HomeMy WebLinkAboutT15N R1W SEC 30 LT 22
GRF ANCHORAGE AREA BO'
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~r~;l~. iS 0~'4~ C.T/~.~ t'~J~y LEGAL OESCRIPTION~0~- ZT. ~c~ ~0 ~"IS'~ ~ J(4J ~'j~
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
INSIDE WIDTH
MATERIAt ~1 C ~"~ J'C~
NUMBER OF
COMPARTMENTS
LIQUID DEPTH
LIQUID CAPACITY J~.~-O GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER ~:~! ORWlDTH~~'/'', LENGTH~/'~/,'f DEPTH
LINING MATERIAL ~1(.~ f-~. CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDING FOUNDATION ~S'l, NEAREST LOT LINE__ ABSORPTION AREA (WALL AREA) ~-7 ~' SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE I C CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION_ LOT LINE SEWER LINE TANK __ SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
DIAGRAM OF SYSTEM~/~
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
Form No, EQ-O31
DATE
APPrOVeD
LA.A.B,
~'~-'&~TER ANCHORAGE AREA BOR~'~,H HEALTH DEPARTMENT '
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
·
SEPTIC TANK:
DISTANCE FROM WELL 2(~(0.~ MATERIA(
LIQUID CAPACITY ~/'~'~;~ ~ALLONS.
MAILING
ADDRESS ~"?,.~ ~:~,,K.~??/~ r-'~,,~'/~'~//~.,,~''' PHONE~-~
DESCRIPTION ~~,~.
NUMBER OF /
LIQUID
INSIDE LENGTH /INSIDE WIDTH. ~ .DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
-- OR WIDTH /'~
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH /.~ w DEPTH
BUILDING FOUNDATION
~'Z ~) SQ. FT.
TILE DRAIN FIELD:
NUMBER OF LINES TRENCH WIDTH
ABSORPTION ARE~/ SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
, OF LINE .
~OIAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL:
Typ E/~-',~//~c/~' , DEPTH
-- NEAREST
LOT LINE . SEWER LINE
· -- DISTANCE FROM WATER
, BUILDING FOUNDATION -~-~'~'~ / SAMPLE /~/~'~?. , NEAREST
SEPTIC SEEPAGE OTHER
· TANK ~r~c~) / , SYSTEM ~.~)~ 7' . CESSPOOL ~ , SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
HEALTH O~.FAv , g,x I '~
327 ~d~
ANCHORAGE, ALA!t~:A .......
Deoth , . Location
The s~, ~,~c'. t~
Was G~ound Water gncountered?~.~-
,~ ~_es~ At What Depth ......
Reading
Date Gross Time Ne't T~tr~e Depth To H2o
Net Drop
Drain Field
.- ~-~'% .... a.~ v~.,:~.~ , ~" p-+ Or '~'~enc~~ /0
Test p~rformed Bv: ~FCC r~ .......