HomeMy WebLinkAboutWESTGATE PARK BLK 4 LT 2
G~' 'rER ANCHORAGE AREA BORG[, ',-I
D~:~'-/~'RTMENT OF ENVIRONMENTAL OUALIT'~/
35(30 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY--s
.MATERIAL
GALLONS.
MAILING
ADDRESS 7/'~"/ ~'..'~'~ /~./A.,'~/'~'A~,~, PHONE ~';~'-~'~
.LEGAL DESCRIPTION .~z~'~.~--'.~,,~
NUMBER OF
.~'~/~.'~ ~7 . COMPARTMENTS
INSIDE LENGTH. ,~-"-'~NSIDE WIDTH ~ DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
OUTSIDE Dl__g~ -- OR WIDTH
~ DISTANCE FROM W~
, LENGTH , DEPTH
BUILDING__j~C~I It-J n AIIg._N.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~.,FOUNDATION , NEAREST LOT LINE
ABSORPTI~A~EA. SQ. FT. LENGTH OF
,/
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: c.~?/:~z.
TYPE b'"~7~.,~"~,"',~7~-~ , DEPTH
NEAREST (~-. SEPTIC
LOT LINE ~ SEWER LINE .,TANK
DISTANCE FROM WATER
BUILDING FOUNDATION.~SAMPLE ~ , NEAREST
SEEPAGE OTHER
~ , SYSTEM ~'~, CESSPOOL · -, SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
k
GRE~'t~R ANCHORAGE-AREA BOI~::;~UGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6*650
ANCHORAGE· ALASKA 99502
TelEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT
NAME OF APPL[CANT~'~'''2~
,,~/~/(,- ~-~-~ ~.-~.~*~
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OF: ~ TANK
SOIL TEST nESULTS
~/~/'J' Y ~ MA]L[NG ADDRESS
SEEPAGE PIT , DRAIN FIELD ~ OTHER
TO BE INSTALLED BY
//~
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJEGT TO pROSEOUTION,
SEPTIC TANK SIZE /~'~)~'2 ~'~'~'~-~'/J/~/ TYPe ~',~'~2//~-'-~ SEePAGe AREA SIZE ///~'~ TYPE
MINIMUM DISTANGEB, REQUIREMENTS
ALSO CONSIDER 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 iRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH ~EGULATIONS REGARDING INSTALLATION,
HEALTH AUTHOR]TY
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
] CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCribED SYSTEM IS iN AccOrDANCE WITH SAID CODE.
GRE,/~*¢~R ANCHORAGE*- AREA BO~,-~:,CUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELePHoNe 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
,,,,STALLAT,ON SEPT'O TA"" × SEEPAge p,4/
8OIL TEST RESULTS .
COMPLETION DATE ANTICIPATED
FINAL iNBPECTION: ~4 HOUR NOTICe: REQUIRED. BACKFILLING OF ANY BYSTi"M WITHOUT FINAL iNBPECTION i~y TIlI~
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
DIAGRAM OF SYSTEM
MINIMUM DISTANCES, REQUIREMENTS
/7'
SEPTIC TANK TO SEEPAGE PET WALLI~/sl
WELL TO SEPTIC TANK
DRA[N FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, , SEEPAGE PiT
TO R VER, LAKE STREAM.
DRAIN ]FIELD
SEEPAGE PIT ~/ DRAIN FIELD
SEE"A E P'T /&0'
ALSO CONSIDER AREA WELLS.
SEEPAGE PET .
DRAIN FIELD
IRON INTO A~ND OUT O~ SEPTIC TANK AND INTO CRIB CROSSIN(~ GAP Of
~ION ~ FEET INTO UNDISTURBED SO. IL.
4 INCH DIAMETER CAST IRON :~[PHON PIPES ON SEPTIC TANK AND SEEPAGE PIT D 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 ABOVE
DESC SYSTEm ES IN ACCORDANCE WITH SAID CODE.~/~