HomeMy WebLinkAboutJO VON LT 5
327 EAGLE ST ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAT,ON
ADDRESS
LEGAL DESCRIPTION
SEPTIC TANK
DISTANCE FROM WELL
LIQUID CAPACITY~--
GALLONS
MATERIAL S~-'~'''~'~''' NUMBER OF /
COMPARTMENTS
~"r"~'t~-i F/l~' i~ LIQUID
INSIDE LENGTH. INSIDE WIDTH DEPTH
SEEPAGE SYSTEM SEEPAGE PIT
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
OUTSIDE DIAMETER
OR WIDTH
DISTANCE FROM WELL
LENGTH ¢ , DEPTH
BUILDING FOUNDATION
"~ ~ ¢ SQ FT
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
TILE DRAIN FIELD
DISTANCE FROM WELL FOUNDATION
NUMBER OF LINES DISTANCE BET,~F~'~'~ES TRENCH WIDTH
ABSORPTION AREA ~Q FT LENGTH
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
WELL TYPE P~"'" 1/~""~'* DEPTH °~ DISTANCE FROM
, BU LDING FOUNDATION
NEAREST ~_ ~, J SEPTIC '~/ j' SEEPAGE
LOT LINE ~l SEWER LINE -- TANK SYSTEM
WATER ,/~/~ NEAREST
SAMPLE
OTHER
CESSPOOL ~ , SOURCES
DISTANCES
DIAGRAM OF SYSTEM
HEAL'TH AUTHORIIY ' ~'
DATE APPROVED
GAAB-HD-2
GREATEK.;ANCHORAGE AREA ' .DROUGH
° Case No
. HEALTH DEPARTMENT
-' 327 Eagle St. Anchorage, Ahska 99501 279-2511 ~ O
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT f~DAt,~ L~..~. MAILING ADDRESS ~,~4 ~--J~-~/ . PHONE NO ---'
RESIDENCE ADDRESS
LEGAL DESCRIPTION /..~..' ,,~-' ~'~0 V (~ h,.) ~ (D~' ~
APPLICATION TO INSTALL SEPTIC TANK ~ ,~EEPAGE PIT , DRAIN FIELD
TO SERVE THE FOLLOWING FAC'iL~'TY~ "~--~,~ ..... ~ /,. ,:.~.~/Z/~
FINANCED THROUGH ~ ~'~ /~ & ~¢&~
~ ,~TO BEJ~STALLED BY
~ ~ ~ ~,~ANTICIPATED DATE OF COMPLETION
~R~TEST RESULTS
~~/Z~-~qo~ BELOW TO BE FILLED O~T BY HEALTH DEPARTMENT
LOCATION OF INSTALLATION
,OTHER
THIS IS TO SERVE AS t~/~' ~ C/' ~/".~,~'.,~' , PERMIT TO INSTALL A ~-<~d_~',~ ~? ,~ ~./~ ,
AS DESCRIBED BELOW SIZE OF UNIT TO BE SERVED
SEPTIC TANK SIZ~_.~TYPE ~/Y~'NJr'~ SEEPAGE AREA t '~'"'~'~ TYPE DIAGRAM OF SYSTEM
DISTANCES
ealth Authority
that I am familiar wzth the requtrements of Greater Anchorage Area Borough
above descrzbed system zs m accordance w~th sazd code
No 28-68 and that the
5
G
7
327 EAGLE STRB~T
ANCHORAGE, ALASKA 99501
This Form Repol'ts a: So~15 Los . ~< percolation Tesl .........
Soil Characteristics
~'Depth
%las G~ound Wate~ Encountered? ...... ~0 ~F~e]
If Yes, At What Depth,-.~ ~ ..;-, --
Location Sketch
Reading Date G~'oss Time Net Time Depth To H20 Net Drop
r£on ......
erco£a ~ate £"/ Minute ...... _
Proposed InstallaTion:' SeepaEe Pit DI'ain Field
Depth' Of Inlet ..... Depth To Bo~om Of P~ Or T~ench
Data Ce~if&ed By: ~~ ~