HomeMy WebLinkAboutKIEFFER TR A
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOS,~L SYSTEM
LOCAT,ON
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY /OL/~
/
GALLONS.
~(-.~.~ ,.~,~,~: NUMBER OF /
MATER~AL CO,~PARTMFNTS
INSIDE LENGTH INSIDE WIDTH __DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
/ OUTSIDE DIAMETER OR WIDTH /,.~
~,,,~.,.v / D,STANCE FROM WELL/._:¥¢' I
~_ :>i -
~--/'~-~) TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH /2-- , DEPTH -~'
, BUILDING FOUNDATION
;--~ '~':~sQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
FOUNDATION
DISTANCE BETWEEN LINES
, NEAREST LOT LINE
fRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
ABSORPTION AREA SQ. FT.
LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
WE~:TYPE :P"//~/ DEPT~ ~ ¢4,
/~/f ~ ~' NEAREST / SEPTIC
SEWER LINE ~O--~-
LOI
LINE
. , TANK
DEPTH OF FILTER MATERIAL BENEATH TILE'.
IN. ABOVE TILE
DISTANCE FRO~
· BUILDING FOUNDATION
' ¢,~?~¢ / SEEPAGE
, SYSTEM
SAMPLE . NEAREST
,_..,,--~ OTHER
DISTA N C E/$~)
,
l
zl
DIAGRAM OF SYSTEM !
/
!
/
DATE
/
APPROVED
GREATE ANCHORAGE AREA OROUGH
HEALTH DEPARTMENT
327EagleSt. Anchor~e, Ahska99501 279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
SEEPAGE PIT ~
MAILING ADDRESS ~gaa ~/,~,~,g(~ PHONE NO.
LOCATION OF INSTALLATION ...~2, oo /,~/~-
, DRAIN FIELD. , OTHER
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ¢//¢-¢4/~¢' (/¢,¢~ z~'~"~,Cc~r~
· SEPTIC TANK SIZE~TYPE~//¢//~ SEEPAGE AREA :"~'¢~- 13 TYPE~ ~
DIAGRAM OF SYSTEM
//~ ~ --'~e~it~-A uth ority -
I certify that I am familiar with the requirements of
above described system is in accordance with said code.
Area Borough Ordinance No. 28-68 and that the
BATE ¢Y / ~