HomeMy WebLinkAboutWAKEFIELD Lot 2ZIII~
GREATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 LAG,.,...,[. ANCHORAGE. ALASKA 99501 27;
I1
........ _-- - ~xlSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LEGAL DESC RIPTION.-(~ d'/¢''
SEPTIC lANK:
DIS1ANCE FROM WELl.
LIQUID CAF a, CHY--
GALLONS.
',}SIDE LENGIEL
NUMBER OF
COMPARTMENTS
WIDTH-']''~-~_/O ~'/ LIQUID
DEPIH _
INSIDE
SEEPAGE SYSTEM:
NUMBER OF PITS
NEAREST [O1 INE_
SL:EPAGE
"~ ! ~t ~ / DEl'TH. ~--.,
OUISDE DIAMETER_ _OR WIDTH ~u __ LENGTH.
DISTANCE :ROM WELL __ ~';~")' 'Z-' BU LDING FOUNDATION~
TOTAL EFFECTIVE ABSORPIION AREA WALL AREA __ '~--:~L -- .SQ. FT.
TILE [)RAIN FIELD:
DISTAhJCE FROM WELL_
NUMBER OE LINES
ABS(~PTIC q AREA -' ' -- _SQ, Fl
DEJ fl4, TOP OF TILE TO -INISEI GRADE_
TOTAL LENGIH
.~ FO~JNDATION -- NF~AREST LOT [ NE .......... OF LINES.
_ I ..-'" \ /'
=..:~__DISTA' 'CE-'~ B~TWEEN~ _INES. _./'~ ..... IRE~CIt WIDTH .... /' ..,' N TOTAL EFF/ IVE
DEPTH OF FII.TER -~ATERIAL BENEATH TILL __IN ABOVE TILE.
4~,, ~.~ DISTANCE FROM WATER
WE_I:_L_~: TYPE /,;]/t. ___ DEP'fH ..... t~UILD~NG FOL NDATION. _ SAMPLE NEAREST
NEARESI SEPIIC SEEPAGE OTHER
LO[ LINE SEWER _INE .... TANK__ SYSTEM ......... ~ESSPOOL ....... SOURCES___--
DIAGRAM OF SYSTEM
DIblANCES:
GREATEh aNCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
. ROUGIt
279~2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
LEGAL. DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK_
TO SERVF THE FOLLOWING FACILITY.
MAILING ADDRESS_~:/~ PHONE
LOCAT,ON ,NSTALLAT,ON
SEEPAGE PIT_ ~,DRAIN FIELD ,OTHF'R
PERCOLATION TEST RESULTS -- ,~'_7'~ _ ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPAFII'iVIENT ff'~
THIS IS TO SERVE AS ~/b, ~-v~t_~ , PERMIT TO INSTALL A
_AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED
_, SEPTIC TANK SIZE, /QPf~C~ TYPF' e(.e(.e(.e(.e(.e(.%~ SEEPAGE AREA
DISTANCES:
DIAGRAM OF SYSTEtVI
dth Authority
I certify that I am familiar with the requkements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.