HomeMy WebLinkAboutBRUCE #1 BLK 3 LT 1
GAAB-HD-1
GRrATER ANCHORAGE AREA BOROI~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 2; -2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
LEGA' DESCR,PTION ~/ ~z~'2 ~~-
SEPTIC TANK:
DISTANCE FROM WELL /'g~'
LIQUID CAPACITY
GALLONS.
MATERIAl
COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH __
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS_ ,,~ ~E DIAMETER ..~"I~?IDTH! , LENGTH--,..-~ , DEPTH
LINING MATERIAL BUlL
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl /.,2 ~ ! FOUNDATION. ~ NEAREST LOT LINE.
NUMBER OF LINES / DISTANCE BETWEEN LINES ~ TRENCH WIDTH
ABSORPTION AREA //t~l~ SQ, FT. LENGTH OF EACH LINE /~'
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH ~'j] _ t
OF LINES i v i~
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
~,~t~l~ DISTAN CE FROM
WELL: TYPE _ , DEPTH BUILDING FOUNDATION
NEAREST SEPTIC /,~t~)t SEEPAGE /.,~ ~'
LOT LINE SEWER LINE , TANK '"'/' SYSTEM
WATER
SAMPLE NEAREST
OTHER
CESSPOOL , SOURCES__
DISTANCES:
DATE
DIAGRAM OF SYSTEM
J r~'o
[t~j/ HEAL~"J~-AUTHORITY
GAAB-H D-2
GREATE[
327 Eagle St.
SEWAGE
. NCHORAGE AREA' )ROUGH
HEALTH DEPARTMENT
· f'.<-~,,~2-79-2~ ] 1
Anchorage, Alaska 99501 ,~-~'C'/~-~'~
DISPOSAL SYSTEM - APPLICATION & PERMIT
Case No.
NAME OF APPLICANT /'/-.o LJ ~)
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
/VIC '~ ~-~ ~O/~/.~MAILING ADDRESS/~z~./ 2'-/~.~L~:~,-~//~PHONE NO¢
LOCATION DF ~NSTALLATION T~ ~.~ ~)~xT.,~
, DRAIN FIELD ~""- , OTHER
Y"" , SEEPAGE PIT
TO BE INSTALLED BY /~x~.,
.~) ANTICIPATED DATE OF COMPLETION
/
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /(,A~ ~,, ~/, /,[,/~.,~.._~ ,PERMIT:,....TO INSTALL A ,-.~'d'/'¢''~'
AS OESC"IBED BELOW. SIZE OF UNIT TO BE SE,VEB
.SEPTIC TANK SiZE ~ TYPE ~~/S~EPAGE AREA ~D~
DIAGRAM OF SYSTEM
,TYPE
DISTANCES:
! certify that ! am [ami]Jar with the requirements o£ Greater A~chora[e Area Borough Ordinance No. 28-68 a~d that the
above described system is in accordance with said code.