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GAAB-HD-I Gk. ---.:R ANCHORAGE AREA BOROI' i
DEPARTMENT OF ENVIRONMENTAL QUALM
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279.8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
y� -fl• _ MAILING
NAME 4 R / 1 l -cam[-�yv� ADDRESS
LOCATION—L-k
SEPTIC TANK:
LEGAL DES
NUMBER OF
DISTANCE FROM WELL C- �� MATERIAL C -AAAA lli -COMPARTMENTS
-
LIQUID CAPACITY GALLONS. INSIDE LENGTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS OUTSIDE DIAMETER
INSIDE WI
PHONE
LIQUID
DEPTH_
OR WIDTH - 45-( , LENGTH 12 t , DEPTH G r
LINING MATERIAL `-- _ ken^i L . DISTANCE FROM WELL ..: �cu p , BUILDING FOUNDATION ,
NEAREST LOT LINE ��%/ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) S� 0 SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WE
NUMBER 9F -LINES DISTA
RPTION AREA
INE\BFOUNDATION NEAR T"COT LINE -
\E PETWEEN
ETWEEN LINES TRENCH WIDTH
SQ. FT.
LINE
TOTAL LENGTH
OF LINES ,
IN. TOTAL EFFECTIVE
DATE \4�C4 r, T—' APPRO
ANCHORAGE AREA B04-nLYGH
v DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO, ---_..-.
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279.8686
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANTzdeW� c�/Y/LoLt� MAILING ADDRESS /`" `-IU�� PHONf
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SEEPAGE PIT '� DRAIN FIELD , OTHER
:vv' IVL(i(`
TO BE INSTALLED BY
SOIL TEST RESULTS NOTE: 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
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJE(/CT TO PROSECUTION.
SEPTIC TANK SIZES �`', "� TYPE -`�'rL/SEEPAGE AREA SIZE �!�'(•
/ �--- TYPE
MINIMUM DISTANCES. REQUIREMENTS
FOUNDATION TO SEPTIC TANK
S
r
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT - �� DRAIN FIELD
TO NEAREST LOT LINE. C�
WELL TO SEPTIC TANK �`��l SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK J� / SEEPAGE PIT /-4n-
DRAIN
4DRAIN FIELD
SEPTIC TAN ry SEEPAGE PIT G DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST�FR6 D OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 9 FEET INTO UN DISTU RB Eq SOIL.
4 INCH-DtA-METERZAST-+RON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHOR
OR
LICENSED D IG ER
DIAGRAM OF SYSTEM
I CERTIFY THAT 1 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.
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DATE / APPLICANT'S SIGNATURE
r, r
L r i� Q T
DEPART MEll F OF E v I R 1 f
L
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
Performed For C. LE M A %I Date Performed 8 -103-7-4
Legal Description: Lot__\__Block *Z Subdivision $ CCL C 1i
This Form Renorts Soils Log -,0 Percolation Test---------
Oenth
Feet Soil Characteristics
7
2 LA 5
4W
is Ir
GW
7 -3 v T
8 RECEIVED,
9 AUU '! 61W� IPM
10 GREATER ANCHORAGE AREA BOROUGH
DEPT-.- I O�LMMTY
Was Ground Water Encountered? Ala
If Yes, At what Denth?_____
z
0
Percolation Hate 1,i nut-
Proposed
iftC-
Proposed Installation: c,e cl :0 � Pit
Death of Inlet 1'.1enth To Bottom Of Pit: Or Trench.
COMNENTS
Test Performed F1,v 7A P a � a t� e r 1. J f e r! rv.
Dat,
I
Reading Date
Gross Time
Net Time Denth to H2O Net DrOD
------------
--j
f - - -
Percolation Hate 1,i nut-
Proposed
iftC-
Proposed Installation: c,e cl :0 � Pit
Death of Inlet 1'.1enth To Bottom Of Pit: Or Trench.
COMNENTS
Test Performed F1,v 7A P a � a t� e r 1. J f e r! rv.
Dat,