HomeMy WebLinkAboutVALLI VUE ESTATES #2 BLK 5 LT 77
oGRE
,ER ANCHORAGE AREA BOR,. IGH
Depsrtment of Environmental Quality
3330 C Street
Anchorage, Alaska ggs03
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
d
LOCATION
LEGAL DESCR PTION /~" "') J"~'~ '~Z~'~
PHONE
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
MATERIAL
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY/(~'~ GALLON S.
TILE DRAIN FIELD:
I Ot, '5' ) TOTAL LENGTH ~)~..-)
DISTANCE FROM WELLO~~''~g' FOUNDATION ~.~ ~ NEAREST LOT LINE OF LINES
NUMBER OF LINES ! DISTANCE BETWEEN LINES ~/~ TRENCH WI DTH3(~IN. TOTAL EFFECTIVE
ABSORPTION AREA ~ SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
DEPTH: TOP OFTILE TO FINISH GRADE ~] BATERIALBENEATH TILE~'~ ~. ABOVE TILE'__IN.
WELL: ~/~-"~
TYPE -- CONSTRUCTION DEPTH
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION__ LOT LINE , SEWER LINE__, TANK__ SYSTEM_
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCE FROM:
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY: ,/'~J~ ~.~
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS: C~
Form LQ*032 '~ ~'~ /
pJtlcgO olr
GRFI'ER ANCHORAGE AREA BO UGH
Department ~3Eon;irs~rnen~;ntal Quality
Anchorage, Alaska 99503
INSPECTION
LOCATION
REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS
LEGAL
SEPTIC TANK:
DISTANCE ~/'~ /~ ,~ /
FROM WELL__MANUFACTURER C "~ MATERIAL
INSIDE LENGTH INSIDE~WIDTH LIQUID DEPTH __
COMPARTMENTS
.LIQUID CAPACITY /<~d~) GALLONS.
SEEPAGE PIt:
NUMBER OF PITS / DIAMETER --OR WIDTH "lC LENGTH/~:~' DEPTH
LINING MATERIAL~--~'Y'~:¢/I~'~;CRIB SIZE: DIAMETER__DEPTH DISTANCE FROM: WELL
BUILDING FOUNDATION ~ NEAREST LOT LINE ~' TOTAL EFFECTIVE
. ABSORPTION AREA (WALL AREA)
SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE
BUILDING
FOUNDATION __
CESSPOOL
APPROVED
NEAREST
SEWER LINE
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
DEPTH DISTANCE FROM:
SEPTIC - SEEPAGE
TANK SYSTEM
REMARKS.
DISTANCES:
I NSTALLE D BY:/~T) ~¢/~?
PiPe MATERIAL:
LOT SLOPE:
REMARKS:
Form NO, EQ-031
DIAGRAM OF SYSTEM
G.~.A.B.
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAl SYSTEM -- APPLICATION'~AND PERMIT
NAME OF APPLICANT
INSTALLATION LOCATION
TYPE AND SIZE OF FACILITY TO BE SERVED 3 ~/fC
FINANCED THROUGH g._
/
COMPLETION DATE ANTICIPATED
TO BE INSTALLED BY
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.
MINIMUM DISTANCES, REQUIREMENTS
SEEPAGE AREA SIZE
TYPE
DIAGRAM OF SYSTEM
I CERTIFY THAT IAM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 20-68 AND THAT THE ABOVE
DATE APPLICANT'S SIGNATURE
NAME OF APPLICANT
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE Of ]FACILITY TO BE SERVED
Greater ANChOrAGE Area BOROUGh
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM-- APPLICATION AND PERMIT
& MAIL'N' AD''E''
SEEPAGE PIT
PHONE
,DRA]N FIELD ., OTHER
FINANCED THROUGH TO BE INSTALLED BY
SOiL TEST RE~LTS /~&"l ~O /~"'~''"~"'' __.,~'.~'~.'.~,~n'/t'/'~'. ~'",''" t'
/ NO?£~ ~HI'~ P£~I~ I~ NO¥ V~LIO WIYHOU~ BOiL
FINAL INSPECTION: 24 HOUR NOT~CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MI[~IIMUM DIBTANCES, REQUIREMENTB
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
* DRAIN FIELD-
SEEPAGE PIT
ALSO CONS]DER AREA WELLS.
//~") SEEPAGE PIT
.. DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST ~RON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABO~/E
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAJD CODE.
- ,EATER ANCHORAGE AREA BOROL ~
DEPARTMENT OF ENVIRONMENTAL QUALITY
" 3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
Legal Description: Lot ~ Block~'-/ Subdivision ~' ~J~
This
CASE #
Form Reuorts Soils Log.
Percolation Test
De~th
Feet Soil Characteristics
5--
6--
7--
8
9__
Was Ground Water Encountered?
If Yes, At what Depth?
ReadinQ Date
Percoiatio Rate
Gross Time Net Time Depth
Proposed
De~th
CnM~ENTS:
Minute
Installation: Seeoaee
Pit Drain
Depth To Bottom Of
to H20 Net Drop
Field
Pit Or Trench
Test Performed By. ~.~ .~.~$~,~ Data Certified By:
Date:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
,.,'~ FOR
1. Approval requested by: ,, t_~. ~ ~
Mail ing Address: _ ,,. Phone:
2. Property Owner: ~ ..~,~ ~, ~.+
MMling Address:
Legal Description:
4.
5.
6.
Type of facility to be inspected ~,~_...~ ~:~ No. of bedrooms ~"
~. .... /./, .-. , ~ .,. ..?
Well Data: ~ :'.:,. ,
~]l ~."? ' : 7~.~,~~5'~, Depth
A. Type ,m~-m..~l~' B.
I
C. Construction D. Bacterial Analysis
Sewage Disposal System:
A. Installed
C. Septic Tank:
D. Seepage Pit:
,.~-:_.~._.~ .... B. Installer /i ~
Size i ~, 0': 9 .~" 2. Manufacturer
" l~ I '~ "
Absorption A~ea ,~ l,. ~, Ba~e~]"
E. Disposal Field:
Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
., Absorption area
Other contamination
/ · , Absorption area
., Sewer Lines
e.ge: t~wQ ~aQ~ ~ Reqqest for Approval ef I..d .... ual Sewer & Water Facilities
~Fq~'~Y~ f~'_' y~'~!]!~..~ ~'].~L ~Z '?~_~appr°ved Date
A~val ~alid for one year from date signed
~mea~e~ Ancherage Area Borough, Department of Environmental Quality
~!AGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date