HomeMy WebLinkAboutLESS NESS Lots 1, 2 & 3
GAAB-HC) I
GPr:ATER ANCHORAGE AREA BORO""~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING
SEPTIC TANK:
DISTANCE FROM WELL
uaU D CAPACnY
GALLONS.
MAIERIAL .¢'~T )~';-~ Z. NUMBER OF
. - _COMPARTMENTS
INSIDE LENGTH /~, .S', i~i~iDE WillfUl~7
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER _OR WIDTH
._. DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
_, LENGTH DEPTH
BUILDING FOUNDATION.
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
/ ,EOUNDATION 1
DISTANCE BETWEEN LINES
/'~ S Q. FT. LENGTH OF EACH LINE
NEAREST LO1 LINE_ ~) / TOTAL LENGTH
· , OF LINES
I.RENCH WIDTH ~-"~ 4-~.,-~"~ ~--~ IN. TOTAL EFFECTIVE
/
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
~ DISTANCE FROM ,,/(~ / WATER
WELL: TYPE '~/'-~L L/.-~J'D~ DEPTH ~ , BUILDING FOUNDATION. SAMPLE_
/ /,
LOT LINE //'~) NEAREST ~,, / SEPTIC ] ~ ~ / SEEPAGE
SEWER LINE , TANK /~-"-~' , SYSTEM /~r~ ,~ , CESSPOOl.
, NEAREST
OTHER
, SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
//7
i ,---A~
A
DATE
/ / /
GAAB-HD-2
GREATEk
327 Eagle St.
ANCHORAGE AREA
HEALTtI DEPARTMENT
Anchorage, Alaska 99501
, OROUGH
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAMEOF APPt. ICANT "'~'7~'~'~Z5'~ ~'~) (~C~'-~-'~- ~'''- - ~MAILING AD]RESS./~).~'~~ PHONE
dRESlDENCE ADDRESS~¢~ /~. ~/,~ LOCATION OF INSTALLATION ~ ~,
LEGAl_ DESCRIPTION_ ~/~ /, '~ ''~ ~/~5'S- ~;Z ~¢/~2 ~'Cc~ /D
APPLICATIONT0 INSTALk: SHPTICTANK ~ SEEPAGE PIT ,DRAIN FIELD g ,0THHR
TO SERVE THE FOLLOWING FAClLITY_~,~<:'~ o
PEaC0LAn0. TEST RaSULTS ~'~q A,T~C~PATE~ aATE 0F COMPkETION~ff~/'
BELOWTOBE FILLED OUTBY HEALTH DEPARTnENT ~&~ /~,>~
AS DESCRIBED BELOW. SIZE ITTO SERVED. ~A~ ~
. SEPTIC TANK SIZE ~-~Z) iEEPAGE AREA ~
DIAfiRA~ OF fiYSTE~
DISTANCES:
;alth Authority
that I aln familiar with the requkements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is 'n accordance with said code.
D 'FE APPLICANTS SIGNATURE ,-7 .