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QGREAII:R ANCHORAGE AREA BORGuGH
Department of Environmental Quality
:3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
'~-~, '(~7-~ J~AILING ADDRESS
NAME
LOCATION ' ~-~J'~ ~'---~"Z.~ c~.'~ , LEGAL DESCRIPTION
DISTANCE ~,,.~.
FROU WELL __ MANUFACTURER ~ MATERIAL
NUMBER OF
COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
I IQUID CAPACITY I~-C~ 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)
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST NEAREST
LOT LINE SEWER LINE
OTHER SOURCES
DISAPPROVED REMARKS
DEPTH
SEPTIC
TANK
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL=.
LOT SLOPE:
REMARKS:~
Fo~m No. EQ-O31
DIAGRAM OF SYSTEM
DATE
GREATER ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
OTHER
FINANCED THROUGH
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
NK SIZE ~0"~ TYPE SEEPAGE AREA SIZE TYPE
WATER MAIN TO SEPTIC TANK * REEPAGE PIT
4 INCH DIAMETER CART IRON SIPHON PIPER ON SEPTIC TANK AND SEEPAGE PIT
DIAGRAM OF' SYSTEM
,I
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER A~HORAGE AREA BOROUGH ORDINANCE NO. 2R.RR AND THAT THE ABOVE
DATE /'-- / / ARPL'CANT.,IG.AT
' ANCHORAGE:. ALASKA 99502
· :"N";~'47~"'"'"' <'~'~" der No ----"~'i- g;ate'-
,~ame ___1 YLL.
CUSTOMER COPY
Address ................
DESCRIPTION
AMOUNT
' ' AMOUNT
TOTAL
ALL Claims and returned goods~UST be accompanied by this bill
A 54.92 .Rec'd b.y