HomeMy WebLinkAboutT13N R3W SEC 14 NE4 SE4
ANCHORAGE AREA BOROI~';H
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
SEPTIC TANK:
DISTANCE FROM WELL //~{J
LIQUID CAPACITY /~-O GALLONS.
MATERIAL ~'~z~:'~/ NUMBER OF ' .
~ COMPARTMENTS ~
.*)'~y£~ .¢~,~F~-= Z LIQUID
INSIDE LENGTH .INSIDE WIDTH DEPTH__--
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIAL~I¢! 10 (/J
NEAREST LOT LINE
OR WIDTH /~ , LENGTH /-~' , DEPTH ~ /
. DISTANCE FROM WELl ;~__.~() x BUILDING FOUNDATION ~)~) /,
TO~AL EFFECTIVE ABSORPTION AREA (WALL AREA) ' SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
, OF LINES.
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE--
WELL:
TYPEcx ,, ~L/Ni,.!!(.Ti) , DEPTH
NEAREST ._ SEPTIC
LOT LINE -- , SEWER LINE ,TANK
DISTANCE FROM ~ ~ ," WATER
, BUILDING FOUNDATION.~-) SAMPLE ~ NEAREST
../~) O" SEEPAGE /
, SYSTEM ,/-":~('-) , CESSPOOL , SOURCES
DISTANCES:
~]0 l,-Iglz~=
DIAGRAM OF SYSTEM
DATE ' '// '
GREATER ANCHORAGE AREA BOROUGH /re/_///,/
SEWAGE DISPOSAL SYSTEM -- APPLICATION AN~ PERMI~/
INSTALLAT]ON LOCATION
TYPE AND SIZE OF FACILITY TO BE SERVED ~'~/~' /'~-/~+~4~'"~'J'~ Y/'/'~/'~'~'J~
FINANCED THROUgh TO BE INSTALLED bY t
~://~ NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
SOIL TE~T RESULTS ~) //~ ~/~ /~/~
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS
WATER MAiN TO SEPTIC TANK // ~/~ SEEPAGE Pit //d~7
SEEPAGE AREA SIZE /~-~*-/j~'//A~- TYPE
DIAGRAM OF SYSTEM
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.
HEAth AUTH(~RI~Y
or
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