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NAME
LOCATION
, ./' GIr~EAI'ER ANCHORAGE AREA BOROI~GH
~ H EALI'H DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279]r251~
INSPECTION .REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY J~6''~
GALLONS.
MATERIAL ~.~i'd ( ~'r~ NUMBER OF /
COMPARTMENTS
INSIDE LENGTH (¢1 LIOUID
INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LfNING MATERIAl_ _
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
!
/~ OR wIDtH .LENGTH .DEPTH
DISTANCE FROM WELL~.. , BUILDING FOUNDATION~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) -~' ~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
TOTAL LENGTH
FOUNDATION , NEAREST LOT LINE , OF LINES
NUMBER OF LINES
DISTANCE BETWEEN LINES
TRENCH WIDTH
IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT, LENGTH OF EACH LiNE
DEPTH: TOP OF TILE TO FINISH GRADE
W~'~' TYPE , DEPTH ~.~2
//~ / NEAREST ~.~' / SEPTIC
LOT LINE /{.~ SEWER LINE. --k/ , TANK
DEPTH OF FILTER MATERIAL BENEATH TILE
DISTANCE FROM ~ / WATER
_, BUILDING FOUNDATION.~SAMPLE
~ , SYSTEM__ , CESSPOOl
IN. ABOVE TILE
NEAREST
OTHER
SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
ih- r6: .2,
DAle
APPROVED
IIEALIH AUTHORliY
GAAB-HD-2
GREATE._ ANCHORAGE AREA
HEALTH DEI'ARTMENT
327 Eagle St. Anchorage, Alaska 99501
_OROUGH
279-2511
Case No. [] 5
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS MO,'~:' LOCATION OF INSTALLATION /
LEGAL DESCRIPTION '">~ '~ ~/ :2/' ,
APPLICATION TO INSTALL: SEPTIC TANK ¢ , SEEPAGE PIT ,DRAIN FIELD
TO SERVE THE FOLLOWING FACILITY ~ ~ ~[~fgt)g]>lr~ ]'6~r}
FINANCED THROUGH TO BE INSTALLED BY__
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION
,OTHER.
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
//
THIS IS TO SERVE AS ,-..,/,,,,- . , PERMIT TO I~STALL A
AS DESCRIBED. BELOW. SIZE OF UNITTO DESERVED
.TYPE
,Aa.a svs m
DISTANCES:
Health Authority
1 certify that 1 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.
'2;
DATE APPLICANTS SIGNATURE.