HomeMy WebLinkAboutKIRK LT 3l:
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~¢~¥$~/~ ~ ~¢¢&£Oi~ MAILING ADDRESS 94~ Spv~ ~A, PHONE
LEGAL D ESC R I PT I O ~~'-~J~'~ ~'~'~' :~:
LOCATION H,
SEPTIC TANK:
DISTANCE
FROM WELl
INSIDE LENGTH
NUMBER OF
INSIDE WIDTH .LIQUID DEPTH LIQUID CAPACITY I~00 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS
DIAMETER --
OR WIDTH ]'~' ,
LINING MATERIAL
CRIB SIZE: DIAMETER__
BUILDING FOUNDATION '~-~¢, NEAREST LOT LINE
ADDITIONAL ABSORPTION
TYPE CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION -- LOT LINE SEWER LINE
CESSPOOL. OTHER SOURCES
APPROVED DISAPPROVED REMARKS
LENGTH ~/'/, DEPTH
.DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~O~-
SQ. ft,
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK __ SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
Form No. EQ.031
DIAGRAM OF SYSTEM
DATE
App ROV ED ~/~, ~--g~
~//G.A.A.~.