HomeMy WebLinkAboutDELUCIA LT 33 051
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GRE/ ANCHORAGE AREA BORC"'H
Q Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
PHONE
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
MATERIAL
NUMBER OF
COMPARTMENTS
LIQUID DEPTH_
.LIQUID CAPACITY /~'~/~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER 4~' OR WIDTH /2'
LINING MATERIAL [4~'~/z~'~;:']'~ CRIB SIZE: DIAMETER
BUILDING FOUNDATION__, NEAREST LOT LINE ~/
ADDITIONAL ABSORPTION
LENGTH/~-, DEPTH ~/~
,DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~
SQ. FT.
TYPE CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION--, LOT LINE SEWER LINE
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DEPTH
SEPTIC
, TANK .
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No, EQ-031
DIAGRAM OF SYSTEM
DAT~ :*l'~! //, /(¢7'CD
jj, '/
APPROVED ?~{~ /(, i
.//G.A.A.B.