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F. TER ANCHORAGE AREA BOROl',r7"H
HEALTH DEPARTMENT
327 EA(: LE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME —ADDRESS
LOCATION e e�LEGAL DESCRIPTIONS -eF=&_-:�" /
SEPTIC TANK:
7 -
NUMBER OF
DISTANCE FROM WELL MATERIAL ✓ 7 COMPARTMENTS
X��LIQUID
LIQUID CAPACITY -GALLONS, INSIDE LENGTH<2r> , 4& —INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS �_OUTSIDE DIAMET OR WIDTH ENGTH. PTH_,
LINING 7, M 1,11 AL— DISTANCE FROM WELL BUILDING FOUNDATION
:
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
"" FOUNDATION TOTAL LENGTH
DISTANCE FROM WELL
NEAREST LOT LINE 25 -17 OF LINES
NUMBEROF LINES DISTANCE BETWEEN LINES —TRENCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
V2 , IX/
DEPTH: TOP OF TILE TO FINISH GRADE
—DEPTH OF FILTER MATERIAL BENEATH TILE 4,11' IN. ABOVE TILE
WELL: DISTANCE FROM WATER
TYPE, DEPTH--- BUILDING FOUNDATION. SAMPLE Z<4- NEAREST
NEAREST REST ?-_crp-" SEEPAGE
TH
'R
LOT LINE,�!ZR LINE ,TANKSYSTEM CESSPOOL SOURCES ES
DIAGRAM OF SYSTEM
DISTANCES
DATE APPROVE
HEALTH AUTHORITY
327 Eaele St. Anchorage, A1aAka 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OFAppUCANT 14raouis hL Larkin
RESIDENCE ADDRESS
\
LEGAL OE8CR|PT|ON__
MAILING ADDRESS
LOCATION OF|NSTALLAT|ON
PHONE No. 694 2237
APPLICATION TUINSTALL: SEPTIC TANK_-25{'SEEPAGE PIT 'DRAIN RELD_______'OTHER_
TOSERVE THE FOLLOWING FACILITY Provide me«uud bathroom to existing bomo now connected to
aaotner working ~ sewage disposal �y~`~~
FINANCED THROUGH TO BE INSTALLED BY Y
PERCOLATION TEST RESULTS
THIS 0TOSERVE AG
DISTANCES:
ANTICIPATED DATE OF COMPLETION 10 June 170
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
' PERMIT TOINSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
.GEPT|C TANK SIZE
HEALTH AUTHORITY
OR
'------------
TYPE
TIAGRAM OF SYSTEM
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I certify that l am familiar with the requirements of Greater /\uuborago Area Borough Ordinance No. 20-68 and that the
DATE APPLICANTS SIGNATURE
