HomeMy WebLinkAboutBRUCE Block 2 Lot 1
GRE,,,i~R ANCHORAGE AREA BOk~,JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
Pc.w-_.
DISTANCE
FROM WELL
MAN U FACTU R E R MATE R I AL
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPAC ITYr-~~LLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
FOUNDATION
DISTANCE BETWEEN LINES
NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
MATERIAL BENEATH TILE
IN. ABOVE TILE IN.
WELL:
BUILDING
FOUNDATION__
CESSPOOL
APPROVED
;k CONSTRUCTION
NEAREST NEAREST
LOT LINE__, SEWER LINE__
DEPTH
SEPTIC SEEPAGE
TANK , SYSTEM
OTHER SOURCES
DISAPPROVED
REMARKS
. DISTANCE FROM:
DISTANCES: --
DIAGRAM OF SYSTEM
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
D AT E ~'/... / ~."//,, App R OV E D~ ~/~~~'
. .-- ~/ - ' G.~,.A.B. (-~
Form EQ-032
NAME OF APPLICANT /~
INSTA'LATION LOCATION
LEGAL DESCRIPTION ,4C,'-~ /
INSTALLATION OF: ~ TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
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
P.ON E//'i,<</~
DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK . SEEPAGE PIT , DRAIN FIELD ('
TO NEAREST LOT LINE. /~
WELL TO SEPTIC TANK SEEPAGE PiT
DRAIN FIELD 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
PITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVE~ BACKFILL
CQNFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OR
LICENSED DESIGNER
SEEPAGE PIT
,, DRAIN FIELD
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF (~REATER ANCHORAGE AREA I=IOROUGH ORDINANCE NO. E8-6S AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
FOUNDATION TO SEEPAGE PIT
SEEPAGE PIT ~ DRAIN FIELD
FINANCED THROUGH TO BE INSTALLED By "--~'----; '',f/"~ '~--.--.
SOIL TEST RESULTS
CO.LET,ON DATEANT,C,PATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLI~I(~OF:/~N~ SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT
ENVIRONMENTAL QUALITY AUTHORITY~.,W~I~I~BE~'UB~IEC~r TO PROSECUTION.
OF
C ~ TYPE
MINIMUM DISTANCes,
DIAgrAM
SYSTEM
FOUNDATION TO SEPTIC TANK
T~
e
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500/Tudor Road, Anchorage, Alaska 99507 279-8686
D, te of Ins~ectton~
I~V~DUA% SEWER & WA~R FOR
5. Type of Facility to be Inspected:
Number of Bedrooms:
Well Data: ~fw-v~¢~-o
A. Type
C. Construction
Sewage Disoosal
B. Depth .....
/'.,
A. Installed
B. Installer
¢. Septic Tank: 1. Size
2. Manufacturer
D. Seepage Pit: 1. Size
2. Material
E. Disposal Field: Total Length of Lines
8. Distances
A. Well To: Septic Tank
, Absorption Area
, Sewer Lines
, Nearest Lot Line
, Other Contamination
B. Foundation to Septic Tank
Absorption Area
C. Absorption Area to Nearest Lot Line
Request.for Approval ~ Individual Sewer & Water Facilf ~s.
Page Two
9. Comments:
Appr~l Valid for One Year From Date Signed
Greater Anchorage-Area Borough, Department of F. nvironmental Quality
DIAGRAM OF SYSTEM
I' certify that the information contained in this rec~est for appreval to be a true
and accurate representation of the subiec~ sewer and water facilities located at:
Signed Date
