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HomeMy WebLinkAboutHIGHLAND PARK BLK 1 LT 6 GAAB.HD. I GREATER ANCHORAGE AREA BOROUO.,H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK,. DISTANCE FROM WELl LIQLJID CAPACITY GALLONS. NUMBER OF MATERIAL ~~['ff'Cj'~.L" COMPARTMENTS / INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINfNG MATERIAL__ NEAREST LOT LINE. SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH /"~ , LENGTH /(? , DEPTH DISTANCE FROM WELL BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPIION AREA (WALL AREA) ~"~';~' SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINE'S" ABS~RI~ilO N AREA ......... r.xFOUNDATION , NEAREST LOT L~I~_[ ..... DISTANCI/ BETWEEN LINES .......... '~ ..... TRENCH WIDTH SO. FT. LENGTH OF EACH LINE TOTAL LENGTH . OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TIL~ IN. ABOVE TILE WELL: LOT LINE TYPE DISTANCE FROM WATER DEPTH ,BUILDING FOUNDATION SAMPLE ~ ,NEAREST NEAREST SEPTIC SEEPAGE OTHER , SEWER LINE , TANK , SYSTEM , CESSPOOL. , SOURCES. DISTANCES: DATE DIAGRAM OF SYSTEM ~/0~ GAAB-HD-2 GRE.ATEK 327 Eagle St. ANCHORAGE AREA HEALTH DEPARTMENT Aachorage, Alaska 99501 }ROUGH 279-2511 Cese N o. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRESS od//dO ,~ LEGAL DESCRIPTION. APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY ..~ FINANCED THROUGH PERCOLATION TEST RESULTS ~..j ~,L.~¢ MAILING ADDRESS ~/0© ~'" z/'_/~- LOCATION OF INSTALLATION__~ ~"~ c) PH ON E N O. ?~.?~ Z~7:¢. '~' ,7 ' // , SEEPAGE PIT. )(' , DRAIN FIELD ____ , OTHER __ TO 'BE INSTAkkED "Y /'-/~2"J '%/~)~ ~ / ANTICIPATED DATE OF COMPLETION~~ ~ // BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS DISTANCES: //~/2 , //~C'~/~:7'/~'-/~.._~,~'PERMi~ To INSTALL A Health Authority I certify that I am fanfiliar 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 7 APPLICANTS SIGNATURE