HomeMy WebLinkAboutTHIBAULT LT 1
GPe~TI"R ANCHORAGE AREA BOROI"~H
HEALTH DEPARTMENT .~ ~>' [ \
327 EAGLE ST. ANCHORAGE, ALASKA 99501 ~9-2511 ~
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL_
__MATERIAL
MAILING ~
ADDRESS,~,/~ '.~'"~ ~.=.~/.~ ~$~ , PHONE~
LEGAL DESCRIPTIO~,~2~-~ ~u,/~ ~:~ ~j
NUMBER OF /
~ ~ ~ COMPARTMENTS
LIQUID~CAPA~CITY~ __GALLONS, _IN~SLD~ LE4~GTH '-- INSIDE WIDTH
NUMBER OF PITS / OUTSIDE DIAMETER___ / , LENGTH___ , DEPTH
LINING M~ERIA~ _~ DISTANC~M WELl 8UILDING EOUNDATION
LIQUID
DEPTH __
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA} SQ. FT.
TILE DRAIN FIELD:
NUMBER OF LINES. ~':~ DISTANCE BETWEEN LINES TRENCH WIDTH
ABSORR.ON ARE^__ ~'"'~/~. ET. LENGTH OE EACH L,NE / ~ ~>' /~!
DEPTH: TOP OF TILE TO FINISH GRADE /.~, .4~ DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH/.. ,,-) /
_, OF LINES //~/ ,
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: TYPE .'~,~'-//~/~-4~/~ ., DEPTH ~/
~ NEAREST /SEPTIC
LOT LINE /~ ./*/~.,'~' , SEWER LiNE ~ .,TANK_
DISTANCE FROM / .,~ WATER ~.~-
.,BUILDING FOUNDATION~ SAMPLE , NEAREST
~-2/47 / SEEPAGE / ~/OTHER
, SYSTEM /~ , CESSPOOL , SOURCES~
___ ,,'~,~,~ -/-~ D I A G r _A~x~.O_F~T ?~
DISTANCES: "':"""""""'~'
DATE
GRE.ATE].
327 Eagle St.
ANCHORAGE AREA
ItEALTtt DEPARTMENT
Anchorage, Alaska 99501
.QROUGH
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICAN _ MAILING ADDRESS_~ 0//.20 ~::~<~/~HONE
.... iv , .~ , .~/__~- '/~ .., ....
LEGAL DESCRIPTION X 0 / ' ~ 6 ~ 5.~¢ · /~~/~L
APPLICATION TO INSTALL: SEPTICTANK~,~~,DR$1N FIELD ~' ,OTHER
P~"gOLATION TEST RESULTS '~.)'__ _ ANTIOIPATED DATE OF COMPLETION.~~O
~'~[/ /,~z /~ / BELOW TO BE FIt. LEO OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS_J~*,~~ .,PERMIT TO INSTALLA .~t~_.~,',--~, ~-~2_~'__~-~'-~~ ,
.,~~ As
DESCRIBED
BELOW S Z~ OF UN T TO ,E SE~VED~ .~-¢' ~X;,~ .... ~,> ,:~:~,.,.~.~,,~
_. SEPTIC TANK SIZE ~ ~ .TYPE~ SEEPAGE AREA.~A~J~'TYPE
DIAGRAM OF SYSTEM
DISTANCES: /
f
Health Authority
I certify that I am familial' with the requh'ements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.