HomeMy WebLinkAboutSOUTH HILLS BLK 2 LT 4
GP-' ~TER ANCHORAGE AREA BORO~'~.H
~ HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 9950! 27~9-'§11
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
N? 107
SEPTIC TANK:
MAILING
ADDRESS ~-~_ .~ '~:,,,~ ... ~.
LEGAL DESCRIPTION
LIQUID CAPACITY ,,./~2 ~ ~.f? GALLONS.
NUMBER OF
MATERIAL ,('~ ~/b/'~'~'~~-~'.'r~-~ COMPARTMENTS
INSIDE LENGTH ~ INSIDE WIDTH ~ DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAl ~""~/(//-~Z~'~
NEAREST LOT LINE
/ OR WIDTH ,, LENGTH , DEPTH /'-~ /'
,/
DISTANCE FROM WELL ./~/~-/") ~ , BUILDING FOUNDATION.__
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) r~:'~.'~''' SQ. FT.
NUMJ~R OF LINES DISTANCE~BETWEEN LINES / TRENCH WIDTH ~/~,~ EFL'~FECTIVE
~)EPTH: TOPOF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
DISTANCE FROM WATER / ~
WELL: TYPE ~'/~//~ '~ , DEPTH .BUILDING FOUNDATION. SAMPLE ~/~/'/) , NEAREST
NEAREST SEPTIC /'.~ ~.~ SEEPAGE /~/.~.)._~, OTHER
LOT LINE , SEWER LINE , TANK ~:~/--'~ , SYSTEM CESSPOOL , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
· . . ; . . · . .' '': ' - f"~' t '_ ' ,.' ?' ~" ~ - ~ ;' ; ; .
. , : , ~ : . , { : . . : ~ · . , :
"' GREATEi..:ANCHORAGE AREA .,, ,DROUGH c,seNo.
,.~ HEALTH DEPARTMENT '~)! ~ .~..
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
'.~t:~gN ~ I'~/.V ,7~, MAILING ADDRESS~ ~, ~ PHONE
LOCATION OF INSTALLA~ ~/~
, SEEPAGE PIT. / ,DRAIN FIELD. , ~OTHER
FINANCED THROUGH ~ ~ TO BE INSTALLED BY
5oz& ~-/,~~¢6~ANTICIPATED DATE OF coMPLETION
~TEST RESULTS
/-
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /f~j~ ~/~-/4 ~¢/ , PERMIT TO INSTALL A 5~- VO e.~- S ~ ,~ ~
AS 0ESC.,~ ~E~ow. SiZE OF U.,T TO .~ SE.V~ -~ ~ ~ ~
. SEPTIC TANK SIZE ;EEPAGE AREA TYPE
DISTANCES:
/~£~ ~ -/00
LUlouT ~tL
edith Authority
/5'
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.
]REATER ANCHORAGE AREA BOROUGH~
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE #
Performed For ,~i%,~,~
Legal Description: Lot~6Lsj_Block
This Form ~epomts a: Solls~'-'~---Log
Depth
Feet
~L
Date Performed 2~ ~/~:~
~.// ..... [., . .Per¢olatio~ Test .......
Location Sketch
If Y~s~ At What Depth
Reading Da~e Gross Time Net Time Depth To H20
.=rcola~lon (aTe 1"/ ~q~n~-m' ..... ' ,,. -~-,
Net Drop
Test Performed B~,:..~~. ....
Data Certified
Proposed Instaliat,~on:''---~'"--Seepage Pit~ Drain Field
Depth Of Inlet, ,~' ....... Depth To Bottom Of Pit Or Tmenc ~"
CO~EN?$ :~A~ k m .~ ~ ~ = '/~,~,~ .......... 5---~