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GR"~.TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL :: MATERIAL ~/'J ~.¢ COMP.4RTMENTS
LIQUID CAPACITY ~ /~"-~ GALLONS. INSIDE LENGTH ~.~ __INSIDE DEPTH__
SEEPAGE SYSTEM:
NUMBER OF PIIS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
/
, DEPTH
DISTANCE FROM WELL .,BUILDING FOUNDATIO
'Y"- TOTAL EFFEETIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
/--% TOTAL LENGTH
NEAREST LOT LINE~ ~ OF LINES
:w (
//~ IDTH . __ . ~EEEEC..TP/
LENGTH OF EACH LINE_
DEPTH: TOP OF TILE.,..,/.~¢/~ ,//TO FINISH GRADE ,
WELL: TYP r - ' ,
), DEPTH BUILDING FOUNDATION. SAMPLE NEAREST
NEAREST SEPTIC SEEPAGE (._.~ OTHER
LOT LINE ~'/'C" , SEWER LINE &----' _, TANK ~ , SYSTEM '~"~' ,CESSPOOl , SOURCES __
DIAGRAM OF SYSTEM
DISTANCES:
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
DATE
APPROVED.
GREATEF ANCHORAGE AREA "9ROUGH
HEALTH DEPARTMENT
327 Eagle St.~~I ~ ~nchorage,.~ ~ ~_2~l~fAlaska 99501~ ~ _~ ~ 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTICTANK_/~' ,SEEPAGE PIT_X ,DRAIN FIELD
PERCOLATION TEST RESULTS
., OTHER
/ ,/
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
· SEPTIC TANK SIZE
, PERMIT TO INSTALL A -,~Z''.( ~.~'¢ .''
AS OESCRI,EO ~ELOYV. S~Z~ O~ U~,T TO ~ S~,V~, %%;~'/¢,,/~'~-'
.TYPE '- ¢-~ SEEPAGE AREA
DISTANCES:
I ify that I am familiar with the requh'ements of Greater Anchorage Area Borough Ordh~o. 28-~8 an e
above described system is in accordance with said code ' ' "'
DATE /~7- APPLICANTS SIGNATURE