HomeMy WebLinkAboutBROOKWOOD BLK 2 LT 14z.¥
GAAB-HD- I
Gg~ATER ANCHORAGE AREA BORO' ~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
PHONE
DISTANCE FROM WELL ~O~'~.,qt;~ ~,,'/)"~.Z/"~'$MATERiAi
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY /t~.~90 GALLONS. INSIDE LENGTH ~A//~/~ INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS __
LINING MATERIAL__
NEAREST LOT LINE__
OUTSIDE DIAMETER OR WIDTH
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH , DEPTH
BUILDING FOUNDATION__
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl FOUNDATION.
NUMBER OF LINES // ~'''/ DISTANCE BETWEEN LINES
ABSORPTION AREA '~ ~'~ ~
DEPTH: TOP OF TILE TO FINISH GRADE
SQ. FT. LENGTH OF EACH LINE
NEAREST LOT LINE
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
/
~,//
I~. ABOVE TILE
B~--~O~ ~/~¢/"_~_(~-----~ DISTANCE FROM WATER
WELL: TYPE DEPTH BUILDING FOUNDATION SAMPLE
NEAREST SEPTIC SEEPAGE
LOT LINE SEWER LINE , TANK SYSTEM CESSPOOL
DIAGRAM OF SYSTEM
, NEAREST
OTHER
, SOURCES
DISTANCES:
'
/9'*¢
L
DATE
APPROVED
HEALTH AUTHORI~~'~
GAAB-HD~2 C~$8 N o.
GREATE.. ANCHORAGE AREA ,JOROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT~-~d~
MAILING ADDRESS ~,~
LOCATION OF INSTALLATION
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH F H ~
PERCOLATION TEST RESULTS /~J '~-~
/~c/ PHONE NO.
,DRAIN FIELD. / ,OTHER
SEEPAGE PIT.
TO BE INSTALLED BY
2-4 oo'nce
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /l'~i~, ~j'/~ ~Ia/~ , PERMIT TO INSTALL A '"~/~
AS DESCRIBED BELOW. SIZE OF UNITTO BESERVED ~
.., SEPTIC TANK SIZE ~TYPE d~2~/~SEEPAGE AREA ~>"~'~PE DIAGRAM OF SYSTEM
f
}
[} /~ / ~
DISTANCES:
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 in accordance with said code.
DATE . APPLICANTS SIGNATURE