HomeMy WebLinkAboutBRUCE Lot 1E GP'~.TER ANCHORAGE AREA BOROI"'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? 395
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
ADDRESS
LEGAL DESCRIPTION ~-~.)~7'"/~---~-' ~'~,~"(.$~ -~"~',,~,
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS.
~I~~~[ NUMBER OF
MATERIAL -~T~'~-~-- COMPARTMENTS ~
LIQUID
INSIDE LENGTH / INSIDE WIDTH ~ DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER. / OR WIDTH
LINING MATERIAJ_~~-~;~''~-~ -- ,~' DISTANCE FROM WELL J~=~
LENGTH ,,~,2. ,~--~' ~'
, DEPTH
BUILDING FOUNDATION .7~' '
NEAREST LOT LINE J-~- ~' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'~ SQ. FT.
TILE DRAIN FIELD: ('~ ~ ~'~-4'
TOTAL LENGTH
· NEAREST LOT LINE OF LINES ~ ,
DISTANCE FROM WELL
AB~TION AREA .... SQ. FT. LENGTH OF EACH LINE
/
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__
W E L L: _.~..~-~j ~-~,~_~z~ -~' ~
TYPE .~,~,,-~_.,~r..~ DEPTH //~:~' t DISTANCE FROM ~ ~' . WATER
, BUILDING FOUNDATION.~'~ ~- SAMPLE ~'~/~--~
NEAREST ~,,~,.~- SEPTIC ,- SEEPAGE
LOT LINE /~/'/-' SEWER LINE , TANK /~ , SYSTEM /'~ , CESSPOOL
, NEAREST
OTHER
, SOURCES
DISTANCES:
DATE
DIAGRAM OF
i~EALTH AUTHORITY
M ~ ,~ Tel~)honed [] Returned your Call [] Came In
I-1 Will call again .,~ Please return the call . I-'1 See me
Message ..~...~....~.. ........... /....~ ............ . .~'_ .~-......... _.-~ ~-~ ..r_~...." _.?_~.....~.?. ......... ....~....,~. .................................
.......................W,::-~:~ .................................... ~,~: ........................ ~ ~'~ .......................... ~: ......................... .~, ............................. ~,, ~ ..........................................
..~.~.~..,...,..L...~...,.:.,...~--..,..::~:.....~.......~.~:: ............. z~..:.......~.~..~ ..........................................
Phone: ~ ~? ~:::~--~ Data ~5,-//~ Time ~-'~'~-- By~
GREATEr NCHORAGE AREA : )ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE AOBRESS ~
LEGAL DESCRIPTION
APPLICATION TO INSTALL:' SEPTIC TANK _/~ , SEEPAGE PIT /)~ , DRAIN FIELD
TO SERVE THE FOLLOWING FACILITY
PERCOLATION TEST RESULTS ~ ~ ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
MAI '=["PHONE NO
LOCATION OF INSTALLATION ~/~/~"'
,OTHER
THIS IS TO SERVE AS
DISTANCES:
~ ,PERMIT TO INSTALL A
AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE
,TYPE ~ ~ SEEPAGE AREA~'.~~_ TYPE
DIAGRAM OF SYSTEM
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
with said code. ~ ~ ~ ~ -- ~.e~-----r-
above described system is in accordance ~ ~.~.~~..,pr~'~' ~]~f' t~
DATE fff~/~'~/~/'/¢/(J~ APPU CANTS SIGNATURE ~ ~~ .'/~----~-~--~' ~ ,
ANC}iORAC'L, AI,AF,kA 99501
This Form Reports a~
.......... . ,. ,= i,oc.o~icn Sketch
Depth
3--
Was Ground Water Zncountered'?~__.
if Yes, At W,"~at
Ne'," Ti~ :h Yo U. 20 Net Drop
Reading Date (,rc~,~ ~--~ ......... T
....
~~ ~,~. ~ / Drain
Depth l o Eot to~ Of P~.t ....
Test: Performed By:.~~ ..... ~/~ -' '