HomeMy WebLinkAboutT12N R4W SEC 12 PARCEL 21
GR~.T~a /tNCHO~E A~A SOnOU¢. ~T '-HORAGE AREA BOROU6~-~
Dep~rtment of Environmental Qualit,,GR~-~ R
N? 957
NAME ~
/(/~-~ f..~.,,~-'~-~.~-. /
LOCATION ~ ~(~.,
~ ..... TANK~
DISTANCE FROM WELT ~~/~ MATEBIAI/~~//~ COMPARTMENTS
LIQUID CAPACITY.~ GALLONS. INSIDE LENGTH. / INSIDE WIDTH D~PTH.~
MAILING ,~, .~' ~ -
ADDRESS -~ 7~'/ --.-~ ~)~'"/~'~ J"~' PHONE ,./,.;~"~'~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS ~TER O~ R WIDTH , LENGTH , DEPTH
BUILDING FOUNDATION
LINING MATERIAL ~ /
NEAREST O~T LINF TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD: /~//,/~
TOTAL LENGTH
DISTANCE FROM WELL , FOUNDATION . NEAREST LOT LINE , OF LINES
NUMBER OF LINES ~TWEEN LINES ,~:~TRL~H WIDTH IN, TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN, ABOVE TILE
WELL: TYPE'~,~/'~/-~"/-~''. DEPTH z/ DISTANCE FROM
, BUILDING FOUNDATION, ,~_.__~_._WATER ~
SAMPLE NEAREST
SEEPAGE OTHER '"
~ NEARESl / SEPTIC ~ ~ , CESSPOOl ~ , SOURCES
LOT LINE , SEWER LINE , TANK SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
H EALT~I AUI'HO~RIT¥
GREA'i E..,~ ANCHORAGE AREA BOR,,.+,U~H
DEPARTMENT OF ENVIRONMENTAL QUALITY
3~00 TUDOR ROAD POUCH 6-650
ANCHORAGE. ALASKA 99502
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
INSTALLATION Of: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
~[NANCeD THROUGH
COMPLETION gA~E ANTICIPATED
, OTHER
NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPEC~TION= 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPEC:TION BY THE
HEALTH DEPARTMENT AUTHORITY WILL SE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE
MINIMUM DISTANCES, REQUIREMENTS
fOUNDATION TO SEPTIC TANK
SEPTIC TANK TO SEEPAGE PIT WALL
TYPe ~£I1~('/'¢~
DIAGRAM Of SYSTEM
SEPTIC TANK , SEEPAGE PiT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
DRAIN FIELD
· DRAIN FIELD
SEEPAGE PiT. [ '2J~f~) /'
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK ., SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, ~ ~ I , SEEPAGE Pit /~ D~AIN FIELD
TO RIVER, LAKE, STREAM.
GI~AVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
-::/'7/.::
H EALT~ AUTHORI~
or
L~CENSED DES~GNE~
GREAT R ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THe ABOVE
I CE'RTIF¥ THAT I AM lAM ILIAR WITH THE REQUIREMENTS Oil:
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE t~¢6 /, //~ Y'~:~ APPLICANT'S $,GNATUR~
/