HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK D LT 11
oGRE,
" ANCHORAGE AREA BO["
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~J,;I TI~e~.~ MAILING ADDRESS A-7O/ L~*~,c4 '~'¢ PHONE
SEPTIC TANK:
DISTANCE
FROM WELL ~"-
INSIDE LENGTH
[ NUMBER OF
INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /Z5-(2 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
DIAMETER ¢6)
CRIB SIZE:
BUILDING EOUNDATION hI,
OR WIDTH 2'~' LENGTH ~/ DEPTH
DIAMETER L//' DEPTH ¢/~,1 DISTANCE FROM: WELL
(]/ TOTAL EFFECTIVE
NEAREST LOT LINE ABSORPTION AREA (WALL AREA)
sQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE
BUILDING
FOUNDATION
CONSTRUCTION
NEAREST NEAREST
LOT LINE SEWER LINE
DEPTH
SEPTIC SEEPAGE
TANK
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCE FROM:
DISTANCES:
DIAGRAM OF SYSTEM
INSTAl_LED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No, EQ-031
/G.A.A.B.
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4§61
SEWAGE DISPOSAL SYSTEM --- APPLICATION AND PERMIT
PERMIT NO.
MAILING ADDRESS
PHONE
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
SEEPAGE PIT
· DRAIN FIELD , OTHER
TO BE INSTALLED BY
NOTE: THIS PERMIT 1~ NOT VALID WITHOUT SOIL TEST
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 TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPT]C TANK
FOUNDATION TO SEEPAGE PIt
SEPTIC 'rANK TO SEEPAGE PIT WALL
SEPtiC TANK ,seePAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK· , SEEPAGE PI'I'
TO RIVER, LAKE, STREAM.
SEEPAGE AREA SIZE
TYPE
DIAGRAM OF SYSTEM
., DRAIN FIELD
, DRAIN FIELD
SEEPAGE Pit
ALSO CONSIDEr Area WELLS.
SEEPAGE Pit
· DRAIN FIELD
CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 PEET 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 REGULATIONS REGARDING INSTALLATION.
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND 'rhAt THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE,
DATE APPLICANT'S SIGNATURE