINES
DEPTH OF FILTER MATERIAL BENEATH TILT IN. ABOVE TILE__
WELL: TYPE d/'V"//~-L DEPTH
NEAREST SEPTIC
LOT LINE G~/.,/F ~ , SEWER LINE , TANK
DISTANCE FROM
,BUILDING FOUNDATION. ~-~ '
SEEPAGE
, SYSTEM /& ~'-//
WATER
SAMPLE ~''
CESSPOOL
, NEAREST
OTHER
.SOURCES__
DISTANCES:
.->
DATE
· GREATE .?ANCHORAGE AREA ,, ?,OROUGH CaseNo.
"~ HEALTH DEPARTMENT
~ J 279-2511 ~
327 Eagle St. Anchorage, Alaska 99501 ~/4/]~t~~~j ,~-:~ .
StWAOt DISPOSAL SYSTE~ - APPLICATIOS & PER~IT
NAME OF APPLICANT ~r~OLD ~e/~'~ MAILING ADDRESS '~,V /0~¢~ PHONE S~
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWIN6 FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
LO CATI 0 N 0 F I NSTA L LATI 0 N
,SEEPAGE PIT t/" , DRAIN FIELD.
,OTHER
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /~)~, (~e ~ (~e-~ , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
, SEPTIC TANK SIZE /O0~ TYPE (~''~' SEEPAGE AREA
TYPE ~.~
DIAGRAM OF SYSTEM
DISTANCES:
~ority
o40 -T. T, ?,
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.
DATE > APPLICANTS SIGNATUR "~ ,
~ :k~ GREATER ANCHORAGE AREA BOROUGk__~'
HEALTH DEPARTMENT CASE
327 EAGLE STREET
ANCHORAGE. ALASKA99501
Performed For, ,
Legal Descrlpt[on: '~°t -_u_~Block~Subd[v[si°n /~%~/? z{.~ ........
This' Form Reports a. So~-~Log '[..~_~'" _'- f[~ercolation Test .
Depth
Feet Location Sketch
Was Ground Water Encountered?
If Yes, At %~hat Depth
Re~dlngJ Date Gross Time Net Time Depth To H20 Net Drop