HomeMy WebLinkAboutSHANE TR ALot
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QGRE
'ER ANCHORAGE AREA BOF*UGH
Department of Environmental (~uality
3330 C Street
Anchorage, Alaska 99S03
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME~,///v/ t'~.AIV~"/.':~o4/ MAILING ADDRESS f,~2,.~0, /~o~.
LOCATION ¢ 7 L/ ~/ (~'9 ~/~ ~.~'-T~ LEGAL DESCRIPTION~.~/? "~
PHONE
SEPTIC TANK:
DISTANCE NUMBER OF
FROM WELL Z¢~ '~ __ MANUFACTURER ~~ MATERIAL _ ..~4 L~'-7'-/:) .~ - COMPARTMENTS ,)
INSIDE LENGTH ~-- INSIDE WIDTH_ '-~ LIQUID DEPTH --~LIQUID CAPAClTY./<~' ,~ ~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS ~/ .. DIAMETER~Z/~.~R WIDTH LENGTH DEPTH _./p~
LINING MATERIAL ~ ~ ~' CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL/~'~"?Z'- .
TOTAL EFFECTIVE
BUILDING FOUNDATION ~',,,~ ~, NEAREST LOT LINE ¢'~.~ ~' . ABSORPTION AREA (WALL AREA) ~
r~ ~ ~S~. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE CONSTRUCTION --- DEPTH
BUILDING NEAREST NEAREST SEPTIC
FOUNDATION~ LOT LINE SEWER LINE /,'~/- TANK
CESSPOOL __ , OTHER SOURCES_
APPROVED_ __ DISAPPROVED _
_ REMARKS_
DISTANCE FROM:
SEEPAGE
SYSTEM j
DISTANCES:
LOT SLOPE:
REMARKS:
Form NO, EQ-031
DIAGRAM OF SYSTEM
0
DATE
G.A.A.B.
GREATER ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AMID PF. RMIT
TYPE AND SIZE OF FACILITY TO BE SERVED
NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TEs'r
SEEPAGE pIT J(~
o
SEPTIC rANI<,'J~(~ f SEEPACE piT ~00{! DRAIN FIELD_
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNB]STURBED SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK ANE) SEEPAGE PIT
I~0 ~ fO r~O d
Leqal
rlescri~ti on: Lo 1:_[C__ g 1 Dc [ .......
[:orm Renorts Soils Loq ...... J/J?2 .................. Percolation Test
!~ e b t h
Feet Soil (:ha~,~c~er~st~cs
Si ]. b-~ Mi
Has 6r'ound Water
[i. ii21iliiii"iX illii.'.'ill lA.... - .ii.i" ..'. J.i_ .-_ i_-i_ _l_ . -rli--ll 'l'-liilll.,l. - ..............
['~PCO ] a t:i o Rate Hi nu(,e
Proposed If~stalla(:ion: 5eenaoe Pit__.~?~ ..... Drain Field
Deoth of Inlet Deoth 'Fo [~ott, om Of Pit
No bedrock or wateP' table 6 ~b. below see~)pit
Performed By_~..J]~m_~[~LG~r ....................... Data Certified By:.qo~Z~9!J:o? '~s}.l:[If!:!;~:
Lab Manager Date: _.~::!flf'7i
DEPART~I[N~'I~F H]~laK'l~f~ ENVIRONMENTAL PROTE~r~ ON~ENTAL I'~ O[EC~ION
ENVIRONMENTAL ENGINEERING DIVISION JA~ a 5 ~979
Telephone 264-4720
IVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEaWAll LITI ES
)IRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing,
PROPERTY OWNER
MAI LING ADDRE.~S.
,PROPERTY RESIDENT (If differ~t'~rom above)
2, BUYER
MAI LING ADDRESS
PNONE
oe z'lo
PHONE
PHONE
3. LENDING INSTITUTIO~N
4, REALTOR/AGENT
PNONE
PHONE
MAILING ADDRESS
B. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ One ~ Four E/ Other_
~ SINGE~ FAMILY ~ Two ~ Five
~ MULTIPLE FAMILY ~ Tnree ~ Six
COMMUNITY
PUBLIC UTILITY
8, SEWAGE DISPOSAL SYSTEM
~ INDIVI DUAL,ON-SITE*'
[~ PUBLIC UTILITY
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available,
If Indlvldual/on-sKe, give installation date
If sys[em ~s over two (2) years old an adequacy test is reouired
by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-O10(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED :
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[~3Septic Tank or [] Holding Tank
Size:' I~)~)t~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER~. ~ ~ ,
TOTAL ABSORPT,ON AREA MATERIAL
4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot, Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~-APPROVED FOR ~ . BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)