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GR~ 'ER ANCHORAGE AREA BOROU
DEP~RTMENT OF ENVIRONMENTAL QUALIT~
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-86R6
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION ..s"'.,'~"'/~,,r--".~-2--' ,,/=~"',~/.,~'~.
SEPTIC TANK:
MAILING
ADDRESS
LEGAL DESCRIPTION
DISTANCE FROM WELL
LIQUID CAPACITY //~----~'~/~
.GALLONS.
MATERIAL J~"~z~--~ NUMBER OF
COMPARTMENTS ~
INSIDE LENGTH ~ INSIDE WIDTH ~ LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS // __OUTSIDE DIAMETER ~ OR WIDTH ~--~- /LENGTH ~ ~ /, DEPTH .~'
LINING MATERIAL -/~')~ ~'-~/~ -- . DISTANCE FROM WELL ~7'~L-~'~'
., BUILDING FOUNDATION
NEAREST LOT LINE /~ ~' TOTAL. EFFECTIVE ABSORPTION AREA (WALL AREA) c::~c:~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL__ FOUNDATION. NEAREST LOT LINE
NUMBER OF LINES~~~'D STANCE BETWEEN LINES ~ TRENCH WIDTH
ABSORPT~d~ SQ. FT. LENGTH OF EACH LINE. ~~//~
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAl_ BENEATH TILE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
.IN. ABOVE TILE
WELL:
TY P E ~-~'--/~/~ DEPTH
NEAREST SEPTIC
LOT LINE '"'""- ~
SEWER LINE , TANK
DISTANCE FROM ~ WATER
, BUILDING FOUNDATION. SAMPLE
~ SEEPAGE
, SYSTEM .... ~"-~ , CESSPOOL
NEAREST
OTHER
, SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
- / [ ,' G.A.A.B.
GrEah ER ANCHORAGE AREA BOROUGh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-65~0
ANCHORAGE, ALASKA 995102
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM M APPLICATION AND PERMIT
NAME OF APPLICANT /~ MAILING ADDRESS
,NSTALLaT,ON LOCATION 'C
INSTALLATION Of: SEPTIC TANK f~ SEEPAGE PIT /~ . , DRAIN FIELD OTHER
SOil TEST RESULTS NOTE: ~HIS PERMIT IS NOT VALID WITHOUT SOI~ TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT 'AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TaNK SIZE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK~
fOUNDatiON TO SEEPage Pit
SEPTIC Tank tO SEEPage Pit WALL
SEPTIC TANK
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
DIAGRAM OF SYSTEM
DRAIN FielD
,, SEEPAGE PIT . DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, ~ SEEPAGE Pit
TO RIVER, LAKE STREAM.
SEEPAGE PIT
, DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 feet INTO UNDISTURbeD SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FitteD WITH Airtight REMOVABLe CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
/ HEALTH AUTHORITY
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH OrDiNANCE NO. 28-68 AND That THE ABOVE
DATE ~~ &/~7/APPLICANT'S SIGNATURE