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GI~'-'~I'ER ANCHORAGE AREA BOROI'~I
DEr-ARTMENT OF ENVIRONMENTAL QUALI~,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
~ '' ; " /' MAILING -:-,./.,,, ' ~ J '. TS-.
NAME /7 /'. .f2"'x(~4 ~A/ /' ' ' /' ..,- . . .x :,, ..,'.; .?..' .- ,,.. , /,/ ~,.,x,,ff,', PHONB:,~,!
, -.. , , ADDRESS (~/,~/r ,-~,""~ , - ,i .-
LOCATION_ /./ .// /'- ~ ~ L ,/~'~', ./,/': LEGAL DESCRIPTION '/' "' '/ ~''
SEPTIC TANK:
DISTANCE FROM WELL, z': ;, ,'.,' ,~' ,,/
LIQUID CAPACITY ~/?/'"< GALLONS.
MATERIAl. '~?/:./;!~ NUMBER OF .~?.
.COMPARTMENTS
-'* / / '<':' /' /,'Z LIQUID
INSIDE LENGTH -' INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS.
LINING MATERIAL ./~',d'(' '
NEAREST LOT LINE
SEEPAGE PiT:
OUTSIDE DIAMETER OR WIDTH~~'4 , LENGTH ,:>'; , DEPTH
,d~'C ~>,,.>,: f' /~' ,~' ~ ~' DISTANCE FROM WELL ~ ,~//= ?:':.,~/,,~ '" -'}; , BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
'TIL-E~._D~.~_R A I N FIELD:
DISTANCE FROM WELL ..... --~
NUMBER OF LINES
ABSORPTION AREA
, FOUNDATION , NEAREST LOT LINE
DISTANCE B~¥~/~EN'NNES. TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAl BENEATH TILE
IN. ABOVE TILE
TYPF'- ~"" ;/? ¢'-/~ · %,, DEPTH
NEAREST
LOT LINE ~ ., SEWER LINE ~
~ DISTANCE FROM
, BUILDING FOUNDATION..
SEPTIC ~,,+~ SEEPAGE
, TANK , SYSTEM
WATER
SAMPLE , NEAREST
OTHER
CESSPOOL
DISTANCES:
':.-' .: Z'¥ " . . .,,',,~
. ')ix.?- ?/~ ,.:
x..: 4:
DIAGRAM OF SYSTEM
APPROVED ~-"~' ~,.
G.A.A.B.
DATE 6'/7/
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT
PERMIT NO.
2205
INSTALLATION Of: SEPTIC TANK ~ SEEPAGE PIT ~ , DRAIN FIELD
FINANCED THROUGH
SOIL TEST RESULTS c~'~'~'~4D'',/~'~°~'~'x ~:~'~-~/~
COMPLETION DATE ANTICIPATED ~ ~
PHONE ~-/~//~
, OTHER
NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE: REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION,
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT DRAIN FIELD .
SEPTIC TANK TO SEEPAGE Pit WALL
SEPTIC Tank ~-~ SEEPAge Pit
, ., DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD ALSO CONSIDER AREA WELLS.
Water MAIN TO SEPTIC TANK /~ ~ SEEPage Pit K/~
DRAIN FIELD ,
SEPTIC TANK, ~ , SEEPAGe Pit .//~/~ DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
Fitted WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL SACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
or
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE APPLICANT'S .. .1~' . . ,