HomeMy WebLinkAboutTUNDRA JEWEL RANCH LT 2A
GAAS.H~I
G~:~TER ANCHORAGE AREA BORO,,,U~H
HEALTH DEPARTMENT
327'l~AGLE ST. ANCHORAGE, ALASKA g9501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
PHONE
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS.
c,,/,.,,r/"- NUMBER OF
MATERIAL COMPARTMENTS
/
/
INSIDE LENGTH ~ INSIDE WIDTH 4/
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS J OUTSIDE DIAMETER
LINING MATERIAl C~(~f~'' 1~ /~ ~
NEAREST lOT LINE /t~i~l ~ j
OR WIDTH / ~
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
,LENGTH /4 ,DEPTH ~--~
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
. FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE.
., NEAREST LOT LINE
.TRENCH WIDTH
TOTAL LENGTH
,, OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE T0 FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
WELL: L, '~P~"/'~:~J~ ~" p~'~C'~_ ,J"~ DISTANCE FROM
TYPE DEPTH , BUILDING FOUNDATION.
NEAREST SEPTIC SEEPAGE
LOT LINE ., SEWER LINE. ., TANK , SYSTEM
IN. ABOVE TILE
· WATER
~SAMPLE , NEAR~ST
OTHER
. CESSPOOL , SOURCES
DISTANCES:
I
GREATE .~-'~ANCHORAGE AREA ~")ROUGH
IIEALTi! DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No. ~]4
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
... ,.,.--,--~ - 7'? - ,.~.
RESIDENCE ADDRESS ')/~,~-~,.
LEGAL DESCRIPTION
A?PLICATION TO INSTALL; SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
TEST RESORTS OATE OF COMPLET,DN
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
· SEPTIC TANK SIZE
AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED ~
!
7J~5"'0 TYPE ~SEEPAGE AREA ~:3~ mTYPE., ~,'~'~
DIAGRAM OF SYSTEM
/ 7Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area, Borough Ordinance Ng. ~8-68 and tha~ the
above described sys. t.em is in accordance with said code. ~~'..'9'¢e~ ~ 4o'/t~
DATE~'//__ / ~", APPLICANTS SIGNATURE . ~
HEALTtt DEPARTHENT
327 EAGLE STREET
ANCHORAGE, ALAZKA 9950!
CASE
Performed F?r ~y;/- /f~Z;I~/F ' Date Performed ·/5"'/~g~ /~
Legal Description: L°t_~._.Block, , Sub%'i~ision ~-d)ND£~ ~,~ff~l~A, fF~
This Fo~ RepoPts a: Soils Log j ~ ~ -~Percolation Tes~ '" · '
Depth
Feet
Was Ground Water Encountered?
If Yes, At.What Depth,,, .
Reading
Date
Gross Time
er~o£a(ioh gate l"i '' itznute
Net Time
Location Sketch
Depth To H20
Net Drop
Frop~sed " ' '
Installatxon: Seepage Pit ~ Drain Field
Depth Of Inlet ~' Depth To Bottom O~f Pi~ Or T~enc~ /,~,.
Test Performed By.'