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Department of Environmental Quality
333OCStreet
Anchorage, Alaska SS5O3
INSPECTION REPORT ON-SITE SEWAPE DISPOSAL SYSTEi%--
MAILING ADDRESS
LOCATION LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE NUMBER OF
FROM WELL /0-9 MANUFACTURER MATERIAL COMPARTMENTS
INSIDE LENGTH— INSIDE vv|DT*_______UQU/oDEPTH_____L|QU|DCAPACITY GALLONS.
SEEPAGE
mUxxoERorp|Ts_---__. DIAMETER —CR w|oTH—. LEwaT*__-. DEPTH .
LINING MATERIAL -_____--__CRIB SIZE: 0AMETER___DEPTH___-DISTANCE FROM:
TOTAL EFFECTIVE
8u|U]|NG FDUmoAT0m__-_. NEAREST LOT umE___-_ . ABSORPTION AREA (WALL AREA)
ADDITIONAL ABSORPTION
WELL: <�
TYPE cOmsTnucr0m
BUILDING NEAREST mE*ncsT
pOUmDAT|ON_____. LOTUmE______. SEWEnUmE
CESSPOOL
APPROVED
, OTHER SOURCES
D|SAPPnOvED________'nEMAR
PIPE MATERIAL:C�'
LOT SLOPE:
_�44
/
WELL ' / �
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DY� SO. FT.
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE (
.
TANK 105 . SYSTEM_6y)
DIAGRAM OFSYSTEM
APPROVED
6.a�B.
GREAT -..-R CHORAGE AREA BORC Gh
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
3330 "C" STREET ANCHORAGE, ALASKA 99503
uuu '71 7 TELEPI-Vl)NE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT
INSTALLATION LOCATION
I
LEGAL DESCRIPTION z— 1.3
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
MAILING ADDR
SEEPAGE PIT
PHONE
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS NOTE. THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
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,
SEPTIC TANK
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT- DRAIN 4q
SEPTIC TANK TO 4114L�ta' WALL 14�17
SEPTIC TANK SEEPAGE PIT -. DRAIN F4Q4�D
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK SEEPAGE PIT - /42 42
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEEPAGE PIT
SEPTIC TANK, /2 0 (, SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE, STREAM.
3 4')
AREA SIZE F TYPE
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH R ULATIONS REGARDING INSTALLATIOM
G.A.A.B.
OR
LICENSED DESIGNER
-rD"IAIR�C OF
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIB D SYSTEM IS IN ACCORDANCE WITH SAID CODE.
, 4
Z " 2
DATE 4, —��APPLICANT'S
FQ NO. E. -01 01 16
L" , I I " (j,
Performed for
IDescription:-—
Legal
This form reports:
Depth
Feet
C---ATER ANCHORAGE AREA BOROUC
Dep-.tment of Environmental Quai,ty
3330 "C" Street
Anchorage, Alaska 99503
ILS LOG - PEROLATION TEST
N -5
2
3
4
6 -
7 -
t5 t :S A,' v ro
8 -
A0
Was ground water encountered? If yes, at what depth?
Date Performed
Reading —]—Date
Gross Time
Net Time
Depthto-Wat*cr
Net Drop
Percolation rate minute.
Proposed iris Lal la!`ion7:- ---S-ee-p—age Pit Drain Field
:Jcpth of Inlet Depth to bottom of At or trench
COHNIENTS:
�qcprcl C k 0(�
Certified By._ ja e
1-."Q--040 (6/74)
LOT 14
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071 1j1 - Q ►�_ q
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IT
W:i,
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V,
-LOT SURVEY CERTIFICATION -
Lot f9f , Block
Anf)N W(23
Anchorage Recording Precinct, Alaska
?d8y: (�D1CW1NcQN-aWNLD.wkLCH-LCC
ENGINEERS ANCHORAGE, ALASKA
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E-: 0 W_ � 5lPt:= :F`4:00, el H
It is the responsibility of the owner or
builder, prior to ccnstri.2ction 'mto verify
Froposed building grade relative to f -
shed grade and utility connections and
to determine the Exisz.�nce of
f ' y ease-
ments, covenants, or restrictions w'rich
do not appear on the recorded subdivi-
sion plat.
MAMAMI
Q Bross Cop Monument
0 Iron Pipe
0 Steel Pin
a Survey Hub 8 Tack
M M�Mw_
M MIM
11MM. ZM MUMENIMU, -alumina
E
M -W DRILLING, Inc.
P. O. Box 4-1224 • 1310C international Airport Road
(907) 274-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner
Location (address of: Township, Range, Section, if known; or distance main
4
_Use of Well
)ad
4P
Size of casing Depth of Hole 7 feet Cased to feet
Static water level ft. (6B& (below) land surface. Finish of well (check one) open end
Screen { ) ; Perforated ( ) »
Describe screen or perforation
Well pumping test at - gallons per (MUY) (minute) for hours with `' ft.
of drawdown from static level.
Date of completion -:
WELL 'LOG
Depth in feet from
ground surface
Give details of fbrmatiens penetrated, size of material, color and hardness
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NWWA Certified of
Pertifficate Nes. 814 973
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2 — STATE
