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- / GRIC4TER ANCHORAGE AREA SOROII +H
I � HEALTH DEPARTMENT r � NO.
2
' 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME MAILING
ADDRESSS_F �_i 5!2 PHONE,9/?�
SEPTIC TANK:
DISTANCE FROM WELL MATERIAL /'/✓�%/C%F� CUMBER OF
OMPARTMENTS � '
LIQUID CAPACITY Z.-�.��! ''� /%�'U LIOUID
GALLONS. INSIDE LENGTH �/ INSIDE WIDTH �� DEPTH '�
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH -/ -;7 C' , LENGTH-� / , DEPTH /
LINING MATERIAL --.L- C) J �X�--X /DISTANCE FROM WELL
LINING � '--'l�'• , BUILDING FOUNDATION 12,f
NEAREST LOT LINETOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)� SO. FT.
TILE DRAIN FIELD:
DISTANCE FROM
NUMBER OF
AREA SO. FT. Lk4rTH OF
LOT
WIDTH
TOTAL LENGTH
OF LINES
TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL'
TYPE- /'/ ��" /=:-- DISTANCE FROM
DEPTH «� , BUILDING FOUNDATION. [� WATER
NEAREST SEPTIC 10i4r SAMPLE NEAREST
LOT LINE ,SEWER LINEy1ANK �i'q. ./� EEPAGE G� OTHER
SYSTEMA , CESSPOOL SOURCES_
DISTANCES:
DIAGRAM OF SYSTEM
DATE
�.-C
GAAB•fID•2 GREATE; (ANCHORAGE AREA
^' IIEALTII DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
r DROUGH Case Na.Lr1PL
279.2511��/
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT/NJ�FG.FiS_ t_/F}�Al MAILING ADDRESS PHONE N �� 2g
RESIDENCE ADDRESS/C7 f f%i%'/✓n,� iE�G�fS LOCATION OF INSTALLATION S c�
LEGAL DESCRIPTION L-07
APPLICATION TO INSTALL: SEPTIC TANK SEEPAGE PITV
,DRAIN FIELD—, OTHER
TO SERVE THE FOLLOWIN�FA ILITY_ ,
FINANCED THROUGH'
PEJiQN TEST RESULTS
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION��i��'tiln«
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS <��•�tf72s , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF d1N1T TO BE SERVED
SEPTIC TANK SIZE �' L TYPE` �^`��' SEEPAGE
DIAGRAM
DISTANCES Ii1Ii/11l11%IJ
U —
2.o
7717 1
4rt. T�-"�'
HEALTH AUTHORITY
OR
LICENSED DESIGNER
AREA
OF S)
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No
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No
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I certify that I am familiar with the requirements of Greater Anch age Area Borough Ordinanc No. 28-68 and that the
above described system is in accordance with said code.
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DATE 0 APPLICANTS SIGNATURE
(—'REATL'R ANCHORA^.E AREA BOROUGH
�.. HEALTH DEPAMIENT CASE 9
327 EAGLE STREET
ANCHORAGE, ALASKA -99501 Lox, j t c 17
dN Z/
Performed For [ ( ice. Date Performed
Legal Description: Lot�_Bloc subeivis or.
This Ferri Reports a: Soils Lot, e-rw o, 7- •iercolation f�feest ---
Depth
Feet Soil Characteristics Location Sketch
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oclF
SFS
-fY SAND / G i(Ay 6L
iiliti■
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MEN
Il
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an
NONE
r3ocri u„�s
cf{cc'�"ivmly �6M�
Was Ground Water Encountered? --A/o_
If Yes, At What Depth
Reading Date Gross Time Net Time
Proposed Installation; Seepage Pit
Depth\Of Inlet Dep
COMMITS: t! /1fn v _
Test Performed By: -75-Seofla-b
Data Certified By: )t
Date: 'j
Depth To H2O ( Net Drop
Drain Field k/
it Or Trench /ca.,
iiliti■
���
�i��■
MEN
Il
.�
an
NONE
Depth To H2O ( Net Drop
Drain Field k/
it Or Trench /ca.,
i