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72-013 (ReA)3/78) ( I
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MUNICIPALITY OF ANCHORAGE
®
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING
DIVISION
825 L Street - Anchorage, Alaska 99501
Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR
WELL INSPECTION REPORT
NAME
PHONE
EW
16 31T
❑ UPGRADE
MAILING AD RE$Fj
LEGAL DESCRIPTION
1/ S /4
L
LOCATION
NO. � FBEDRO i MS
0 c
G V
lCf 7
Well
Absorption @rea
Dwelling
PERMIT NO.
DISTANCE TO:
UY
a Q
Manufacturer
Material
No. of compartments
wl
CA)
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
0 Y
DISTANCE TO:
Well - �� d
-�
Dwelling
PERMIT NO� ®�
1
jaz
1
O Z <
Manufacturer
Mate ri
Liquid capacyty 'n gall ns
(�
0
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO.
w=
J LL Z
No. of lines
Length of each line
Total length of lines
Trench width
Distance between lines
FZw
�
inches
Top tile to finish
Material beneath
Total
F
of grade
tile
effective absorption area
0
inches
_
Length - -
Width _
Depth
_
_ -
PERMIT NO.
w
C7
Q H
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w°
Lu
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
c
PIPE MATERIALS
SOI L TEST RATING
f
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Q
REMARKS
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APF?ED
DATE LEGAL
7 -No(
( rI
1f-1
72-013 (ReA)3/78) ( I
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X6
R
' I, AUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME jPHONE
P Cz i,l A R 1 � 1� U 1- D C- RS
�L� c�"15,51
5(NEW
1-1 UPGRADE
MAI LING ADDRESS �c
ALMKA �STLA� �LO l� /S' 5f. &1,11 DAAgp K J�J�.3
LEGAL DESCRIPTION )4TR R CT j � %� 1�I I G ��; Lt t3 D
LOCATION
-7
NO. OF BEDROOMS NA
DISTANCE TO:
Well
Absorption area
Dwelling
PERMIT NO.
VY
CL ZQ
Manufacturer
Material
No. of compartments
wF
Cn
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
z
DISTANCE TO:
Well
pReQaslF'--(%0
Dwelling
g �f'(1 F✓a :ti �Ya�1u} i 17;/d'r
PERMIT NO.. o .y
% ��%J
C7
= z F
Manufacturer G R TE E T / ��
Material
r� L
Liquid capacity in gallons
.S
-2-000
❑
w=
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO.
LL z
No. of lines
Length of each line
Total length of lines
Trench width
Distance between lines
P:Zw
inches
ccF.
Top of tile to finish grade
Material beneath tile
Total effective absorption area
❑inches
-
Length -
Width
Depth - -
PERMIT NO:
w
C7
a F
w °L
Type of crib
Crib diameter
Crib depth
Total effective absorption area
Lu
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
TK
j 3
iG
i'
REMARKS
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APPROVED V�'� DAT/LEGAL
8E.�(,/
72-013 (Rev. 3/78)