HomeMy WebLinkAboutMURRAY BLK C LT 5Oq2
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GP'~.TER ANCHORAGE AREA BOROIJr'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? 777
INSPECTION REPORT ON-SITE SFWAGE DISPOSAL SYSTEM
MAILING ~"/_~...~ .~ - ~,~2.~.~.~ ,,~,~. ~ ~ ~ PHONE
NAME ~--~'~"z"-O /r'~% /~/.,/~K/~/~:z~. ADDRESS
LOCATION ~'~-/',~ ~"~ /~-~'~r"Z'C~-'~'~'~'"~'~,'~ LEGAL DESCRIPTION -/---~;"
SEPTIC TANK:
DIS'rANCE FROM WELL
LIQUID CAPACITY -.~'~"~'-'"
GALLONS.
NUMBER OF
MATERIAL ~'~..-~.~- ~-- ~ COMPARTMENTS
INSIDE LENGTH ~ INSIDE WIDTH
SEEPAGE SYSTEM: SEEPAGE PIT:
LIQUID
DEPTH
NUMBER OF PITS ' O.._.UTSI~._~IAME-TER ' ~ . OR WIDTH
LINING MATERIA}~.~ , DISIANCE FROM WEL~
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH , DEPTH
BUILDING FOUNDATION____
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION.
NUMBER OF LINES ,..,-.-"D~TWEEN LINES
ABSORPTION ARE,~~ SQ. FT. LENGTH OF EACH
, NEAREST LOT LINE
LINDE TRENCH WIDTH
TOTAL LENGTFI
OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
.IN. ABOVE TILE__
WELL:
LOT LINE
TYPE: ./~--~/:-'.~':~-~-~2 DEPTH ('~ ~r~' / DISTANCE FROM WATER
,BUILDING FOUNDATION ~ SAMPLE //~ , NEAREST
/~ ~ NEAREST SEPTIC SEEPAGE~ . ~ OTHER
., SEWER LINE /~ ~, TANK /~)~ , SYSTEM ~/~, CESSPOO~ , SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
LEGAL DSSCmPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO Be SERVED
FINANCED THROUGH //~
soil TEST RESULTS
ADDRESS
SEEPAGE PIT DRAIN FIELD
TO BE INSTALLED BY ~*c¢l
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TES'r
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INBPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE BUBJECT TO PROSECUTION.
FOUNDATION TO ~t~ ~ANK
FOUNDATION TO SEEPAGE PiT .. DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK . SEEPAGE PIT , DRAIN FIELD
TO NEAREST LOT LINE.
ELL TO S~ ~ANK { ¢-~ ~1 SEEPAGE PIT
DRAIN FIELB ALSO CONS]DER AREA WELLS.
WATER MAIN TO SEPTIC TANK , SEEPAGE
DRAIN FIELD
SEPTIC TANK, SEEPAGE PIT ., DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION ~ FEET INTO UNDISTURBED SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
SEEPAGE AREA SIZE TYPE
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THF. REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH,ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRII~ SY TEM IS IN ACCORDANCE WITH SAID CODE. //)
17
NUISANCE COMPLAINT FORM
.~-~,,~n~ oz ~act~ ~de tb the bes~f my belief and know-
ledge. I request that the fomegoing matter be investi[{ated and that appropriate
action thereafter be taken, I am willing to testify to the facts stated in the
foregoing complaint in court if n~cessapy.
Compls inant
REPORT OF ACTION TAKEN
Date Inv.. st igat ed :__~
Action Taken
DATE COMPLAINANT WAS CALLED REGARDIIIG DISPOSITION OF COMPLAINT:
