HomeMy WebLinkAboutFIRE LAKE LT 4 TR D
GRE
-R ANCHORAGE AREA BO
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
N A M E ~Y,.~O (~('l ~_
LOCATION
SEPTIC TANK:
DISTANCE ECI
FROM WELL
INSPECTION
~o,o M^,L,NG ADDRESS % ~,8. ~ ~ ~
REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
PHONE
INSIDE LENGTH
INSIDE WIDTH
~..,3 ?¢<"~'~'~. NUMBER OF ~.
COMPARTMENTS
MATERIAL
LIQUID DEPTH .LIQUID CAPACITY /t~O~) GALLONS.
SEEPAGE PIT:
NUMBER Of PITS --
LINING MATERIAL
BUILDING FOUNDATION
CRIB SIZE: DIAMETER DEPTH DISTANCE FROM~ WELL
/
TOTAL EFFECTIVE
, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) ~ SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE
BUILDING
FOUNDATION --
CESSPOOL
APPROVED
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
DEPTH
NEAREST SEPTIC ~'t.-I SEEPAGE
SEWER LINE TANKO~/ SYSTEM
REMARKS
DISTANCE FROM:
I
DISTANCES:
INSTALLED BY:
PIPE MATERIAl.'
LOT SLOPE:
Form No. EQ~031
DIAGRAM OF SYSTEM
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