HomeMy WebLinkAboutDELUCIA LT 14: 051
GRE:~TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MATERIAL COMPARTMENTS
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LIQUID CAPACITY -7~-,,~ GALLONS. INSIDE LENGTH INSIDE WIDTH' DEPTH___
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT L/NE
SEEPAGE PIT:
/ OUTStDE DIAMETER OR WIDTH ?
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH ( 7 , DEPTHS,
TILE DRAIN FIELD:
DISTANCE FROM WELL
FOUNDATION
NEAREST LOT LINE
TOTAL LENGTH
OF LINES
NUMBER OF LINES
DISTANCE BEIWEEN LINES
TRENCH WIDTH
IN. rOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE__~ DEPTH OF FILTER /v~ATERIAL BENEATH TILE
WELL:
TYPE -.~ ~EPTH ~ , BUILDING F~NDATION / ~ SAMPLE
/ NEAREST /
LOT LINE SEWER LINE -~ SEPTIC ~ / SEEPAGE /~;~
, ~,TANK SYSTEM ~ ~ U , CESSPOOL
IN. ABOVE TILE
,~J~t"~ , NEAREST
OTHER
, SOURCES__
DISTANCES:
t~'->o .: IOrg
t
DATE
DIAGRAM OF SYSTEM
I
APPROVED
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HEALTH A U Ti40'~TY
GAAB-HD-2 Case N o.
GREATE'
327 Eagle St.
.tNCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
L ROUGH
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ~'C !:
PE"ff~~ TEST RESULTS AI~TICIPATED DATE OF COMPLETION
BEL0~ T0 BE FILLED 0BT BY HEALTH DEPARTMENT
MAILING ADDRESS ~' '~? ~-~ ~
. .-~, ~..- PHONE NO.
LOCATION OF INSTALLATION --~~,?'~,/~__~-- ~
SEEPAGE PIT. ~ ,DRAIN FIELD ,OTHER
THIS IS TO SERVE AS , ~; 'x;:',':i ,: ~>': N:~-~ PERMIT TO INSTALL A ,_
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~'~ ~¢:)/ /~'
· SEPTIC TANK SIZE ~ TYPEC~[J~J~SEEPAGE AREA
DIAGRAM OF SYSTEM
/~'~
DISTANCES:
/ -' !. --. .:.
Health Authority
I certify that I am familiar with the requirements of Greater horage
above described system is in accordance with said code.
DATE
Area Borough Ordinance No. 28-68 and that the
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APPLICANTS SIGNATURE