HomeMy WebLinkAboutHIGHLAND PARK BLK 4 LT 1Al_lA
GRt:ATER ANCHORAGE AREA BORO[;GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAIION ~/~ :[~'~'
SEPTIC TANK:
LIQUID CAPACITY_~ SO ¥--
GALLONS.
ADDRESS6' ,Z ': .-'
~'~- '"' NUMBER OF
MATERIAL f~'Z~ COMPARTMENTS
INSIDE LENGTH ~ ~
INSIDE WIDTH ~ DEPIH ( '
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE'~/~
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH ,)
D,STANCE EROM
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTHJ "~' , DEPTH ~? /
t'
· BUILDING FOUNDATION''~'O '!
sQ. ET.
TILE DRAIN FIELD:
DISTANCE FRC~M WELL FOUNDATION , _N~L..LI~E
NUMBER OF LINE~_ _/~ DISIANCE BETWEEN LINES TRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF 11LE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: ' DEPTH ~-
NEAREST SEPTIC
LOT LINE ~/~'- , SEWER LINE__ .~,~'¥ , TANK
DISTANCE FROM _ ~.- WATER
, BUILDING FOUNDATION. ~/~-- SAMPLE '/~'/¢' , NEAREST
,~ ,/(.~ SEEPAGE OTHER __
· SYSTEM ,~/<ZZ_ , CESSPOOL ~' , SOURCES__
DIAGRAM OF SYSTEM
DISTANCES:
DATE
GAAI~-IiD-2
GREATE?
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT .~[~-r~
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
__ MAILING ADDRESS /~/~0 ~'e,.~.~,~ PHONE NO.-~,~'' ~'~'~y
LOCATION OF INSTALLATION_ ::z~4~.
\/
SEEPAGE PIT_ /, , DRAIN FIELD
,OTHER
//
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION/~ '''~
BI:LOW TO BE FILLED OUT BY ttEALTH DEPARTMENT
THIS IS TO SERVE AS
AS DESCRII~ED BELOW.
. SEPTIC TANK SIZE
DISTANCES:
, PERMIT TO INSTALL A .~'&:~/'¢//
S, E DP UN,T TO ,,E SERVED,
TYPE ~ SEEPAGEA~EA
DIAGRAM OF 8Y~T~M
I certify that i am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above~njbedk _ ' system is in,.accordance with said code.~ (::~':~d~'~'~ ('~/~)~7~.'/' '/ ~~~' ' ~
DATE~'~'~ :~,::':') APPLICANTS SIGNATURE X
GREATER ANCHORAGE AREA BOROUGH
ItEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
Legal Desczip%ion: Lot _~_~BlocK._~' · '1 lq~ab, 1,'~ .~_?~.~__
This Form Reports a: Si, ils Log .~.-~ Z_ __ [.Pev~olati'on Tesz_f'--'-~,7
Depth
Feet
3
Soil Characteristics
¥~ ~-~,~ ~ 'd~-'~ I3
Was Ground Water Encountered? .......
if Yes, At What Depth
Date
Reading
Gross Time
Net Time
Location Sketch
Net Drop
Proposed nstallatxon: Seepage Pit ~ Dpain Field
Depth Of Inlet __~_z~' __ Depth I'o Borg'it Or,
Test
Performed
Data Certified