HomeMy WebLinkAboutTIMBERLANE PARK #1 BLK 3 LT 14GAAB-HD-J
G~gJ:~TER ANCHORAGE AREA BORO~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
O,STANCE EROM WEL'
LIQUID CAPACITY
MATERIAL ~z,"~l C/~~ NUMBER OF
~ COMPARTMENTS
~J ~/~/'kl t~l.~' ~9~-~ LIQUID
.GALLONS. INSIDE LENGTI I INSJDE~WIDTH ~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS ,'ENOTH , ,
LININGIIN~/4~4ATERIAIATERIAI . DISTANCE FROM WELl
TILE DRAIN FIELD:
DISTANCE FROM WELt /~'~
NUMBER OF LINES /
ABSORPTION AREA 7~ ..~
DEPTH: TOP OF TILE TO FINISH GRADE
, FOUNDATION /-~'?(~/ ~NEAREST LOT LINE
DISTANCE BETWEEN LINES TRENCH WIDTH. IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILl
~"~ ~ IN. ABOVE TILE
WELL:
NEAREST
LOT LINE . SEWER LINE
DISTANCE FROM 7~, ,/'-~" WATER
, BUILDING FOUNDATION. . SAMPLE NEAREST
£~,~ OTHER
SEPTIC i/~/J~L_I SEEPAGE / D(,7)
· TANK · ' , SYSTEM . CESSPOOl . SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
APPROVED
G~AAB~H 1~-2
GREATE~',ANCHORAGE AREA/~'~OROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NA[dE OF APPLICANT
RESIDENCE ADDRESS
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ~,~
PERCOLATION TEST RESULTS
M)/IJ~?,~/~ ~ '~t~J,I MAILING ADDRESS/M~ PHONE
,~, LOCATION OF INSTALLATION
LEGAL DESCRIPTION t~F f,;~:'~.L ~,~,,~ ,,~ ~/f~l~C
) TO BE INSTALLED BY ~' ~ ~ ~ X
~ [~gl~NTICIPATED DATE OF COMPLETION 24 A
mow To ,E F.LL~. OUT ~ HEART..E,ARm~T
___ AS OESCR,.ED REm/s,ZE OE GN,T T.?,¥ SERVED
. SEPTIC TANK SIZE/O~C~ TYPE~/~J~ SEEPAGE AREA ~ ~ TYPE DIAGRAM OF SYSTEM
DISTANCES:
I certify that I am familiar with the requkements of Greater Anchorage Area Borough OrdNance No, 28-68 and that the
above described system is in accordance with said code.
DATE . APPLICANTS SIGNATURE ~~54~¢~4~5~'''
~,,,. ~
This Form Reports at
kocat J on Sketch
Depth ~ .-.. ct eristics
Feet Soll ~h~ ....
Was Ground Water Encountered?.~//.--~ .... x°
~:~ Det~th 'fo ~20
'-~ ,,',' Time Ne~ ~,,e . ".'- , ..~. ......
Reading Date l~. c .... ,~ e
oa(9oI-GS)
o,_4(9Ol. C~e)