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G~A~ER ANCHORAGE AREA BORO,IJ.~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME C'~~:d~?-/~-~ J ~
LOCAT,ON
SEPTIC TANK:
DISTANCE FROM WELl
L QUlD CAPACn¥ ?_9--7)
GALLONS.
MATERIAL
~ N UM B E Rk'~N~---'~ /
(_~/,.4 ~ ~J J COMP^RTMENTS
1NSIDE WIDTH DEPTH
INSIDE LENGTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER_
/
~ ~ OR WIDTH , LENGTH , DEPTH ~ /,
DISTANCE FROM WELl //~"~ / , BUILDING FOUNDATION -7(~,-
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ ~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRAOE
, FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
WELL: AJ 0 ~'- ~7~t t t-~..]b ¥ f'--7"--
iYPE. ., DEPTH/
, NEAREST LOT LINE.
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILl'
TOTAL LENGTH
., OF LINES_
IN. TOTAL EFFECTIVE
IN. ABOVE TILE.--
NEAREST SEPTIC
LOT LINE , SEWER LINE ,TANK
· BUILDING FOUNDATION
SEEPAGE
, SYSTEM_
SAMPLE
, CESSPOOL
NEAREST
OTHER
, SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED
GREATEI. '_ NCHORAGE AREA )ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No. ~ ~"'""
SEWAGE DISPOSAL SYSTEM - APPLICATION 8, PERMIT
NAME OF APPLICANT/~-b~/~'~,
RESIDENCE ADDRESS ~,¢),~46" ~ ~,f'A~/[./,~{~ LOCATION OF INSTALLATION
APPLICATION TO INSTALL: SEPTIC TANK (/ , SEEPAGE PIT '/ , DRAIN FIELD
TO SERVE THE FOLLOWING FACILITY ,~ ~-,,~>,~//~f'
FINANCED THROUGH '~"~ TO BE INSTALLED BY
PERCOLATION TEST RESULTS
,OTHER
ANTICIPATED DATE OF COMPLETION L'"/ff./~~:''''
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERvE As '/~ ~ ,PERMIT TO INSTALLA/
,, SEPTIC ~ANK SIZE '~
TYPE .~ SEEPAGE AREA ~ TYPE
DIAGRAM 0F SYSTE~
DISTANCES:
I certify that I am familiar with the requkements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE ~///.x, ~...}. ~ / APPLICANTS SIGNATURE