HomeMy WebLinkAboutWESTGATE PARK BLK 2 LT 4Lo -
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/ " '~ER ANCHORAGE AREA BOROU'~ ~'1
L .=,;~"t~RTMENT OF ENVIRONMENTAL OUALI~h,~
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING
ADDRESS
LEGAL DESCRIPTION
~ TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
NUMBER OF
oJ ~-'~-~-'~ MATERIAL COMPARTMENTS J
LIQUID
GALLONS. INSIDE LENGTH ~ INSIDE WIDTH. ~-- DEPTH __
SEEPAGE SYSTEM: SEEPAGE PIT:
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTA CE FROM WELl
NUMB OF LINES
A SO i /
DEPTH: TOP OF TILE TO FINISH GRADE
// ES ,.~ENCH WIDTH X~_~ I~TAL EFFECTIVE
S(~ FL
DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL:
TYPE ~-~ ~ ·
LOT LINE "./- ~ O
DISTANCE FROM WATER
b,J'~'~'~,9..DEPTH. -,BUILDING FOUNDATION _SAMPLE , NEAREST
NEAREST SEPTIC SEEPAGE OTHER
, SEWER LINE _, TANK , SYSTE/~_ , CESSPOOL , SOURCES __
DISTANCES:
DIAGRAM OF SYSTEM
/ ! ' G.A.A.B.
Gl':, ,,~.-,~R ANCHORAGE AREA BOR'~UGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO,
PHONE
MINIMUM DISTANCES. "E~/~IR~ME~'~'')
FOUNDATION TO SEPTIC TA~.~._.~.....~ ~'
FOUNDATION TO SEEPAGE PIe~~ DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL ~ [ ~; ~
~5 ~ SEEPAGE PIT~DRAIN FIELD
~ TO NEAREST LOT~ ~ / / h ~ ~ CAS~Y~R~¢
4 INCH DIAMETER CAST IRON ~JPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
· (J J HEALTH AUTHORITY ~ h!l:AIk!'lU'flOlt
TYPE
DIAGRAM OF SYSTEM
CRIB
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENT~ OF GREATER ANCHORAGE /~REA BOROUGH ORDINANCE NO. ES-68 AND THAT THE ABOVE
//? 7 ?-. APP,,OANT'S .,..',T.... _
IABLE)