HomeMy WebLinkAboutTURNAGAIN BLK 4 LT 4
MUNICIPALITY OF ANCHORAGE
He h and Envzronmental Prot6
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
~ ' ' ,~ ADDRESS '~Y~-%~- -/']~ _
.... : ? ,' .....
LOCAT,ON ..~;~ -¢¢'"'¢ LEGAL OESCR,PT'ON
SEPTIC TANK:
DISTANCE ~
FROM W E LL't"-'4~
INSIDE LENGTH
J p~,~, ~. NUMBER OF
MANUFACTURER ~Jz'_c'~t.-~LL---- MATERIAL _'t/~,.-'F-4~-~(~' ...... COMPARTMENTS ~
INSIDE WID]H ._ LIQUID DEPTH LIQUID CAPACITY/''~'~' GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL
FOUNDATION __
TOTAL LENGTH
NEAREST LOT LINE ........... OF LINE
DISTANCE BETWEEN LINES ..... TRENClt WIDTH~/,¢~ TOTAL EFFECTIVE
MATERIAL BENEATN TILE
ABSORPTION AREA /"~/
DEPYH: TOP OF TILE TO FINISH GRADE
SQ. FT. LENGTH OF EACH LINE
DEPTlt OF FILTER
ici. ABOVE TILE ¢ ¢¢ IN.
SEEPAGE PIT:
DIAMETER OR WIDTH--, LENGTH___, DEPTH
Log Crib
BUILDING FODNDATION
Rings/CRIB SIZE: DIAMETER ..... DEPTH , DISTANCE FROM: WELL
TOTAL EFFECTIVE
_ , NEAREST LOT LINE.____ ABSORPTION AREA (WALL AREA)
FT.
Class: 9.3;~L~ Dept~:
Well Distance To: Lot Line
Bldg: Sewer Line:
Pipe Materials:
# of Bedrooms:
Installer:
Remarks: ~ %~
DATE~'~- ~/''} APPROVED
PERM:IT b40.
FII='F'L. iCRNT BI..If?I'EI:;:.' NEI-qTOiq Eb,I'T' E:O::':', 40,172 I'q STFI
I_OCFITiON 1_:~:-,4 E[:~-'f'URNF:IGFI~:~:D
LEGFIL. I...:3:.-4 E',4 TUI:~:I'.,IFIGRII'.,I SUE:D LOT
L:; l 2:E
278-90;:::5
,':I-E~E~00 .SQLIRF?.E FEET
I'¥PE I-)F SOIL F:IB'SORE:T]:OIq S'¢STEM !S: DIE:FIINF=ZEL.[:,
MI:tX I MUM NLIFIE:EI:;:'. OF' [.:.:EDROOi"I:':; = .0
SOIL. RIRTII'.,IG (SQ FT,.."BR)= 0
T'HE REQLI i F?.EI} S I ZE OF "['HE '=301 L FIDSORF'T I ON S'¢'.E;TEM I S:
THE I_EI'.,!EiTH DII',IENSIOb~ IS THE I_ENGTH (IN FEET) O1= THE TI~:EI'.,E:H OF.: DRFIINF'IL:]..I}.
"f'l.4E [:,E]:'TH OF FI TRE]'.,ICH OR F'IT IS THE L":,i£-i;TFINCE BI~ETI.'.IEEN THE SI. ff.}.FFICE O1::' THE:
GRO(JI",ID FtNI} TPIE E',OT"FOM OF: THE E',:.:',CFIVFI-FION ,:.'IIq I=EET).
THE TIq'.ENE:H I.,.III)TH FOF~'. DRFIINFZEI_[:":'~; I:E; 3: FEET.
THE GF~:I=IVEL [)EPq-H I'.'E; THE: MINZMUM DEPTH OF GRFI'v'EI._. E',ETI4EEN THE OLJTFF:IL.L PIPE
I=IND THE E:OTTOM OF' THE EXC:FIVRTION (ZN FEET).
EITHER FI CLFISS i OF:'. II NSF: FIF'PROVE[:, PL. RNT i"IFIY E::E Ib,ISTFILMED.
R E:ONTIiqUOLJ'.:~; i'flFIZNTEI',IRI'.,ICE FIGREEMENT ;IS REQUIRED. IF R MFI:[NTENFINCE
RGI::,:EEMENT IS NOT KEPT CUI:;.'.RENT ',?OIj I"lFl'-r' BE REQIJIRED TO IEI",ILI::IRGE ]"HIE
RBSORP'I-iON S"r'STEf'I RND,.-"OR '*r'OU MR¥ BE StJE:,)'ECT TO
I1=' FI CLRSS I S'¢S"I-EM :IS IJSEI} THE LEb,IGTH !S i. 0 FEF]T.
~[::' FI C[...FIS~; ][][ S'¢STEM IS USED THE LENC'i]-H IS i. 0 F'EET.
BFtCI<F'Z L.L i i'.,ll]i OF' FIN'¢ '.S'.?STEM [,! I TFIOUT F I I'-,IFIL.. ! NSPIEC]" ! ON FIND FIF'F'ROV£:IL E?:-' TH I 'S
DEPF:fFfTMENT I.,.II'LL 8E SUE:JECT TO PROSECUTZON.
M]]'.,IIP'IIJM DISTRNCE BE"['I4EEb,I FI 14EI...L Iqi'.,ll} R1'4'¢ OI",b-'==.;ITE SEI4RGE DI:E';F'O'='_';FIL. S"r'S]"EM ii;
tOO I::EE'T FOR I=l PRt'v'F(f'E 14ELL. OR' 200 F'EET FOR FI F'I._IE:L. IC: !.,.IELI ....
I,.!IEi._.L L. OGL=.; FIRE RE6]UZRED FIND ]','ll...l'_.=qT E:E Iq:ETLIRNE[> TO -f'hlE E:,EPF:IRTMENT WZTHZN ]:0 [)FI"r':E;
OF' 'THE 14EL.L. COP'IPLE'TIOi'q.
'.::;PECZF'ICFFi"ICd",I'-:~i FINE:, COI'.,ISTI:,~rUCTION DIF~GI;?.FtFI'_:_'; I=IF::E FIVFIII...FISLE TO INSURE F'ROF'ER
:( b,l'.-~; ]" F4 L L. FI T' 101",1.
I CERTIF'"r' 'THI:4T
FORTH B'¢ THE' i"IUNICIPFtL. ZT"¢ OF f=INCHOt~:f:K_:iF.:.
2: i 14ILL II"~tS"I'FIL.L TFIE S"?ST[=-'M ]:N FtCCOFd}FIN(::E HITH THE
SIGNED:
FIPPL]!CFINT [3USTER 1'4EI.,.I-FOb,[ lENT
Z S:.:.;UED E;'~'1
I I'.,1SF'EOT I O1'.,I I-.I ! S]7]F::'.r' - SEI.,.IER :1. 0 SEI4Ef-~: 2 0
NAME OF APPLICANT
GREATEr ANCHOrage AREA BOROUgh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456!
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
MAILING ADDRESS PHONE
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
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL SE SUBJECT TO PROSECUTION.
DIAGRAM OF SYSTEM
MINIMUM DISTANCES. REQUIREMENTS
t
FOUNDATION TO SEPTIC TANK ~
FOUNDATION TO ~"E~IE~P] - ° ~ _ ., DRAIN FIELD
DRAIN F~ELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD ~ ~,
SEPTIC TANK, I(~0
TO RIVER, LAKE, STREAM.
SEEPAGE PiT
4 iNCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC: TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
CONFORM TO ~O~OUGH REGULATIONS R£GA~E~NG INSTALLA'rION.
OR
GREATER ANC OROUG NCC I~O. 28-6B AND THAT THE ABOVE
, CE~TIFY THAT [ A~ FAMILIAR WITH THE REQUIREMENTS OF ~~,AG~ ~~
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE ~ ''~. PLICANT'S SIGNATURE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6.650, Anchorage, Alaska 99502 276-2221'
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
1
2
3-
4-
7-
8-
9-
10-
11-
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
COMMENTS
72-008 (7/76)
PERCOLATtON RATE ~ (minutes/inch)
CERTIFIED TE:
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-050, Anchorage, A~aska 99502 276-222'~
SOILS LOG - PERCOLATION TEST,/
LEG^LOESCR,PT,ON= Lo¥ 4
[] PERCOLATION
TEST
1
2
3
4
5
6
7
8
9
SlOPe' ~,~ SITE PLAN
10
11
12
13
14
15
16
17
18
19-
20-
WAS I ;ROUND WATER
YES, AT WHAT
Gross~ Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
COMMENTS
:ORMEO
72-008 (7/76)
FT AND
minutes/inch)
-- FT