HomeMy WebLinkAboutT12N R3W SEC 19 W2E2SE4SE4 PTN (W OF RR)'Ti;IN
G?~TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
N? 763
NAME ~/L//:_.~'
LOCATION ~-~>~/-~'
SEPTIC TANK:
MAILING
LEGAL DESCRIPTION
DISTANCE FROM WELL
NUMBER OF /"
MATERIAL ~(~"'~:~- COMPARTMENTS
LIQUID
LIQUID CAPACITY /~) /~"~ GALLONS, INSIDE LENGTH ~ INSIDE WIDTH ~ DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAt
NEAREST LOT LINE
SEEPAGE PIT: /uz~ ~,x~
H ~ LENGTH ~,, DEPTH~
~ DISTANCE FROM WELl ~'~ , BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
j
FOUNDATION ///-) /7/~ , NEAREST LOT LINE
DISTANCE BETWEEN LINES ,~ /'~ TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE ~ ~ ~ /
DEPTH OF FILTER MATERIAL BENEATH TILE
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH~ ~ /
, OF LINES ~:~'~
IN. TOTAL EFFECTIVE
IN. ABOVE TILE ~///
WELL: (:~.~/~ z~ .~-.~./~ >
T Y p E x~,.~;~C~/'/~--~-'' DEPTH /
LOT LINE /~ /~ NEAREST SEPTIC
, SEWER LINE ~ (~ . TANK
DISTANCE FROM
BUILDING FOUNDATION. /~, /~z-~ WATER
, SAMPLE /~/'~ NEAREST
~ SEEPAGE / OTHER
~ . SYSTEM /~ , CESSPOOL~ , SOURCES/~
DISTANCES:
DIAGRAM OF SYSTEM
HEALTH AUfHORITY
GrEAi:ER ANCHORAGE AREA BOI~OUGH
DEPARTMENT OF' ENVIRONMENTAL, QUALITY
3500 TUDOR ROAD POUCH
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
NAME OF APPLICANT . aDDRESS PHONE
LEGAL DESC~ PT ON - ~ ~
INSTALLATIO~ OF: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD . ., OTHER
PINANCED THROUGH ~ ~ /TO BEj~INST LLED BY
COMPLETION DATE ANTIC~PATED ~, ~ /
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
FOUNDATION TO SEPT C ~AN. ~ '~;~ ~;;;; .~ // ~-
FOUNDATION TO SEEPAGE Pit, ., DRAIN FIELD /¢
SEPTIC TANK TO SEEPAGE PIT WALl
SEPTIC TANK ., SEEPAGE PIT
TO NEAREST LOT LINE.~h~ ~
WELL TO SEPTIC TANK '~}
WATer MAiN TO SePT,O TaN l o
DRAIN fIELD/;~0 ¢
SEPTIC TANK SeePaGe PIT
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 F~EGULATiONS ReGARDiNG iNSTALLATION.
LICENSED DESIGNER
iDEC;CR;:;~DT~;;TIE~4~i;~MIALIc~RWDIATNHcT~/i~tQ~L~;%~NDTE% OF G~/~2~R(/~CHORAGE ARE.,A BOR//0/UGH ORDINANCE NO. 28-68 AND THAT THE ABOVE