HomeMy WebLinkAboutT14N R2W SEC 11 S2 NE4 Lot 3
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GRF~TER ANCHORAGE AREA BOROLr~'~I
D~..4FITMENT OF ENVIRONMENTAL O. UALI,.
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING ,J'~J~O //~/.~J~/~'~[/ .~)~-/. PHONE ~577
.ADDRESS
//
LEGAL DESCR PT ON
DISTANCE FROM WELL P~i"Op. ~4'6 '-~
LIQUID CAPACITY
MATERIAl ,5 ;r//~ .¢/'~.~L
GALLONS. INSIDE LENGTH.
NUMBER OF
COMPARTMENTS
/ ~C~'~ LIQUID
INSIDE WIDTH ~ DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL_ /
NEAREST LOT LINE
OUTSIDE DIAMETER ..,r OR WIDTH
O~Je~ DISTANCE FROM WELLPr~OP' /~0
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA}
, LENGTH /..~, i , DEPTH
, BUILDING FOUNDATION"~. '~),
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~~FOUNDAT?N T LINE
NUMBER OF LINES D~~
ABSORPTION AREA // SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
DISTANCE FROM WATER
WELL:
TYPE /~-~/')./O. DEPTH , BUILDING FOUNDATION.
SAMPLE
NEAREST SEPTIC SEEPAGE
LOT LINE , SEWER LINE . TANK , SYSTEM , CESSPOOl
, NEAREST
OTHER
, SOURCES
DISTANCES:
T~ST: ~s~''
DIAGRAM OF SYSTEM
('-'!ATER ANCHORAGE AREA BOROU/-~
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
CASE #
1
2
3
5
6
7
Performed For
Legal Oescription: Lot Block
This Form Renorts Soils Log
~e~th
Feet Soil Characteristics
9
10--
Date Performed ~- i- 72.
Subdivision
Percolation Test
Was Ground Water Encountered?~
If Yes, At what Depth?
Reading Date Gross Time Net Time Depth to H20 ~ Net Drop
Percolation Rate Minute
Proposed Installation: S,eeDage
Demth of Inlet
CO~ENTS:~~j~,.~
Pit Drain Field
Depth To Bottom Of Pit Or Trench
Test Performed By '7"~ e~_~4~ Data Certified
By:
Date:
Greaier ANChorage Area BOROUGH
DEPARTMIrNT OF ENVIRONMENTAL, QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279.8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PER"'T
LEGAL DESCRIPTION ~
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE DP FACILITY TO BE SERVED
/ ~ DRAIN FIELD , OTHER
FINANCED THROUGH TO BE ,NSTALL~D .Y /~ ~ ~/~b~~
COMPLETION DATE ANT]CIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY TIlE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE K/~"~)~/ TYPE J~7~'~'uZ~
WeLL TO SEPTIC TANK ~' / . SEEPAGE Pit
SEPTIC TANK, ~' SEEPAGE PIT
SEEPAGE AREA SIZE f'"~"~/~/'"~'//~'~//~/-- TYPE
OF SYSTE"
4 INCH DIAMETER CAST [RON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WiTH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
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 . /I