HomeMy WebLinkAboutPEG LT 20AQGRF
ANCHORAGE AREA BO"'
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~-~ .~r~ CE MAILING ADDRESS PHONE
LEGAL DESCRIPTION ~._/)~?~ ~_~.~
LOCATION
SEPTIC TANK:
DISTANCE
FROM WELL
MANUFACTURER
MATERIAL~--ONCR~
NUMBER OF
COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPACITY I00~) GALLONS.
SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
BUILDING FOUNDATION
ADDITIONAL ABSORPTION
DIAMETER /22,
. OR WIDTH Ctl',
CRIB SIZE: DIAMETER
NEAREST LOT LINE.
LENGTH~0', DEPTH .~TM
DEPTH ~' DISTANCE FROM: WELL ]/'/0'
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~b SQ. FT.
WELL:
TypE ~'~ i~ I L/.. ~-"1~
BUILDING
FOUNDATION
CESSPOOl
APPROVED
CONSTRUCTION
DEPTH
NEAREST NEAREST
LOT LINE , SEWER LINE
DISTANCE FROM:
, OTHER SOURCES
DISAPPROVED REMARKS
SEPTIC ~ SEEPAGE
TANK I1'~0___0 ' SYSTEM //901
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS: ~'~ALLO~)
Form No. LQ-031
DATE ~
G.A.A.B.