HomeMy WebLinkAboutLAZY ACRES LT 5
GP"%TER ANCHORAGE AREA BOROI'"~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
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INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
SEPTIC TANK: ~J/~ b
DISTANCE FROM WELL MATERIAL
INSIDE WIDTH
MAILINg ~_~ 13 0~) ,,/7 ~'_ ///~
ADDRESS - PHONE
NUMBER OF
COMPARTMENTS.
~..:l,~ /~'~ ,4~,~'~//- LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
I /
NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH ~. ., LENGTH /~/'~ DEPTH
NEAREST LOT LINE ..,~_~ ~.f~2 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA] '~" ~'~ ~' SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ---. ~ , F._~OUNDATION
NUMBER OF LINES DISTANCE BETWEEN LINES
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE.
DEPTH: TOP OF TILE TO FINISH GRADE
, NEAREST LOT LINE
TOTAL LENGTH
OF LINES
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. TOTAL EFFECTIVE
IN. ABOVE
"~.~.: '~
WELL:
(~ ~'~,~.~' ~. DISTANCE FROM WATER
TYPE /¢' ~,/~'~? . DEPTH , BUILDING FOUNDATION __SAMPLE_
NEAREST SEPTIC SEEPAGE
LOT LINE , SEWER LINE , TANK , SYSTEM , CESSPOOL
DIAGRAM OF SYSTEM
DISTANCES:
., NEAREST
OTHER
, SOURCES.__
HEALTH' AUTHORI1Y '
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GREATEF
327 Eagle S't.
NCHORAGE AREA r '-' ROUGH
HEALTH DEPARTMENT
Anchorage, Alaska 99501 279-2511
Case No. L~) /'7
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH '-.~,, I_ 1'
PERCOLATION TEST RESULTS
t
MAILING ADDRESS
LOCATION OF INSTALLATION
SEEPAGE PIT ; _,DRAIN FIELD ,OTHER
TO BE INSTALLED BY_ (':~
ANTICIPATED DATE OF COMPLETION :) ':} l:~i'~ /\iolR: f ,
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~'~,k, ~-"JJa , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNITTO BESERVED ,
. SEPTIC TANK SIZE ~ l~)(~(') TYPE ('(?t¥[~:).SEEPAGEAREA TYPE
DIAORA~ 0F SYSlEI~
DISTANCES:
'(EA LTH AUTHORITY
/ qO /
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No, 28-68 and that the
above described system is in accordance with said code.