HomeMy WebLinkAboutT12N R4W SEC 10 LT 16 S2Onsite File
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HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? 599
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
MAILING
ADDRESS ~'~"' ~C,'
LEGAL DESCRIPTION ,~
DISTANCE FROM WELL ,~'-~"
LIQUID CAPACITY ..~'~;:
GALLONS.
NUMBER OF ~:- -)
MATERIAL . ~< ~"i]~.::-:"'~;:Z.- .COMPARTMENTS
INSIDE LENGTH ..... INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT:
/
NUMBER OF PITS l/ OUTSIDE DIAMETER ~-' .OR WIDTH
,,~'~,//.,,,z~:. ~':~'::;/.~:~:7~-'%.:% /? / c~~ .~ ~:~ /
LINING MATERIAL (: z:,~/(:~::'z:, ?:Z, /~:':,:~ (~'mJ~ DISTANCE FROM WELL
,.:,£T~/ /
NEAREST LO[ LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH /~i~ , DEPTH
BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
?
DEPTH: TOP OF TILE TO FINISH GRADE
, FOUNDATION NEAREST LOT LINE.
DISTANCE BETWEEN LINES L TRENCH WIDTH
SQ, FT. LENGTH OF EACH LINE
.DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
- ' DISTANCE FROM / . .' WATER
TYPE .<.<:~.z: ~;-' , DEPTH/~'F4-' .¥~/?-'/. BUILDING FOUNDATION. -'z ~ "' SAMPLE -'l/~' , NEAREST
NEAREST -'~ ~'~>/%'.~-~ ~ SEPTIC / SEEPAGE : OTHER
LOT LINE ~:~, ~/ ' , SEWER LINE /? '::-~ ., TANK ~/g'/ , SYSTEM ./~?/~"' , CESSPOOL ../[:.?:~h~?, SOURCES.:~¥~~
DISTANCES:
DIAGRAM OF SYSTEM
DATE
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-6S0
ANCHORAGE, ALASKA 99502
TELEPHONE 279-B686
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
PHONE __
FINANCED THROUGH
SOIL TEST RESULTS
/ //
SEEPAGE P[~ r
DRAIN FIELD,
TO SE INSTALLED BY
/
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL, TEST
COMPLETION DATE ANTICIPATED ¥ '/.~ '] - / /
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION DY THE
HEALTH DEPARTMENT AUTHORITY WILL BE ~UBJECT TO PROSECUTION.
SEPTIC TANK SIZE I/ ~ )" ~,'~ // TYPE ~ ~ ~ ' / SEEPAGE AREA SIZE /
MINIMUM DISTANCES, RE~UIREMENT~
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
_, DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK .
.SEEPAGE PIT DRAIN FIELD
TO NEAREST LOT LINE.
/
WATER MAIN TO SEPTIC TANK /~ ':t SEEPAGE PIT
SEPTIC TANK, SEEPAGE PIT .
TO RIVER, LAKE, STREAM.
, DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 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 TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
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
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE ~ [ ? " APPLICANT'S SIGNATURE ~ r (6/ ~ ' /
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Jewel Lake Small
gravelly silt
gray sandy fine to medium
gravel ,(GM)
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