HomeMy WebLinkAboutLAZY ACRES LT 2X''t i 50
G~'~=&TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME f,~.~ ~';~Z~ AT-
LOCATrON ~.C/T'...~ O,~F-
SEPTIC TANK:
::2- MAILING
DISTANCE FROM WELL /,'~D ! '/-
LIQUID CAPACITY / C'"Y-"~'~ GALLONS.
C.~ '~/--?"F-'/~'~'~ NUMBER OF
MATERIAL (~ i~...L~ ½ ~'%-' COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH____
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
__ OUTSIDE DIAMETER
'~--' OR WIDTH f "'~
!
DISTANCE FROM WELl. / ~O
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH /"/ '.DEPTH 6 ' '
BUILDING FOUNDATION.
sQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF ~
TOTAL LENGTH
~,..~'"'"~"~ISTANCE BEIWEEN LINES ~"'-TIRENC. I~r~'~ IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
NEAREST
SEWER LINE
SEPTIC
, TANK
WELL: DISTANCE FROM WATER
., BUILDING FOUNDATION SAMPLE
SEEPAGE
LOT LINE SYSTEM CESSPOOL
DIAGRAM OF SYSTEM
DISTANCES:
, NEAREST
OTHER
, SOURCES_
APPROVED7 HEALTH AUTHORIIY
GAAB-H D-2
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
iROUGIt
279-2511
No. -,-" /',/
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME 0F APPL,CANT"tq0 _ MA,'.NG ADD,ESS
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ",.),-, t ~/ TO BE INSTALLED BY_ ('~/;:~¢;1(~.
PERCOLATION TEST RESULTS //~0 .]'~//'~/V~_ ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
/~'~'~; ['"/t ~PHONE"~t~' NO.~ 7q~r.~¢~.
LOCATION OF I~STALLATION ~-~ ~' .Id,
,'~t~ ( l' ~'~
, SEEPAGE PIT ~ ,DRAIN FIELD, __,OTHER
TH~S ~S TO SERVE AS I& ~-, % ~-e.~,~'~ ~% , PERn,T TO ,NSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE ,/~-9(~_L(2__TYPE 4"-~¢ ~v;l:/~iq SEEPAGE AREA
TYPE
DIAGRAM OF SYSTEM
DISTANCES:
(:~/~' h ~,'(? ~..
/// / ~EALTH AUTNORIT¥
LICENSED DESIGNER (_'~ .,
I certify that I a~n familiar with the requirements of Greater Anchorage Area Borough Ordh~ance No. 28-68 and that the
above described system is in accordance with said code.
/~/~ ~'"(~J k)'~l- l~:~ J'~') L~ ~' '
DATE APPLICANTS SIGNATURE ,~ ' ' ) '
CREATER ANCHORAGE AREA BOROUGh
ItEALTti DEPAkTMENT
327 EAGLE STREET
ANCHOR^GE, ALASKA 99501
Performed For ~ ' [~o ~ ' Date Perfm. med Z ' ~ '
Legal Descl~lPtion: hot ~.~.~..DI. OCK._~bUD(11VlSlOn~~ .....
Depth
Feet $oi1 Characteristics Location Sketch
Was Gpound Wate~ Encountered?_~
If: Yes~ At What Depth
Reading
Date
Gposs Time
Net Time
Net Drop
Pmoposed Instal]~Seepage Pit //--- DPa:[n FieJ.d
Depth Of Inlet
Test' Perforroed By:~,~,