HomeMy WebLinkAboutWAKEFIELD Lot 151o
GREATEF_
327 Eagle St.
.,NCHORAGE AREA
ItE:kL .- H DEPARTMENT
Anchorage, Alaska 99501
>ROUGH c.se s0. ~.
279-2511.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT_
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
LOCAI'ION OF INSTAI. LATION ~.~_~[ ~_ (~ ~'/J (S~_,
LoT' I
., SEEPAGE PIT_
4
, DRAIN FIELD ~"~"~' , OTNER.
FINANCED THROUGH
~/~: Z
PERCOLATION TEST RESULTS__ //'~/P'///Mz~__ ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIB[D BELOW. SIZE OF UNIT TO BE S[RVED
24 ].~ro ~UO~TC ~
~. F E E ,L e e /'/i ,oh" 7- oR. ''-'-)f') ["~
/~).5~0 _TypE
SEEPAGE AREA__ ,..--.--O,~_.TYPE.
OF SYSTEM
· SEPTIC TANK SIZE
H~-~lth Auihority
I certify that I an] familiar with tke req~
above described system is in accordance witk said code.
DATE -- :///6 :/ APPLICANTS SIGNATU RE
Ordinance No. 28-68 and that the
GR'-'TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
· ' 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING
ADD RE SS ~J~,~'J A~/-~/J~//~./~C,,~ PHONE
SEPTIC TANK:
DISTANCE FROM WELl
LIQUID CAPACITY /'~ '~--~ GALLONS.
MATERIAl ~-~,~,~ '~/~'~,~ ~'7 ~ 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
· DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
· LENGTH_ __, DEPTH
, BUILDING FOUNDATION.____
SQ. Ff.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF llLE TO FINISH GRADE_
~ TOTAL LENGTH
FOUNDATION. ---- , NEAREST LOT LINE , OF LINES
DISTANCE BETWEEN LINES '~ IN. TOTAL EFFECTIVE
.SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
TRENCH WIDTH
WELL:
LOT LINE
DISTANCES:
TYPE , DEPTH
NEAREST
, SEWER LINE
DISTANCE FROM WATER
, BUILDING FOUNDATION SAMPLE NEAREST
SEPTIC SEEPAGE OTHER
, TANK. , SYSTEM CESSPOOl , SOURCES
DIAGRAM OF SYSTEM
DAlE
APPROVED