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GAAB-HD-I
GE'~\TER ANCHORAGE AREA BOROI{'~'tl
DI:rAflTMENT OF ENVIRONMENTAL QUALI'I¥
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
ADDRESS r~-3 / '~ ' '~ PHONE
LEGAL DESCRIPTIONT/')"-'~'~ ~-~C("O,...) ,~,~ )_ ~-~.._.
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY '7--~-~'~LL~ .GALLONS.
MAT ERiAL (..\~ ~. ,~'
INSIDE LENGTH
NUMBER OF
COMPARTMENTS
LIQUID
INSIDE WIDTH DEPTH____
SEEPAGE SYSTEM: . SEEPAGE PiT:
NUMBER OD-JJiTS OUTSIDE DIAMETER / WIDTH , LEN~G.T.H , DEPTH
..' ',.. // N ...-.~""- ~. ~. '" - -'~
LININ~ MATERIAl ' D].~TANCE FROM WELL 'x'x~ ~"~"~' ' ...... ~'
.......... BUILDING FOUNDATION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
, FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAl. BENEATH TILE
NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE --
WELL:
LOT LINE
TYPE ~ '~-~'~, DEPTH
NEAREST
~ SEWER LINE
DISTANCE FROM
, BUILDING FOUNDATION.
SEPTIC SEEPAGE
lANK , SYSTEM
WATER
SAMPLE
, CESSPOOl
NEAREST
OTHER
, SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE rjr) ~'~
GREATER ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PHONE
NOTE: THts /ER~IT 15 NOT VALID WITHOUT ~OIL TEST
pFRMTT VAlin ~NF VFAR
FINAL INSPECTION, 24 HOUR NOTICE: REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL I~P~TION BY TH--
MINIMUM DISTANCES, REQUIREMENTS
FOUND TION TO.SEEPAGE Pier 20 ~:~6. DRAIN FIELD
SEPTIC NK TO SEEPAGE PIT WALL [~ f[ ·
TO NEAREST LOT LINE.
WELL. TO SEPTIC TANK (~)/'~'~
WATER MAIN TO SEPTIC TANK :1.0 ~:'~e
DRAIN FIELD 10
ALSO CONSmER A.E^ WELLS.
, SEEPAGE P~T ~0 ft.,
25 fi;. SEEPAGE PIT 100 f¢6. , DRAIN FIELD 50 ~C~..,
TYPE
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE ~REA E~OROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE