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GPrATER ANCHORAGE AREA BOROUf-~H
HEALTH OEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ~'~.~m ~)
NAME ~//~,/~x.~'.~c' ,.~'~,.~) ~z:,U ¢~- ~-~; ~-, A D D RE S S ~-'5;,<' _~: ~ ,..//-~./(,.~, ,'~-.:_.~,~_ ~ PHONE~
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SEPTIC TANK:
DIS~'^NCE EROM WELL
LIQUID CAPACITY__ .~"~.
.MATERIAL
?
NUMBER
OF
COMPARTMENTS
GALLONS. INSIDE LENGTHen__INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS___ __OUTSIDE DIAMETER OR WIDTH__
LiNiNG MATERIAL ,,~- .c:) ~4"=.j'" DISTANCE FROM WELL ~-~ /
NEAREST LOT LINE ~ /
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH ,-/'~' /, DEPTH
., BUILDING FOUNDATION
TILE DRAIN FIELD:
.//"~-~) TOTAL LENGTH
DISTANCE FROM WELL / , FOUNDATION_ , NEAREST LOT LINE! , OF LINES
ABS EA SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILB TC) FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TIL~
IN. ABOVE TILE
DISTANCE FROM · ~ WATER
WELL: TYPE/~,~.~/~.~.~':-='~'~') , DEPTH ,BUILDING FOUNDATION /'~ SAMPLE-"~'~"~ , NEAREST
NEAREST SEPTIC / ~ /
LOT LINE .~J · ~ , SEWER LINE __,TANK ~[~-~ SEEPAGE OTHER __ .
. ~ , SYSTEM , CESSPOOL '~-- , SOURCES
C,...'C-/~,'~ ~,';';';';';"~7- ~""~'"-.,~..~/4-~'~-7~----~/~-//-'~ DIAGRAM OE SYSTEM
DISTANCES:
GREATE'
327 Eagle St.
ANCHORAGE AREA
tIEALTH DEPARTMENT
Anchorage, Alaska 99501
279-2,511
SEWAGE DISPOSAL SYSTEM - APPLICA?ION & PERMIT
APPLICATION TO INSTALL: SEPTIC TANK_
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH SO .L- lC'
PERCOLATION TEST RESULTS
I. EGAL DESCRIPTION. ~C)'F ~)~, ~/'z) LI~- I -F~AX~, ~, ~S' ~ , SEEPAGE PiT_ , D~AIN FIELD , OTHE~
A~TmmATE~ ~ATE OF CO~LETmU~ ::~ :~:'~d~
BELOW TO BE FILLED OUT BY HEALTH DEPAR'rMENT
THIS IS '1'0 SERVE AS-- ~J~' /~ ~-? U(9 ~'- , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
DIAGRAM OF SYSTEM
DISTANCES:
TYPE
hLTH AUTHORITY
! certify that ~ am familiar with ~he requirements of G~m~c~%Area
above described system is ill accordance with said code. ~-'~Z~--z~
.- .~f,
'/ /
i]REATER ANCHORAGE AREA BOROUGH
ItEALTIi DEPARTMENT
32'7 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE
r,~,o, al Descrip~.on; Lot Z6 Block~ . o~on '~&~a~,~,~
This Form Reports a: SeLls Log ~/ ~ercola~~ ~
Reading
2Z-_71
Ii: Yes, At !,lhat Depth ............
Date
Gross Time
,
Location Sketch
Net Drop
P~oDoged ~ '-~'~" ~T~.~'
. Inotaliat~on, Seepage Pit / [)rain Field
Depth Of inlet ~ / ~ ~ '
Test Performed '~_~ t
Date :~' :~""'~~
~--~71.~ ........