HomeMy WebLinkAboutT15N R1W SEC 20 E2 W4 SW4Zo
LOCATION /~,/Z~/('~
~ATER ANCHORAGE AREA BORQ'~-L~H
' HEALTH DEPARTMENT
0?/2
SEPTIC TANK:
DISTANCE FROM WELl
LIQUID CAPACITY
689
MAILING ,/~, C"~, ~///~' PHONE~('~'~'//~''
ADDRESS
MATERIAL (f/')/c'J(~XT~'-~'~~COMPARTMENTsNUMBER OF
GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH__--
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS /
LINING MATERIAL (~,Z~,(~")/.'-~/Z'~'
NEAREST LOT LINE ~O J
OUTSIDE DIAMETER OR WIDTH_
~',~//Ly ~' DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
., LENGTH / 7 , DEPTH
BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES /
ABSORPTION A~/
DEPIH: TOP OF TILE 10 FINISH GRADE
DISTANCE BETWEEN LINES ~ TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE~
TOTAL LENGTH
IN. ABOVE TILE--
WELL:
T y p E/~,'~i//(=/~' : DEPTH
NEAREST
LOT LINE ~ . SEWER LINE --~
~.~ DISTANCE FROM / WATER ~ ,~
, BUILDING FOUNDATION '~ ('2 SAMPLE./'7~~/~ Z;' , NEAREST
SEPTIC ~_~ ~ SEEPAGE / OTHER
· TANK , SYSTEM /~)() , CESSPOOL '-- , SOURCES
DISTANCES:
/~,~.:-.,
DATE
DIAGRAM OF SYSTEM
APPROVED~ ~---~__ HE~A~LiH AU~i'HORiiY
~"'~-~ GREATEI ANCHORAGE AREA 'BROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
TO SERVE THE FOLLOWING FACILITY .~ ~'-~
FINANCED THROUGH .- · TO BE INSTALLED BY --~ -~~~/~
PERCOLATION TEST RESULTS ANTICIPATED DATE ~COMPLETION
BELOW TO ~E FILLED OBT ~Y HEALTH DEPARTMENT
THIS IS TO SERVE AS ~v ,~ ~ , PERMIT TO INSTALL A ~
. AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED -,~- __c~_~j,~.~,~_... _¢~¢_,~
SEPTIC TANK SiZE /~-~ TypI~'~-~_,~'~"~EEPAGE AREA TYPE
DIAGRAM OF SYSTEM
DISTANCES:
Health A~t~o~y 7
! certJ£y that ! am £am~ar with the requirements o£ Oroatcr Anchorage Area Boroush O~d~ance No. 25-~8 and that the
above described system is in accordance with said code.
DATE~ J/-~-;,.~Y-----. APPUCANTS S~GNATURE ~).3't~. '
Reading Date gPos:s Time Ne,. *~'
'~ '~ ;~.e Depth To ~20 '~
-- - ~et Drop