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'ER ANCHORAGE AREA BO~
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
"UGH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL _ --
INSIDE LENGTH
MANUFACTURER ~d~t'~'~r-'"~ MATERIAl
INSIDE WIDTH__ LI(~UID DEPTH_
NUMBER OF
COMPARTMENTS
__LIQUID CAPACITY '/~)~ GALLONS.
SEEPAGE PIT:
q
NUMBER OF PITS I DIAMETER I0~1 _OR WIDTH___, L.ENG'FI-I~--I, DEPTH
LINING MATERIAL ~i~r~//.t6~-r~: CRIB SIZE: DIAMETER ~1 DEPTH ~t_ DISTANCE FROM: WELL
BUILDING FOUNDATION.3 ~1 TOTAl_ EFFECTIVE
, NEAREST LOT LINE ~0t ABSORPTION AREA (WALl_ AREA)
.SQ. FT.
ADDITIONAL ABSORPTION
WELl_: -1'~
TYPE
13UILDING
FOUNDATION --
CESSPOOL
APPROVED
CDNSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
__ DISAPPROVED__
DEPTH DISTANCE FROMt
NEAREST SEPTIC SEEPAGE
SEWER LINE TANK SYSTEM
_REMARKS
DISTANCES:
INSTALLED BY:
PIPE MATERIAL'
LOT SLOPE:
REMARKS:
Form No, EQ-O31
DIAGRAM OF SYSTEM
(/ G.A.A.B.
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGI: DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
LE,,A~. ,:,E,OR,,'"',O'" /¢'r 7/ ~.* ?
NOTEI THIS PERMIT IS HOT VALID WITHOUT SOIL TEST
INAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
iEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL bE SUBJEET TO PROSECUTION,
WELL TO SEPT'C TANK _1~0
SEEPAGE AREA SIZE ~J~ TYPE
FI'TTED WITH Al RTIGHT REMOVAI3LE CAPS,
GRAVEL BACKFILL
CONFORM TO BOROUGH ~EgULATIONS REGARDING INSTALLATION,
I CERTIFY THAT [ Ahl FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ASOVE