HomeMy WebLinkAboutALYESKA BASIN BLK 2 LT 4
GREI
:R ANCHORAGE AREA BOP""IGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~OWb ~])O.~"~.~'~1~.. MAILING ADDRESS
LOCAT,ON ~\\~/~ ~ lC i~ LEGAL DESCR,PT,oNLF
PHONE
DISTANCE
FROM WELL(~'~N~ ~f~' MANUFACTURER ~
INSIDE LENGTH INSIDE WIDTH
MATERIAL
NUMBER OF
COMPARTMENTS I .....
LIQUID DEPTH
LIQUID CAPACITYC~O(5 . GALLONS.
SEEPAGE PIT:
NUMBER OF PITS __
LINING MATERIAL
BUILDING FOUNDATION__
ADDITIONAL ABSORPTION
DIAMETER ~ OR WIDTH__
CRIB SIZE: DIAMETER__
, NEAREST LOT LINE__
LENGTH , DEPTH
DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
SQ. FT.
WELL:
TYPE ~~
BUILDING
FOUNDATION __,
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE
DEPTH
SEPTIC
, TANK __
REMARKS
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
INSTALLED BY:~)_ ~
PIPE MATERIAL:~~~
LOT SLOPE:
REMARKS:
Form No. EQ-031
DIAGRAM OF SYSTEM
DATE "t?' ;~'/ '];, ~( APPROVED
G.A.A.B.