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LOT
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OAAB-HD I
~'~,TER ANCHORAGE AREA BORO~ ~
HEALTH DEPARTMENT
327 i:~GLE ST, ANCHORAGE, ALASKA 99501 2/9-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELl. C~..~- / _MATERIAL <:~'-~Z~Z'~-c~~-- NUMBER OF
-- COMPARTMENTS
LIQUID CAPACiTY~// ~.2(~/-.) _.GALLONS. INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSFEM:
NUMBER OF PITS_ / _ OUTSIDE DIAMETER
LINING M A / E RIAL ___ ~.~-~-'~_~_~
_OR WIDTH
DISTANCE FROM WELL_
LENGTH /,~ / DEPTH
NEAREST LOT LINE.~.~_,'~
TOTAL EFFECTIVE ABSORPTION AREA (WALL
TILE DRAIN FIELD:
NUMBJ~'LfNES. --DISTANCE B~WEEN LIN.~'~ ___ .TRENCH WIDTH_L
^BSOR.IG AREA SQ. OF LAC. LINE_
__, BUILDING FOUNDATION.
SQ. FT.
TOTAL LENGTH
, OF LINES_
....... INJ-?OT~'I_ ~EFECTIVE
DEPTH: 1'O? OF TILE TO FINISH GRADE
__DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE.
WELL:
NEAREST
LOT LINE c~:~,(-) / ~Z' ~, SEWER L'r'JE
DISTANCES:
///,¢ <~ =/.2g '
7~o/- ~ ~ /
,' .. DISIANCE FROM /~7~__ WATER
DEPTH /~.)~-] · , BUILDING FOUNDAHON.~O SAMPLE--//V/ /2__, NEAREST
SEPTIC ,~,..~- /' SEEPAGE / -~ OTHER
..... , TANK , SYSTEM_ /~-~)-~' --, CESSPOOl SOURCL--S-~'~_~
DIAGRAM OF SYSTEM
GREAT ,
327 Ea§le St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
I[ OUGH
279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RES DENCEADDRESS,C~'~/,/?~ ~/']-~¢/~,'~ ~__LOCA'I ONOF NSTA.LATON
APPLIgATIONTOIN~TALL: ~EPTIgTANK:~SEEPA~EPIT.
TO gE"VE THE FOLLOWING FAfilLITY~.~ /~.~.. ~.__~
FINANCED THROUGH_ ~:~ __TO BE INSTALLED BY
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
DESCRIBED 8f~OW. SIZE OF~UNIT TO BE SI:iRVED --~-~-~J.2.~,~,,-.,~,- -
~ ~ ........ , .. - .
__. SEPT C TANK S ZE ~~TYPE ~g~. SEEPAGE AR EA __ TYPE ~* ~ ~ ~'~;'~
DIAGRAM OF SYSTE~
DISTANCES:
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that
above described system is in accordance with said code.
BATE ~'--- / ,~ ~---' ~('~ APPLICANT88,GNATURE
OAAB HD I
GP'~TER ANCHORAGE AREA BOROI'qH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME__ /'~ ~'Z~'~c"'~7~ 7~ MAILING
SEPTIC TANK:
DISTANCE FROM WELL_ ~;b /-/-
L,OU,D CAPAC,T OALLONS.
~' ~ ~ ~_. NUMBER OF
MAT E R I A L ~-~/v/(J/~Z~7'(-~ __COMPARTMBNTS
INSIDE LENGTH ~ __INSIDE WIDTH
LIQUID
DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS__ / OUTSIDE DIAMETER OR WIDTH_
, LENGTH , DEPTH
BUILDING FOUNDATION.__
NEAREST LOT LiNE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA} _SQ. ET.
TILE DRAIN FIELD:
· '~ .. ........~'\ IOTAL LENGTH
DISTANCE FROM WELL_1 ,FOUNDATION( , NEARES! LOT"LINE___~ ,OF LILIES..)
~. ~-'"'~'~' ~-~ ............. ~"~ .-~ TRENCH WIDTH __IN. TOIAL EFFECTIVE
ABSORPTION AREA_ "-,__-.-.~'-~ SQ. FT. LENGTH OF EACH LINE__
DEPTH: TOP OF TILE TO FINISH GRA~ , _DEPTH O~FILTER MATERIAL BENEATH TILE.
,*' - DISTANCE FROM WATER
WELL: TYPE~/d~ _, DEPTH .,BUILDING FOUNDATION ~ ~SAMPLE
LOT LINE /~ ~ NEARES? I SEPTIC ~ SEEPAGE ~ ~
, SEWER LINE ~m '~ ., TANK~' ~ . SYSTEM ~Z~O 't~ , CESSPOOL
IN. ABOVE TILE____
/k/'/~ _, NEAREST
OTHER
, SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE APPROVED
)ROUGH c~so No._Z~
GREATEI ),NCHORAGE AREA .
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT_: ,.~J,/~Z'/~-- r~/ ~'~_o/)~/~MAILING ADDRESS
RESIDENCE ADDRESS '/"~2/'1~//14/o~r'/ ~ ~ 0 ~ LOCATION OF INSTALLATION. _ LEGAL DESCRIPTION__,~/ 6 '7- ~ .~) .~-'¥_', ~
APPLICATION TO INSTALL: SEPTIC TANK. /~ , SEEPAGE PIT_ , ,DRAIN FIELD
TO SERVE TIlE FOLLOWING FACILITY ¢.~ .&~-.~.~.-x,
FINANCED THROIJGH~/~d~7- ./~/~,'7~ .'~'~/2~TO BE INSTALLED
PERCOLATION TEST RESUL'FS ANTICIPATI-'D DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPAHTMENT
PHONE
,OTHER
THIS IS TO SI.:RVE AS. ,, PERMIT TO INSTALL A
AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED
SEPTIC TAN K SIZE _.r~,~'A .~'/~../.~TYPE ~/./~/Z~Z'~.. SE EPAG E
DIAiiRAM 0
DISTANCES',
·
__
/ /
....
F th Authority
I certify that I am familiar with the requa'ements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE , C~ , APPLICANTS SIGNATURE