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Ge~,ATER ANCHORAGE AREA BORO~'~H
~ ! HEALTH DEPARTMENT ~ ~
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
N? 649
NAME "~/--' ,,,'~"/'~,~,~J
SEPTIC TANK:
DISTANCE FROM WELL //~) -~
LIQUID CAPACITY ,/.,.~Z~ GALLONS.
MAILING
ADDRESS.,,~A/ j~.~. ~.,y/.~./.,,~s%~.~..,~.,~,,~. PHONE ,..T'/.~--~-~.
LEGAL DESCRIPTION,,'~'~'~'~/,'~'~-~ ~/~-~
NUMBER OF /
MATERIAL/'r,*:~-~- ~'~ ~'~/C-.~'~''~'~ COMPARTMENTS,
INSIDE LENGTH / INSIDE WIDTH ~ DEP/H
SEEPAGE SYSTEM: SEEPAGE PIT:
,e, / ·'
NUMBER OF PITS // OUTSIDE DIAMETER OR WIDTH
UN~NG MATER~AI ~'~,~.'/~f,-.~ ,,"~J,,."~/~"~' -'~ D~STANCE FROM WELL //,r~,-~
NEAREST LOT LINE
· TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH /~" ' , DEPTH ~'
~. BUILDING FOUNDATION
· .~"~ so. Ft.
TILE DRAIN FIELD:
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
OF LINES
,IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL:
LOT LINE
TYPE/~,~''z.z--.d-''~ DEPTH ,~d'~ /
/,,,,,~ /~,~. NEAREST SEPTIC
, SEWER LINE,"~,,~ '~'*' ,TANK
DISTANCE FROM ·~ WATER
,BUILDING FOUNDATION /,L) ~'~ SAMPLE ,,~,~ , NEAREST
//,,~.. / SEEPAGE / OTHER
. SYSTEM ,,/..~-'~'~ , CESSPOOl ,,,'e/~'~'~'- , SOURCES
DISTANCES:
7'o ~'=/,~-" /
DIAGRAM OF SYSTEM
.......... , :-:-,.- .............. . . . ,.
...... 1 '~ : ~ ; , i
DATE
GREATE? .ANCHORAGE AREA f OROUGH
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Case
NAME OF APPLICANT
RESIDENCE ADDRESS
Hildemsn, A1
Birchwood Loop LOCATION OF INSTALLATION
LEGAL DESCRIPTIO~ S. ec. No. 8 Lot 170 B~rchwood
125o A
APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT , DRAIN FIELD ~..
Four (~) Bedroom Souse
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH SELF
PERCOLATION TEST RESULTS
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
Box lo3 N~
MAILING ADDRESS '~ PRONE
H &H Nursury
Loop
, OTHER
TO BE INSTALLED BY Wallace Cons't Co.
ANTICIPATED DATE OF COMPLETION 6-1~-71
THIS IS TO SERVE AS
· SEPTIC TANK SIZE
DISTANCES:
, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
TYPE SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that thc
above described system is in accordance with said code.
DATE.
APPLICANTS SIGNATURE