HomeMy WebLinkAboutT12N R3W SEC 4 LT 20
GRr:6.TER ANCHORAGE AREA BOROLI~'-~H
H EAL1,H DEPARI'MENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 27v-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~)~"'/~ ~- ~- ,~91~"' ) '
~.7~.~ LEGAL DESCRIPTION 5~'rZ. cf "/L/Z./~' ~.~' ~,'J (-o"TZO
SEPTIC TANK:
DISTANCE FROM WELL ~ :~ MATERIAl STI¢- ~ COMPARTMENTSNUMBER OF /
LIQUID CAPACITY //~(~) GALLONS. INSIDE LENGTH .INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
SEEPAGE PIT:
NUMBER OF PItS / OUTSIDE DIAMETER OR WIDTH ~ , LENGTH_ ~'¢' , DEPTH
LINING MAIERIAL ~..0 ~r.~' DISTANCE FROM WELL ~ff') ' BUILDING FOUNDATION.
NEAREST LOT LINE ~:~O ~ ~"~'~
TOTAL eEeecnve ABsORPtION AReA (WALL AreAl sQ.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
__, NEAREST LOT LINE
TOTAL LENGTH
· OF LINES
FRENCH WIDTH
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: TYPE 23~1 f~l~O . DEPTH_ /
NEAREST SEPTIC
LOT LINE , SEWER LINE. , tANK_
DISTANCE FROM WATER
, BUILDING FOUNDATION SAMPLE
¢3t SEEPAOE
· SYSTEM , CESSPOOL
DIAGRAM OF SYSTEM
NEAREST
OTHER
SOURCES
DISTANCES:
GAAB~HD-2
GREATEIk ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
'7(2
)ROUGH c se No.
279-2511
SEWAGE DISPOSAt, SYSTEM - APPLICATION & PERMIT
NAME OF
ADDRESS ~e,
RESIDENCE
LEGAL DESCRIPTION
APPLICATION TO I~ ~EPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PER CO LATION TEST RESU LTS
MAILING ADDRESS '-~ ~)~ ~'~, ~. PHONE NO~
~_~ LOCATION OF INSTALLATION__
BELOW TO BE FILLED OUT BY HEALTH DEPAR'rMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
SEPTIC TANK SIZE ,~<:~-'3 TYPE F~-dd~ SEEPAGE AREA
DISTANCES:
~g~ '~'/ TYPE
DIAGRAm1 OF SYSTEM
I :hat I am familiar with the req[
above described system is in accordance with said
/]
DATE ~~f APPU CANTS SI GNATU FIE
tge 28-68 and that the