HomeMy WebLinkAboutLot 42
GAAB-HD-I
Gg~:ATER ANCHORAGE AREA BOROI'GH
'~.~/ HEALTH DEPARTMENT ,, /
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATu
SEPTIC TANK:
ADDRESS , PHONE __
LEGALOESCR,PT,O, --' J Z
DISTANCE FROM WELL
LIQUID CAPACITY
'~ ,~'~'~ GALLONS.
MATERIAL ,L~:~ ~-? COMPARTMENTS / )
INSIDE LENGTH 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
FOUNDATION , NEAREST LOT LINE
DISTANCE BETWEEN LINES~ TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILT:
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE__
WELL: (?/1/~
TYPE
XlEAREST
LOT LINE . SEWER _INE
DEPTH
DISTANCE FROM WATER
,BUILDING FOUNDATION. · SAMPLE__ , NEAREST
SEPTIC SEEPAGE OTHER
., TANK , SYSTEM CESSPOOL , SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
APPROVED
HEALTH AUTHORITY
GA~BoHD :2~
GREATEh~ANCHORAGE AREA'~'OROUGH CaseN0.
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS ~'~--/7 ~//' /-c~°~"'~ LOCATION OF INSTALLATION
APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT ~ ,DRAIN FIELD ,OTHER
TO SERVE THE FOLLOWINB FACILITY / ~ ~¢-~e~
u,m .s ..sum
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~)' , PERMIT TO INSTALL A --~:~.4Z/JM,-~-~ . _,~Z~/'.~ .2 ',
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~"~ ~:~.~-- ~-/~ ,¢¢~,.-r~ ~
,. SEPTIC TANK SIZE ~ TYPE ~EEPAGE AREA /~ ' TYPEf~~
~~IAGRAM OF SYSTEM
DISTANCES:
Hoa~th AuthodW
I certify that i am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described systen~ is in accordance with said code.
~'~' " ~L ' GREATER ANCHORAGE AREA BOROUC~H
, HEALTH DEPARTMENT '~ ~,~" CASE
32? EAGLE STREET
·
Legal Description: Lot~lock~S~division~ ~ ~/~z,~z~~%.
This Form Reports a: Soils Log ~ ..... .~eb60iatio~ Tes~_~
Depth
Feet
Was Ground, Water Encountered?~. ---- d~'F,O~¢~ ]
If .Yes At Wba~- Depth~.~_~ ~
.~g ~ rate Gross Time ' Time
~rcoiazlon ~are I / Minute
Proposed Instal~Seepage Pit ~
Location Sketch
Depth To H20
Drain Field
Net Drop