HomeMy WebLinkAboutGREEN FOREST BLK 1 LT 3L$
GR""TER ANCHORAGE AREA BOROV'"H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N.° 701
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING -,
ADDRESS
LEGAL DESCRIPTION /'~::
SEPTIC TANK:
DISTANCE FROM WELL//~.~,~4: ~'~
LIQUID CAPACIiY / ...... GALLONS.
NUMBER OF
INSIDE LENGTH ' '- INSIDE WIDTH '
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAl ~2 z:~'-'
NEAREST LOT LINE
OUTSIDE DIAMETER ~"~ OR WIDTH
r"T~<L~-"¢ ~,,,/">,/:~,~/×,/ ?. DISTANCE FROM WELl /"/)/:~ ' /"
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH ' ~" DEPTH
BUILDING FOUNDATION. :Y~'"
~-~/"i ....~_2. SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LI.L~ S~/
A BSO~ O~N AREA
, FOUNDATION ~ , NEAREST LOT LINE
DISTANCE BETWEEN LINES ~ TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
EFFECTIVE
IN, ABOVE TILE
' DISTANCE FROM
TYPE ~:~'///.~-~' DEPTH /:~//:~ , BUILDING FOUNDATION
· NEAREST // SEPTIC /..'..'~C:f ~.l:, SEEPAGE
LOT LINE ///) ' -/ , SEWER LINE -//: , TANK, ~"~' / , SYSTEM
WATER
SAMPLE
CESSPOOL
, NEAREST
/~i//,/ -.'t,
OTHER . '
, SO URC ES,"r~/;~/~::'
DISTANCES:
// ....4':~.?,e '
DIAGRAM OF SYSTEM
DATE
GREATEF I, NCHORAGE AREA ' ')ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
~'A~/// SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Case No.
MAILING ADDRESS
RESIDENCE ADDRESS ~'~'~, dY~ ~'--4~
APPLICATION TO INSTALL: SEPTIC TANK / ,SEEPAGE PIT ,~ ,DRAIN FIELD~,OTHER
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH .~.~& l TO BE INSTALLED BY_ /~-7 ~'Z', ~.
PERCOLATION TEST RESULTS ~¢W~/ , ANTICIPATED DATEOF COMPLETION
BELOW TO BE FILLED OUT 8Y HEALTH DEPARTMENT
THIS IS TO SERVE AS/~t /~Y,~4~(,
AS DESCRIBED BELOW.
· SEPTIC TANK SIZE
DISTANCES:
HEALTH AUTHORITY
OR
LICENSED DESIGNER
, PERMIT TO INSTALL ~
SIZE OF UNIT TO BE SERVED
TYPE SEEPAGE AREA
DIAGRAM OF SYSTEM
TYPE
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ol'dhmnce No. 28-68 and that the
above described system is in accordance with said code.
HEALT~'i nv?AF ;T~?~7 ~" ....
327 Et~,%LE f. TR?ET
ANC? ORAGZ,
Depth
Reading Date Gposs Ti~e Ne~ Time
Fro~o~sed instal~on: ~eepaT~e