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Home My WebLink AboutBIRCH HILLS TERRACE #2 BLK 4 LT 1 QGRE, ~ ANCHORAGE AREA B0[ Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 3H LOCATION INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM Z i~"~- MAILING ADDRESSX]~ ~O--g 7--~Z~: ~' ~ PHONE> LEGAL DESCRIPTION ~- ff;ll SEPTIC TANK: //j FROM WELL INSIDE LENGTH MANUFACTURER J'/~2 :~1~ ~/d~ MATERIAL COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY ? 1~' GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER_ OR WIDTH /~, LINING MATERIAL/" / /~/~CRIB ~IZE: DIAMETER ADDITIONAL ABSORPTION LENGTH //~, DEPTH DEPTH '7 DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) /_.-/ .SQ. FT. WELL: FOUNDATION , CONSTRUCTION NEAREST ~ ! LOT LINE b'"~ .~ ge ~' ~g'~q ~'/ DEPTH NEAREST /~.'~ SEPTIC SEWER LINF~, -- , TANK II3 DISTANCE FROM: SEEPAGE SYSTEM CESSPOOL APPROVED , OTHER SOURCES DISAPPROVED DISTANCES: INSTALLED BY: PIPE MATERIAL: O'//C ~';/~1 LOT SLOPE: REMARKS: Form No. LQ-031 DIAGRAM OF SYSTEM GREATEr ANCHORAGE ArEa Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMit NO. SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESG:RIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL. TEST reSULTS SEEPAGE PIT DRAIN FIELD OTHER TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. '~ SEPTIC TANK SIZE IOOO TYPE d(~'~'~,.(~;-,~"'~- SEEPAGE AREA SIZE , YPE ~/~ ~ /'~/ (~ MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ I FOUNDATION TO SEEPAGE PIT- , DRAIN FIELD SEPTIC TaNK tO SEEPAge Pit Wall / ~ SEPTIC TANK SEEPAGE Pit ~ TO NEAREST LOT LINE. WELL TO SEPTIC TANK . ~ DRAIN FIELD WATER MAIN TO SEPTIC TANK 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 EXCAVATION 5 FEET INTo UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit Fitted WITH AIRTIGHT REMOVABLE CAPS. ,, DRAIN FIELD / o SEEPAGE Pit ~ ALSO CONSIDEr AREA WELLS. SEEPAge PIT GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING/~TALLATION, G .A .A .B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT i AM fAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGh ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SY. STEM IS IN AccOrDANCE WITH SAID CODE. APPL,C^.T'SS,gNATU.E ><.. .,,C...,,,_,., FORM NO. EO-OI 6 ". u~ I~E RECEIVED ' ~ ' INSPECTION APPOINTMENTS ¥1ME TIME TIME INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE NIUNIClPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT, OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION NOV :3 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWJ~F~II~[' DIRECTIONS: Complete all parts oil page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing. I PHONE MAILING ADDRESS PROPERTY R ESI DENT (If different from above) w PHONE 2. BUYER PHONE' MAI LING ADDR ESS 3. LENDING INSTITUTION ' HONE MAILING ADDRESS - PHON 4~ REALTOR/AGENT MAI LING ADDRESS ,5. ~EGAL DESCRIPT~.ION / STREET LOCATI ~..N ~'" SINGLE FAMILY [] MULTIPLE FAMILY [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY * ATTACH WELL LOG, A well log is required for all wells dril ed since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ~"~:~' ~ 1'~ ~'--~ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] NDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified i--ISeptic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] ONE [] THREE [] TWO [] FOUR PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING [] FIVE [] SIX [] OTHER MANUFACTURER MATERIAL Septic/Holding Tank IAbsorption Area lSewer Line INearest Lot Line 5. COMMENTS DATE APPROVED FOR BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) DISAPPROVED 72-010 ( Rev. 6/79)