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· ~D-I G~'~TER ANCHORAGE AREA BOROU~"'~H,
HEALTH DEPARTMENT h
327 E~GLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY //~'~'~ GALLONS.
MATERIAL.
INSIDE LENGTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LJNF
OUTSIDE DIAMETER OR WIDTH
TOTAL EFFECTIVE ABSORPTION AREA WALL AREA
LENGTH , DEPTH
. BLrLDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION
NUMBER OF LINES DISTANCE BET~E-EN
ABSORPTION AREA ~---'"'~ SQ. FT. LENGTH OF EACH INE
DEPTH: TOP OF TILE TO FINISH GRADE
,..~NEAREST LOT LINE.
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILE'
TOTAL LENGTH
OF LINES
N. TOTAL EFFECTIVE
IN. ABOVE TILE.--
WELL: TYPE DEPTH
~//~ NEAREST / SEPTIC
LOT LINE ~ SEWER LINF ~-'"'~ TANK
DISTANCE FROM ~.. ~ /' WATER /,~ NEAREST
· BUILDING FOUNDATION SAMPLE
/~ ~ J SEEPAGE ! OTHER
. SYSTEM / ~ ~ , CESSPOOL ~-' , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE APPROVED
' GAAB-HD-2
GREATEi-'ANCHORAGE AREA " '? ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
LEGAL DESCRIPTION "~ '~' /''c/Z-''' /~'~/'"~
~ ,,SEEPAGE PIT
MAILING ADDRESS_/~A~~f'~9-~/'/;~' . PHONE NO.
, BRAIN FIELD , OTHER.
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~'~//~/" ,~¢"~,4'q~.4t_ , PERMIT TO INSTALL A . . /
AS DESCRIBED BELOW· SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE ? ~'~"'~ TYPE ~ SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
DISTANCES:
Health 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.