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OAAS-HD- I
GI~'",TER ANCHORAGE AREA BORO~,'""~
Db-ARTMENT OF ENVIRONMENTAL QUALI,,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAIL lNG / ~ /
NAME --~'~,.<~ .,_~,,,~/,,.,'~,,,'~' ~~~ ADDRESS ~/~
LOCATION ~ ~~ /~ LEGAL DESCRIPTION
SEPTIC TANK:
/ NUMBER OF
DISTANCE FROM WELL ,~,~,z" MATERIAL ,,'~*'Z_/'/~'~--~~,~-~- COMPARTMENTS
~ LIQUID
LIQUID CAPACITY / .GALLONS. INSIDE LENGTH ~ INSIDE WIDTH DEPTH~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER '~ OR WIDTH
LINING MATERIAl ~~ ~/~ . ul~/Am~ r~
LENGTH - -~"~ DEPTH
BUILDING FOUNDATION _
NEAREST LOT LINE.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~,::~") SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~ , FOUNDATION ~ , NEAREST LOT LINE
NUMBER ~S DISTANCE BETWEEN LINES TRENCH WIDTH
ABS~ON AREA SQ. FT. LENGTH OF EACH LINE ~.~________ /
TOTAL LENGTH
, OF LINES
_4N-r-TOTA~VE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
WELL: '"':'¢~"~×- '~- ~'"~"~ /"~
TYPE*'~-,~/~:.~-~:'~ : DEPTH
NEAREST SEPTIC
LOT LINE ~/~J~, /~" , SEWER LINE '~ ~ . TANK
DISTANCE FROM
, BUILDING FOUNDATION._
~ / SEEPAGE
· SYSTEM.
WATER
SAMPLE
OTHER
CESSPOOL,/~/~/Z~~' SOURCES'~/~'~-~
DIAGRAM OF SYSTEM
DISTANCES:
G.A.A.B.
DATE
GAAB-JqD, 1
GR,; ,'ER ANCHORAGE AREA BOROLr I
DEPAFITB/1EBIT OF EBIVIFIONMENTAL QUALITY
3§00 TUDOR ROAD AI\IOHORAGE, ALASKA ggs07 27g-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
MATERIAL
INSIDE LENGTH
MAILINGADDRESS ~$"~':""~'/~, ~-~/~/¥" ~-~--' ~:-"'?~ '~ PHONeme
LEGAL DESCR PT ON --. ~.~ ~, ~ ~, ;~
NUMBER OF ~
~7~ ~/' COMPARTMENTS
~ INSJOE WIDTH ~ DEPTH
SEEPAGE SYSTEM: SEEPAGE PiT:
NUMBER OF PITS. // OUTSIDE DIAMETER
LINING MATERIAL ~,/.)/'~./~C~,.~,,~
NEAREST LOT LINE /
OR WIDTH
· DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH ~"~2 , DEPTH
BUILDING FOUNDATION
,..~ ~'~ ~// SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~0~' ~. . NEAREST LOT LINE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE__
WELL.~"~'7~'/-/:'//~z""'¢'/,~/-,~..~F,~ ~ DISTANCE FROM
' TYPF~~ , DEPTH ~/~, , BUILDING FOUNDATION.
LOT LINE /~ /~ NEAREST ~ SEPTIC / SEEPAGE
. , SEWER LINE ., TANK /~ ~ , SYSTEM_
//:
WATER
SAMPLE .-d~..-~--~X NEAREST
OT' ER
CESSPOOL ,,/~--'~, SOURCES'''~''d~'/'''(/
DISTANCES:
DATE
DIAGRAM OF SYSTEM
'
ANCHORAGE AREA BORO?~H
HEALTH DEPARTMENT ~]',O ~.~T
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-251 !
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
PHONE
DISTANCE EROM WEL'
UQU~D CAPACITY ~7£0 gA,EONS.
~.~.~ NUMBER OF
,NS,DE LENGTH ',Z2.~, ~ /77~ L,OU,D
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBE~
ABS~ffPTIO N AREA
, FOUNDATION ~ . , NEAREST LOT LINE
-/~SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES
IN. TOIA L ..E.~C't'~
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL:
LOT LINE
(~d 7...~/'~ ...... DISTANCE FROM
TYPE DEPTH(-~qZ~'/~'~'~2"//6~ BU LD NG FOUNDATION
NEAREST SEPTIC /(~! SEEPAGE
SEWER LINE , TANK/~/ , SYSTEM
WATER
SAMPLE
/~'5' . cEssPoo,
NEAREST
OTHER
, SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
.. ] ~ : : ' · - .
APPROV HEALTH A~JTHORITY
· , GREA'i:ER ANCHORAGE AREA BOROUGH /~_~..¢~/'
. +, DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO, _
ANCHORAGE. ALASKA 99502
{ I t TELEPHONe 279-8686
- "SEWAGE DI~O~AL SYSTEM -- APPUCATION AND PERMIT
:Toe
FINANCED THROUGH TO be INSTALLED BY
SOIL TEST RESULTS NOTE~ THI~ PERMIT
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 DIAGRAM OF SYSTEM
FOUNDATION TO SEEPAGE PIT . ,. DRAIN FIELD
WATE~ MAIN TO SEPTIC TANK /~) , SEEPAGE PIT
DRAIN FIELD
CAST ~RON 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 P~T
FITTED WITH AIRTIGHT REMOVABLE CAPS,
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OR
LICENSED DESIGNER
I CERTIFY THAT IAM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DATE APPLICANT'S S GNATU
GAAB-HD-2
GREATEi ANCHORAGE AREA
HEALTH DEPARTMENT
" 327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~-~f-/z~--%~ _~z~:_~.-j~../ MAILING ADDRESS -,~'~-~5' ~'T-~. ~.~- PHONE NO. )~":¢z~(
RESIDENCE ADDRESS -~-- :/:-~-/'~-~-~"" LOCATION OF INSTALLATION ._.<~z~k'/Y.~.,~
'gROUGH
?
Case No. //'-~'~
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLAT'DN TEST RESULTS
SEEPAGE PIT ~ DRAIN FIELD. OTHER,
TO BE INSTALLED BY .~./d, .~--,)(d.
ANTICIPATED DATE OF COMPLETION-f'~'"~'~/~'?7'~"/
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~/'~.~..,,~,~ , PERMIT TO INSTALL A ~'.L~i~.~.~ .-~>~.~/,~
AS DESCRIBED BELOW. SIZE OF UNIT T0 BE SERVED
SEPTIC TANK SIZE ~ TYPE ~~EEPAGE AREA
' ~~ D~AGRA~ OF SYSTE~ /~.X/~
I certify that I am familiar with the requirements of Greater Anchorage Area B6rough ordmance l'qo~ '28z68 arid that the
above described system is in accordance with said code.
DATE
APPLICANTSSIGNATURE :~/~-):
]REATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
Legal Description: Lot Bl'o~k Subdivision
This Form Reports a: So~-~Log,
Depth
Feet Soil Characteristics
Was Ground Water Encountered?
If Yes, At What Depth_ ,,
Date
t
Gross Time
Reading
Location Sketch
Net Time
Depth To H20
I:: I '1' 1 ::T~I~
Net Drop
Proposed nstallatxon: Seepage Pit Drain Field
Depth Of Inl'et
, . ])ep%h To B~ttom Of Pit Or T~enc~- - "'
COMMENTS: ~:~;~o~c~ _~ .~ ~"/~" ' .... '
Data Certified By ~ ' ~' '.
.' DateL,...~.~ ;