HomeMy WebLinkAboutT14N R2W SEC 1 NW4 NW4 NW4
,~--~
GI'~'~,TER ANCHORAGE AREA BOROL /H
DEI~ARTMENT OF ENVIRONMENTAL QUAbfY
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION C~.'//~'~ ~/~HO %~J~
SEPTIC TANK:
DISTANCE FROM WELl
LIQUID CAPACITY
GALLONS.
MATERIAL C~t~c~'~Z~- -X~'/~C~//~COMPARTMENTsNUMBER OF
INSIDE LENGTH. .INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE Pit:
NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH
LINING MATERIAl ~~)~!¢~b~/t~- /~J'o(/~ DISTANCE FROM WELt
NEAREST LOT LINE .~TM ~ '/~''/ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
· LENGTH / ''~ , DEPTH
BUILDING FOUNDATION
sq. ET.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER GE LINES
ABSORPTION AREA
FOU , NEAREST LOT LINE
~S~ TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE~
(
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
LINES ,
OF ~L EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL:
TYPE ,Z~'~'~'//~-z~' _, DEPTH
~ NEAREST ~
LOT LINE , SEWER LINE
DISTANCE FROM //~ , WATER
~) ,,/L Z,'/~' g~ NEAREST
~ , BUILDING FOUNDATION.__~ SAMPLE
SEPTIC ~ ! SEEPAGE / --- OTHER
. TANK C)/ , SYSTEM /'~(~ , CESSPOOL , SOURCES
DISTANCES:
/~,b~..,
DIAGRAM OF SYSTEM
3'4 '
DATE
GREA,'ER ANCHORAGE AREA BOROUGH /~.:.~q~
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO, ~
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT ~ , ~ ~q¢-zff<l
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT ~ DRAIN FIELD · OTHER
COM PLET,ON DATE ANTICIPATED
MINIMUM DISTANCES, REQUIREMENTS
~EPTi~ T^N~ TO ~EE~^GE PIT WALL
TO NEAREST LOT L'NE.~ /
DRAIN FIELD
TYPE
DIAGRAM OF BYBTEM
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
L/ ~/ HEALTH ALI
OR
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE