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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: ,