HomeMy WebLinkAboutT12N R3W SEC 4 Lot 18
G ~.TER ANCHORAGE AREA BORO )H
OEPAfl'rMENT OF: ENVIRONMENTAL QUALITY
3500 TUDOR IIOAD ANCHORAGE, ALASKA 99507 279-8686
INSPECHON REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
/(,~ ,, - ~ MAILING ,-."~ ~ __. ¢/'"/- i~ ....
SEPTIC TANK:
DISTANCE FROM WELL_ ~.)(.¢.. g, MAi. ERiAL (_~l_(~)jt3(,~j,3,1?~ iD NUMBER OF
COMPARTMENTS_
LIC)UIO CAPACIIY~:~_.~)Cb .... GALLONS iNSiDE LENGTH__ J I ~ INSIDE WIDTH.
SEEPAGE SYS1EM: SEEPAGE PH:
LIQUID ~,.,.~ -~
DEPTH
LINING MATERIA~.~ ...... DISTANCE FROM W"~.~.~.,_ . , ~OUNDATION
NEAREST LOT LiNE . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT
TILE DRAIN I:IELD:
D,STANCE FROM WEL, 1 .... FOUNDAI,ON
NUMBER OF lINES ~"~ _._ DISTANCE BETWEEN LINES
ABSORPTION AREA__ ~'*~'~) SQ. FT LENGTH OF EACH LINE
DEPTH: TOP OF ]ILL TO FINISH GRADE
, NEAREST LO[ lINE/
TOTAL LENGTH .-~,~,,)
, OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF EILTER MAJERIAI BINEATH TILE
IN. ABOVE Tile
WELL: TYPE ,~-., I I '~_1 ) DEPTH
NEAREST -
LOT LINE .... SEWER LiNE
DISTANCE FROM
, BUILDING FOUNDATION._
SEPtiC ~z'~ , SYSTEM
SAMPLE ~J L~ D L~zC; , NEAREST
OTHER
, CESSPOOL , SOURCES_
GAAB-HD-2
GIlEATE , ANCHORAGE AREA OROUGH
ItEALTIt DEPARTMENT
327 Eagle St. .. / Allehorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT6~:>-"a'~'~ /~fi]. /'~'~ MAILING ADDRESS~~ PHONE NO./..~V?
RESIDENCEADDRESS_~,~'~& /~"' ~?-,Z~ LOCATION OF INSTALLATIDN--~-2 ¢/~ ~r~
t. EGAL GESCRIPTION..-~--O 7L (] ¢~)/ ,,.~"e t~i~/ ~-/~ A/,,.. ~),j~, 1/~/ ,~,,
APPLICATION TO INSTALL: SEPTIC TANK_ /,"/~,8EEPAGEPIT_ ~,ORAINFIELD_ .,OTHER.
TO SERVE THE FOLLOWING FAClIJTY
FINANCED THROUGH_ ~' ~
OERCOLATION TEST RESULTS
TO BE INSTALLED BY_ ,3'eg/-.~"
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH OFPARTMENT
THIS IS TO SERVE AS-, ,.., PERMIT TO iNSTALL A ~ ~I~
TYPE
DIAGRAM OF SYSTEM
DISTANCES:
Health Authority
I certify that I am familiar with the requh'ements of Greater Anchorage Area Borough Ordinance No. 28-68 mrd that the
above described system is in accordance with said code.
1
GREATER ANCHORAGE AREA BOROUG'
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE~ ALASKA 99501
CASE
' FOr '7-- /'~ ' ' Date Pe~'fopmed~
Pe~ fo~med .~_/ ~ .... /t)(2t?~ ~ _ ......... ~--~.~_ _..
Legal DescDip~oD: Lot Block . Subdzvzszon
Depth
' V Soil ChaPacteristias Location Sketch
~ee ,
If Yes, At What Depth~.~
Reading Date GPoss Time Net Time Depth To H20 Net [)pop
Proposed Instal~eepage Pit [)~ain
Test Perfor,r0ed BF:~~
Data Certified