HomeMy WebLinkAboutSUMMIT ESTATES BLK 2 LT 17· .s./o
il?
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G£ /;ER ANCHORAGE AREA BORG[ ,!
n~"i~/~RTMENT OF ENVIRONMENTAL QUALI~¥/
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 270-8686
INSPECTION REPORT ON-SiTE SEWAGE DISPOSAL SYSTEM
NAME ~r /~~'~
LOCATION (~'
SEPTIC TANK:
ADDRESS ,~/~J/ PHONE
LEGAL DESCRIPTION ~ ~7'~ ~'/'A~ ~-~;~/,'u/' E"/-~'.J ;~"~
DISTANCE FROM WELL OO''/"
LIQUID CAPACILY /'~;'?'-~- GALLONS.
MATERIAL (~(¥Z'~("~%'=~'~//~/~rZ~' NUMSER GE
COMPARTMENTS
INSIDE LENGTH /~' 'j~ INSIDE WIDTH ~/
LIQUID /
DEPTH ~.~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER ~ OR WIDTH
X,4~' ,'}'~, -)DISTANCE FROM WELl ,~/'('t~
/~ I~ /~*'~//i TO~AL EFFECTIVE ABSORPTION AREA (WALL AREA)
NEAREST LOT LINE ·
, LENGTH /'~' , DEPTH
, BUILDING FOUNDATION
/~ r~' .SQl FT.
TILE DRAIN FIELD:
NUMBER OF LINES / .DISTANCE BETWEEN LINES TRENCH WIDTH
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
, OF LINES r
ri .~IOTAL EFFECTIVl
DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
/~/?///.W~ DISTANCE FROM
WELL: TYPE /~ , DEPTH. ., BUILDING FOUNDATION
/ , ._ r~/' SEEPAGE //~, '
LOT LINE ~ ~(~"-'~ NEAREST SEPTIC
SEWER LINE ., TANK , SYSTEM.
WATER
SAMPLE ,~7"~/OZ~ , NEAREST
OTHER
, CESSPOOL. "~ , SOURCES
DISTANCES:
~
/,
DATE
DIAGRAM OF SYSTEM
GREATER ANCHORAGE AREA BOI:~OGH
PERMIT
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
TYPE AND SIZE OF FACILITY TO BE SERVED ~ ~ f ~ /
DRAIN FIELD
TO INSTALLED "Y
PHONE
OTHER
NOTE; THIS PERMIT IS NOT VALID WITHOUT BOil. T~ST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. EACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTB
SEPT[C TANK TO SEEPAGE PIT WALL
SEPT[C TANK PIT , DRAIN FIELD
WELL TO SEPTIC TA , SEEPAGE
DRAIN FIELD , ALSO CO
DIAGRAM OF SYSTEM
WATER MAIN TO SEPTIC TANK . ., SEEPAGE PIT
DRA{N FIELD.
SEPT,° TAN .
, SEEPAGE PIT , DRAIN FIELD
TO RIVER, LAKE STREAM.
~CAST iRON INTO AND OUT. OF .SEPTIC TANK ANDii iNTO CR[B CROSSING GAP OF
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
..... ~ ...... ~'~ 17 ~,: ~ ,' 2 ,~,!: .~,':. Summit
1 Brown silty sand (SM)
Gray sand a~d gravel
.. ~._~__.