HomeMy WebLinkAboutBRUCE #2 Lot 1
GAAB-HD-I
C-~' ,~.TER ANCHORAGE AREA BOROI'~H
/
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ·
NAME ADDRESS
LOCATION J~/-~/~~ ~ P~//~I-~ LEGAL DESCRIPTION
,
SEPTIC TANK:
· PHONE~
DISTANCE FROM WELL ~ /"~'' MATERIAL
LIQUID CAPACITY / ~ GALLONS. INSIDE LENGTH
NUMBER OF J
COMPARTMENTS
t~_~.j[ ~?~,~ ~ ,J~ I~p~ LIQUID
INSIDE WIDTH__DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
FouNDATiON.
DISTANCE BETWEEN LINES
NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
WELL: TYPE //~'!'//~ ,DEPTH.
NEAREST '~
LOT LINE /~ J~' , SEWER LINE '
DISTANCE FROM
° , BUILDING FOUNDATION.
SEPTIC ~ /' SEEPAGE
, TANK "~ , SYSTEM
IN, ABOVE TILE r ~ ~
WATER ,~/~
/Oil/~. SAMPLE !~r~ , NEAREST
/~,~ /~, OTHER
, CESSPOOL .--- , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED
H ~"A LT H AUTHORITY
GAAB-HD-2
GREATEI
327 Eagle St.
]kNCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Ala~/~a 99501
ROUGH Ca,a No.
279-2511 .,~M
& PERMIT~
SEWAGE DISPOSAL SYSTEM - APPLICATION
NAME OF APPLICANT
RESIDENCE ADDRESS
,~/¢I,M / e.
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANC'ED THROUGH
/
PERCOLATION TEST RESULTS /-4tO
F-O,~:)MAILING ADBRESS/~O / 7'~d/0£~ ~PHONE "0.
LOCATION OF INSTALLATION ~~ ~ ~'~ ..
SEEPAGE PIT. ,DRAIN FIELD ~ , OTHER
T0 BE INSTALLED BY ~ ~
ANTICIPATED DATE 0F COMPLETION ~4 ~ ~ ~/g~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
TRIS IS TO SERVE AS [V~I i .r r,g-FaP---b , PERMIT TO INSTALL A ,_~'~'/"//,~t~ :~_~.~
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ ~ b A~
,., SEPTIC TANK SIZE (~ ~ ~ TYPE ~~SEEPAGE AREA .~ TYPE
~O~U~ ~L~ DIAGRAM OF SYSTEM
DISTANCES:
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough ordinance No. 28-68 and that the
described system is in accordance with said code.
DATE APPLICANTS SIGNATURE :' '"' ,
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