HomeMy WebLinkAboutBRUCE Lot 1D G-~A, TER ANCHORAGE AREA BORO'"~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? 393
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
MAILING
ADDRESS ,,/-~7~'''~''
PHONE~~--
SEPTIC TANK:
DISTANCE FROM WELL
MATERIAL
LEGAL DESCRIPTION ,/--~-~'-'/~, /j~,,~_m-'
~~ ~ COMPARTMENTS
LIQUID CAPACITY
GALLONS. INSIDE LENGTH
LIQUID
INSIDE WIDTH ~ DEPTH_
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH
LINING MATERIAL ~.~9~/~_,~-'"~ ~/~,,I,/~-.,~' DISTANCE FROM WELL
LENGTH ~-~' /
, r , DEPTH
BUILDING FOUNDATION
NEAREST LOT LINF~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
TILE DRAIN FIELD:
SQ. FT.
DISTANCE FROM WELL
NUMBER OF LINES
ABS~
DEPTH: TOP OF TILE TO FINISH GRADE
~.~,..~~,,~AREST LOT LINE
~DIS.TANCE BETWEEN LIN ES ~,RENCH WIDTH
SQ. FT. LENGTH OF EACH LINE ___~. _
DEPTH OF FIllER MATERIAL'B~N£~-'CI~LE'~
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
LOT LINE
TYPE /~'L/~ ; DEPTH //~' ~'
/,O ~, ~ NEAREST ~ SEPTIC
SEWER LINE ., TANK
DISTANCE FROM WATER
BUILDING FOUNDATION. z.~ ~/~" SAMPLE_
,~ ~':~4. SEEPAGE . ~ ~ /'
, SYSTEM ,/*-~'--~' , CESSPOOL
NEAREST
OTHER /~'//
SOURCES/.,~ ~
DISTANCES:
DATE
DIAGRAM OF SYSTEM
HEALTH -AUTHORITY
GAAB-H D-2
GREATEI'
327 Eagle St.
ANCHORAGE AREA * 9ROUGH
HEALTH DEPARTMENT
Anchorage, Alaska 99501 279.2511
Cass N o.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
_ MAILING ADDRESS 7~":/--/.'"/~'~:'~ ~, PHONE NO.,
LEGAL BESCRIPTION (¢'~ j~ ~ ~~'~
APPLICATION T0 INSTALL: SEPTIC TANK ., SEEPAGE PIT '~ , DRAIN FIELD , OTHER
BELOW T0 BE FILLED OUT BY HEALTH DEPARTMENT
AS BESCRIBED BELOW. SIZE OF UNIT TO BE SERVEB
· SEPTIC TANK SIZE .TYPE SEEPAGE AREA ~ ~-~ TYPE ~ :
DIAGRAM OF SYSTEM / ~"'
DISTANCES:
~ ~Jfy that ] am famflJa~ with the ~egu~eme~ts of G~eate~ A~cho~a~e A~ea Borough O~d~a~ce No. 28-68 and that the
above described system is in accordance with said code. m~ /~.J~ t . -