HomeMy WebLinkAboutT12N R3W SEC 4 Lot 21
GF 'TER ANCHORAGE AREA BOROI, H
HEALTH DEPA"TMENT NO* 703
327 EAGLE ST. ANCHORAGE, ALASRA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
ADDRESS~./,/~,,Z.~ ~4~. ~X~ ~? ~h?'~ PHONE ---
LEGAL DESCRIPTION~
DISTANCE FROM WELL_ __MATERIAl ,/?~%: c'/~.z/' ' ,~,/;)/~./(-,~..:z:/~? COMPARTMENTS. /"
LIQUID CAPACITY /z~/~,> GALLONS INSIDE LENGTH '~J INSIDE WIDTH /---- DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS ~:~
OUTSIDE DIAMETER OR WIDTH . LENGTH DEPTH
/~Y~'l("J DISTANCE FROM WELL //5~/~::"~"~ BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) -~- ~- -:~-' SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES ~/~ DISIANCE BETWEEN LIN
ABSORPBON/AREA SQ. FT. LENGTH OF EA
_/
DEPTH: TOP OF TILE TO FINISH GRADE
, NEAREST LOT LINE
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILE.
TOTAL LENGIH
, OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: 4 <;-~?...'::;~"' : ×.~..:..~.~,.r.
-- TYPE ,.'.~/~zzz.~. , DEPTH -f~"
NEARES[ / SEPTIC
LOT LINE /z~ ' /~ , SEWER LINE /~ ~-, TANK
DISTANCE FROM / z WAIER
· BUILDING FOUNDATION.~__BAMPLE .x[*c, _, NEAREST
SEEPAGE . OTftER
~ zl ~ , SYSTEM~/~-~ ~ CESSPOOL .(/z./~:' , SOURCES/~/-~:;-'~-~:
DISTANCES:
DIAGRAM OF SYSTEM
., '
I'Z
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAl. QUALITY
3~OO TUDOR ROAD POUCH 6-6~O
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND Pr-:RMIT
PERMITNO,
FINANCED THROUGH ~~T ~E iNSTALLED
SOIL TEST RESULTS .-/~2¢~/; ~ ~~ NOTE: THIS PERMIT iS NOT VALID WITHOUT SOil TEST
FINAL INSPECTION~ 24 HOUR NOTICE REQUIRED. SACEFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
Well TO sePtiC TANK ~ / ~ / SEEPAGE Pit ~' /~
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRI~ CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit
FITTED W~'FH AIRTIGHT REMOVABLE CAPS.
GRAVEL BAC:KFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQU[RENtENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE
DESCRIBED System IS [N ACCORDANCE WITH SAID CODE.
DATE *~'~ ~,/ APPLICANT'S SIGNATURE ~C'"'~/¢/ ~;~ ' ('/~// ~