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GR=.ATER, · ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
LOCATION
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
INSPECTION REPORT ON-SiTE SEWAGE DISPOSAL SYSTEM
7
/~ GALLONS. INSIDE LENGTH INSIDE WIDTH. DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NEAREST LOT LINE /~) f
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
,LENGTH /'"'"~ ,DEPTH
BUILDING FOUNDATION
E 76 sQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION , NEAREST LOT' LINE
NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH
ABSORPTION AREA 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 TILLS:
IN. ABOVE TILE
WELL: TYPE '~/~-.i L.C~,.J) DEPTH
LOT LINE CZ~.D ¢ NEAREST 2.~! SEPTIC
· SEWER LINE , TANK
DISTANCE FROM
, BUILDING FOUNDATION,
: SYSTEM
~:~71 WATER
- SAMPLE
/'~'-'~! , CESSPOOl
,,~(~) , NEAREST
i '~7 I OTHER
, SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
APPROVED ~.~ HEALTH AUTHORIIY
GAAB-HD-2
GREATEff '~'
':ANCHORAGE AREA'.OROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Ah&a 99501 279-2511
cas. No. ~/-5"'"
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT'~ g, ~/~ MAILING ADDRESS ~ //~ PHONE .
RESIDENCE ADDRESS ~~ LOCATION OF INSTALLATION ~ ~~
APPLICATION TO INSTALL: SEPTIC TANK / , SEEPAGE PIT ,DRAIN FIELD. ,OTHER
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION ~/
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ ~r~~
,. SEPTIC TANK SIZE /r--~~Z) TYPE EEPAGEAREA ..~~/TYPE
~_~ DIAGRAM OF SYSTEM
DISTANCES:
y~ He.,th
Authority
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.//~/~//~/ F_~</.~~__Z~z.4_~n
DATE APPLICANT8 8IGNAIURE
%REATER ANCHORAGE AREA BOROUGH/
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
~__~ .... ~ F~r 2 lJ r-'~ ...... e_> hate Performed ~ .... fJ /i~
This Form Reports a: Sozls Log ..... ,~ .... k[~ti~o,~TTefft__~ . ,,
Depth
Feet
If Yes, At What Depth ~
Was Ground Water Encountered?~ ~e
Location Sketch
%¢[ss Ne Depth To Net Drop
1
Fpoposed ~nstallatmon: Seepage Pit Dmain Field
Depzn Of~Inle~ ~ Depth To Bottom Of P~t Or T~ench
est .er¢om~ed By=
Date ' ' ..... ~='~' - ~'~