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C'~.ATER ANCHORAGE AREA BORC"GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511
N? 135
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION .~'.,.:e~/~ ..,,z,,/k~._ _ 5'2 ,'
SEPTIC TANK:
MAILING ·
.ADDRE~//--_,)~fl~,..~,~",,~_.~''~(~.~'''~5,, ~, ~' PHONE
LEGAL DESCRIPTION~
D,STANCE EROM WELL'
LIQUID CAPACITY r/'~2~ ~'?'), GALLONS.
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE_
NUMBER OF
MATERIAL '--9~,,'~ - "'~'~"-' COMPARTMENTS
INSIDE LENGTH. / INSIDE WIDTH
LIQUID
DEPTH
OUTSIDE DIAMETER / OR WIDTH"~,. LENGTH~'//.~ , DEPTH
DISTANCE FROM WELL /0 ,~ , BUILDING FOUNDATION ~ /
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA}
TILE DRAIN FIELD:
DIS'rANCE FROM WELL_ , ~---~'/~~ATION.
t~ .~¢~) SQ. FT.
~ TOTAL LENGTH
, NEAREST~, OF LINES
IN. TOTAL EF.~FECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
.IN. ABOVE TILE__
WELL: TYPE ~/'2~/4'*,~?~ DEPTH /~"/~('~') DISTANCE FROM ~ '. WATER
, __ , BUILDING FOUNDATION~~SAMPLE
NEAREST ~SEPTIC ~' / SEEPAGE /~ t
LOT LINE /~ ~ ~ . SEWER LINE ,~ANK , SYSTEM . , CESSPOOL
DIAGRAM OF SYSTEM
DISTANCES:
OTHER
, SOURCES
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GAAB-HD-2
GREATE!
327 Eagle St.
ANCHORAGE AREA
HEALTIt DEPARTMENT
Anchorage, Alaska 99501
OROUGH
279-2511
Case No.~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT?~-~a / >/'d
RESIDENCE ADDRESS
LOCATION OF INSTAELATION_
, SEEPAGE PIT_ //'// .,DI]AIN FIELD
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK_: ,OTHER
TOSERVET.EFOLLOWIN~ FAC~UT¥ - ~
PERCOLATION TEST RESULTS ,~&~ ~ ANTICIPATED DATEOF COMPLETION
BELOW T0 BE FILLED OUT BY HEALTH DEPARTMENT
THIS 'S TO SERVE AS_~" ~~ ,PERM,T TO .NSTALLA -~'~'~ ~'~ ~" // ,, ,
' ~ ~ DIAGRAM OF
DISTANCES:
I certify that I am familiar with the requ~'ements o: Greater Anchorage Area Borough Ordnance No. 28-68 and
above described system is in accordance with saki code.
'REATER ANCRORAGE AREA BOROUGH
ltEALTtt DEPART~ENT CASE
327 EAGLE STREET
· ANCHORAGE, ALASKA' 99501 ~
Depth
Soil Characteristics
if Yes~ At What Depth
LULi
Location Sketch
~_~eadzng [ Date Gross Time Net T'ime t Depth To HpO I Net Drop
Proposed Instal~~eepaga Pit ~ DPain Field
Depth~ Of Inlet__ Dep~~~],~ Or Trench
Data Certified ~y: