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GREAYE�IANCHORAGE AREA BORQUl Sr;'
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
_ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAMEI-IV110LA<YIUK MAILING ADDRESS bel IL'L' � tw. 4 rk "Julf PHONE
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LOCATION de'(S CCK LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE
FROM WELL ZOO
INSIDE LENGTH_
JFK S+�L. NUMBER OF
MANUFACTURER MATERIAL S40 -L_ COMPARTMENTS_
WIDTH LIQUID DEPTH I IQUID CAPACITY ldoz) GALLONS.
SEEPAGE PIT:4L¢-�6i346
NUMBER OF PITS ' DIAMETER WOR WIDTH (Bi , LENGTH IS , DEPTH �1 ,
LINING MATERIAL CG CRIB SIZE: DIAMETER-LDEPTH-LDISTANCE FROM: WELL
_SL_
& TOTAL EFFECTIVE 39�
BUILDING FOUNDATION (00, NEAREST LOT LINE . ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
WELL: f .
TYPE ' CONSTRUCTION
BUILDING NEAREST
FOUNDATION -,LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
DISTANCES:
DEPTH
DISTANCE FROM:
NEAREST SEPTIC SEEPAGE
SEWER LINE , TANK -,SYSTEM_
REMA
DIAGRAM OF SYSTEM
INSTALLED BY:
V„k
PIPE MATERIAL:
? 1
I N Or
LOT SLOPE:
1
REMARKS:
DATE 2 73
Fo,m No. EQ -031
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AS
M -W DRILLING, Inc.
P. O. Box 4-1728 • 2811 Dawson.
A C 907-279-1741
ANCIIORAGE, ALASKA 09503
DP.ILLI"IG !Q0
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Well Owner r",", "i^^ " `
-Use of Wcli___
Location (address of: Township, Range, Section, if known; or distance main road-
Size
oad
Size of casing t nepth of 1Iole feet Cased to 1' feet
Static water level ft. (above) (below) land surface. Finish of well (check one) open end ( );
Screen ( ); Perforated ( ).
Describe screen or perforation
Well pumping test at gallons per (hour) (minute) for hours with - '' ft.
of drawdown from static level.
Date of completion -
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
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