HomeMy WebLinkAboutMILE HI BLK 3 LT 4
Gt' \TER ANCHORAGE AREA BORO! ~H
~'~/ HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
N? 736
MAILINGADDRESS ~7(00~'~ ~'~/'~'~ PHONE
LEGAL DESCRiPTiON.~P~/ ¢ ~J~ 3 ~;/~ /~/
SEPTIC TANK:
DISTANCE FROM WELL j~ ~'~/d/2~t~/"//
LIQUID CAPACITY /000 GALLONS.
MATERIAL
NUMBER OF
COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL ~'
NEAREST LOT LINE
SEEPAGE PIT:
!
OUTSIDE DIAMETER ~J'@~r' OR WIDTH
/2-
~--~' DISTANCE FROM WELL //]'~ ~"/~'/~[
· TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
., LENGTH .,.~0 , DEPTH
BUILDING FOUNDATION~;
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
NEAREST LOT LINE , OF LINES
TRENCH WIDTH IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
LOT LINE
TYPE DEPTH
NEAREST SEPTIC
, SEWER LINE ,TANK
DISTANCE FROM WATER
, BUILDING FOUNDATION. SAMPLE , NEAREST
SEEPAGE OTHER
, SYSTEM · CESSPOOl , SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
DATE
HEALTH AUTHORIIY
NAME Of APPLICANT f~ //~' //~J~/<~--~./~/O MAILING ADD.ESS
INSTALLATION LOCATION ~ ~ ~ ~
LEGAL DESCRIPTION ~ ~ ~ ~~ ~/~/ ~/~/
iNSTALLATION Of: SEPTIC TANK SEEPAGE PIT.
Greater ANChOrage Area BOROUgh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA g9502
TElePHONE 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO. /
PHONE
DRAIN FIELD. , OTHER
TYPE AND SIZE OF FACILITY TO BE serVED
F~NANCeD THROUGH
Soil TeST reSULTS
COMPLET,ON Date aNT,O,PATeD --
TO Be INSTALLED bY
NOTE: 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.
MINIMUM DISTANCES, REQUIREMENTS /
FOUNDATION TO SEPTIC TANK
FOUNDATION TO seePAGE PIT J ~;~ DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALl
SEPTIC TANK ~ .. SEEPAGE PIT ~' DRAIN FIELD
WELL TO SEPTIC TANK ~ // SEEPAGE PIT
WATER MAIN TO SEPTIC TANK /~ , SEePage PIt
SEPTIC TANK, ~/ ///~/~ /
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION E FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
DIAGRAM OF SYSTEM
GRAVEL BACKFILL
CONFORM TO BOROUGH ~:~EGULATIONS REGARDING INSTALLATION.
OR
LICENSED DESIGNER
[ CERTIFY THAT I AM FAMIL]AR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS In ACCORDANCE WITH SAID CODE, /~j~/0~
,,~,r 9~'PEET
ANCHOI~ACE - AI,AFEA
. , , ' Date
Lr, rJ-,~l Descrzpt~ont ~°t~'''~ ~
!,oc:at J. on Sketch
~leading Date Gross Time Ne'r Time Depth Tc-H20 Net Drop
.,.-~,-~'rd~_.-~c .~ .,~ ~';* / Drain Field
PrcDo;::,ea insi'a~.lal'~on: ~e~apa~,e Oep~h To Bottom Or ! ~.t u,...
Test ~erformed By: .~