HomeMy WebLinkAboutRAYMOND TEDROW BLK 3 LT 24
GP"~.TER ANCHORAGE AREA BOROu'~H
HEALTH DEPARTMENT
327 ~:AGL~: ST. ANCHORAGE, ALASKA 99501 279-2511
N? 514
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS.
- B:, NUMBER OF
MATERIAL ~0 J(/~'~ ~'~ ~' COMPARTMENTS
.~, ~,'
INSIDE LENGTH ' INSIDE WIDTH ~'-~ '~'- /
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MAIERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH 7~/ ~ LENGTH
, , DEPTH_ /'~' /
DISTANCE FROM WELL BUILDING FOUNDATION____
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
E~ TOTAL LENGTH
DISTANC ROM WELL FOUNDATION ., NEAREST LOT LINE OF LINES
DEPTH: TO~-OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
4'"//~ ' DISTANCE FROM ,/TV I WATER
WELL: TYPE '~'/'~r (.. DEPTH , BUILDING FOUNDATION SAMPLE , NEAREST
~.~1 NEAREST SEPTIC /~.~1 SEEPAGE /~O ' /,,~/ OTHER
LOT LINE ' , SEWER LINE , TANK , SYSTEM , CESSPOOL , SOURCES__~
DISTANCES:
DATE
DIAGRAM OF SYSTEM
/t~EATER ANC!-IOP~.GE APf2A BOROUGH
!!EAL~I DEP/~RTb~NT
327 EAGLE STREET
t~NCHORAGE, ALASKA 99501.
279.-2511
DATE RECEIVED
INSPECT:
REQUEST FOR APPROVAL OF
INDIVIDIIAI, SELVAGE AND WATER FACILITIES
FOR
Approval Requested By~/~k~4g~X~ ~}%0 4~. ~~...
Address ~ff~" ~Z/¢ fi' ~~
2. Property Owner .~/~/J/Z44/[_t'-~ Phone
5, Well Data:
B, Depth
C, Size
D, Construction
E. Bacterial Analysis
Sewage Disposal System:
A.
Septic Tank (If homemade, show diagram on back)
1. Size.. __~__~,~
3. ~4anu£acturer
4, Installer