HomeMy WebLinkAboutCARLSON LT 2
GRF~TER ANCHORAGE AREA BOROUGH
' ~ HEALTH DEPARTMENT ~' ~
327 E,~GLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
MAILING ~'~ ~--PHONE '
ADDRESS ,
LEGAL DESCRIPTION ~'~/"~- ,
SEPTIC TANK:
~' n ,.~,.~.~,-'~. NUMBER OF
DISTANCE FROM WELL ("/2 j~-~.~ MATERIAl ~ - -~-/ COMPARTMENTS
uou,o c.~.aJJ / ~ / O*L~O.S. ~S,~E L~O~. ,~S,D~
LIGUID
DEPIH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAL ~/t~L,~.,/~o ~/'~
NEAREST LOT LINE .7 /
OR WIDTH
TOTAL EFFECTIVE ABSORPTION AREA(WALL AREA)
LENGTH / 2.- / , DEPTH ('/'
BUILDING FOUNDATION ~''~ /,
~. ~-' (~7'~ SQ. FT.
TILE DRAIN FIELD:
FROM WELL , FOUNDATION /~I~ LOT LINE
DISTANCE
NUMBER OF LINES DISTANCE BETWEEN ~-''''''~ TRENCH WID!H
ABSORPTION AREA SQ. FL ./~GTH. OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
~//..1~..~, DISTANCE FROM WATER
WELL: TYPE DEPTH . BUILDING FOUNDATION, SAMPLE , NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE , SEWER LINE TANK , SYSTEM , CESSPOOL , SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
,,'j_~ ~ --/~-/
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
· LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCEI~ THROUGH '~'~-"'~'"~
~TEST RESULTS
/,, SEEPAGE PiT
TO BE INSTALLED BY
, ANTICIPATED DATE OF COMPLETION
,. , DRAIN FIELD , OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS. IS TO ,~-,, .... -- O~ ' '
AS DESCRIBED BELOW SIZ~F~ TO BE SERVED ~ ~2
' . sEPTIc TANK SIZE ~TYPE .~ac:r.u. --
' ~~IAGRA~ OF SYSTEM
DISTANCES:
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described systen~ is in accordance with said code.
DATE APPLICANTSSIGNATURE _ . _ ' '