HomeMy WebLinkAboutTRANQUILLITY HEIGHTS BLK 1 LT 11II
G' ~.TER ANCHORAGE ARFA BORO ~H
Ur. PARTMENT 0F ENVIRONMENTAL QUALI1 ¥'
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION RE-PORT ON-SITE SEWAGE DISPOSAL. SYS'fEM
SEPTIC TANK:
MAILING '~?/
ADDRESS ..~
LEGAL DESCRIPTION ~--Z9~"~/./~'//~_~/',,
DISTANCE FROM WELL .,~/~_~_~-~ ..... MATERIAL -~'-~'~--- NUMBER OF
COMPARTMENTS
SEEPAGE SYSTEM: SEEPAGE Pit:
NUMBER OF PITS OUTSIDE DIAMET~EJ~= ~ OR WIDTH , LENGTH .... DEPTH_
NEAREST LOT LINE__ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '""~:~- SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ,/,.~,..~ )~f'.~--~5. , FOUNDATION__
NUMBER OF LINES___.~.~ __ DISTANCE BE1WEEN LINES
.~ / TOTAL LENGTH ~. ~ j
,,/'~:f:~ . NEAREST LOT tINE ~'~'~ OF LINES
~TRENCH WIDTH .~/~ _IN. TOTAL EFFECTIVE
DEPTH OF FILLER MA[ERIAI. 8ENEA]H life ~ IN. ABOVE [ILE
ABSORPTION AREA__ .,/'~' ____SQ, FT./-LENGTH GE EACtl LINE
DEPTH: TOP OF TILE TO FINISH GRADE___~",z-/ '/
W E i. L .. -z~.~-'./,'/,~-;"z-~ ..~.~ ~..~'' ~'~7~' DISTANCE FROM
TYPE__/~/Z--¢~/~:--~' DEPTH ~ , BUILDING FOUNDATION. .__
NEAREST SEPTIC SEEPAGE
LOT LINE ~"~'~, SEWER LINE_ ~ . TANK ~ , SYSTEM_._ ~-~'
WATER
_SAMPLE .... NEAREST
OTHER
, CESSPOOL ~ SOURCES*---
DIAGRAM OF SYSIEM
DISTANCES:
DATE
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIROnMENTAl. QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE. ALASKA 99502
TELEPHONE 27948686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
NAME OF APPLICANT
INSTALLATION LOCATION
LEGAL DESCRIPTION
MAILING ADDRESS · ~//~/K.'/ ~'~? ~J /~/~ PHONE
TYPE AND SIZE OF FACILITY TO BE SERVED
SOIL TEST RESULTS ~ ~¢~/
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL 'TEST
COMPLETION DATE ANTICIPATED /_~'.~7/ ~"~/¢~'~'/~ ~//2- d~
FINAL IN~PECTION~ 24 HOUR NOTI~e REqUIReD, BACKFILLING OF ANY ~M~TEM WITHOUT FINAL INSPECTION BY THE
HEALTH D~PARTMeNT AUTHORITY WILL BE ~UBJ~CT TO PROSeCUTIOH,
~' ~,~ TYPE /~ ~/ . SEEPAGE AREA SIZE / TYPE
SEPTIC
TANK
SIZE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK -~ , SEEPAGE PIT
TO NEAREST LOT LINE.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, · , SEEPAGE PIT
TO RIVER, LAKE, STREAM.
DRAIN FIELD
SEEPAGE PI~
, ALSO CONSIDER AREA WELLS.
., SEEPAGE PIT
, DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRl~ CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH A]RTIGHT REMOVABLE CAPS,
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
Or
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DATEDESCRIBED SYSTEM~ ~//IS.IN ACCORDANCE WITHAPPLiCANTS SAID CODE.siGNATURE ~ /K--~[~/.~ J;"- ~L ~ /~///~1~///~~' ~