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$RF T- K ANCHORAGE AREA BO:
~partment of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSP~,~TION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME . _~/7~ ~"~ ,~/V~'-//,
LOCATION
MAILING ADDRESS. PHONE
LEGAL DESCRIPTION
~ TANK:
NUMBER OF
DISTANCE _._.._ /
FROM WELL MANUFACTURER ..,.~.'Y,~g'-7--/~J'r~'¢~. MATERIAL ~/~:~'~//~:~ , COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH ~ LIQUID DEPTH ~ .LIQUID CAPACITY~)C)O GALLONS,
SEEPAGE PiT:
NUMBER OF PITS--~ DIAMETER OR WIDTH , LENGTH , DEPTH
LINING MATERIAL ~ DEPTH/~ FROM: WELL
~FFECTIVE
BUILDING FOUNDATION ~ABSO Rp~EA) __
ADDITIONAL ABSORPTION ' ~
SQ. FT,
WELL: /~///~ '
~~TON'S~4AJJ CT, O N DEPTH/ DISTANCE FROM:
BUILDING N C SEEPAGE
FOUNDATION -- LOT LINE , SEWER LINE~.~ TANK SYSTEM_
CESSPOOL OTHER SOURCES ~
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY: ~F'
PIPE MATERIAL: /.A~/<~-~. ~'
LOT SLOPE:
REMARKS: ~'~/t/X-
Form No. EQ-031
DIAGRAM OF SYSTEM
DATE
APPROVED
G.A,A.B.
~qarch 15, 1913
One i..~aldec Circle
Anci~oracj~ ~1 ~ ~' · 99[i04
Subject: ?~i>'l ic
i)i
. . · '. bull<in<
,.~ ' ~}FFice,
you h~x'~? ~.,y ~u~s~io~s~ please
si ncerely,
Si~ni cari,~n I