HomeMy WebLinkAboutMURRAY BLK B LT 18
GAAB-HD. I
~' ,'ER ANCHORAGE AREA BORC I
UEPARTMElYT OF ENVIRONMEBITAL QUALITY
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 2'19-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING ?~"
LEGAL DESCRIPTION/Z//~Jz ~'Z/( /~
DISTANCE FROM WELL. '~"~ ' ""
LIQUID CAPACITY_ ~ ~'OC) GALLONS.
,c' /~ -/:Z,./ X~ NUMBER OF
MATERIAL
COMPARTMENTS
-:'..'vu., .' ,- ..x-z4',-:,''''r
INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH __
SEEPAGE SYSTEM_: S E E p A~G~E~p4 ~..~ _;~~
NUMBER OF PITS ~/ OUI"SIDE DIAMETER ~ __OR WIDTH__.
LINING MATVIA~t DISTANCE FR~M-w~-E~I,_
NEAREST LOT LINE_
., LENGTH__ J , DEPTH
BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL .---'"~' FOUND~A NEAREST LOT LINE.
QN.,~ ,
NUMBER OF LINESzz"/~ DISTANCE BETWEEN LINES~. TRENCH
WIDTH
/
ABSORPTION AR~A SQ. FT. LENGTH OF EACH LINE~.~.~
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTEI
, OF LINES
IN, TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: TYPE/~/',:;/~~ -/) . DEPTH ,/'~"'~' / DISTANCE FROM " WATER
BUILDING FOUNDATION. ('~? _ SAMPLE .Z(~
/.A~ /I~ ~,~) j SEEPAGE
NEAREST SI~PTI 'C
LOT LINE .~d) f",~'¢ /'t/'w~'/ , SEWER LINE '- ' ., TANK , SYSTEM ..... CESSPOOL
DIAGRAM OF SYSTEM
NEAREST
OTHER
SOURCES
GREATER ANCHORAGF' AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE. ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMit
NAMe OF APPLICANT
INSTALLATION LOCATION/~ ~ ~/' ~'~/Z
INSTALLATION OF: SEPTIC TANK
TYPE AND 81ZE OF FACILITY TO BE served
MA,L,NG AODRESS ¢X
SEEPAG PIT , DRAIN FIELD
PNoNe .¢¢V
,OTHER
SOIL TEST RESULTS
NOTE: THIS PERMIT IS NOT VALIO WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BAGKFILLING OF ANY SYBTEM WITHOUT FINAL INSPEGTION BY'THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROBEGUTION.
AREA
SIZE
TYPE
MINIMUM DIBTANCE$, REQUIREMENTS DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT
TO NEAREST LOT LINE.
, DRAIN FIELD
., DRAIN FIELD
SEEPAge PIT
ALSO CONSIDer ARea WELLS.
SEEPAGE PIT
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, , SEEPAGE PIT ,, DRAIN FIELD .
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF S~ /TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S 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 ~OROUGH REGULATIONS REGARDING INSTALLATION.
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ~RAGe AREA BOROUghS5 ANDTHATTHE ABOVE
,, GREATER ANCHORAGE AREA BOROUGH
!j ,DEPARTMENT OF ENVIRONMENTAL QUALITY
35oo TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
APPROVAL REQUESTED BY:
ADDRESS:
2. PROPERTY
4. TYPE FACILITY TO BE INSPECTEDL.~/
NUMBER OF BEDROOMS:
WELL DATA:
A. TYPE
B. DEPTH
C. SIZE
D.
E.
SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK)
1. s i z E __ "S: d ~ 4./~-~>~ !
/
2. AGE
3. MANUFACTURER ::~,l,(,~,< ./1
4. INSTALLER
CONSTRUCTION ~"~-- ~
BACTERIAL ANALYSIS
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
B. SEEPAGE PIT
1. SIZE
2, LINING
C. DISPOSAL FIELD
1, NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE
E.
F.
G.
H.
WELL TO OTHER POSSIBLE CONTAMINATION
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEEPAGE PIT TO PROPERTY LINE
8. COMMENTS:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY
GREATER ANCHORAGE AREA BOROU6
HEALTH DEPAR~ENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
279-2511
REQUEST FOR APPROVAL OF
INDIVIDUAL SELVAGE AND WATER FACILITIES
FOR
1. Approval Requested By . ~
~roperty ~, ~~ .~ , ,/ , ~/~ Phond
- c .......
/
Nu.b.r Of Bedrooms ,~ ~/~ - ~ ~
5. Well Data:
B. Depth
D. Construct~on__.<~.: ..<,( ,' ~.//7'"- ~ ¢.
E. Bacterial Analysis ~~ ..
Sewage Disposal System: ~
A. Septic Tank (If homemade, show diagram on back)
1. Size (~w~.~__ ( /.~ .- :. ~ /
2. Age
5. Manufacturer
4. Installer
Approval Request for ~ ge & ~ater Facilities
Page Two
B. Seepage Pit
1. Size
2. Lining .~.-~.
C. Disposal Field
1. Number of Lines
2. Total Length
Required Measurements
Ae
B.
D.
E.
F.
G.
[Veil to Septic Tank
Well to Seepage Pit
IVell to Sewer Line
l~ell to Property Line
IVell to Other Possible Contamination
Foundation to Septic Tank
Foundation to Seepage Pit
Seepage Pit to Property Line
COMMENTS:
GREATER ANCttORAGE AREA BOROUGH HEALTH DEPARTMENT
EDll70