HomeMy WebLinkAboutEVENSON Block 4
GRE[ 'ER ANCHORAGE AREA BOI
O Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
'JGH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ,, ~ ..
FROM WEL~ MANUFACTURER /~/X~J~ ~
INSIDE LENGTH INSIDE WIDTH
%. NUMBER OF
MATERIAL COMPARTMENTS '~"
LIQUID DEPTH LIQUID CAPACITY / " GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER __
LINING MATERIAL~-~:~,~-~' CRIB SIZE:
BUILDING FOUNDATION I NEAREST LOT LINE
OR WIDTH ~
DIAMETER
ADDITIONAL ABSORPTION
LENGTH ("~,(DEPTH C~ !
ABSORPTION AREA (WALL AREA) ~7/'~-~I~ {j SQ. FT.
WELL:
TYPE ~"~'-{I~ ¢-J
BUILDING~
FOUNDATION
CONSTRUCTION
NEAREST
LOT LINE
NEAREST
SEWER LINE
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK __ SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:(--~ C'~:'~r~t L(~
LOT SLOPE:
REMARKS:
Form NO.
REMARKS
DIAGRAM OF SYSTEM
DATE '-~" C. "1 ¢' APPROV ED
G.A.A.B.
GREATER ANCHORAGE: AREA BOROUGH
TELEPHONE: 274-4561
SEWAGE DISPOSAL SYSTEM
INSTALLATION LOCATION
INSTALLATION OF: SEPTIC TANK / SEEPAGE PI3'--__ _ ~d"'* ., DRAIN FIEL['~ ..... OTHL'R .
TYPE ANDSiZE OF.~'ACiL]TY TO BE SERVED ~ ~_~ ~ ............. 5Z~_G~~
~,~ ~,~o,~~_~ ~ ~ ............. ~o ~ ,~ ,~ .... ~ ~
MINIMUM DIS"~'ANCES, REQUIREMENTS ~ ] IEI~AGRAM OF SYSTEM
:L.O~ ,.
WELL '1'O SEPTIC TANK .... lO0 ~ [ OO~
........ SEEPAGE PiT ........
~EP',',C qANK. ~ O ~2E~E PIT .............. DRAIN ~,~,.D ....
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
G~AVEL ll]/~(~K FI LL
(~.ONFOrqM TO ~OROUGH ~EGULATIONS REGAR[31NG iNSTALLATION.