HomeMy WebLinkAboutLot 01611)
Loc'
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-"ER ANCHORAGE AREA BO, .UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl, SYSTEM
LOCAT,ON
MAILING ADDRESS~O/ ~'. ~J~"¢/~ 1~O~4E_~/'~ '-'~_
G~STANCE ~ -_U~____~ ~~_ NUMBER OF
FROM WELL /~ MANUFACTURER ~.~,~- MATER,A~ ~'~- COMPARTMENTS
INSIDE LENGTH_ "-- INSIDE WIDTH__ --~LIQUID DEPTH ~-_LIQUID CAPACITY,/OO(-~ GALLONS·
SEEPAGE PIT:
NUMBER OF P,TS I D.AMETER_ OR W,DT..2D,'. LENGTH~b', DEPTH ~¢
LINING MATERIAL O,.~ CRIB SIZE: DIAMETER_ DEPTH~ DISTANCE FROM: WELL
BUILDING FOUNDATION I~) !¢7. ~_~,,¢_ TOTAL EFFECTIVE
NEAREST LOT LINE . ABSORPTION AREA (WALL AREA) ~ _ .SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE D/~'//~'_~/~.~ CONSTRUCTION O, ~", DEPTH /~/'O'~ DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE SEWER LINE TANK SYSTEM
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED__ REMARKS
DISTANCES:
INSTALLED B Y: .~d~~7
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. EQ-031
DIAGRAM OF SYSTEM
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF' ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE~ ALASKA 99503
TELEPHONE 274~456] j{_/~_:_~ ~j~
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
Perm IT NO
-- - PHONE
DESCRIPTION ~-~ --
-EGAL 7'O7' I
INSTALLATION OF: SEPTIC TANK . K' SEEPAGE PIT ¢ ., DRAIN FIELD ., OTHER
TYPE AND SiZE Of FACILITY TO Be SERVED
FINANCED THROUGH TO BE INSTALLED ~Y
SOIL 'rEST RESULTS / 7"~/~ ! ~ C / ~?~/ NOTEi THIS PERMIT IS NOT VALID WITHOUT BOIL TEST
COMPLETION DATE ANTIG,PATED ~'~//~ 7¢
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITROUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE /l~'~ ~/~R'~'~ TYPE
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPtiC TANK ~/ I~) /
, DRAIN FIELD
/~
'~-o /
, DRAIN FIELD
/
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
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
EKCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT ~EMOVABLE CAPS.
GRAVEL BACKPILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION,
i CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NC~. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID COOK.
GREATER ANCtlORAGE AREA BORO'
Department of Environmental Q~lity
3330 "C" Street
Anchorage, Alaska 9g~03
SOIIJS I,OG PEllOLATION TEST
Performed for <<'~ c'~,<'-~.'q\ ~>-,-,~o ~,-]-~]~-[i~. Date Performed ~ '//- ) ¢
Legal Descript~%-fi:~rZ~F-T-~[~,~' ~-~)~,~-~.~ ~
lh]s form reports: So~ls log__~ ..... '?] ....~_ Percolation test
L)eptt~
Feet
'l- --Y-
/~
Was ground water encountered?
If yes, at what depttl?
Reading Date Gross Time Net Time Depth to Water' Net Drop
Percol ati on rate ..... ]l~i~ti-~-.
Proposed installa~T6-n?'-~-~i)~!le Pit. ................ Urain Field ......................
Depth to bottom of pit or [rench
:)cptl~ o'f Inlet ................... . ........................
g0i,ll IE[ITS:
040 (6/?4)
· DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. P/ease allow ten (10) days for processing,
1. PROPERTY OWNER PHONE
PROPERTY RESIDENT fdifferent fromabovel PHONE
2. BUYER PHONE
MAILING ADDRESS
3. rLENDI'NG INSTITUTION
MUNICIPALITY O~ ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
~UE
ENVIRONMENTAL ENGINEERIN~ DIVISION N0 7 lg 8
Telephone 264-~720
PHONE
2
E. LE?AL ESOR PT,O.
S~REET LOCATION
6. TYPE O~ RESIDENCE ' '
NUMBER OF BEOROOMB
[] One [] Four [] Other
[] Two [] Five
[~ Three [] Six
(
"~ ATTACH WELL LOG, A well log is required for all wells drilled
/ since June 1975, For wells drilled prior to that date, give well
IN depth (attach log if aveilable.) ~('"'C /~-~f' ~---'~- P~"~
''if individual/on-s [e, give installation date ~ ~! C /~'~'.
If system IS over two (2) years old an adequacy test is reomrea
oy this Department,
,,[~' SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATEB SUPPLY
INDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
8, SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTI LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORI-' PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
· DATE RECEIvED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
I NSP ECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified _ INSTALLER
[] Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[] APPROVED FOR BEDROOMS
~ ~)NDITIONAL APPROVAL (letter must accompany certificate)
~ DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev, 3/78)