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HomeMy WebLinkAboutCONROY RUSHTON BLK 7 LT 11 on t,-0 i ttSh tSO n GRE ,.FR ANCHORAGE AREA BO _JGH Depsrtment of EnvironmentsI QusliW 3330 C Street Anchorsge, AIsska gg§03  ON REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ...... MAILING ADDRESS 4/~-?~--)~ PHONE SEPTIC TANK: DISTANCE FROM WELL ,~1~0 (-"/-' INSIDE LENGTH MANUFACTURER ~ INSIDE WIDTH MATERIAL NUMBER OF COMPARTMENTS LIQUID DEPTH __ LIQUID CAPACITY/~GALLON$. TILE DRAIN FIELD: / DISTANCE FROM WELL~2~0~ '''//'-- FOUNDATION /0 __ NUMBER OF LINES / DISTANCE BETWEEN LINES ABSORPTION AREA /~ O SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE ! TOTAL LENGTH _NEAREST LOT LINE__ /0 .OF LINES ,~Ol /Jr////~ TRENCH WIDTHE IN. TOTAL EFFECTIVE '~/ ..41~. ABOVE TILE ¢ IN. WELL: TYPE BUILDING FOUNDATION CESSPOOL APPROVED _ CONSTRUCTION NEAREST NEAREST LOT LINE_ SEWER LINE OTHER SOURCES DISAPPROVED DEPTH SEPTIC SEEPAGE TANK, __ SYSTEM REMARKS DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: SEWER LINE DEPTH: ~'/ ! PIPE MATERIAL: LoT SLOPE: Form EQ-032 6.. 0 '~UNICIPALITY OF ANCHORAGE Heal and Environmental Protec, 3n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TAHK: DISTANCE~ k!~_D FROM WiS LL __~ ...... MAI',iUFAC ] UR E R ~"~ M,ATE RIAL INSIDE L_ENGrH___ ~ .... INSIDE WI[)Ttt ...... LIQUID DEPTH Tiff O"AIN FIELD:'~~ COMPARTMENTS LIQUID CAPACITY_ ~¢~GA[_LONS. DISTANCE FROM WELL .......... FOUNDATION ~ of Lines ..... !. ....... DISTANCE BETWEEN LINE5 ABSORPI :ON AREA .... ~_.~ .............. SQ. F'T. LENGTH OF EACH LINE DEP7tl OF FILTER DEPIlI: TOP ()F ~ILL TO FINI51t GRADE ~ O I TOTAL LENGTH NEAREST L. OF LINE ..... ~_~,f~__~C~. ........ OF LINE --'~C~ ~' ENCH VVIDTI-4~_ IN. TOTAL EFFECTIVE MATERI/\L BENEAI'I-t 'rILE ~7 ~ IN. ABOVE TILE ~ IN. SEEPAGE PIT: Log Crib Rings Crib Size: Ol/\METE,q .... BUILL)ING FOUN©ATION .... NIEAREST LOT LINE____ LENGTH , DEPTH DEP'I-~t_____ DISTANCE FROM: WELL TOTAl._ EFFECTIVE ABSORPTION AREA (WALL AREA) ,SQ. FT. Well ~_~ l~lzO Class: Depth: ' Well Distance To: Lot Line ,, , : Bldg: Sewer Line: Pipe Materials: %[o~1~ ~ of Bedrooms: (~'-iL.~'-~ ~.~,~.~ I Installer: ~ ~L~ '~.I', ' Remarks: ~ ~ · -1'I GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION _--J~'~~ iNSTALLATION Of: SEPTIC TANk {' TYPE AND SiZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS TO BE INSTALLED bY DRAIN FIELD ~ . OTHER NOTEz 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 MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC tank FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK ~ ( . SEEPAGE PIT TO NEAREST LOT LINe. WELL TO SEPTIC TANK ~)0I DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, , SEEPAGE Pit TO RIVER, LAKE, STREAM. DRAIN FIELD , DRAIN FIELDt [0t SEEPAGE PIT ~JO (' ALSO CONSIDER AREA WELLS. SEEPAGE PIt ., 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 SEPJ~IC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BA~-.,KF'ILL CONFORM TO BOROUGH REGULATIONS REGTRDIIG INSTALLATION. G ,A ,A ,B, OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THA~ THE ABOVE DATE ~--/ ~-- '-~ "~ APPLICANT'S SIGNATURE FORM NO. EQ-01 6 GRE, ER ANCHORAGE AREA BO}. .,UGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION Of: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS ~5 SEEPAGE PIT DRAIN FIELD ! TO BE INSTALLED BY PHONE OTHER ~¢"'~ 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 BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC Tank ~- . SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK /~) DRAIN FIELD / SEpTic TANK, /_~I SEEPAGE PIT TO RIVER. LAKE, STREAM. ALSO CONSIDER AREA WELLS· · SEEPAGE Pit /~) / . ~ 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 lEON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. 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 DESCRI BED SYSTEM IS IN ACCORDANCE WITH SAID CODE.~/ 7 7 7 ~~~~1~~ EQ-O16(3-75) Department of t fealth .'~d Environmentn] Protection 2516 E. Tudor Road Anchorag'c ,276_2221Alaska 9950~t~;¢~ Soils log ...... .wf_ ..................... PercolaLian L~_st Depth Feet i----- 2- 4- 5- 6- 7- 8- 9- 10- 11 12 13- t4 - Nas 9~;ound water encounb~red? -Proposed i,,stalla~¥6}{':--~%i2p¥~}e Pit V L)rain l-ield ~ Dui)th of Inlet .... . Dept'J~-~¥'lJ'¥c'Cb¥'¥r"'l)i t.. . or. trellc~, . ......... .......... ~ .... s .............. ~... -= ..... of }tea':th ,~d l:nvironment:fl Proteetiou 2516 E. Tudor.' Road Anchorage, Alnska 99507 ?,:: . 276-2221 · ..~ ~,. ~~-~'~, ~ ~4~ ~ .................... ~ ~ ~ ,~,., &/Oho wate~ encountered? Date Gross Time Net Time j i)epth to Wat,,r I ~poS~'d installat~b}[:---~b~:-~T.qe pit [)rain Field V' ' Xh of Inlet',' . l)opth to bottom of I)i t or trench, ~',, ~,:-~ ~.i~..:. Anchorn~l'e, Alaska 99507 -. 276-22~1 tcction 9- 10- 11 - 12- 13- Ul::l-'l. OF HEAt. IH & ) ~,-, ENVIRONMEN [AL PROl ILC'.l K)N ].)cpartment of t lealth ,~tld Environmentnl t rot(.ction ~ 2516 E Tudor Road ~- ...... 9 .. ' o~::r a 1977 ' Anehoz'ag'e, Alaska 99507 S()11,2 1,()(; I'I.;II(/I,ATI(iN '11.:S'I' This form repgrts:"- S,~i]s-'l~g ]-].].]-~__.]__r].]._~__~-Pe~}:olatiol~ Lest 6- IJ ~as ground ~a[c~ encoun[ered7 ~¢ If ves, at ~;mL 951(; K. Tudor.' I4cmd Ane}mr:~g'e, Al:~qk:~ 99507 276-2221 :Pth Feet- )d water: encountered? at i f v c s :i:'I)Jte-, ' Gross Time t:l(,t Time, i}upth' to Wat,,.-, tier' 1' "' .~ -'t M '~ ';. .~ ;':..~ ....................................................................................... -.~ [3y'