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G~-RTER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT l
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
632
NAME /FP/~/ ADDRESS
LOCATION /~/~C///c:)~.~/~) ,~'~O.,x) LEGAL DESCRIPTION ~---/ ~2~~~ -~J~//
SEPTIC TANK:
DISTANCE FROM WELL //L~- / NUMBER OF -~
MATERIAl ,~:~ COMP RTMENTS , ~'~
~,~.~ .~'~L~Z~,~-~. ~'~-' ~/~ ~--~/LIQUID
LIQUID CAPACITY /~'~/~ GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
/
NUMBER OF PITS OUTSIDE DIAMETER
L,N, O MA'ER'A Z5' 0
NEAREST LOT L,NE /~ 'g
OR WIDTH /~.~/ LENGTH /5- ?
~ , DEPTH
DISTANCE FROM WELL /~ BUILDING FOUNDATION~$'~'~/2~?
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~/~(r) SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELl , FOUNDATION , NEAREST LOT LINE. ., OF LINES
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE.--
~).~///Z~/_~ .-- DISTANCE FROM WATER --
WELL: TYPE , DEPTH , BUILDING FOUNDATION, -- SAMPLE , NEAREST
LOT LINE /~ zj NEAREST .~ SEPTIC . Z SEERAGE ~' ,~ OTHER
· SEWER LINE TANK /~-?~' SYSTEM /~(~ , CESSPOOL , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
GREATER ANCHORAGE ArEa BOR.~!L1Gh
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERglT
PERMIT
,NSTALLAT'ONIOCAt'ON
LEGAL DESCRIPTION
INSTALLATION Of: SEPTIC TANK ~
TYP~ AND SIZE OF FACILITY TO BE SERVED
SOIL TEST rESULTS ~ ,~.' 7' '
SEEPAGE PIT ¢ ~ DRAIN FIELD , OTHER
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROGECUTION.
SEPTIC TANK SIZE //~/~/0 ~./~[, TYPE ~----~/'~e_~__/ SEEPAGE a. EA S,Z£ ~'/ TYPE L~ ~
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK .. SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK .
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRA~N FIELD
SEPTIC TANK, , SEEPAGE PIT
TO RIVER, LAK~. STREAM.
DRAIN FIELD
DRAIN FIELD
SEEPAGE PIT .
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
DRAIN FIELD
CAST IRON INTO AND OUT OF SEptic TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION ~ FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
DIAGRAM OF SYSTEM
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
APPLICANT'S ~IGN^TGI~E