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Ge rER ANCHORAGE AREA BOROU' q
D'~,-ARTMENT OF ENVIRONMENTAL QUALll,
3500 TUDOR ROAD ANGHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LEGAL DESCRIPTION,
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
NUMBER OF
MATERIAL -~7''f,~ Z- COMPARTMENTS.
GALLONS.
,~-~.~'~/R-~...~_ J.~-~.,~'~ ~..Z. l'- ~/~ ~/,,~/ LIQUID
/ INSIDE WIDTH ~' .... DEPTH--~'---
iNSIDE LENGTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS__~ / .- ..OUTSIDE DIAMETER
LINING MATERIAL '/---" ~) (~ ~"'~'~'/"'~'
NEAREST LOT LINEJ~//~'''~' ~'~ /
~'/ OR WIDTHJ-9~ , LENGTH ....2~.? , DEPTH
¢ ~ //~ BUILDING FOUNDA~ION~
DISTANCE FROM WELL. ~ ~
· TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
SQ, FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ,~:.~LgN~OI,I ~ ~ , NEAREST LOT LINE
NUMBER, ER OF~OF LINES DISTANCE BETWEEN Lliq ES ~'~,~LREN 7~
ABSORP~ AREA_ SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: T y p E .,,~.~./.jj~,~.;.~-~- ~ DEPTH ~/ DISTANCE FROM
, , BUILDING FOUNDATION.__
~ NEAREST ~ SEPTIC ~ SEEPAGE
LOT LINE , SEWER LINE , TANK , SYSTEM
WATER ~
SAMPLE NEAREST
OTHER
CESSPOOL. ':"~-' SOURCES
DISTANCES:
G,A.A,B.
DATE /~'7/..~/'~/.~__ APPROVED
GRE.,FER ANCHORAGE AREA BOrg'UGH
DEPARTMENT OF ENVIRONMENTAL GUALITY PERMIT NO.-
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
FINANCED THROUGH TO BE INSTALLED BY
SOiL T~ST
COMPLETION DATE ANTICIPATED
NOTE~ THIS PERMIT IS NOT VALID WITHOUT ~OIL
FINAL IN~PECTION~ 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY TH~'
MINIMUM DISTANCES, REQUIREMEN'I1
/
SEEPAGE P~T ~--~ / '~
/
, SEEPAGE PiT /~)
, SEEPAGE PIT/~/
SEPTIC 'rANK,'~""~J~/ . SEEPAGE PiT//~/Z~'/ DRAIN FIELD
GRAVEL. BACKFIll.
OR
DIAGRAM OF ~YSTEM
' CERTIFY THAT I AM FAMIL'AR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.