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NAME
~ 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
Dr. Bruce KiesslingI~PHONE I ~EW
MAILING ADDRESS
DISTANCE TO: ~ell Absorption area I O~lling
Manutecturer ~ Material
Width
Liq. capacity in gallons I F HOMEMADE: Inside length
Manufacturer . / '
DISTANCE TO: Well Foundation
No, of lines Length of each line Total length of lines
Top of tile to finish grade Material beneath tile
Materials
Trench w:
Nearest lot line
inches
NO. OF BEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
inches
Length W)dth Depth PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
'r~o: Wetl Building foundation Nearest lot line
DISTANCE
.~lass Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PiPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
/
7013 (Rev. 3/78)