HomeMy WebLinkAboutELLEN COURT LT 8b_ I
GAAB-HD-J
GR,r--6.TER ANCHORAGE AREA BORO~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
· INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
ADDRESS-.~'."~Z)/' .,~.~-,~,~_r'.;~"- ~"~-.2~r~ PHONE~___~___-
LEGAL DESCRIPTION .~L~.,~-'.,.~'"
SEPTIC TANK:
DISTANCE FROM WELL ,~--~2 '"
LIQUID CAPACITY '~"~,~'~ GALLONS.
NUMBER OF
MATERIAL -'¢'"",'~'""~'~'?'/--- COMPARTMENTS
.~'~'~"'~"~"~"' "~-"~"*~ '~'.'~" ~'~ LIQUID
INSIDE LENGTH ~ INSIDE WIDTH ~ DEPTH.__
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDEDIAMETER OR WIDTH
, DISTANCE EROM WELL
TOTAL EFFECT,VE ABSORPT,ON AREA /WALL AREAl
LENGTH ~"~'~ '
, , DEPTH
, BUILDING FOUNDATION"~'
~"~"~(~ SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
OF LINES
IN. ABOVE TILE__
~ DISTANCE FROM
W ELL: TYPE ,,~,,-'(/~ DEPTH ~J~'~ , BUILDING FOUNDATION.
J NEAREST f SEPTIC ~;:~/~ ! SEEPAGE
· SEWER JNE , TANK /,z' ~ , SYSTEM
LOT
LINE
WATER
SAMPLE -/~/'~'~ , NEAREST
/OTHER
CESSPOOL SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
WATER WELL DRILLERS LOG DO NOT FILL IN
Drilling Co. �s P-$-1 Isn/n USGS No.
Driller C.S 5 Area
Well Owner H /fid i!jAnn/ Use 'of Ile 11 .:
Location (address of: Township, Range, $ Section (if known); distance from road:
Size of Casing--LDepth of Hole feet. Cased to Q feet.
62.2 ! v
Static water levelfeet (above) (below) land surface. Finish of well
(check one) Open end ( Screen ( ): Perforated ( ).
Describe screen or perforations:
Well pumping test at,7P gallons per (hr) (min for
feet of drawdown from static level,
Remarks
WELL LOG
r _Depth in feet from
Give details of formations penetrated, size of material,
ground surface
color, and hardness.
to �I
to
S er N 01V rl'"idF
_..... tos
Atd .hed
+5 to
4ragi ✓ ,06 arc,'
to
Zl2_ to SQ
to
5
'to _0.
to
to
to
to
~ GAAB-HD-2
GREATEI~ANCHORAGE AREA>gROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
LOC^T,ON o~ ,NSTALLAT, ON d.Z~ ~
NAME OF APPLICANT
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACI/LIT~Y/
FINANCED THROUGH
PERCOLATION TEST RESULTS
RESIDENCE ADDRESS
D' ,SEEPAGE PIT. //'/", DRAIN FIELD , OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE OF UNI.T TO,BE SERVED
· SEPTIC TANK SIZE 9 ~'~ TYPE '(~'-~ SEEPAGE AREA
TYPE
DISTANCES: · ~')' ~'~ ',;"~'6 '~" -~'., ;~,¢l~g. ~ =
/ '~t~' -
I certify that I am familiar with the requkements of Greater Anchca~e Area ~r~h Ord~anc~o~2~68~nd tha~e
above described .ystem,is in accordance with said code. ~~:~.Z>/.;,.~
DIAGRAM OF SYSTEM