HomeMy WebLinkAboutT13N R3W SEC 26 NE4
GRE ER ANCHORAGE AREA BOr JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~O/O "~'~A/~ MAILING ADDRESS ~'~--/~ /?~/~/~e'Jr~/O PHONE
SEPTIC TANK:
DISTANCE / NUMBER OF /
FROM WELL ,./O 0 MANUFACTURER ~..~./'o,5'~---~ ,/~,~gMATERIAL ~-'/J'~:"'~'~/"~J" COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH .LIQUID CAPACITY '/~ ~'% GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER OR WIDTH /'~ ! " /~ /
. LENGTH ~ DEPTH
, / .~ TOTAL EFFECTIVE
BUILDING FOUNDATION 90 ' NEAREST LOT LINE '~¢ /~. ABSORPTION AREA (WALL AREA) ~ ~ ~ SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE Z~'~'//"/~¢~ CONSTRUCTION 0 ~,, DEPTH DISTANCE FROM:
NEAREST .- -- NEAREST SEPTIC SEEPAGE
FOUNDATION __ LOT LINF ~--~ SEWER LINE TANK SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
PIPE MATERIAL,
LOT SLOPE: ~O '~' 7/~'P~Z~'/g~.
REMARKS:
Form No. EO-O31
DIAGRAM OF SYSTEM
DATE
G.A.A.B, :
GREATER ANCHOrAgE AREA BoROuGh
DEPARTMENT OF ENVIRONMENTAL QUALITY
TELEPHONE 274-45~1
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
NAM~ OF APPLICANT '/~0 /~'/~ 0 ~'
INSTALLATION ~OCATION ~/~ ~~ ~/
MAILING ADDRESS
PHONE
INSTALLATION OF: SEPTIC TANK / SEEPAGE PIT K~ DRAIN FIELD
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED ~L~/ ~
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.
SEEPAGE AREA S Z ~ / ~ ~ ~ / TYPE
MINIMUM DI~TANC:E$, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
/0/
· SEEPAGE PIT ., DRAIN FIELD
TO NEAREST LOT LINE.
WELLTO SE"'C ANK
SEEPAGE PIT
DRAIN FIELD / ~ , ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK ~
DRAIN FIELD
SEPTIC TANK, /~ / SEEPAGE PIT
SEEPAGE PIT
/ /a-7 /
, DRAIN FIELD
CAST ]RON INTO AND OUT OF SEPTIC TANK AND INTO CRI~ CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTUrbED SOIL.
/~ INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OR
I CErTIfY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 aND THAT THE ABOVE
"O~e te~ is w~h a th~sand o~inlons"
verformed For ~o~Zd /D, ~A~r~' Date Performed .'
Leaal Description: Lot Block I Subdivision ~~mg
Percolation Test
This Form Re~orts Soils Log
~enth
Feet Soil Characteristics
Encountered?
Was Ground Water
I¢ Yes, At what Depth?
i
I
Reading Date Gross Time Net Time Depth to H2O Net Drop:
I
I i I
Percolation Rate Hinute
Proposed Installation: Seepage Pit ~.~ Drain Field
Deoth of Inlet Deoth~o Bottom Of .Pit Or Irencl~
CA~t~ENTS: ~ ~, ~'~, ~/~ ~ ~ox~~--~n~ .~
*est Performed B.y /l~ ~~ Data Certified BY:r~ r~~~
n.t :