HomeMy WebLinkAboutLot 27000
GI~EA?ER ANCHORAGE AREA BORO'"~H
HEALTH DEPARTMENT
327 EAGLE S¥. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
UaU~D CAPACITY
GALLONS.
NUMBER OF /
MATERIAL '~ COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS_ /~ OUTSIDE DIAMETER OR WIDTH //'S , LENGTH /(~" , DEPTH
LINING MATERIAL . DISTANCE FROM WELL BUILDING FOUNDATION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'//~ ~) SQ. FT,
TILE DRAIN FIELD:
TOTAL LENGTH
DIS'rANCE FROM WELl _ , FOUN~)AT ON ~-~.F,.~A.REST LOT LINE ~ /.:~ , OF LINES
ABSORPTI~ ~EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH [ILE
IN. ABOVE TILE
~;~ " ~ ~ WATER
WELL: TYPE '~'"'(~/~'~ DEPTH /1 ~ DISTANCE FROM
· BUILDING FOUNDATION. '~-- SAMPLE ~ , NEAREST
LOT LINE ~..e' NEAREST SEPTIC ~-~/,~ SEEPAGE C"?~' ~ OTHER
, SEWER LINE ., TANK , SYSTEM , CESSPOOl , SOURCES__
DIAGRAM OF SYSIEM
DISTANCES:
DATE
APPROVED
/7'
H£AL[H AUTHORITY
GREATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT 7f~5~
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE
Date Performed__~,~
Performed ror_/)g~f~f~.._
Legal Description: Lot Block Subd~v~s~on~'~'ez~
This Form Reports a: S~Log
Depth
Feet Soll Characteristics Location Sketch
WaSlf GroundA.t k:~'atWater Encountered?~/_jZ~2
Yes, Depth ...... ~
Readh:g [ i'~te~ [ Gr, ot~'s Time
Frop~sed lnM:alZat~on= Seepage Pi~
Net Time
Depth To H20
Drain Field
Net Drop
'Pest Performed
Data Certified By :__~ZZ~,£~Z~.~-}'
Date';.- ~2 ,~' ~ ~ ~
G \B-HD-2
GREATE1
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
I)ROIJGHca e
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279.2511 - V2o
SEWAGE
NAME OF APPLICANT'~--~
RESIDENCE ADDRESS
LEGAL DESCRIPTION /
APPLICATION TO INSTALL: SEPTIC TANK / ,SEEPAGE PIT
TO SERVE THE FOLLOWING FACILITY ~=~
DISPOSAL SYSTEM - APPLICATION & PERMIT
MAILING ADDRESS~~''¢'4¢~!~' PHONE NO.
LOCATION OF INSTALLATION /7/
).
DRAIN FIELD. , OTHER
FINANCED THROUGH_ ~c~':' TO BE INSTALLED BY. ~/~'~'U'-~-~'/~ ~'~,~p">~C~,m~
· 5P~-~TEST ,ESULTS_ ANTICIPATED BATE OF OO~PLE?IiON ~//'~ ~ ~
~DESCRIBE~BELOW SIZE~FUNITTQBESERVED ~~~
SEPTIC TANK SIZE ..~'~-Z) _TYPE,~'~--~ · SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
Authority
I certify that I am familiar with the requh'ements of Greater Anchorage Area Borough Ordh~ance No. 28-68 and that the
above described system is in accordance with said code.~>,4,[
APPLICANTS SIGNATURE ~.,,,~.~L~. I ~.,~
DATE / ~ z t - , ,v ......