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Well Decommissioning Log
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GRE ,, R ANCHORAGE AREA BOR ,dGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAMES'/r~/(¢//~/¢ ~/~'~'-~Y'~'~,~.~MAILING ADDRESS r~(~-~~''*~ ~:~ ~/t~/'~l~, PHONE
LOCATION OF/: Ho/t~ ~')-~/~O ~¢/~o- LEGAL DESCRIPTION LcT//~ l¢/¢¢1~4 /=-~t~z
SEPTIC TANK:
DISTANCE
FROM WELL /05
INSIDE LENGTH
MANUFACTURER ,.~(.,,,,Z(,,),,~,~%, ~ MATERIAL_f/~~7~COMPARTMENTsNUMBER OF l
INSIDE WIDTH . LIQUID DEPTH LIQUID CAPACITY ./~ g~:~¢'~ GALLONS.
SEEPAGE Pit:
NUMBER OF PITS I . DIAMETER-- OR WIDTH / ~ LENGTH /'~, ! DEPTH /~--~ /
LINING MATERIAL CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL /~'~
BUILDING FOUNDATION ~ ~' TOTAL EFFECTIVE ~t~1¢) ¢
NEAREST LOT LINE ~f¢! ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE D~¢~///¢¢ 0 CONSTRUCTION
BUILDING NEAREST
FOUNDATION '~ ~" ¢ LOT LINE ~¢~ *'
CESSPOOL. OTHER SOURCES
APPROVED DISAPPROVED
,5'
NEAREST
SEWER LINE
REMARKS
DEPTH ,/ Z¢¢' DISTANCE FROM:
SEPTIC ,~ SEEPAGE ;~ ~'
TANK /¢5-- SYSTEM / 2
DISTANCES:
INSTALLED BY: /¢~'
PIPE MATERIAL: ~'1~ '~ ,~)~)~
LOT SLOPE: __
DIAGRAM OF SYSTEM
DATE
G.A.A.B.
GREA; r ANCHORAGE Area BOr~'lgh
DI~pARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
PERMIT NO.
NAME Of
INSTALLATION OF: SEPTIC TANKRVED
FINANCED THROUGH
COMPLETION DATE ANTICIPATED
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.
SEPTIC TANK SIZE ~ :PAGe J sIZE_~,
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION ~0 SEEPAge PiT. ~ DRAIN FIELD -"- ~ ~*-- ---'-'-' .__~__.
DRAIN FIELD
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
TO RIVER, LAKE, STREAM.
SEEPAGE PIT
DRA,N E'EL/ J
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 SEEPA PIT
FITTED WITH AIRTIGHT ~DV~?LE~.~
CONFORM TO BOROUGH~ REG~JLAT]ONS REGARDING INSTALLAT O .
LICENSED DESIGNER
I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
O Er E GEOTECHNICAL Er DEVELOPMENT CO.
Box 90. Davis St.. Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Soils Et Foundations
Earl Ellis
688-2280
Land Development
SOIL LOG
Perfomed for:
Name: 5'?,('//,/~ (Z~'~£/~ ~c"~c,~P~,,'F~l. No.
Hailing Address:/~-~ fs~ ~7-,,~/g ~u}-~. c,e,~/~/,~/~. ,,r//~, 'P~'~/'~7'
So11 Characterlsttcs
Legal Description:
Depth (feet)
0
1
2
3
5
6
7
8
lO
ll
12
Ground Water Encountered: Yes__No ~ If yes, what depth
Proposed Installation: Seepage Pit Drain Fte~d
Comments: