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GREA IER ANCHORAGE AREA BORvuGH
Department of Environmental Quality
ID
3330 C Street
Anchorage, Alaska 99503 (]
1
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME —�ifl�(n=� ING ADDRESSleG%.%T�frC ']i>/Ldl" PHONE
LOCATION LEGAL DESCRIPTION
SEPTIC TANK:
APPROVED --
PPROVEDDISTANCES:—ok-
DISTANCE
FROM WELLA T!/V MANUFACTURER
_ MATERIAL �s—_
NUMBER OF
COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 100_0 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER -- OR WIDTH IL, LENGTHA� DEPTH
�
LINING MATERIALp
_ CRIB SIZE: DIAMETER rJ DEPTH �/ DISTANCE FROM: WELA l �I
TOTAL EFFECTIVE
BUILDING FOUNDATION, NEAREST LOT LINE, ABSORPTION AREA (WALL AREA) '5(� SQ. FT.
ADDITIONAL ABSORPTION
WELL: Ho IF /A
TYPE
BUILDING
FOUNDATION
CESSPOOL_
APPROVED --
PPROVEDDISTANCES:—ok-
ol k-
DISTANCES:—
:54/
INSTALLED BY:
_CONSTRUCTION
NEAREST
LOT LINE
, OTHER SOURCES
DISAPPROVED
PIPE MATERIAL: ['/9S/ 11ZOAl _
LOT SLOPE:
REMARKS: Ogg 1A_
NEAREST
SEWER LINE
REMARKS
DE=PTH
SEPTIC
TANK_
DIAGRAM OF SYSTEM
DISTANCE FROM:
SEEPAGE
SYSTEM
DATE _� �' ��� APPROVE
G. A. A. B.
GREATER ANCHORAGE AREA BOROUGH
yR�h�ae �
:� il� hobo DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. —
Ilul € 3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
�Pi i�GLttCe / tett/i.SCil l�irr ") r� C��uc I�n »_ 2
NAME OF APPLICANT MAILING ADDRESS }� _)L PHONE �•
INSTALLATION LOCATION � C -
7
LEGAL DESCRIPTION z- "' /y "� '7LGDi�W(.C�✓�f(ZL(/- ✓b �i-L-1
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INST LLED BY L,y /L✓
SOIL TEST RESULTS ��� Gvfs - c� `lf'� �" OTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
i
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENTOF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE TYPE
MINIMUM DISTANCE"✓, REQUIREMENTS
FOUNDATION TO SEPTIC TANK 5 /
FOUNDATION TO SEEPAGE PIT
20
SEPTIC TANK TO SEEPAGE PIT WALT
It (Ae
DRAIN FIELD
SEPTIC TANK SEEPAGE PIT'_, DRAIN FIELD
TO NEAREST LOT LINE.
SEEPAGE AREA SIZE i C�riL(` `��J �'Y/ TYPE
WELL TO SEPTIC TAMC /�/IG SEEPAGE PIT �Glv� ,
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, - SEEPAGE PIT ` DRAIN FIELD
TO RIVER, LAKE, STREAM.
CASTT IRON INTO ANR_2U— OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
—
EXCAVATIZ3N 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 -REGULATIONS REGARDING INSTALLATION.
G.A.A.B.
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINA
DESCRIBED/,)SYSTEM 15CIN7ACCORDANCE WITH SAID CODE.
DATE '" g'// / APPLICANT'S SIGNATURE.I-'�--
26-68 AND THAT THE ABOVE
cNHa
GREATER ANCIIOkACA Aki.A IAMY
Department of LnvironmenLaI Qua Ii Ly
3330 "C" St.reet
Anchorage, Alaska 990;;
5OILS__L-_O?- (.
P�ERr �-O-I--A�—t
[O-N----T— -S-_T
Performedfor E� _
-- -- -r_ate _r_e_rfor_r_J
Legal Uc�criptio__
This form reports: Soils lo
-----------_..__:. Percolation Lest
Depth
Feet:
cam c-,
3 —
7 _
8 - Y
9 _
10 -
12 -
13 -
Was ground water encountered?
Pi
If yes , at wira L depth"? —
tcadiny
Date
Gross Time
Net Time
--- -
..._._ -__ .
-.___ - -- ---
Depth to Water Net Oror
------------ -
Percolation rate minute.
— ----------
Proposed installaion: Seepage Pit, Drain [ic
Id
Depth of Inlet —--------___-_—. Depth to bottom of pit or trerrci —
CO[4[1ENTS :
--- --
Performed
Certified [3y: .___ Data: