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HomeMy WebLinkAboutKIMBERLY MANOR BLK 1 LT 16Onsite File s`V HEALTH DEPARTMENT ................ 327 EAGLE ST. ANCHORAGE, ALASKA 99501 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAILING _.~,~ ~..&"~ 'r-l;~..~. ~ , ; , · , ADDRESS ./b ~ / PHONE SEPTIC TANK: . ~'~ DISTANCE FROM WELL. LIQUID CAPACITY /,~..z~ O GALLONS. MATERIAL ~>'/VC~-~'-- 7-~ NUMBER OF / COMPARTMENTS LIQUID INSIDE LENGTH ~ INSIDE WIDTH DEPTH SEEPAGE SYSTEM: NUMBER O'F PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER i ~ OR WIDTH , LENGTH .r DEPTH ~_~.,C? . DISTANCE FROM WELl BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA). '~ ~ (-~ SQ: FT. TILE DRAIN FIELD: DISTANCE FROM WELL , FOUNDATION , NEAREST LOT LINE NUMBER OF LINES ,DISTANCE BETWEEN LINES TRENCH WIDTH ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH , OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH~ GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE DEPTH NEAREST LOT LINE . SEWER LINE DISTANCE FROM WATER ,BUILDING FOUNDATION. · SAMPLE , NEAREST SEPTIC SEEPAGE OTHER · TANK. , SYSTEM , CESSPOOL , SOURCES DISTANCES: DATE DIAGRAM OF SYSTEM HEALTH AUTHORITY ~*^~-"~'~.. ' GREATEL~ANCHORAGE AREA~,~.OROUGH CasiNo. ~ ~ · HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alas~ 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT TO SERVE T"E PERCOLATION TEST RESULTS / BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT T U 'S IS TO S E R V E AS :~ ~.~:~ Ir , PERMIT TO INSTALL A /(1 AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED / · SEPTIC TaNZ S~ZE /~ TYPE ::::~EEPaGE aaEA BIAORA~ OF SYSTE~ 1 Health Authority I certify that I am familiar wire me requirements Anchorage Area Borough Ordinan¢¢No. 28-68 and above describe~ system is in accordance with said code. '~C>I C. / ~ De ~-~t~ *-~o~ © I I ~GREATER ANCHORAGE AREA BOROUGI ~ x_~' HEALTH DEPARTMENT 327 EA~LE STREET .... ANCHORAGE, ALASKA 99501 's Fo~m Re oP~s a: So~ls Log ~ .... ~~Tes~ Depth · Feet Soil Characteristics Was Ground Wate~ Encounte~ed?....~k] q if Yes, At What Depth Reading Date Gross Time Net Time Depth To H20 Location Sketch Net D~op GAAB-HDr2 GREATEL .tNCHORAGE AREA , jJROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. SEWAGE DISPOSAl SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS LEGAL DESCRIPTIDN APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FDLLDWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS ~ LOCATION OF INSTALLATION , SEEPAGE PIT ~ ,DRAIN TO ~ 'NSTALLED BY/ ANTICIPATED DATE OF COMPLETI~ BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS AS DESCRIBED BELOW· · SEPT,~TAN K-S~ze SIZE OF UNIT TO BE SERVED I YPE ;SbbPAGE AREA ~TYPE DIAGRAM OF SYSTEM 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//~Fin accordance withAPPLiCANTS SIGNATURE DATE // /'