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GAAB HD I
GRr~'TER ANCHORAGE AREA BOROU~',H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LEGAL DESCRIPTION
SEPTIC TANK:
NUMBER OF
DISTANCE FROM WELL MATERIAL
LIQUID CAPACITY /~'Z~'~ GALLONS. INSIDE LENGTH iNSIDE WIDTH DEPTH____
SEEPAGE SYSTEM: SEEPAGE PiT:
NUMBER OF PITS J OUTSIDE DIAMETER OR WIDTH /~ , LENGTH ~O , DEPTH
LINING MATERIAl ~' DISTANCE FROM WELL j~J~-~¢'(' . BUILDING FOUNDATION
~"' .~J ~ SQ. FT.
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCENuMBER OF LINEsFROM WELL.y .*~.* , FOUN [1~,~, NEAREST LO . OF LINES ~.~ .
ABSORPTION AREA ~.._~ ,~' .SM. H. L~NL~,H UF'~ L,N~ i~/'~TAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WATER
SAMPLE
WELL:
DISTANCE FROM
TYPE'~/~/~/~0~'~) , DEPTH .BUILDING FOUNDATION ,
NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE . SEWER LINE .. TANK . SYSTEM . CESSPOOL , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DAlE
APPROVED// .
HEALTH AUTHORITY
GREATEF-' NCHORAGE AREA Y' ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT~'"~%,~.~/
RESIDENCE ADDRESS .-/~-r~ g)
EEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK /- , SEEPAGE PIT ~ ,DRAI~ FIELD
TO SERVE THE FOLLOWINB FAClLITY/~/~
FINANCED THROUBH /~ ~ ~
PERCOLATION TEST RESULTS ~ . ANTICIPATED DATEOF COMPLETION
I ?0 ~ BELOWTOBE FILLED OUT BY HEALTH DEPARTMENT
MAILING ADDRESS~'~X /,~"~,,,,"/~ZL/~,,~- PHONE NO.
LOCATION OF INSTALLATION ,..~2"z,.,'~
,OTHER
THIS IS TO SERVE AS ._~ ,'~/~ r~-'-/~¢'~ , PERMIT TO INSTALL A
AS
DESCRIBED
BELOW.
, SEPTIC TANK SIZE /d~ TYPE ~ SEEPAGE AREA
DIAGRAM OF SYSTEM
DISTANCES:
ify with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above de~l~ed system is in accordance with said code. ~//~/~&-d~/
~ APPLICANTS SIGNATURE
DATE /
/~GREATER ANcHoRAGE AREA BOROUGH?~
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE~ ALASKA99501
CASE
Performed For
· . I~l.~1~'~'~ ......, Date Performed..
Legal Descrzptzon: ~ot ~, Block / Subdivision -~-<~/g-'~ -~
This Form Reports a: Sol-'~sLog ..~
Depth
Feet
.~--
~---~
Soil Characteristics
Location Sketch
Ti
if Yes, At ~qhat
I i i
Reading Date Gross Time Net Time Depth To H20 Net Drop
ere°la'ion ~ate i"!
Proposed Instal~Seepage Pit L/ Drain Field
Depth Of Inlet ~-' I'Dep~ To Bottom Of Pit Or Trenc~
COMMENTS: /VA ,> ½ :~ 7~5" /~ ' /~ZF~,~ , '
Ce txfxed By. ~ ~