HomeMy WebLinkAboutT15N R1W SEC 18 LT 190A
eGREA
ER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ' ~'' ~'"*'~/~/~/ MAILING ADDRESS C', ~-~'-¢~-/;<y'~"rL:~''~'~'~'~
LOCATION '"¢¢/¢I¢""¢~/-4~2'/')¢9"~¢' /"~/'/'¢'"" ~/~
SEPTIC TANK:
DISTANCE '~/¢~'~:~ ~¢% ~/J~ '~'- NUMBER OF
FROM WELL'~'/2£]: . MANUFACTURER /~/~¢~ MATERiAL//~'z¢'/~'..~.//:-/~¢~-~ COMPARTME,NTS~
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS.
SEEPAGE PIT:
NUMBER OF PITS ~ DIAMETER OR WIDTH ., LENGTH DEPTH
LINING MATERIAL ~' /'/~¢~z/.:: CRIB SIZE: DIAMETER ~ DEPTH ~ /
DISTANCE FROM:
BUILDING FOUNDATION ~' <~7-, NEAREST LOT LINE /~ /'~ TOTAL EFFECTIVE
. ABSORPTI~,F-,", {W.~LL A~F ,A~
ADDITIONAL ABSORPTION
WELL:
TYPE /['¢-~'~ CONSTRUCTION
BUILDING NEAREST
FOUNDATION -- LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
DISTANCES:
PiPE MATERIAL:
LOT 5LOPE:
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM
NEAREST
SEWER. LINE
I .Ep ._TMENTOP.NV,.O'MEN ALQUA"T --'
TELEPHONE 274-456 I
SEWAGE DISPOSAL SYSTE~ ~ APPLICATION AND
INSTALLATION LOCATION
iNSTALLATION OF: SEPTIC TANK~
TYPE AND SIZE OF FACILITY TO BE SERVED ~,'~
FINANGED THROUGH
SOIL TEST RESULTS / ~°I
SEEPAGE PIT DRAIN FIELD , OTHER
TO BE INSTALLED BY ----~ .~
/
NOTE= THIS PERMIT IS NOT VALID WITHOUT BOIL
COMPLETION DATE ANTICIPATED .
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION,
SEPTIC TANK SIZE/ /~)C~ TYPE
FOUNDATION TO SEEPAGE PIT ~ i DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK ~2~ t SEEPAGE PIT <~{ , DRAIN FIELD
WELL TO SEPTIC TANK (~:) C~ SEEPAGE Pit
SEPTIG TANK, . f(:~ C") , SEEPAGE PIT ~/0 C) DRAIN F]ELD
SEEPAGE AREA
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2B-68 AND THAT THE ABOVE
GREATER ANCHORAGE AREA BOROUG!'
~epartment of Environmental Qua
3330 "C" Street
Anchorage, Alaska 99503
SOILS LOG - PEROLATION TEST
~y
~b *:5~ Date Perfomed /~/-/' 7D
Performed for ~ci ~ ,-L~_~ ~ ~ _ .~_~.. .~ ..... ~ ....
Legal Descrip-tio-n: ~.~-~__~-~/?xg. ~_~?_~.~n_~tele~stO~____/-,-.{9--~/---V0 --
This form reports: So~ls log. ?~. verco~a~on
Depth
Feet
1
2-
3-
4-
6-
7-
B-
9-
10-
I 1 -
13-
grou~nd water encountered? __..~.(0~ .... If yes, at what depth?
Reading Date Gross Time Net Time
~th to Water Net Drop
Percolation rate minute.
Proposed ~ns[allat~on Seepage Pit
Dept~i--ti~-bottom of p]~ or trench
',X!pth of Inlet
COHf'IEI4TS:
Performed By:_~J~:~:¢L:.~-.gJ~z~Z~t--.-. Y'
EQ- 040 (6/74)