HomeMy WebLinkAboutBENITO BLK 3 LT 2
GREA~R ANCHORAGE AREA BORudGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~ ~
LOCATION I .... .,~ ~ ~_. ~.,.~ ~<~..
SEPTIC TANK: ~'~ ~ ~ ~ ~ ~ ~
DISTANCE
FROM WELL
MANUFACTURER
LEGAL DESCRIPTION
,, .
NUMBER OF
MATERIAL COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH_
LIQUID CAPACITY
GALLONS.
SEEPAGE PIT:
NUMBER OF PITS __
LINING MATERIAL
BUILDING FOUNDATION__
ADDITIONAL ABSORPTION
DIAMETER __ OR WIDTH__
CRIB SIZE: DIAMETER__
, NEAREST LOT LINE__
LENGTH , DEPTH
DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
.SQ. FT.
WELL:
TYPE CONSTRUCTION
BUILDING NEAREST
FOUNDATION -- , LOT LINE
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED
DEPTH
NEAREST SEPTIC
SEWER LINE , TANK__
REMARKS
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARXS: F
DATE ? ' _~0~- 4'~,8/' APPROVED
Form No. EQ-031
Gr'~ATER ANCHORAGE AREA BORO'"GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
421
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WEL~~~
LIQUID CAPACITY /Z~'"'i~7 GALLONS.
MAILING
ADDRESS
LEGAL DESCRIPTION
MATERIAL (~- ~'~qC l/'e t~ NUMBER OF /
COMPARTMENTS
INSIDE LE~CTH , INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
/ /~"
NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH LENGTH ~ '~/, DEPTH
L,N,NGMATER,A,C , :'e: /:/': .D,STANCEFROMWE . .BU,LO,NOFOUNDAT,ON
O'
NEAREST LOT LINE '~, ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 7~) ~ sq. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
N UMB'Eq~F LINES
ABSORPTION A'~J~
F.OIJI~'b'~,~ION ~~ , NEAREST LOT LINE.
DISTANCE BETWEEN LINES \ TRENCH WIDTH
'
SQ. FI, LENGTH OF EACH LI ......
TOTAL LENGTH
OF LINES
............ ~ECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL:
LOT LINE
DISTANCES:
TYPE
DATE
DEPTH
NEAREST
SEWER LINE
DISTANCE FROM WATER
BUILDING FOUNDATION SAMPLE
SEPTICS-- ' ~EEPAGE //tnt ~ '
,""
NEAREST
OTHER
, SOURCES~
DIAGRAM OF: SYSTEM
/Z)
/¢ ?0
APPROVED
-HEALTH AUTHORITY
GREATEr ANCHORAGe AReA BorOUGh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM I APPLICATION AND PERMIT
PERMIT NO.
,NSTALLAT,ON EGAL DESCR,PTIoNLOCAT'ON, A I .
MAILING ADDRESS
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD
PHONE 4'qX--?Ai3
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
TO BE iNSTALLED BY
NOTE: THIS PERMIT IS NOT VALID WITHOUT ~OIL 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
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, , SEEPAGE Pit
TO RIVER, LAKE, STREAM.
SEEPAGE AREA SIZE
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 BIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
LICENSEE) 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
DATE APPLICANT'S SIGNATURE
FORM NO. EQ'016
GAAB-'H D-2
GREATE:-
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
"OROUGH
279-2511
case No.
SEWAGE DISPOSAL SYSTEM APPLICATION & PERMIT
NAME OF APPLICANT.
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
MAILING ADDRESS &
LOCATION 0F INSTALLATION
PHONE N0 ~7~-/¢'?~;"
SEE. PAGE PIT ~( , DRAIN FIELD , OTHER
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
DISTANCES:
~ ~[-~/~'~ , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
.. SEPTIC TANK SIZE //,~7,) TYPE SEEPAGE AREA//~/~J~rd/' TYPE
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage ~28-68 and that the
above described system is in accordance with said code. '~)/~ 6y.a4~f[/b,d,.[.~,,,ff/~~,~"~