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GAAB-HD I
GR TER ANCHORAGE AREA BOROI.' H
DEvAFFI'MENT OF ENVIRON~IENTAL QUALlt~
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION J'~)_L~- go~'.i,~e-~__j_~_l~q~/'~ 'q~o_~t [~)/~;I)~__LEGAL DESCRIPTION ~/~'(" ~'~-/ /'J'/'/~"~r, '~'--~-~J~_~' '/~'¢"/{~'/~-~"/'~F'~'~-.S'
SEPTIC TANK:
DISTANCE FROM WELL_ / ~",~ / NUMBER OF
.COMPARTMENTS
LIQUID
LIQUID CAPACi]Y /~()~ GALLONS. INSIDE LENGTH INSIDE WIDTH. DEPTH
SEEPAGE SYSTEM; SEEPAGE PIT:
NUMBER OF PITS___~7.-~- OUTSIDE. DIA~METER_ OR WIDFH , LENGTH__ __~DEPTH_
'~- w
LINING M/A~RI A L __ D IS~J'ANC]~_E~_F ROM ELL_ ~ ~.~J~ - NDATION__
TILE DRAIN FIELD:
' %
O'BTANCE P~O~ WEL, /~ ' FOUND^T,ON ~2' NEAREBT LO~ L~NE ~/O S TOTAL LENGm XCOd~ '
· , OF LINES '
NUMBER OF LINES _~? .DISTANCE BEIWEEN LINES_._ /'~" TRENCH WIDTH ¢~' IN. TOTAL EFFECTIVE
A,SORPT,ONAREA VZ / SQ. PT. LENOTH OPEACHL,NE .....
DEPTH: TOP O~ T,LE TO E,~,SH GRADE ('~ ~ DEPTH OP F,LTER MATER,AL ~ENEATH ~.~LE & *N. ABOVE T,LE ~
WELL: TYPE~l~ J J~'b DEPTH ,~ / DISTANCE FROM / ) WATER
BUILDING FOUNDAIION ~'~ NEAREST
, . ......... SAMPLE j~,/~L- ,
,~ ~ NEAREST SEPTIC /.~ SEEPAGE ~ OTHER
LOT LINE ~'Z) )~ , SEWER UNE. ~ ,TANK_ , SYS~EM~ /~ , CESSPOOL_~-~ _. SOURCES
DIAGRAM OF SYSIEM
DISTANCES:
GAAB-HD-2
GREATEF
327 Eagle St.
ANCHORAGE AREA
HEAL"I'll DEPARTMENT
Anchorage, Alaska 99501
9ROUGH
279-2511
Case No, ':
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
S
SAME OF APPLICANT - /':~Z~/' '"~/-/','~..___ MAILINB ADDRESS~X / ?~ PHONE
RESIDENCE ADDRESS ~g¢ LOCATION OF INSTALLATION
LEGAl DESCRIPTION ~'/~ ~a~L~rA Z-z'/,~/e.r
....... / /,
APPLICATION TO INSTAl_L: SEPTIC TANK_ ~ ,SEEPAGEIIT __~ ,DRAIN FIELD__~ ,OTNER
TO SERVE THE FOLLOWING FACILITY. / eW. ~e~O (' ~ ~/
/ ~'_ ANTICIPATED DATE OF COMPLETION ~-- ~
PERCOLATION TEST RESULTS ' ~-~'
BELOW TO BE FIt. LED OUT BY FIEALTH DEPARTMENT
THIS IS TO SERVE AS ~- /"O/"'f/!''/' , PERMIT TO INSTALL A J~-~-~-f¢'/'- ~-'
'' ' .~' , /
AS DESCRIBED BEk0W. SIZE 0F UNITT0 BESERVED~d' ~¢.fO ~
_, SEPTI~ TANK SIZE ~eO ~TYP"~" J'~/ SEEPAGE A~EA ~0~ TYPE
DIAGRAM OF SYSTEM
PmTANCES:
LICENSED DESIGNER
I certify that I am familiar with the requb'ements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE _.4~'' / ,g' 7 / - APPLICANTS SIGNATURE __~~J ~?.~' i
GREAT!i}~ ^NCHORAGE AF, E^ BOROUG}
327 EAGLE STREET
ANCHORAGE, ALASKA 99501.
This Form Repo~ts a: S~l~'Log.~ ....... ~i'e~colat~.on rest
Depth
Fee~- Soil ChaPacteris~ics Location S~e.ch
.
Yes, At }/hat Depth
Reading Date
G~oss Time
Net Time
Depth To H20
Net Drop
ro.,,~0sea install--a zo~'Seepage-Pit Drain rte].d~
Depth Of Inlet._ '
Test Performed B}:,
Data Certified By; ~'V*~ ~/ 1 ~ I ....... ~ '