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GRE.A R ANCHORAGE AREA BORr-:!GH
Department ;~3Eon~ir_c~rn:~ntal Quality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
MAILING ADDRESS 90 /'l/gg'~R-TOld ~'X,
LEGAL DESCRIPTION ~0"]~L I~~-
PHONE
SEPTIC TANK:
DISTANCE
FROM WELL t021
INSIDE LENGTH
MANUFACTURER
MATERIAl. ~'~c"-'~'¢v~1-~ NUMBER OF
COMPARTMENTS
INSIDE WIDTH
LIQUID DEPTH __
LIQUID CAPACITY. I OD0 GALLONS.
SEEPAGE Pit:
NUMBER OF PITS __
LINING MATERIAl
,
DIAMETER ~0 OR WIDTH I~l LENGTH /~', DEPTH
~0~C¥~T~. CRIB SIZE: DIAMETER t~ DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE ABSORPTION AREA (WALL AREA) ~ SQ. FT.
BUILDING FOUNDATION__
ADDITIONAL ABSORPTION
WELL:
(_, CONSTRiCT,ON
TYPe
BUILDING
FOUNDATION
CESSPOOL
APPROVED
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. EQ~031
DIAGRAM OF SYSTEM
APPROVED
DATE /¢//~/7~ )~A,B, //~ ~
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street
ANCHORAGE, ALASKA 99503
Performed For ]!~
Legal Description: Lot
This Form Reports Soils
I 9_. Block
Log.
Soil
Depth
Feet
2--
3--
6~
8~
9~
O~
4~
Test Must Be Logged To 4'
Soil Characteristics
Case #
Dated Performed 1~-1-75
Subdivision~
Percolation Test
Below Proposed Seepage System
Was Ground Water Encountered?HO
If Yes, At What Depth?
Reading Date Gross Time Net Time Depth to H20 Net Drop
_
Percolation Rate Minute
Proposed Installation: Seepage Pit Drain Field
Depth of Inlet Depth to Bottom of Pit Or Trench
;OMMENTS: ·
Performed
BY
~ Date Certified BY:
Date: