HomeMy WebLinkAboutHENKINS BLK 1 LT 11
GREATEI ANCHORAGE AREA i )ROUG" Cas. No.
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT 'o%~.~)~/~/ ~, {~rr't~k~A/~~MAIklNGADDRESS -~rcx/
RESIDENCE ADDRESS ]~', 19, ~ LOCATION OF }rqSTALkATION ~t~ ~ ¢~fy_/~fl_~A~t~
LEGAL DESCRIPTION /~f'~ / [ L~'~'// '/-/~A/~'"/_.~A2~' ~..~/J_/_,~2.
APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT. P~, DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
TO BE INSTALLED BY /Z~/'~--/~,z~.,~-z..~
ANTICIPATED DATE OF COMPLETION .""'~-/~/
BELOW TO BE FILLEO OUT BY HEALTH OEPARTMENT ~ ~ Z.~(~2~,~/__~_~
THIS IS TO SERVE AS ~'/'~'~ · (/"~~ , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BkSERVED
. SEPTIC TANK SIZE ,,/~-2~2 TYPE (~~SEEPAGE AREA
DISTANCES: /¢'~//[//
~.q-.~/~ / TYPE
DIAGRAM OF SYSTEM
4 -/~uthOrit¥ -
I certify that I am familiar with the requirements of Greater Anchorage Are,~,~3orough Ordinance No. 28-68 and that the
above described system is in accordance with said code. / ] /'~
i.~/~ / g~ APPLicANTs SIG NATU R E '-}'~/~~ ~~.~ 5~
GJER ANCHORAGE AREA BOROU,~i,H
HEALTH DEPARTMENT ~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~,~, /0~'~ k~ LEGAL DESCRIPT,Oi'~
SEPTIC TANK:
DISTANCE FROM WELl k~--¥
L,OU,D CAPAC,TY /DOD
GALLONS
MATERIAL
INSIDE LENGTH
COMPARTMENTS
INSIDEWIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT JNE
SEEPAGE PIT:
I.
OUTSIDE DIAMETER
DISTANCE FROM WELL /~7 ~ /
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
,LENGTH J 5 .DEPTH
BUILDING FOUNDATION
sO. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl.
NUMBER OF LINES
ABSORPTION AREA
· FOUNDATION
DISTANCE BETWEEN LIN ES
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
. NEAREST LOT LINE.
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL .ENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
.5~/..1~//~) DISTANCE FROM WATER
WELL: TYPE ]'~l:}G DEPTH CO , BUILDING :OUNDATION. ~'~:~ /
· · SAMPLE /~/"~ , NEAREST
LOT LINE /~'"'~ '/ ~ NEAREST C~ / SEPTIC L~-:~ /' SEEPAGE'/~/,~ / OTHER
SEWER LINE , TANK , SYSTEM ~"(fi' , CESSPOOL ' -' SOURCES
DISTANCES: