HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 9BI--ql
(~g. EATER ANCHORAGE AREA BOROU-,GH
HEALTH DEPARTMENT ~
327 EA~.E ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
/ 75 o)<
MAILING ~ ~ ~
ADDRESS .v.-,- - ~ PHONE
SEPTIC TANK:
DISTANCE FROM WELL.
LIQUID CAPACITY ~-~~~GALLON S.
MATERIAL ~ '~(~ /
INSIDE LENGTH
NUMBER OF .~
COMPARIMENT/S ~r
INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER OR WIDTH /~----~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
· LENGTH / ~' . DEPTH
BUILDING FOUNDATION.~
?,C,-" so. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
. FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
.DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL:
LOT LINE
~ ~"'"~/d~/7'~J' ~ DISTANCE FROM ' WATER
, DEPTH ,BUILDING FOUNDATION · SAMPLE .... NEAREST
NEAREST SEPTIC SEEPAGE OTHER
. SEWER LINE , TANK , SYSTEM . CESSPOOL , SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE ~/~ APPROVED
tlEALTll DEPARTMENT
327 Ea~le St. Anchora§e, Ala~.a 99501 279-2511
SEWAGE DISPOSAL SYSTEM- APPLICATION & PERMIT
NAME OF APPLICANT_'~-~'f~~ '-~:-";~:' MAILING ., ~: o:':' .... ~ r/
~' ,BRAIN FIEL , OTHER
APPLICATION TO INSTALL: SEPTIC TANK ~/' , SEEPAGE PIT
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS IV/
ANTICIPATED DATE OF COMPLETION
,~,BELOW T0 BE FILLED OUT BY HEALTH DEPARTMENT~<~--
THIS IS TO SERVE AS~~4'' "'~-~- / , PERMIT TO INSTALL A
/ .t ,
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ ...~t~'~r~qq/
. SEPTIC TANK SIZE /~ 0 TYPE~.,~ SEEPAGE AREA~TYPE
DIAGRAM OF SYSTEM
DISTANCES: ~[~'~'
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE 7/7/6~ APPLICANTS SIGNATURE