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GP~:ATER ANCHORAGE AREA BOROI'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS.
~,".,~',,'v ~ m ' ' 'O "~"r~ NUMBER of
MATERIAL
, COMPARTMENTS
INSIDE LENGTH. INSIDE WIDTH
LIQUID
DEPTH __
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
L,N,NG MATER,A O x/e' r--e'
NEAREST LOT LINE ~,~, !
-- OR WIDTH
· DISTANCE FROM WELL dj r
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH /
, , DEPTH P
, BUILDING FOUNDATION ~'~
'~ ¢ .SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ,/.~ ~ION ~NEAREST LOT ~
NUMBER OF LINES ~,..~.g't'S~ANCE BETWEEN LI-~'~'~ES '~"TI~'~NCH WIDTH M _
TOTAL LENGTH
ABSORPTION AREA.
DEPTH: TOP OF TILE TO FINISH GRADE
WELL: TYPE~,
LOT LINE
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE'
DEPTH ~
NEAREST SEPTIC
SEWER LINE ~ , TANK
IN. ABOVE TILE
DISTANCE FROM
, BUILDING FOUNDATION.__
SEEPAGE
· SYSTEM
~ WATER
· -- SAMPLE
~:~/~ CESSPOOL
NEAREST
OTHER
SOURCES__
DISTANCES:
DIAGRAM C~ SYSTEM
171
DATE
APPROVED
~HE ~LTH AUTHORITY ~
GAAB-HD-2
GREATE,
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
OROUGH
279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
PHONE NO.
LOCATION OF INSTALLATION.~
APPLICATION TO INSTALL: SEPTIC TANK"t"~ "J .~ , SEEPAGE PiT ~,DRAIN FIELD .,
OTHER
TO SERVE THE FOLLOWING FACILITY
FINAI~CED THROUGH ~ ~' TO BE INSTALLED BY. ~'~/~,
~ TEST RESULTS ANTICIPATEB BATE OF COMPLETION ~'~" ~XI' ~1~.~-~. - .
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS BESCRIBEB BELOW. SIZE O.F UNIT TO~.SERVEB ;~:~_z~ ~
· SEPTIC TANK SIZE .~,.~,~._~_.TYPE ~ SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
DISTANCES:
Ua/.t
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE ~ APPLICANTS SIGNATURE~