HomeMy WebLinkAboutALYESKA BASIN BLK 1 LT 6
GRE! '{ ANCHORAGE AREA BOF
Department of Environment Quality
3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
~TAN K:
DISTANCE //~ NUMBER OF
FROM WELL ~ (3 MANUFACTURER. ~ MATERIAL COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY ,~I~x:'~ GALLONS.
TILE DRAIN FIELD:
TOTAL LENGTH
D STANGE-,FtROM WELL FOUNDATION .... , NEAR'EST EOT 'LINE .................. OF LINES
NUMBER OF LINES . ._ DISTANCE BETWEEN LINES "..-t TRENCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
..... DEPTH OF FILTER
MATERIAL BENEATH TILE
/
DEPTH: TOP OF TILE TO FINISH GRADE
TYPE
CONSTRUCTION DEPTH
IN. ABOVE TILE IN.
. DISTANCE FROM:
BUILDING NEAREST
FOUNDATION , LOT LINE __
NEAREST SEPTIC SEEPAGE
, SEWER LINE__, TANK__, SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
DATE7~' /~'"7 dAPPROVED
Form PW~027
GReaTEr ANCHORAGE AREa Borough
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456!
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
NAME Of APPlICant ~7~///.
LEGALINSTALLATION LOCATION ~
· z_ /
DESCR~
FINANCED THROUGH TO BE INSTALLED BY
UTHER
SOIL TEST RESULTS
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.
/(~T~N K SIZE
MINIMUM DISTANCES, REQUIREMENT.~S
FOUNDATION TO SEPTIC TANK
FOUNDATIO~ SEEPAGE Pit
SEPTIC TANK TO SEEPAGE Pit WA~LL
SEPTIC TANK ~ .. SEEPAGE PIT
TO NEARESt/ LC~T L)~I~ E.
DRAIN FIELD
, DRAIN FIELD
WATER MAIN TO sePtiC TaNK ~
DRAIN FIELD
SEPTIC TANK , SEEPAGE PIT I~
TO RIVER, LAKE, STREAM.
., DRAIN FIELD
SEEPAGE PiT
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 SEPTIC TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE
DATE~__ APPLICANT'S SIGNATURE _ .
FORM NO. EQ'01 6