HomeMy WebLinkAboutMCKINLEY HEIGHTS #1 BLK 3 LT 10
GR ,' ANCHORAGE AREA BC H
O Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING ADDRESS
LEGAL DESCRIPTION /o¢ /~
PHONE
SEPTIC TANK:
DISTANCE r ~t- ~ NUMBER OF
FROM WELL __ MANUFACTURER
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITM J 000 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS I .
LINING MATERIAL LC' ~-*
BUILDING FOUNDATION__
DIAMETER F/~/' ORWIDTH /O' /~ pi
, LENGTH DEPTH
CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE__ ABSORPTION AREA (WALL AREA)
.SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION __ LOT LINE SEWER LINE
CESSPOOL OTHER SOURCES
APPROVED . DISAPPROVED REMARKS
DEPTH
SEPTIC
TANK __
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL'
LOT SLOPE:
REMARKS:
Form No. EQ~031
DIAGRAM OF SYSTEM
DATE
APPROVE/E~], /~ ~
SEW'AGE
GREA~ ER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
D~SPOSAL SYSTE~ ,~ APPWCAY~O~ AND PERMIff
PERMIT NO.
INSTALLATION OF: SEPTIC TANK V . ~ SEEPAGE PIT___v ,, DRAIN FIELD ~
COMPLETION DATE ANTICIPATED
FINAL iNSPECTION: 24 HOUR NOTICE REQUgRED, BACI(FILLING OF ANY SYSTEM WITBOUT FINAL INSPECTION BY THE
DEPARTMEt~T OF ~=NVIRONMENTAL QUALITY AUTHORITY WiLL B~ SU~,JECT TO PROSECUTION.
FOUNDATION TO SEPTIC TANK
WEI-L TO SEPTIC TANK--
, SEEPAGE PIT~
ALSO CONSIDER AREA WELLS.
, SEEPAGE PIT
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND 'THAT THE ABOVE
DESCRISED 'YSTE iS IN ACCORDANCE WITH SAID CODE. //~
APPLIr 'NT FILLS OUT UPPER HA' *ONLY
;- ' '~ ~ .' ~ ;~i ~,- ~?, ~.T~ Phone
Property Owner (..~' ~ ['?~l ',:,' (~'~ /
Mailing Addre~ ,~ j,;,., /*., ,
/
Buyer
Address Zip Code
Phone
Lending Institution
Address Zip Code
Phone
Realty Co. & Agent
Address Zip Code
Street Locati~ (~>.~i¢.:~0 ¢ ,, [ C'':
Ty~esi~nce
~ngle Family
~ Multiple Family No. of Bedrooms_
~ Other
Water Supply
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
~ ~i~idual
~'Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer ~posal ~ ¢~ ~¢ '" ¢" ':' '
'~¢~dividual Year Individual Installed: ~
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time ~ime
Date Date Date Date
~nspecto~ Inspeotor ~nspector
( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
LJ
Soils Raling Date ~wer installed Well To Absorption A[ea Well Log Reoeived
72-023 (3/82)