HomeMy WebLinkAboutWILK LT 1B
GAAB-HO-I
GR~.~TER ANCHORAGE AREA BORO[ H
DEPARTMENT OF ENVIRONMENTAL OUALI~I~'
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8685
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
ADDRESS
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY ./~.~ .~'-~2) GALLONS.
NUMBER OF
MATERIALf~'~"~',.-:~J'~'- C'?~'?~/~'~F'.,~'- COMPARTMENTS
INSIDE LENGTH ¢"'-- INSIDE WIDTH.
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS ~ETER ~ OR WIDTH , LENGTH DEPTH
LiNiNG MATERiAl//~'~ DISTANC~FROM WELl _ / BUILDI~NDATION
NEAREST LOT LINE. TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~'~, /~, /--~, , FOUNDATION //~ / , NEAREST LOT LINE
NUMBER OF LINES
DISTANCE BETWEEN LINES -'//'~" //--~, ~--~ TRENCH WIDTH
ABSORPTION AREA ~-~ -~-';' SQ. FT. LENGTH OF EACH LiNE ~7~ C~ ~-~,
DEPTH: TOP OF TILE TO FINISH GRADE
~ /' ,~ ~" DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH . /
OF LINES ~2.~.~ ~'.
IN. TOTAL EFFECTIVE
IN. ABOVE TILE ~ x/
WELL: ~
TYPE z~'z:'',~'z'---''~ , DEPTH
NEAREST ~.~,.~S/PTI C
DISTANCE FROM / WATER
., BUILDING FOUNDATION SAMPLE ~ , NEAREST
SEEPAGE , OTHER
~ , SYSTEM___ '~ , CESSPOOL ~ , SOURCES'~-~
DISTANCES:
DIAGRAM OF SYSTEM
G.A.A.B.
DATE
GREAk~TER ANCHORAGE AREA BOI~:~UGH
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT
3500 TUDOr road POUCH 6-650
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT ;
NAME OF APPLICANT e?~/.~ k'~ ~ / I ~/ MAILING ADDRESS
~NSTALEATION OF: SEPTIC TANK ~ SEEPAGE PIT
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS . /
EOUNDATJON TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WAL£
SEPTIC TANK SEEPAGE PIT . DRAIN FIELD --
TO NRA.eST L'NE. A.t,6 u..-' &
WELL TO SEPTIC TANK -, SEEPAGE PIT
DRAIN FIELD . ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK .. SEEPAGE Pit
DRAIN FIELD
SEPTIC TANK, . , SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SO[L.
DIAGRAM OF SYSTEM
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
fitted WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
LICENSED DESIGNEE
I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS Of GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-65 AND THAT THE ABOVE
' k--j ~ HEALTH Dui Ar, [ rlEt~ 1
' 327 EAGLE STREET
~,." ~ ANCHORAGE, A[,,:A~K:~' 99501
Ler,'s3 Descplp~O.-. Lot_~ ~-~ .Percolation lest
This Fomm ~epoPtS a. Soils Lo~
Depth .. -,
Fee~ Soil Chamacterzs~zcs
Brown SiiW Sand (ML)
Dark Gray and Brown Peat
Fine to Coarse Well
· (SW)
Location Sketch
~-~o Gross Time Net Time Depth To H20
Reading i .....
Net Dmop
F...oFose,~ %nstalPiatzon: Seepage Pi% Dmain Field
Oep~.a Of Inlet ])ep~~6~-~it Or TPench
COMMENTS:
Tes~ Performed BV; R.B. Carlisle, National Testing Services
Data Certified
Date: = _: ............