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GAAB HD I G TER ANCHORAGE AREA ROROP 4
DErARTMENT OF ENVIRONMENTAL QUALIl Y
_ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279.8686_
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
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NAMEI_!�/�� _ADDRESS` PHONES/�{
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LOCATION_ C3 %?�f3`�=_/'n/�/'_ ______ LEGAL DESCRIPTION -
SEPTIC TANK: L t [
/� < NUMBER OF
DISTANCE FROM WELL 4 _MATERIAL sTt=' _ __COMPARTMENTS
LIQUID
LIQUID CAPACITY '4� ) ___GALLONS. INSIDE LENINSIDE WIDTH — DEPTH
SEEPAGE SYSTEM:
SEEPAGE PIT: /p�-G'l/r `</fir �!</! c!%✓�%Ti'�i/1
NUMBER OF PITS OUTSIDE DIAMETER ""� _OR WIDTH— LENGTH ��^ DEPTH,
LINING MATERIAL ���'_ _/___ _, DISTANCE FROM WELL_Z�_�Z_l BUILDING FOUNDATION/ !!
NEAREST LOT LINE �?O 21 _ . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA(. SCJ. FT,
TILE DRAIN FIELD:i[�1A
DISTANCE FROM WELL
NUMBER OF LINE .
ABSORPTI AREA
CE BETWEEN LINES
FT. LENGTH OF EACH LINE
NEAREST LOT LIN
TRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTW TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATE F 77TH TILE
IN. ABOVE TILE
4"/�/F7;�/C.-CEFRO
WELL: DIST
DEPTH
AFI', BUILDING FOUNDATION,
WATER
SAMPLE /yD/✓�,
NEAREST
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/SEPTIC
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NEAREST
LOT LINE ALJ / SEWER LINE_ `�
i SEEPAGE /
, TANK SYSTEM__-Z_?/�,
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S0URCES<��11�/
DISTANCES:
DIAGRAM OF SYSTEM
DATEi� z�- APPROVED_
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PPROVED...�
G.A.A.R.
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G.A.A.R.
GREATER ANCHORAGE AREA BOROUGH /
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 APPLICANT
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE ..n ,
MAILING ADDRESS /y !� C
PHONE
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
DRAIN FIELD
TO BE INSTALLED BY
THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
c1
SEEPAGE AREA SI
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEEPAGE PIT
SEPTIC TANK,, 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=CASTIRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITHAIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
I—q
HEALTH AUTHORITY
OR
I LICENSED DESIGNER
TYPE A'd ZCCCl O'G.
r`
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
DES RI D SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE APPLICANT'S SIGNATURE
FOUNDATION TO SEEPAGE PIT ��"
DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT
DRAIN FIELD
TO NEAREST LOT LINE.
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/(-
WELL TO SEPTIC TANK,
SEEPAGE PIT
DRAIN FIELD
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEEPAGE PIT
SEPTIC TANK,, 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=CASTIRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITHAIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
I—q
HEALTH AUTHORITY
OR
I LICENSED DESIGNER
TYPE A'd ZCCCl O'G.
r`
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
DES RI D SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE APPLICANT'S SIGNATURE