HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 2 LT 8B Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ~o~..o. ~. ~ 7~x ~ ~?~ ~.~o~.,pT,o. Z .t~ ~tt~ S~ ~ANK: DISTANCE R~~ ~O/4j(,¢/(~4.~__~..' NUMBER OF FROM WELL ~'~) /' MANUFACTURE 'A)'Z~"'~" MATERIAL COMPARTMENTS O~ INSIDE LENGTH INSIDE WIDTH LIQUIDDEPTH IIQUID CAPACITY GALLONS. SEEPAGE PIT: NUMBER O F PITS ~/,~T ER _ ~"'~ID~,,~ LENGTH--. DEPTH LINING MATERIAl.,,/ _ CRIB SIZE; DIAMETER '"',.DEPTH DISTANCE FROM: WELL ~ ~AL EFFECTIVE ADDITIONAL ABSORPTION ' SQ. FT. WELL.' TYPE BUILDING FOUNDATION CESSPOOL ~ CTION DEPTH '~ DISTANCE FROM: NEAREST NRA R EST~'"..~ SEPTIC SEEPAGE LOTLINE SEWER UNE~..~ , TANK.. ~VSTEM~ . OTHER SOURCES . REMARKS APPROVED DISAPPROVED DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: ~'~'~ ~ . REMARKS: Form PW-026 DIAGRAM OF SYSTEM DATE I'ER ANCHORAGE AREA BOROUGH WAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT I.STALLAT,ON LOCATiO. ~ ~'~C LEGAL D.ORI.,O. /6r /-~',/Z~,,~' TYPE AND BIZE OF FACILITY TO BE SERVED FINANCED THROUGH PNO.E SEEPAGE PIT DRAIN FIELD TO BE INSTALLED BY OTHER BOIL TEST RESULTS COMPLETION CATE ANTICIPATED / NOT~; THIS PERMIT IS NOT VALID WITHOUT SOIL I'~ST FINAL INSPECTION~ 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL. SE SUBJECT TO PROSECUTION. TYPE, SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO ~EPT4~-TANK CRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD TO RIVER, LAKE, STREAM. SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF EEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. CONFORM TO E~OROUGH 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