HomeMy WebLinkAboutLot 01mIL. LIN
ii
r"'"EATER ANCHORAGE AREA BORr"IGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511
N? 537
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
LOCATION
ADDRESS ~' 7') ) ":' - * PHONE
LEGAL DESCRiPTiON ¥'J" / ' V.//..-, .S /://
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS.
,.-" '-/ NUMBER OF
MATERIAL ,'2 / '(;'(~;~'1( .,,. _COMPARTMENTS
INSIDE LENGTH. -~'/ ...... ' INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF P,TS ? .OUTS,DE D.AMETER OR W.DT. / 6Z
LINING MATERIALC~'-,f")~ c'" /" ,'~'/'-kz~ :" ' (T' ~". DISfANCE FROM WELL ( .~'~ '
NEAREST LOT LINE 1OTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH // ~"~, DEPTH
BUILDING FOUNDATION
':~.-- ~g '~ sq. F~.
TILE DRAIN FIELD:
DIST,~NCE FROM WELL
NUM E LINES
'" -----, FOUNDATION
DISTANCE BETW_EEN LINES
., NEAREST LOT LINE
''~ ' TRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO EINISH GRADE
~,p E f/:: //
WELL: T , DEPTH
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
DISTANCE FROM WATER
.,BUILDING FOUNDATION.____SAMPLE , NEARES]
SEPJlC/~jt'~t SEEPAGE (~] '2 OTHER
TANK ,/~ , SYSTEM ~'"" , CESSPOOL , SOURCES__
NEAREST
LOT LINE , SEWER LINE
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED
HEALTH AUIHORITY
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8586
PERMIT NO.
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND BERMIT
NAME OF APPLICANT ~ MAILING ADDRESS ~* ~¢k~ PHONE
LEGAL DESCRIPTION C~ ' ~~ ~
INSTALLATION OF: SEPTIC TANK
TYPe AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SEEPAGE Pit-- I' , DRAIN FIELD , OTHER
SOIL TEST RESULTS
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION~ 24 HOUR NOTICE REC)UIRED, BAC:KFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
DIAGRAM OF SYSTEM
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT ~) DRAIN FIELD
SEPTIC TANK TO SEEPAGE Pit WALL
TO NEAREST LOT LINE.
WELL. TO SEPTIC TANK
DRAIN FIELD
., DRAIN FIELD
SEEPAGE PIT
ALSO CONSIDEr Area WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD .
SEPTIC TANK, '~'/ /~0!
, SEEPAGE PIT , DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSINGGAP OF
EXCAVATION S 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 'toBOROUGH REGULATIONS REGARDING INSTALLATION.
OR
LICENSED DESIGNER
[ CERTl~J~AT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DEEC ED YSTEM IS IN ACCORDANCE WITH SAID CODE. ~ ~
DATEF~ 2~, /¢7/APPL'CANT'S SIGNATURE . ~/'~,~ /~