HomeMy WebLinkAboutMOUNTAIN SHADOWS BLK 1 LT 3 locF-...
~-%.. GREif ER ANCHORAGE AREA BOR~)UGH
~¢I~ Department o f Environment al Quality
~,,."~;,~,'/~/ 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOOAT,ON ,_EC, ALOESCR,PT'ON/ ¢' g ¢4 /
SEPTIC TANK:
DISTANCE h'/ 7-"
FROM WELL~~) I ..,¢../b~. MANUFACTURER.~p--/''~, -
INSIDE LENGTH.
INSIDE WIDTH
fvlt\TE RIAL COMPARTMENTS.
LIQUID DEPTN .... LIQUID CAPACITY/~'''''5~C9 GALLONS.
SEEPAGE PIT:
NUMBER OF P,TS _ I .-. D,AMETER OR W,OTH /5' lC' ~ /
__ ____, t_ENGTH .. DEPTH
LINING MATERIAL/0(''~ C~L~-- CRIB SIZE: DIAMETER ~_OEPTPI---- DISTANCE FROM: WELL/~~'//v
TOTAL EFFECTIVE
BUILDING FOUNDATION~r_'¢ NEAREST LOT LINE~~g. ABSORPTION AREA (WALL AREA) 5 9~ SQ. FT.
ADDITIONAL ABSORPTION
WELL: h/~ /~
TYPE ____ CONS I-RUCTION.
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTNER SOURCES
APPROVED DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPfH __ DISTANCE FROM:
SEPTIC SEEPAGE
TANK ____ SYSTEM
DISTANCES: ___
INSTALLED BY:~ '
REMARKS:
DIAGRAM OF SYSTEM
GREA ,R ANCHORAGE AREA BOR
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 ' lCI I STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274"4561
JGH
PERMIT NO.
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PI:RMIT
DRAIN FIELD OTHER
;OMPLETION DATE ANTICIPATED
"INAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
:)EPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
1 ,5 0 TYPE
BEPTIC TANK SIZE AREA SIZE ~ ~ TYPE
/% 7
/
, SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
B EPT'C TANK. 1~"/2 SEEP*GE P,T. D.A,N F,ELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit
PITTed WITH AIRTIGHT REMOVABLE CAPS,
GI'~AVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION,
Ca,
OR
DIAGRAM OF ~.¥..~TIZM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DATE ' ~'''" ~-,,~ . APPLICANT'S SIGNATURE ¢' "{"-
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
pERMIT NO.
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
qAME OF APPLICANT
NSTALLATION LOCATION /~] _~~
INSTALLATION OF: SEPTIC TANK SEEPAGE Pit DRAIN FIELD .... OTHER
SOIL TEST RESULTS' ~ ~ ~- ~ J~ / NOTE: THIS PERMIT IS l~OT VALID WITHOUT ~OIL
COMPLETION DATE ANTICiPA'~ED
FINAL INSPECTION: ;~4 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THI'"
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILt. be SUBJECT TO PROSECUTION.
MINIMUM DISTANCE,~, REQUIREMENTS
FOUNDATION TO SEPT]C TANK
7-.O
· SEEPAGE Pit ~' ~) DRAIN FIELD
/~ 0(
, SEEPAGE Pit .
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
TO NEAREST LOT LINE.
SE~T,C TAN,*, /~ O ¢ ~ / 0 ~ /
SEEPAGE PIT-~/~'2 ~/~ , DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 PEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON sePTiC TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GI~AVEL BACKFILL
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH 'THE REQUIREMENTS OF (3REATEr ANCHORAGE AREA [3OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ~'
,, ~,~ ;,~fl\ ._~. Department of Environmen[al Quality
,~,'d ~- 3330 "C" Street
S()[I,~ hO(; -- lq,;II()I,ATION '['EST / ] ~
I'erformed for ~},~ /'~..Z~~ ,]ate Eerformed ~1~/:~
Ttds form reports: So~ls lo~ .... ~
Del) th
Feet
:T.-..~'-~ 7 L ....................
- 3-
i 6-
12-
13-
~4~ ~../_./.,/3o '/h~ ,'1z t ~ ',-~,"
Nas ground ~ater encountered? _~0 ....
Reading
Date
Gross Time
ILZ
If yes, at wha~ depth?
Net Time Depth to Water
Net Drop
~ercolation ~'-a t--e- ......... in'i-nu te.
-Proposed insta]]a~-o-n-:--.~6~:.qe Pit -- ~ Drain Fiel9
- - trenct,
Depth ~-6'-[f6YGiZo=CPit or . ~ ~ .... '//
Depth of inlet '-- ___._ ' . ~ ~..-?~_-~ _L~ND_.~gj6_I'
':.C~g -~'_-7:.. ~._~_-~ .......... ~'- '-'"'"
Well Owner
Location
tV1-W DRILLING, Inc.
P.O. Box4-1224 · 1310C In/:ernationalAirport Road
(907) 274-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
.Use of Well.
(address of: Township, Range, Section, if known; or distance main road
Size of casing ' _Depth of Hole
Static water level 51 ft.
Screen ( ); Perforated (
Describe screen or perforation.
Well pumping test at 'i gallons per (hbffr)
of drawdown from static level.
Date of completion ':~' ~ ' ~ ~? :'J
'?r, feet Cased to :~-~ feet
(below) land surface. Finish of well (check one) open end (
).
(minute) for i hours with
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
ft.
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