HomeMy WebLinkAboutT15N R1W SEC 18 LT 16
G~-6.TER ANCHORAGE AREA BOROI'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N.° 140
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING .~;,~ ~.~.~/x~.,/~¥~x>~.~4~ PHONE...~.~f.~'~4'
NAME ~ ~/~7/~ ADDRESS .
LOCATION ~ .~' ~/~~ ~/~ LEGAL DE . . , ,
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
~ , . ~ NUMBER OF
MATERIAL ~--~/~/ ~ ~-----'~'~' ~'~'J' COMPARTMENTS
GALLONS. INSIDE LENGTH ,~ / INSIDE WIDTH ~'~ / DEPTHLIQUID
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF P~TS / OUTSIDE DIAMETER.
NEAREST LOT LINE
~ OR WIDTH/~/~J'/~' LENGTH ~'/~'( , DEPTH
DISTANCE FROM WELL ~/~ /
. BUILDING FO U NDATIO N-~,~
~O l'~ TOTAL ~FFECTIVE ABSORPTION AR~A (WALL AREA) ~.~ ~ SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE PROM WELl ~TION ~'~ . NEAREST LOT LINE , OF LINES,- ,
NUMBER OF LIN,~~ DISTANCE BETWEEN LINES ' TRENCH WIDTH /IN. TOTAL
EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER /9~.T,~F~IAI B~t,~-AIH TILE IN, ABOVE TILE --
(/.~/j~/I/'l~'b'''(i~'~'''~ ~,~' .~;J/~' DISTANCE FROM / WATER
SAMPLE~~
WELL: TYPE~, DEPTH ~' ,BUILDING FOUNDATION. /~ ., NEAREST
/~ NEAREST / SEPTIC ' SEEPAGE ~z ~ OTHER
LOT LINE , SEWER LINE , TANK ~ , SYSTEM , CESSPOOl , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
GREATE!
32? Eagle St.
ANCHORAGE AREA~
HEALTH DEPARTMENT
Anchorage, Alaska 99501
OROUGH C~s~ .~.
279.2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT,/~ /~"/ MAILING AoDREss/~¢ ~['~/;,'[~(/~ .,,'~ .~HONE
!
APPLICATION TO INSTALL: SEPTIC TANK ~"' ,,,~EEPAGEPIT ~ ,ORAIN FIELD ,,OTHER
~ TEST RESULT~ ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
~,,~ ,s ~o ~,w ~s/~../~,~': ,,~,~,~ ~o ,~s~ ~ 3~x ~~,~.
BIAGRAM OF "~TEM
DISTANCES~'c
/
I certify that I am familiar with the requirements of Greater Anc,~rage Area Borough Ordinanc,~ No. 28-6~ and that the"x~
above described system is in accordance with said code ....
DATE
Gr
GREATER ANCHORA~ AREA BOROUGH
CASE
HEALTtt DEPARTMENT
3~7 EAGLE STREET
ANCHORAGE, ALASKA 99501
Date Performed ~ ~ /~
o ' ' '
Was Ground k!ater Encountered?
If Yes,,,.'~ ~',*~:,~t i,%th' '~: ~
Read:ir:? ~ i'~te ~ Gmoss Time
..~ .... , ,:,: ~epage Pit
Net Time
Depth To H20
Drain Field
Net Drop
Der~Lh ,~: '[r:!.et ~ 0~ Depth To Bottom Of Pit Or !'pench....ly~..~~ ...................
Test' Performed By: ~[ t~ ~'" t,,,. 6
Data Cert~.faed By: ,