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GRID No.
MUNICIPALITY OF ANCHORAGE —SEWER UTILITY
Name.., Address
Plat No. Subd.
Residential C7 Commerial ❑
Industr'lal
❑ No. of un -its
Acct.No
Lot 9 n Block —"
CONNECT* .�
Main Tap On Property ❑ Permit No,. Size Ty p
Drawing No. Size Main �TypeDepth at Connect.
Insulation ❑ Cleanouts Type
Connect Agent Inspector Date
Comments
Connect Location
ASSESSMENTS*
L.I.D. No. Private Dev,. No.- --isubd. Agreement No; `%3ia i.5
Sewer Agreement D No. P.T.E. ❑ Roll No.
DYE TEST:
Positive El Negative O N.S.A. O Date
Page No., M.H. No. Billing Cycle
Tested B y
Comments-
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G:~:~TER ANCHORAGE AREA BORe H
HEALTH DEPARTMENT
327 E., .E ST. ANCHORAGE, ALASKA 99501
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION -~'--~'-~ '-~----~
ADDRESS _
LEGAL DESCRiPTiON /-_,~Z-"- .~C' ~ ~Tz~
PHONE __
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE.
SEPTIC TANK:
DISTANCE FROM WELl. 2.~.---.
LIQUID CAPACITV GALLONS.
SEEPAGE SVSTEM: SEEPAGE PIT:
l-c
OUTSIDE DIAMETER
NUMBER OF
__MATERIAL O,f~,~4''I ~' ~ / COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH __
~ X._5 i.5'
OR WIDTH ,
D~STANCE FROM WELL ~-- /.Z. /
E' -/~-7 /
BUILDING FOUNDATION
TOTAL EFFEC-TIVE. ABSORPTION AREA (WALL AREA) Q~'/~) C,?~J~- SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL.
NUMBER OF LINES
ABSORPTION AREA
FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
., NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
. OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE.__
WELL: TYPE ~)J~Ji--~'~-J~ DEPTH ~-~7~-~ DISTANCE FROM ' //// WATER
, , BUILDING FOUNDATION. / ~ . SAMPLE /~7'_/~) , NEAREST
LOT LINE 4 7 / NEAREST / SEPTIC f/ , . £ SEEPAGE ' OTHER
....SEWER LINE ~ TANK, D.~L~t SYSTEM ~'/~-~/~, CESSPOOL SOURCEST
DIAGRAM OF SYSTEM
DISTANCES:
/
H->~=,_5-7/
~->8=
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/
HFAITH AtJTHORITY
DATE mh W APPROVED
GREATEI _iNCHORAGE AREA . ~ROUGH Ca,eNo.
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APP,CANT~ ~ a ~ %o g~?~X MAlUNG ADDRESS :~?.~ I ~, 7~ P,0NE
RESIDENCE ADDRESS LOCATIO~ OF INSTALLATION
LEGAL DESCRIPTION Lo~ ~ C ~ ~ ~ ~.~a7 ~,~ ~,..
APPLICATION TO INSTALL: SEPTIC TANK ~)/ , SEEPAGE PIT.~ ~I~RAIN FIELD , OTHER
FINANCED THROUGH ~e L-~ TO BE INSTALLED BY ~ C
PERCOLATION TEST RESULTS. ~ ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS //"1~' ~L)C~7
AS DESCRIBED BELOW.
'76-o
· SEPTIC TANK SIZE i~.¢o
DISTANCES:
, PERMIT TO INSTALL A ~ ~,c~_
SIZE OF UNIT TO BE SERVED ~o
TYPE ff~//?~/d~-SEEPAGE AREA
DIAGRAM OF SYSTEM
Health Authority
TYPE
that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described/..~/~/~system is in acc/~dance/~-- ,,"2 with said code.