HomeMy WebLinkAboutNORTON PARK #1 BLK 1 LT 5
&:-o 1, 0 *20 (14 52'� Ancho'.age Vvell& Pump Suf 9,0724 -074 P.8
Legal Description Property 0'kvner ;ame &- A ddres�:
r � tj Joa,7-k I L5
ct'-Ky AW
9,16
Pump lustallarkirt !'ate:
Puinpintake Depth BeInw Top jif�A,ell felt
Pump IvInnul'acturer's Nawc: u.,
Fu in p Model:
Pump six, VII lip
Pitic3s Adapier Burial Depth: � Z—feet
Fitivsi Adapter Installer:
Well Disiaketed Upon No
Method of Disinftcficip:
Comments:
Ilump, Installer Name: '~ hcrnp' kvftl
& PLrnp Service,
MI, Fast 76th Avenn
Anchorage, A?,' 99518
h0ile.- 907-243-0749
Ak 907-24347A)
Attention: Theda -YS Of P imp
punip instalIer sji,�jll PtOv;dd 0 puLlPiPstallation lo,21 to the DSD - L insa!'at.011.
5
R. 1
P,C. Ro.— 1S6650
Pump Installation Log
Well Drilling Perm it ber:
zt,
SW Date ollssue.
Parvel Identirkation Number.
3 5
Legal Description Property 0'kvner ;ame &- A ddres�:
r � tj Joa,7-k I L5
ct'-Ky AW
9,16
Pump lustallarkirt !'ate:
Puinpintake Depth BeInw Top jif�A,ell felt
Pump IvInnul'acturer's Nawc: u.,
Fu in p Model:
Pump six, VII lip
Pitic3s Adapier Burial Depth: � Z—feet
Fitivsi Adapter Installer:
Well Disiaketed Upon No
Method of Disinftcficip:
Comments:
Ilump, Installer Name: '~ hcrnp' kvftl
& PLrnp Service,
MI, Fast 76th Avenn
Anchorage, A?,' 99518
h0ile.- 907-243-0749
Ak 907-24347A)
Attention: Theda -YS Of P imp
punip instalIer sji,�jll PtOv;dd 0 puLlPiPstallation lo,21 to the DSD - L insa!'at.011.
ER ANCHORAGE AREA BOROU
DEPARTMENT OF ENVIRONMENTAL QUALI1 ~
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl_ SYSTEM
-- ~,: ........... _LEGAL DESCRtPrlOFT~-~-~-:-_,_.~- ~ ~" >,, '-Tt//
SEPTIC TANK:
DISTANCE FROM WELL ~-~ / MATERIAl ~/---~--~"",...?./,,~_ ~;.~ NUMBER OF
~ ~ - ~ -COMPARTMENTS
LIQUID CAPACi~Y~_~-~ _ ~GALLONS. INSIDE LENGTH ~/._INSIDE WIDTH ~
LIQUID
__DEPTH
SEEPAGE SYSTEM: SEEPAGE Pi1:
NUMBER OF PITS (')UfSIDE DLS, MD-J'~R_ ~ OR WIDTEt LENGTH ,
LINING M A T E R I A _ ~..7.~::--~.'----'''-'~-~- ~ ....... DEPTH__
~---~- DISTANCE F BUILDING FOUNDATION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA} SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WEL£~=2~? / .... FOUNDATION _~2 / ~
NUMBER OF LINES ~ _DISTANCE BE[WEEN LINES_ '~
ABSORPTION AREA ~_.~:'..~C". _SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE IQ FINISH GRADE ~ /
· NEAREST EOT LiNE __
.TRENCH WIDTH
__DEPTH OF FILTER MATERIAL BENEATH TILE
/ TOTAL LENGTH ..~.
· ~/~-_ _, OF LINES
IN. [O~AL EFFECTIVE
~N, ABOVE TILE
TYPE /~'.-~"~/z~/-~`---¢ ~ DEPTH _.~", .~
. NEAREST ~ SEPTIC
LOT LINE ~-/~' ~/~ __, sewer u.e
DIAGRAM OE SYSTEM
DISTANCES:
"
DISTANCE FROM WATER
- __, BUILDING FOUNDATiON/~z,~'~.~_'y2j~'.'~ _SAMPLE /'f/,~' ., NEAREST
,,~-~--5 / SEEPAGE ., OTHER
, SYSTEM_.._~L~Z''> -, CESSPOOL ,.~'_~ SOURCF~-~/~-o.,-~/
DATE
P 7-
GREA'iER ANCHORAGE AREA BORuuGH
.¢ (: ~ DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCN 6-660
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
Sl~WAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
NAME Of APPLICANT ~ .... MAILING ADDRESS
'NSTALLAT,ON LOCATION
PERMIT NO.
PHONE
/,//t?
LEGAl- DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FI N ANCED THROUGH
SOIL TEST RESULTS
/~/ SEEPAGE PIT ~/ , DRAIN FIELD
, OtHEr
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPEOTION~ 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSEC. UTION.
SEPTIC TANK SIZE /?'~() TYPE ', ;:~' ;~ SEEPAGE AREA SIZE
/
DIAGRAM OF SYSTEM
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
WELL TO SEPTIC TAN~
DRAIN FIELD
., DRAIN FIELD
SEEPAGE ,,,
, SEEPAGE PIT
DRAIN FIELD
CASI IRON INTO AND OUT Of sePtIC TANE AND INTO CRIBCROSSING GAP OF
EXCAVATION 6 FEET INTO UNDISTURBED SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TA_iNJK AND SEEPAGE p T
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
?),: ::
LICENSED DESIGNEr
I CERTIFY THAT I AM FAMILIAr WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28.68 AND THAT THE ABOVE
DESCr[~)~ SYSTEM IS IN ACCOrDaNCE WITH SA D CODE.
DAT--'d'J:' /