HomeMy WebLinkAboutPREUSS #4 BLK 8 LT 7Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATI ON SEPTIC TANK: DISTANCE FROM WELL/~)O INSIDE LENGTH MANUFACTURER /~'1¢1//~'~1/). MATERIAL C~))IC J/~ ~L-i~ NUMBER OF i COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY ) ~-'O GALLONS. SEEPAGE PIT: NUMBER OF PITS J DIAMETER __ LINING MATERIALC~ [/~ CRIB SIZE: BUILDING FOUNDATION OR WIDTH ZO DIAMETER NEAREST LOT LINE ~- . LENGTH 7..) DEPTH £, DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA), /--TL~/~-~ SQ. FT. ADDITIONAL ABSORPTION WELL: FOUNDATION CONSTRUCTION ~,~,/~/") Ug 7,'/ NEAREST /,~! NEAREST LOT LINE SEWER LINE DEPTH //--./'-'~' DISTANCE FROM: SEPTIC SEEPAGE TANK ___ SYSTEM CESSPOOL OTHER SOURCES APPROVED . DISAPPROVED REMARKS DISTANCES: PiPE MATERIAL: ~// C~,~,/''' LOT SLOPE: REMARKS: Form No. LQ-031 DIAGRAM OF SYSTEM i? ~u~ll GreATER ANCHORAGE AReA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! NAME OF APPLICANT ,NSTALLAT,ON LOCaTiON .//.,C/~; 'f ~O~ 1~ INSTALLATION OF: SEPTIC TANK / SEEPAGE PIT PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT /!.q~,~. I.b~d F~ ~.~U/~-i~ MA,L,NG ADDRESS PHONE DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SO~L TEST rESULtS ~LO i~ COMPLETION DATE ANTICIPATED TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT ~OUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REGUIREMENTS FOUNDATION TO SEPTIC TANK~ FOUNDATION TO SEEPAGE PIT ~ DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL septic TANK i SEEPAGE Pit-- ~ 0 , Drain FIELD TO NEAREST LOT LINE. i0 ' WELL TO SEPTIC TANK · SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK ., SEEPAGE PIT DRAIN FIELD SEPTIC TANK, SEEPAGE PIT ., DRAIN FIELD TO RIVER, LAKE. STREAM. CAST IRON INT~__O ANr~ C~HT DF 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 FITTED WITH AIRTIGHT REMOVABLE CAPS. DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUGH PEG ATIONS REGARDING INSTALLATION. LICENSED DESIGNER CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE GP, EiVFER A?iCHORtNGE AREA BOROUGH DEPARTMENT OF ENVIRONMFNTAL,~nU~.,..rTY. 3330 "C" S'creet ANCHORAGE, ALASKA 99503 Case # Performed For ~'t'I~1~,1~_~'~ __ ~~'~".,~ Dated Performed Legal Oescription: Lot ~ ~-~ck ~ Subdivision__~:~l~o$~ This Form Reports Soils Log)< Percolation Test - Soil Test lqust Be Logged To 4' Below Proposed Seepage System Soil ' ' ' Characteristics Depth Feet Was Ground Water Encountered? If Yes, At What Depth? 5-- 6m 7~ 8~ 9~ lO~ !1~ i2~ 13~ i4~ ' Fi i Reading Da te I ' 1. Gross Time Net Time Depth to H20 Net Dropl I Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom of Pit Or Trench CO~ME,~i S: Test Performed BY Date Certified BY: Date: ~ U ~.~i'~E RECEIVED ~ INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR ~ MUNICIPALITY OF ANCHORAGE MUNiCIPALiTY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HP_ALTH &  825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ?E©TECTION ENVIRONMENTAL SANITATION DIVISION NOV 1 0 1981 ,~ Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~~'~ DIRECTIONS: Complete ail parts on page 1. I~complete requests will not be preceded. Please allow ten (10) days for processing. PHONE MAILING ADDRESS ~. ~. ~,~ PROPERTY RESIDENT (If different from above) ) PHONE 2, BUYER MAILING ADDRESS 3. LENDING INSTITUTION [ PHONE MAILING ADDRESS 4. REALTO./A~ENT ~ ] PHONE MAI LING ADDRESS LEGAL DESCRIPTION ;TREET LOCATION NUMBER OF~BEDROOMS 6. TYPE OF RESIDENCE ~ One Four ~ SINGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM '"~. INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, ~'Nv~'wellti ~' ~ depth (attach log if available.) \~' ~ ~ /~/~ %.~ ~'{) ¥1 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [~ THREE [~ FIVE [] TWO [] FOUR [] SIX [~] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified [~Septic Tank or [] Holding Tank Size: ,'1~i~-..~ If Tank is homemade give dimensions: PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: MATERIAL Absorption Area to nearest Lot Line Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line 5. COMMENTS DATE [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [~. DISAPPROVED 72-010 (Rev, 6/79) .... ~, ~:~OX 405 ~:~q.lo River~ Ai{ 99577 o~. tluc~ ~duni. cip,~l!ty o~ AnChO'¢ag~ --U--,it~ed tO this . · t-~.- existing 1~=,~ with in~pervio"s tvpe sc, il.