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oGREA
R ANCHORAGE AREA BOR,.
Department of Environment (;~uality
3500 Tudor Road
Anchorage, Alaska 99507
GH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELl_ 76 __
INSIDE LENGTH
NUMBER OF
COMPARTMENTS
INSIDE WIDTH ~ LIQUID DEPTH '" LIC;)UID CAPACITM/~g~GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL 1~'-~" FOUNDATION .//O" ) TOTAL LENGTH
__NEAREST LOT LINE~.,~'O _OF LINES
NUMBER OF LINES__ ¢ DISTANCE BETWEEN LINES ];"RE'N,_,,, WflE~ I-I ~rN. TOTAl_ EFFECTIVE
ABSORPTION AREA ~'~ ,~.~.R,¢)'~ SQ, FT. LENGTH OF EACI-I LINE ~.O .~k// //¢ ,,¥
DEPTH OF FILTER TII E ,~'~_~ffN ABOVE TILE ~ IN,
DEPTH: TOP OF TILE: TO FINISH GRADE ~' MATERIAL BENEATH _ __ .
WELL:
TYPE ~)RII/~.O
BUILDING / NEAREST
FOUNDATION ~/¢ , LOT LINE ~(~
CESSPOOL OTHER SOURCES
APPROVED
CONSTRUCTION /~')~/~ I DEPTH.
NEAREST ! SEPTIC z SEEPAGE
SEWER LINE /~ TANK ~/~ , SYSTEM
DISAPPROVED--
REMARKS
DISTANCE FROM:
DISTANCES: ~ ~k~'~
DIAGRAM OF SYSTEM
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS: (~ ~R/~ __.
Form PW-02?
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT GF Er, lVlRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
PERMIT NO.
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
TYPe AND SIZE Of FACILITY TO BE SERVED
SEEPAGE PIT,
DRAIN FIELD
TO BE 'NSTALLE~ bY
NOTE: THIS PERMIT IS NOT VALID WITHOUT BOIL TEST
MINIMUM DISTANCES, REQUIREMENTS
SEPTIC TANK TO SEEPAGE PIT WALL ~/2~/2
SEPTIC TANK __ , SEEPAGE PIT ~-~,% DRAIN FIELD
TO NEAREST LOT LINE.
WELL l'O SEPTIC TANK ~ //'/ / ., SEEPAGE Pit
WATER MAIN TO SEPTIC TANK, /~ ~ , SEEPAGE Pit _
DRAIN FI ELD
SEPTIC TANK, /~/ ., SEEPAGE PIT //~)
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION ~ FEET rNTO UNDISTURBED SO]L.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLe CApS
GRAVEL BACKFILL
CONFOJ~M TO BOROUGH REGULATIONS REGARDING INSTALLATION.
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WiTH THE REQUIREMENTS OF GREATER ANCHORAGE AREA ~OROUGH ORDINANCE NO. 28-6B AND THAT THE ABOVE