HomeMy WebLinkAboutSOUTHWOOD PARK #1 Plat of Block 5 Lots 48A & 50A
Oe®
Application to Install:
SEWAGE DISPOSAL SYSTEM - APPLICATION ~ PERMIT .
Na~ of Appllcant ~qt;~ ~/~ ...... Mailing Add~ess~.~_. ,.,/~,~,~, ~Ph. ~7~/.~.
Residence Ad.ss ~ ~/~go~ .... Looa%ion of Ins~allaTion ~~ '~~:
Septic ~k ~Seepage pit , ~ain field__, ~he~
To Serve the Following Facility
Financed Through
Percolation Test Results
Anticipated Date of Completion,, ~ ....
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
This is to serve as,,'4~..T~U/~ ,~&~,,, permit to install a ............
, , ~ as described below. Size of ~it ~o be served
'~IL~ . 2ep~ic tank .izeD~pe ~?,S~page ~ea~. : T~o
DISTANCES:
'°
Health Authority
· I certify that I am familiar 'with the requirements of Greater Anchorage Area Borough
Ordinance No. 28-68 and that the above described system is in accordance with said code.
GP~ATER ANCHORAGE AREA BORC 'DH
~._~, HEALTH DEPARTMENT~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
DISTANCE FROM WELL ~-"/~" L'"]~
LIQUID CAPACITY /~,-~ ~- ~) GALLONS.
MATERIAL d-~/')'/'~' ~'~ lC -/'~'-',~:T'~ NUMBER OF
COMPARTMENTS /
/ ~/'~,~ LIQUID
INSIDE LENGTH INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE.
OUTSIDE DIAMETER
OR WIDTH
TOTAL EFFECT,VE ABSORPTION AREA /WALL AREAl
, LENGTH ~Z~'~ , DEPTH
BUILDING FOUNDATION '~
so. ET.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
FOUNDATION . NEAREST LOT LINE.
DISTANCE BETWEEN LINES TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE:
TOTAL LENGTH
OF LINES
IN. TOTALEFFECTIVE
IN. ABOVE TILE
C~, j~. ~ i.~.l,t~T~:/~ DISTANCE FROM WATER
WELL: TYPE. - DEPTH , BUILDING FOUNDATION · SAMPLE ., NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE ., SEWER LINE ., TANK , SYSTEM_ , CESSPOOL , SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
APPROVED