HomeMy WebLinkAboutLAZY ACRES LT 13
GR' .,,:R ANCHORAGE AREA BOROL'
DEi,AFITMENT OF ENVIFIONMENTAL QUALll t
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
NUMBER OF
DISTANCE FROM WELL__~:"~)~/~<~~' ./'~-~-~-~c~--MATERIAL--~'~f L)''</'~'~-~:- ~'~--~=:'' COMPARTMENTS
LIQUID CAPACITY /._~"'~/'¢7~) GALLONS. INSIDE LENGTH__ ~ INSIDE WIDTH. ~'""-'
LIQUID
DEPTH_
SEEPAGE SYSTEM:
NUMBER OF PITS_
LINING MATERIAl
NEARESI LOT LINE
SEEPAGE PIT:
___OUTSIDE DIAMETER
OR WIDTlt_ /'.~'2... , LENGTH ~..L)__.._ , DEPTH_
DISTANCE FROM WELL_~'/'/~'~,~-..f~/'--.~'~'''''''''''''''''~-~/2 , BUILDING FOUNDATION
c-c-c-c-c-c-c-c-c-c~ ~.) '~' .~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~"~) ¢~"~';~ SQ. FT.
'FILE DRAIN FIELD:
DISTANCE FROM WELL___
NUMBER OF LINES_ :~.~"'"'"'"~ DISTANCE BETWEEN LINES
ABSORPTIQIN'q'A~A-- SQ. FT. LENGTH OF EACH LINE
FST LOT LINE
TOTAL LENGTH
, OF LINES.
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE_
DEPTH OF FILl'ER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: TYPE~'~'~',',',',',',',','~,,¢'~,~/,(,//,~'-.~, DEPTH ~,,,~,- DIS'~ANCE FROM ¢,_.--- WATER
,BUILDING FOUNDATION ........ SAMPLE.. , NEAREST
OTHER
NEAREST / SEPTIC SEEPAGE "'""'~- , CESSPOOL ~"~"~ SOURCI::S~'
LOT LINE /, SEWER LINE ., TANK /' , SYSTEM_ ,
DIAGRAM OF SYSTEM
DISTANCES;
GAAB-HD-2
GREATEP
327 Eagle St.
.NCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
ROUGH
279-2511
Case No./'/~ ~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT/~¢~"'~' ,5~/~'r'"'t~'~/)''' MAILING ADDRESS PHONE NO.
RESIDENCE ADDRESS LOCATION OF INSTALLATION ~
LEGAl_ DESCRIPTION ¢ /-;~ ~
APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT__ ~ ,DRAIN FIELD ,OTHER
T0 SERVE THE FOLLOWIN6 FACILITY ~¢~, ~¢~;gL4 /~'~¢'~ ~
/
PERCOLATION TEST RESULTS ~¢~/ ~ ANTICIPATED DATEO~MPL~N ~/ ~f:'
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
/'/~' ~'¢ ., PERMIT TO INSTALL A /¢~d.~7/ ' ~-~
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
TANK
SIZE
/'~'~'D DIAGRAM OF SYSTEM
DISTANCES:
ab ove
DATE ,- APPLICANTS SIGNATURE