HomeMy WebLinkAboutSUMMIT ESTATES BLK 2 LT 40I$
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Bloc,
GR/F.k.,. R ANCHORAGE AREA BOB.: .vU1
Department of Environmental O_uality~
3330 C Street
Anchorage, Alaska 99503
. INSPECTION
NAME ,),/~ffi4~_~ 4,~C,_,
LOCATION
LEGAL DESCRIPTION X ~
SEPTIC TANK:
DISTANCE
FROM WELL
REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS ~ ["~:~ ~:' ~ ~ ~'~':~ PHONE
MATERIAL
MANUFACTURER
NUMBER OF
COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPACITY__ GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE ~'~ (
FOUNDATION /'~ NEAREST LOT LINE ~/{) !OF LINEsTOTAL LENGTHx?
DISTANCE BETWEEN LINES ,JC~./,/g TRENCH WIDTH''~'~¢'~l"- TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE
MATERIAL BENEATH TILE_ I~f. ABOVE TILE IN.
WELL: . , ,
BUILDING
FOUNDATION . ,
CESSPOOL
APPROVED
NEAREST
LOT LINE __
OTHER SOURCES
DISAPPROVED
DEPTH
NEAREST SEPTIC SEEPAGE
SEWER LINE__ TANK__ SYSTEM
REMARKS
DISTANCE FROM:
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS: ,~f~
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GR(" ~TER ANCHORAGE AREA BOROI~ ~H
; HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 2~-9-~511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
PHON
- ' ' -- MAILING ~?C'
LOCATION 4'~i ~? '~" ~. ~'~h--%~,. /~L~GAL DESCRIPTION
SEPTIC
i
DISTANCE FROM WELl ~ I MATERIAL ~zc~ u~z.~ NUMBER OF
LIQUID CAPACITY /~;~-'C'~ GALLON~. INSIDE LENGTH S:}, '~ INSID~ WIDTH ~/ , 2 DEPTH· .~. ~"
SEEPAGE SYSTEM: SEEPAGE Pit:
NUMBER OF PItS / OUTSIDE DIAMETER OR WIDTH J/~ /., LENGTH / ~-~'~ I , DEPTH
LINING MATERIAL C~.~'l-~'C. {,4/.-:// DISTANCE FROM WELL ,/'~' ~' /
· BUILDING FOUNDATION
/
NEAREST LOT LINE /~) TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '~ "~>'(0~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
TOTAL LENGTH
, OF LINES
, FOUNDATION , NEAREST LOT LINE
DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE
SQ. ET. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TIL~'
IN. ABOVE TILE
WELL:
LOT LINE
TYPE ., DEPTH~ , BUILDING FOUNDATION, -- SAMPLE ~]*~'('~ .. NEAREST
NEARESTsEPT,c / ' SEEPAGECESSPooL oTHER
'~') ~ .. SEWER LINE . lANK _ . SYSTEM , . SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
12,
APPROVED
GAA~-HD-2
: ' I'
GREATEIL.,ANCHORAGE AREA ~,j)ROUGH
~'~-~. HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511 ~" '~,~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMII'
NAME OF APPLICANT
RESIDENCE ADDRESS
APPLICATION TO INSTALL: SEPTIC TANK I"'"/ , SEEPAGE PIT V/'" , DRAIN FIELD.
TO SERVE THE FOLLOWING FACILITY ~ ~.'~ /~ c/r~
FINANCED THROUGH ~')~.~/-,-,~_~ TO BE INSTALLED BY ~
PERC0'AT'0N TEST RESULTS ~/'~.'~/~'¢~ ANT,C,PATED DATE OE C0MP'ET,~
~BE~¢E .L'ED OUT BY .EA'T. DEPA.T~ENT
- ~^~ LOCATION ,OF INSTALLATION,
,OTHER
As DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
.SEPTiCTANKSIZE//~?O4',~/flTYPEu~¢~',4/~' SEEPAGE AREA ~d~.Z~' TYPE ~'~
;bCoevr;idfYestchr:;eI_¢stf;~i;;a]nWXtchcotr~eanr;qeUwiri~r;:il: :fodGe:eater Anchm~
lorough Ordinance No. 28-68 and that the
ATER ANCHORAGE AREA BOROUG~
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
~EQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
1. APPROVAL REQUESTED BY:
ADDRESS: ~<'f/~ ~xJJ/
2. PROPERTY OWNER: ~"~n~ PHONE:
/
4. TYPE FACILITY TO BE INSPECTED: !~/4~YxY~ -
NUMBER OF BEDROOMS:
WELL DATA:
B.
C.
D.
E.
TYPE
DEPTH
SIZE
CONSTRUCTION
BACTERIAL ANALYSIS
6. SEWAGE DISPOSAL SYSTEM:
SEPTIC TANK (IF HOMEMADE,
1. SIZE 4 ~ d
2. AGE / ~./~
3.
4.
SHOW DIAGRAM ON BACK)
' MANUFACTURER
I N S T A L L E R ~/~
SEWER & WATER FACILITIL,,~j
APPROVAL REQUES~N.~O R
PAGE TWO
SEEPAGE PIT
1. SIZE
2. LINING
DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
WELL TO SEEPAGE PIT
WELL TO SEWER LINE
WELL TO PROPERTY LINE
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B.
C.
D.
E. WELL TO OTHER POSSIBLE CONTAMINATION
F. FOUNDATION TO SEPTIC TANK ~,O~
G. FOUNDATION TO SEEPAGE PIT ~ /
H. SEEPAGE PIT TO PROPERTY LINE /~ /
COMMENTS:
APPRO/~~
DATE~/f
APPROVAL
l~ /~ ~,/~ DISAPPROVED:
ALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY