HomeMy WebLinkAboutALYESKA BASIN BLK 3 LT 1
oGRE'
'ER ANCHORAGE AREA BOt'-UGH
IDepartment of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING ADDRESS ,~,C~
LEGAL DESCRIPTION
PHONE
~~ANK:
-'-'~--' - NUMBER OF
DISTANCE /
FROM WEL~--~¢-'/~/)'I MANUFACTURER /'-" ./~'~t "~-/k= . MATERIAL ,¢~" '~' "¢"-'/¢ COMPARTMENTS J
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH . .LIQUID CAPACITY/C'~'L~)~' GALLONS.
LINING MATERIAL ~ CRIB S~ISTANCE FROM: WELL~.
WELL:
*~--"~'~ "~"~'--"--"-'% ~ DEPTH :
CONSTRUCTION NEARES~IC SEEPAGE
BUILDING
FOUNDATION __
CESSPOOL
APPROVED
NEAREST
, LOT LINE
, OTH E R~U_.R~
..----"-"~ SA P P R O V E D REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
PIPE MATERIAL:
/2// ~,~,~ /
LOT SLOPE:
REMARKS:
Form No. EQ-031
i)
X,
GREATER ANCHOrAGe AREA Borough
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT
PERMIT NO.
LEGAL DESCRIPTION L7~ / ~:~- ~
TYPE AND SIZE OF FACILITY TO BE SERVED
SEEPAGE PIT
DRAIN FIELD
OTHER
FINANCED THROUGH TO BE INSTALLED BY
SOIL' TeSt NrE:AUTLET~ ip/~A~Te~ 0~1...~ NOTE: THIS PERMIT IS NOT VALIB WITHOUT SOil Tim"'
COM PLETIO NTIC v- ~/
4'iNAL iNSP~ E ~OOU~ N~TIC:E REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
~K SIZE~O~ TYPE~/~~ SEEPAGE AREA SIZE
--TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION *ro ~NK ~- I
FOUNDATION TO SEEPAGE PiT
SEPTIC TANK TO SEEPAGE PiT WALl
WELL TO ~C 'TA~N} .-.~I~) r
DRAIN FIELD
WATER MAIN TO SEPtiC TANK
DRAIN fIELD
SEPTIC TANK .... SEEPAGE PIT
TO river, LAKE, STREAM.
DRAIN FIELD
, 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
REGARD~/~
CONFORM TO BOROUGH REGULATIONS 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
DESCRIBED SYSTEM IS in ACCORDANCE WITH SAID CODE.E~ ~~ ~"'J [f'~ ~ E~ .,..._ f ~-~/~'~ {/~/'~.-'"~' ~-~/-'~ '
DAT - -- -- APPLICANT'S SIGNATUR v - v .... -
FORM NO. E(~-016