HomeMy WebLinkAboutMCCAUGHEY BLK 1 LT 1
GRr-'~TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT ~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279~2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
MAILING ~0
ADDRESS
LEGAL DESCRIPTION
PHONE
SEPTIC TANK:
DISTANCE FROM WELl
LIQUID CAPACITY
/
/ 7 ~'~'~ GALLONS.
' UMBER OF
MATERIAL IL.. COMPARTMENTS
!
INS DE LENGTH /
_ NSIDE WIDTH
LIQUID
DEPTHJ
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH
DISTANCE FROM WELl f~'~'O
TOTAL EFFECTIVE ABSORPTION AREA WALL AREA
, LENGTH (~ , DEPTH ~/'
BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF L NES
ABSORPTION AREA
· FOUNDATION
.DISTANCE BETWEEN LINES
SQ~ FT. LENGTH OF EACH L NE
DEPTH: TOP OF TILE TO FINISH GRADE
NEAREST LOT LINE_
, TRENCH WIDTH
TOTAL LENGTH
OF LINES_
TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL:
TYPE ~'d7~'"'''''~'''"'''''~ DEPTH
NEAREST
LOT LINE SEWER LINE.
SEPTIC
· TANK
DISTANCE FROM
· BUILDING FOUNDATIOI':4.
9*' /' SEEPAGE
. SYSTEM
WATER
SAMPLE
· CESSPOOL
NEAREST
OTHER
· SOURCES
DISTANCES:
4G
DIAGRAM OF SYSTEM
DATE
APPROVED
HEALfH AUTHORITY
GAAB-H D-~.~~
GREATEI~ ~NCHORAGE AREA ~'~ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK b/' SEEPAGE PIT. f DRAIN FIELD OTHER
To SERVE T.E ~GLL0W.NG FAC,L,TY -3v, upl<~_ &
BELOW TO BE ~ILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
· SEPTIC TANK SIZE
STANCES:
NO (~O~Jl~ ~
40' os
~0~ -~ ~' p~d. to S
Health Authority
· g~'~o-t..f~---',~-~:~-~-'~ , PERMIT TO INSTALL A
AS DESCRIBEQ BELOW. SIZE OF UNIT TO BE SERVEB
."/~7~"'~:)TYPE S'[ ~2Z~.~ . SEEPAGE AREA d~5~(--;0 ZJ' TYPE J~Zb,.~ ,.
DIAGRAM OF SYSTEM
I certify that I am familiar with
above described system is in accordance
Anchorage Area Borough Ordinance No, 28-68 and that the
said code.
APPLICANTS SIGNATURE//--~ ~-' )-P'~ ~: <d . -
GREATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT CASE
32? EAGLE STREET
ANCHORAGE, ALASKA 99501
For ~ £, · Date Performed
Le.~al Descriptibn: Lot / 'Block~Su~vlsion , ~ ( f~
~J? F ~m ReLoPts a: S~L°g --- ~ Pemcolatio~Tesz
Was G~ound Water Encountered? ~/~_~
Location Sketch
Depth
Feet
::g ~ Da~e Gross Time Net Time Depth To H20 Net Drop
Readi~:
,ate 1 I . MinQte
Proposed ~nstallatlon: Seepage Pit Drain Field
De~pth Of Inlet W~ Depth To 'B'ottom Of '~it Or Trench'
Test Performed BS,:'
Data Certified By: ~ ~Z/~A~/~ ,/,/ ?>//~Z~
Date'~5-- ' .