HomeMy WebLinkAboutT12N R3W SEC 9 LT 32
GP"~TER ANCHORAGE AREA BORO~
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? 86
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING ~,~.,~) ~-~ ,..~
ADDRESS PHONE
DISTANCE FROM WELL_
LIQUID CAPACITY__/"
NUMBER OF /
LIQUID
GALLONS. INSIDE LENGTH INSIDE WIDTH ~
SEEPAGE SYSTEM: SEEPAGE PIT:
LINING MA IAL FROM WELL
NE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
D~STANCE FROM WELL /~'
NUMBER OF L~NES__ /
ABSORPTION AREA--~2-~'~ ~
DEPTH: TOP OF TILE TO FINISH GRADE_
/
FOUNDATION_ ,~,~ / TO TAL t EN OTH ...~.~__.
, . NEAREST LOT LINE . OF LINES
IN. TOTAL EFFECTIVE
DISTANCE BETWEEN LINES TRENCH WIDTH__
SQ. FT. LENGTH OF EACH LINE
~'5~ DEPTH OF FILTER MATERIAL BENEATH TILE
WELL: Typ E~,~/~~ DEPTH_
.~ NEAREST SEPTIC
LOT LINE K.~ C) ~
, SEWER LINE , TANK
DISTANCE FROM / WATER
· BUILDING FOUNDATION.. ~ SAMPLE , NEAREST
/ SEEPAGE ../. ~,~,~Y / OTHER
_~'(~ , SYSTEM , CESSPOOL z/~, SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
GREATEI
327 Eagle St.
kNCHORAGE AREA
HEALTIt DEPARTMENT
Anchorage, Alaska 99501
~ROUGH
279-2511
SEWAGE DISPOSAl. SYSTEM - APPLICATION & PERMIT
AD D R ESS ~_,'~
NAME OF APPLICANT__ ';¢'~¢~'f~' ~ MAILING
RESIDENCE ADDRESS LOCATiOn, OF I~STALLATION
LEGAL BESO,,PTIBN. ~.'-: ': z ._./:::./: ~/z./4'
APPLICATION TO INSTALL: SEPTIC TANK_
TO SERVE THE FOLLOWING FACILITY. //
FINANCED THROUGH
PERCOLATION TEST RESULTS
PHONE NO. ~,7 ~?~'~y~
/ ~: ,>'-',,cf
SEEPAGE PIT __,.~RAIN FIELD ~] ,OTHEr_
:., ,:~./:. ..:,:~ :' . , .
TO BE INSTALLED BY_ (..Y.Z:-a'~..(¢-¢~-d/:~' '~A'>'~f~'dC:.,< .?
BELOW TO BE FILLED OUT BY HEAL'rH DF'PARTMENT
,SEPTI6 TA"K SIZE ~'¢D _TYPE ~/ SEEPA6E AREA ~'' '~"" TYPE
DISTANCES:
DIAGRAM OF SYSTEM
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordh~ance No. 28-68 and that the
above described system is in accordance with said code.
BATE APPLICANTSSIGNATURE~ "'¢ '' *"' '