HomeMy WebLinkAboutEARL RAY BLK 3 LT 33 REM051 i13
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Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME (-~/¢~4
LOCATION
PHONE
SEPTIC TANK:
DISTANCE
FROM WELt
INSIDE LENGTH
-, / NUMBER OE %
INSIDE WIDTH LIQUID DEPTH I_IQUID CAPACITY~&~0~?~'~ GALLONS,
SEEPAGE PIT:
NUMBER OF PITS I DIAMETER
BUILDING FOUNDATION__
OR WIDTH /~)~
DIAMETER__
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 SOU RCES
APPROVED DISAPPROVED REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK __ SYSTEM
DISTANCES:
INSTALLED BY:
/
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. EQ-031
DIAGRAM OF SYSTEM
DATE
/~G.A,A.B.