HomeMy WebLinkAboutMEADOW BROOK BLK 2 LT 8
GREI'"' ANCHORAGE AREA BOF, "H
Q Department of Fnvironmental Quality
3330 C Street
Anchorage, Alaska 99503 .-w~
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS PHONE
SEPTIC TANK:
DISTANCE
FROM WEL[
INSIDE LENGTH
INSIDE WIDTH LIQUID DEPTH __.LIQUID CAPACITY /~//¢~) GALLONS.
SEEPAGE PIT:
NUMBER OF PITS--/ DIAMETER ~V/ /7' ,/~'~f ¢'
· OR WIDTH , LENGTH ., DEPTH
LINING MATERIAL ~.O0,'t]~)~_ CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL
BUILDING FOUNDATION /.-~1 NF_AREST LOT LINE ~)~ TOTAL EFFECTIVE
ABSORPTION AREA (WALl_ AREA) i~¢¢ _
SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE & JM~A; l¥ CONSTRUCTION DEPTH
BUILDING NEAREST NEAREST SEPTIC
FOUNDATION LOT LINE SEWER LINE TANK __
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS.
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:.
DIAGRAM OF SYSTEM
INSTALLED BY:
PIPE MATERIAL'
LOT SLOPE:
REMARKS:
Form No. EQ-031
DATE
,/"1/2 ,,'? ¥~
//G.A.A.B.
SEWAGE
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456I
DISPOSAL SYSTEM --- APPLICATION AND PERMIT
pERMIT NO.
,NSTALLAT,ON LOCAT'O'" k'
MAILING ADDRESS
PHONE
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
SOIL TEST RESULTS
SEEPAGE PIT. {~ DRAIN FIELD OTHER .
NOTE~ THIS pERMIT I$ NOT VALID WITHOUT SOIL Tt"'$"t
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY aUTHORII'Y WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE /~' TYPE ~/ ~*'~/'~'5~ SEEPAGE AREA SIZE /Z /V/~ V ~ TYPE
MINIMUM DISTANCES, REQUIREMENT~
FOUNDATION TO sePtIC TANK
DRAIN FIELD
FOUNDATION TO SEEPAGE PIT
SEEPAGE Pit 2~' ! DRAIN FIelD
SEPTIC TANK
TO NEAREST LOT LINE.
//~'?~ /
SEEPAGE PIT /C' ~./
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
/~/l~' ~'("? / DRAIN FIELD .
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4~ INCN DIAMETER CAST IRON SIPHON pIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO ~lOROUGH REGULATIONS REGARDING INSTALLATION.
G,-,ER
/// LICENSED DESI '
DIAGRAM OF ~YSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA E~OROUGH ORDINANCE NO28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE,
DATE ~-22--/~ ~:/7/~'~/ APPLICANT'S S,GNATURe
/ /