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GRE'~,ER ANCHORAGE AREA BO:TUGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAT,ON~"~C~Y,~'~'~.~-~ ~.(,'~!~ LEG^LDESCR,PTION L~ 13
DISTANCE I i
INSIDE LENGTH ~ INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS
I.IQUID CAPACITY ~.r30
GALLONS.
SEEPAGE PIT:
NUMBER O~
LINING MATERIAL
BUILDING FOUNDATION
ADDITIONAL ABSORPTION
AREA)
WELL,'
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
RUCTION__ DEPTH / DISTANCE FROM:
NEAREST SEPTIC ~SEEPAGE
OTHER SOUR~E~C , SEWER LINE ~ ~.TANK / ; SYSTEM·
DISAPPROVED REMARKS
D ISTA N C ES: C~)LO"~'~
LOT SLOPE:
REMARKS:
Fo~m No. EQ-031
DIAGRAM OF SYSTEM
DATE b-
G.A.A.B,
GRr'~T~'R ANCHOR~G~* AR£A BOR~)UGH
-.~
SEWAGE DISPOSAL'SYSTEM -- APPLICATION AND PERMIT
PERM IT NO.
COMPLETION DATE ANTICIPATED
FINAL INSPECTION:.Z4 HOUR~NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION,
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