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G~-~;~T~ER ANCHORAGE AREA BORC~"~
' HEALTH DEPARTMENT ]
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N°. 186
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING ....
ADDRESS~,//,~'~/2.)~/-/.~.~ ~'?~//-/~'-//~f].(/ PHONE:
LEGAL DESCRIPTION ~/~¢ ~, ~~,
.~'./~,
DISTANCE FROM WELL //~? ~'~
LIQUID CAPACITY
GALLONS.
NUMBER OF
MATERIAL ~L ~/t/'~ ~'~ '~"~'"~ COMPARTMENTS
INSIDE LENGTH ~'~SlDE WIDTH DEPTH_
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PiTS / OUTSIDE DIAMETER ~ OR WIDTH
LINING MATERIAl /-~ C) d-~J- '--~ ~;~'~'~'~ . DISTANCE FROM WELl
NEAREST LOT LINE /·'~x~ ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
· LENGTH /~ , DEPTH
, BUILDING FOUNDATION
~? -~'~'~ SQ. FT.
TILE DRAIN FIELD:
TOTA~.J,E,N CT.u,
DISTANCE FROM WELL ./~, ~ , NEAREST LOT LINE ~ LINES. -~',
NUMBER OF L S /
AB SQ. FT. LENGTH OF
DEPTH: TOP OF IILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE --
WELL: TYPE ~,,~'~/'/---'~"-~'~ DEPTH -~-~' * DISIANCE FROM ~ / WATER
· BUILDING FOUNDATION· SAMPLE__ //~/~) NEAREST
~ NEAREST D/SEPTIC Y SEEPAGE /~/~ / /OTHER
LOT LINE /~) "/~ , SEWER LINE , TANK /~.~ , SYSTEM , CESSPOOl , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
HEALTH AUTHORIIY
GAABoHD-2
GREATEL NCHORAGE AREA '"ROUGH
HEALTH DEPARTMENT
397 Eagle St. Anchorage, Alaska 99501 g79-gSll
Case No. /'~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT /~'.~/z"~_/~:¢/-/- ,.~/'/,.~/-/~"~ MAILING ADDRESS /'~/725.,~? NONE NO.
RESIDENCE ADDRESS /~.% ,%,~_ LOCATION OF INSTALLATION
LEGAL DESCRIPTION ~..~.~2~ .....(~:~I. _~::' ~,,-'~, ~-2_~.~?
APPLICATION TO INSTALL: SEPTIC TANK ~i SEEPAGE PIT- ~ ,DRAIN FIELD ,OTHER
TO SERVE TNE FOLLOWING FACILITY
FINANCED THROUGH ~__~
PERCOLATION TEST RESULTS
TO BE INSTALLED BY_
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
BIAGRAM OF SYSTEM
DISTANCES:
! certify that ~ am £amJ]Ja~ with the ~¢quireme~ts of G~eat¢; A~cho~age A~ea Borough O~dinance No. 28-68 and tlmt the
above described system is in accordance with said code,
DATE -~///~' APPLICANTS SIGNATURE
,~'~-~R~ATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
CAS~ #
· ~/~O~=I~jtgi~lp~f~'.At~ion: Lot._,?__~lock , SubdivisiOn Sec. 30 TS-15 ~. t0~,l~
Soll Characteristics
brown sandy Silt (ML)
gray fine to coarse sand
with gravel (GW)
Depth
Feet
6
8~
l0
silty gravel
fine to coarse sandy gravel
(OW)
Was Ground Water Kncountered?
If Yes, At ~,~bat DepTh___
Location Sketch
· -n~,.~l~,~ca: Seepage PiT
Drain F~eld
Depth Of Inlet
''~. -- Dep~fl--J-~~t or Trenc~ .....
COMMEN.o. --
Te$~ Performed By:__R. E. Carlisle These recommendations are computed
from visual observations and based
Da~a Certified By: National T~t%n~ Service I~.the unified classification system.
Date:~ '~
Gross ,~me Net Time Depth To H20 Net Drop
Minute ~ ~