HomeMy WebLinkAboutLot 14, 15
GAAB HD I
Go~'~,.TER ANCHORAGE AREA BOROU~',H
H EAL'rH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYS'[EM
NAME.
LOCATION
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
SEEPAGE SYSTEM:
(~'~} / __MATERIAL__
GALLONS. INSIDE LENGTH
'"~'
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE__
OUTSIDE DIAMETER
~)/~/¢~ ~ ,~. ' 7-~F NUMBER OF /
.COMPARTMENTS
LIQUID
INSIDE WIDTH _ .DEPTH
OR WIDTH_ , LENGTH__ __, DEPTH
DISTANCE FROM WELL__~Ik_~!-- ., BUILDING FOUNDATION
TO[AL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES_
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
, FOUNDATION_ __, NEAREST LOT LINE
.DJSTANCE BEIWEEN LINES_ TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: r'~ k~ ~
TYPE__~(~IVvL~'~-d' , DEPTH.
NEAREST
LOT LINE , SEWER LINE
kT' °,STANCE FROM 93'
-, BUILDING FOUNDATION
WA[ER
SAMPLE
____ CESSPOOl
DIAGRAM OF SYSTEM
, NEAREST
OTHER
, SOURCES
DISTANCES:
ft-.G:
.;\-n ':
0 ,..u
I
DATE APPROVED
GAAB-HD-2
GREATEk ANCHORAGE AREA ~ 91t~OUGH
ItEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF
RESIDENCE ADDRESS
LEGAL. ,DESCRIPTION
APPLICATION T0 INSTALL: SEPTIC TANK_ ~'~__, SEEPAGE PIT.__
TO SERVETHE FOLLOWING FACILITY ,~ 8~ ~V'O0 Iv~
_ MAILING ADDRESS '-~';
LOCATION 01: INSTALLATION
PHONE ND.__
FINANCED THROUGH
PERCOLATION TEST RESULTS
, DRAIN FIELD. , OTHER
TO BE INSTALLED BY_
ANTICIPATED DAI'E OF COMPLETION
THIS IS TO SERVE AS
DISTANCES:
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED___
. SEPTm TANK S~ZE. '7,Si:~ .TYPE d~,'~'C'ZZ_/~EEPAGE AREA
DIAGRAIVl OF SYSTEM
/~' ?'1/': ,PERMITTO ,NSTALLA ,S¢/~.p+((~, '"'j"E'4 [)~-~
Health Authority
I certify that I am familiar with the requb'ements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code,
DATE__ / ~ APPLICANTS 8IG NATU RE '~-~?'~:~/