HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 30D'r
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Department nfEnvironmental Quality
3330 CStneet
Anchorage, Alaska 8S5O3
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME CL -C-52 61. C4 MAILING ADDRESS PHONE
LOCATION LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE mUKx8EROF
FROM WELL ___---__MANUFACTURER MATERIAL (- COKxPARTwENTS
INSIDE LEmGTH_______INSIDE vv|DT*______-L/Au/oOEpTH_____L|QU|DCAPACITY Z2 GALLONS.
�
NUMBER OFPITS DIAMETER —OR WIDTH 1E LENGTH/7, DEPTH
/-
LINING Kx8TER|Axn�� CRIB SIZE: DIAMETER—DEPTH DISTANCE FROM: WELL ----.
TOTAL EFFECT/VE
BUILDING FOUNDATION ~�_�� . NEAREST LOT L|NE_����' � Ao50RpT|Om AREA (WALL xnE*)OW- SW. FT.
ADDITIONAL ABSORPTION
Tvps cowSTRucT|om DEPTH 'DISTANCE FROM.
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
rOumD*r/Om_____. U}TLiNE______-. SEWER LINE ______-. TANK _____. SYSTEM .
CESSPOOL —, OTHER SOURCES
xPpnovso____-_-_-DISAPPROVED -___REMARKS .
o|ST*wceS. DIAGRAM OF SYSTEM
INSTALLED BY: 69M d
p/pE xxxJEn|AL:`
LOT SLOPE:
REMARKS: -^°''
/41 ken—
_..- APPROVE
41G. P.A. B.
Form No. su-0x1
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT No
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT
INSTALLATION LOCATION
LEGAL DESCRIPTION
MAILING ADDRESS
PHONE
INSTALLATION OF: SEPTIC TANK L. SEEPAGE PIT — z DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY PZ�l
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 SIZE TYPE SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT -.-24 _DRAIN FIELD
_/
SEPTIC TANK TO SEEPAGE PIT WALL
2
SEPTIC TANK _, SEEPAGE PIT .(�2 DRAIN FIELD
TO NEAREST LOT LINE
WELL TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, &I'Q... , SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER -i
FITTED WITH AIRTIGHT REMOVABLE CA
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
G.A.A.B.
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. .11
DATE
APPLICANT'S SIGNATURE
z
THIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME '
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER 11 SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
x�
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER: s
TOTAL ABSORPTION AREA
MATERIAL,
:F ^ j
4. DISTANCES
W E L L`TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
K'I APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
r�
BY (Title)
LEGAL DESCRIPTION
