HomeMy WebLinkAboutCOLONIAL PARK BLK 4 LT 6A
GREA ER ANCHORAGE AREA BOR ,dGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
~-f,/v/-/'~- MAILING ADDRESS -J"~'m¢:~ ",~2/'f /'~'~/- ~' PHONE
2~ _~ -- /___~. ~ ~,~ LEGAL DESCRIPTION ~-~"~/"~._- ~"/~' ~
NAME
LOCATION
SEPTIC TANK:
DISTANCE NUMBER OF
FROM WELL ~]/./~./~. MANUFACTURER -'~"g'~////~/~;"~'~ MATERIAL/~g~'~;~(~ COMPARTMENTS ~/~
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH __.LIQUID CAPACITY /"/~2~ GALLONS.
SEEPAGE PiT:
NUMBER OF PITS __. DIAMETER OR WIDTH ,
LINING MATERIAL ~"~'-~'~- CRIB SIZE: DIAMETER '~'
BUILDING FOUNDATION /~ ~;~NEAREST LOT LINE //D ~'~
ADDITIONAL ABSORPTION
LENGTH ~; DEPTH /~i--/~ .....
DEPTH /~ DISTANCE FROM: WELL {'~/~<2~.
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~'-~g9 SQ. FT.
WE LL: ~/:$f~~'-~
TYPE /~'~::~¢¢'~ ~--' CONSTRUCTION
BUILDING NEAREST
FOUNDATION __, LOT LINE
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED
NEAREST
SEWER LINE
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK __ , SYSTEM
REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
//~,/~/.~
PIPE MATERIAL:--'~'"'// ~~' -
LOT SLOPE:
R E M A R KS: ~i~ "~ l/~ ~J~'-
Form No. EQ-O31
DATE
Gre~ :r ANCHORAGe Area BoF
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456]
NAME OF APPLICANT
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION Of: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
/ ~ TE:
SOIL TEST RESULTS I
Jgh
PERMIT NO.
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
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 . TYPE -- - SEEPAGE AREA SIZE
BlAGRA~
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGe PIT
DRAIN FIELD
SEPTIC TANk TO seePAGe PIT WALL
SEPtiC TANK
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
, SEEPAGe PIT . DRAIN FIELD
/
C~ ~ - , ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
SEPTIC TANK, , SEEPAGE PIT ., DRAIN FIELD
TO RIVER, LAKE, STREAM.
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.
G .A .A .B.
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROl~l~H ORDINANCE NO. 28-68 AND THAT THE ABOVE
~.,:~ ~' /
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ~/~ , ~.,,~,~' ~'
DATE APPLICANT'S SIGNATU[[ ' [
FORM NO. EQ-016 ~
Pe rfo rmed
Legal
This
GREATER ANCtlOt<t\(;L /',I~Li\ UOROUG,,
Oepartment of EnvironmeriLal (tuality
3330 "C" Street
Anchorage, A1 aska 9%03
SOII,S l,()(i I'I';ROI,ATION 'FI';ST
for ;)ate Perforn~cJ ~ 27
form reports' Soils log. ~' Percolation ~est
Del) ~h
Feet
12-
13-
14-
1
Was ground water encountered?
If yes, at wha~ depth?
Reading Date Gross Time Net Time Depth to Water Net i~rol.)
Percol ati on -r-a t--e- ............. in-i-n-u-t-e-.
..Proposed installatl~-:--'~a~e Pit Urain Field
DepU~ of Inlet . Dcpt~¥~'-5~-m--0¥-pit or trenc~
EQ-040 (6/74)
APPLIC _,*iT FILLS OUT UPPER HAL ONLY
Property Owner ' ~..,~'. ;" ~ / / Phone
Address Zip Code
Phone
Lending Institution ~ .'"?~' "~-' ~ " '" ' "*'/ ~ ?/~: ' ' ~" ~ ~ .' .2 '": ~ ,
Address ,/
~. , '*,'=' ,,. F . ., . . , ~ ,..,-. ,,/ Zip Code . .
Realty Co. & Agent ~ ~ ?, ..,.~ ~ ~ ~ /:- ,.,, /~.~ ,~ ,
Legal Description /' ~ ,- .~." ',? ~. /-.. . /.
Type of Residence
_,~' Single Family
[] MUltiple Family No. of Bedrooms
[] Other
Water Supply
[] Individual ATTACH WELL LOG. A wetl log is required for all wells drilled since June 1975·
Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal .: , ~ ~': .... ~.,*
Year Individual Installed: ,'/~;'; '
~:~, Individual .. .
Publtc Utility ......· When Connected to Public Utility:
[] Holding Tank " '~'
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date/ L -'"~"'//~'/< O("/'~,
Inspector Inspector Inspector Inspector
MAY 1 1 1983
.--._..__'Uunicip tity of Anchorag0',
"Dept. nf He-',!t~ &
( )APPROVED BEDROOMS ~S OF APPRO~,~.~virollmentaj Protect/on,'
( ) DISAPPROVED
/
/
Soils Rating Date Sewer Installed Well To Absorption Area I g ~/Vell LooL~ eceived
Well to Tank Septic Tank Size
72-023 (3182)
TIME
DATE
INSPECTOR
DIRECTIONS:
. _ THIS SIDE FOR OFFICIAL USE ONLY
I NSPECTI ON APPOI NTM ENTS
.. . TIME, ,-,* ,.~ , . ~
DATE . :
' ' INSPECTOR ';
1., TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
[] INDIVIDUAL
TIME
DATE
[] ONE
[] TWO
PERMIT NUMBER
~ COMMUNITY
[] PUBLIC. UTI LITY
DEPTH OF WELL
' D~,TE DRILLED ' '
I
Connection Verified . r'LoG RECEIVE D
3.",SEw^6E' D PosA, SYSTE=' I PER ,T UME E
'l~ INDIV!DUAL/ON~.s TE I DATE. INSTALI~ED
[]PUBLIC UTILITY
Connection Verified I . ~-~
INSTALLER
~Septic T~nk or-~Holding Tank J ~ ·
Size: ~if Tank is homemade ~ SOl LS RA~ING
give dimensions: ~ ~ ~
TYPE OF TANK ' J MANUFACTURER
TOTAL ABSORPT~0N AREA ~ MATERIAL
4. INSTANCES ' J'Septi~/Ho~di.~ T;~k
' - WE LTO: I
Absorption"~rea te neare~ Lot Line
'5. COMMENTS
NUMBER OF BE[~ROOM$
THREE [] FIVE
FOUR [] SiX
E~ APPROVED FOR ~ 'BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
DATE
[] DISAPPROVED
JSewer I'i~e
[] OTHER
' 'J N~ari~st~'Lot Line
I ~'-~ ,,,
72-010 (Rev. 3/78)