HomeMy WebLinkAboutNORTON PARK #3 BLK 1 LT 3/._07"
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GP 'ER ANCHORAGE AREA BOROI '~1
DL,-~RTIV1ENT 0F ENVIRONMENTAL QUALI~ ,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
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INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS __.~ _
PHONE.
LIQUID CAPACITY ~'--~" GAL[ONS. INSIDE LENGTH - INSIDE WIDiH
SEEPAGE SYSTEM: SEEPAG
OUTSIDE OR WIDTH
NUMBER OF PITS DI~E~E~
LINING ~ATERIA[ .... DISTA~ROM WEtI
NEAREST EQ] LINE TQTA[ EFFECHVE ABSQRPDON AREA iWAL[ AREA)
LIQUID
DEPTH
., LENGTH , DEPTH
BUILDING FOUNDATION.____
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL_
NUMBER OF LINES
ABSORPTION AREA
~~ , NEAREST LOT LINE
____DISTANCE BETWEEN LINES~.~
SQ. FT. LENGTH OF EACH LliX,.~L.
DEPTH: TOP OF TILE TO FINISH GRADE
TRENCtl WIDTH
TOTAL LENGTH
, OF LINES
DEPTH OF FILTER MATERIAl BENEATFI TILE
__IN, TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
TYPE DEPTH
NEAREST SEPTIC
LOT LINE , SEWER LINE ., TANK
DISTANCE FROM WAIER
,BUILDING FOUNDATION ......... SAMPLE__
SEEPAGE
, SYSTEM , CESSPOOL_
_, NEAREST
OTHER
, SOURCES___
DIAGRAM OF SYSTEM
DISTANCES:
GREA]'ER ANCHORAGE AREA BOF~UUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-050
ANCHORAGE, ALASKA 99502
SEWAGE DISPOSAL SYSTEM w APPLICATION AND PERMit
PERMIT NO,
~ · - ~ ¢ - 7(00
INSTALLATION OF: SEPTIC TANK ~LfOID(¢( f~ ~ ' S~EPAGE Pit , DRAIN FIELD , OTHE.
~INANCED THROUGH TO B~ INSTALLED BY
SOIL TEST RESULT9
COMPLETION DATE ANTICIPATED
FINAL INSPE:CTION: 24 HOIJR NOTICE REQUIRED. I~ACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPE(:TION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION,
~0~ L TYPE SEEPAGE AREA SIZE TYPE
MINIMUM D I B'rA N C E $,-t'~,E Q&,,I.I R E I'~'1 ~ N T S
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SF*gF'-AeE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
., DRAIN FIELD
., SEEPAGE PIT
/
, DRAIN FIELD
, SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, , SEEPAGE PIT
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
LICENSED D ESIG NT:(~
DIAGRAM OF SYSTEM
] CERTIFY THAT I AM FAMILIAR wI'rH THE REQUIREMENTS Of GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. /? __
DATE '~/~- 7/ ~ / APPLICANT'S SIGNATURE~~'~-~
REATER ANCHORACE AF, I:A BOROUGH
HEALTH DEPAF:TY,£NT CASE ~7
327 EAGLU STREET .....
ANCHORAGE, ALASKA 99501 ,' ¢4 ' '
] /-02 R /),"'~ I Ir'fO?Pa> f'-'~"':" ", ~ , '
Performed For ~./..~/~., /~-~.,..,.,.~.,:,~ Date Performed ~--,Z--
~n~s rcvm ~epor;s a; bo~s bog ~ Papco%a~on f'~t " ~
Depth
Feet Soil Characteristics
Was G~onnd Wa~e~ Encoun~ered?_.d~p
if Yes, A~ Wha~ Dep~h_~
Reading
Location Sketch
Net Drop
Proposed Instal~'~--Seepage Pi~ Drain Field
Depth Of lnl~t Dept-~--~-° ~"~~'i~ Or ,Tren¢~
C04,EN.o.~.o.~_~.2~ .~l~a, ~o' - ~-r~ ('~~ ~',~ ~ ~ ~ ~- .......
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