HomeMy WebLinkAboutCAMPBELL HEIGHTS #1 BLK 8 LT 21019
4
GR~,TER ANCHORAGE AREA BOROU~,,H
,- DL,,,~RTMENT OF ENVIRONMENTAL QUALI'~.
· 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION .J"'"',,~.~,,-.-,'~/'~'""-~":'~ --'~'~'"~
SEPTIC TANK:
NUMBER OF
DISTANCE FROM WELl. ~'~"/-),,~'~/~'~','~//~ MATERIAL_,~,('-~-'~-~',,~J~-~ ~-~//'/~'~ COMPARTMENTS /
~/~ ~ ~~ LIQUID
LIQUID CAPACITY '~ ~ GALLONS. INSIDE LENGTH / INSIDE WIDTH ~ DEPTH __
SEEPAGE SYSTEM: SEEPAGE
NUMBER OF PITS '~ ~'~ OR WIDTH__, LENGTH . DEPTH
LINING MAT~/~I~I~/''~ , DISTANCE FROM WE~.~.~ ~ . DL'~G FOUNDATION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREAl SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER OF LINES / DISTANCE BETWEEN LINES TRENCH WIDTH
ABSORPTION AREA ~'",~ SQ. FT. LENGTH OF EACH LINE /~--------~
DEPIH: TOP OF TILE TO FINISH GRADE ~ DEPTH OF FILTER MATERIAL BENEATH TILE
FOUNDATION /',-~'~- Z/~', NEAREST LOT LINE
TOTAL LENGTH /
, OF LINES ~ ,
IN. TOTAL EFFECTIVE
IN, ABOVE TILE
DISTANCE FROM WATER
WELL: TYPE ~,~e,.,~,, ~//,--~ . DEPTH / . BUILDING FOUNDATION._~/~_____..~SAMPLE / NEAREST
SEEPAGE OTHER
NEAREST / SEPTIC / /'/ CESSPOOL /., SOURCES
LOT LINE ~'~, SEWER LINE TANK , SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
DATE APPROVED
G .A.A.B.
GALA,ER ANCHORAGE AREA BOR,,.)UGH
DEPARTMENT OF' ENVIRONMENTAL QUALITY
I NSTALLA. TION LOCATION
LEGAL DESCRIPTION
PERMIT NO,
SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT
MA~LING ADDRESS ,.C/.~r._--'-//,',' PHONE
FINAL INSPECTION= 24 HOUR NOTICE REQUIRED.
HEALTH DEPARTMENT AUTHORITY WILL BE
OF ANY SYS'T~M WITHOUT FINAl. INSPECTION BY THE
MINIMUM DISTANCES. REQUIREMENTS
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK ~/ SEEPAGE PIT ~ff /DRAIN FIELD
WELLTO Sg~ICTANK ~/~ ~ ~GE PiT
/
WATER MAIN TO SEPTIC TANK /~ , SEEPAGE PIT
DRAIN FIELD ' /~
GE~IC TANK~/. SEEPAGE PIT /~I /DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURSED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
GRAVEL DACKFILL
CONFORM TO E~OROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOR~,t~GH ORDINANCE NO,
GReAter ANchOrAgE Area BOrOUgH
PERMIT NO.
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
LEGAL DESCRIPTION 'L ~ ~
INSTAL~TION OF: ~ TANK
FINANCED THROUGH ~ . TO BE INSTALLED BY
ROIL TeST RESUL?$I~)c'~- ~O$$',L~(J ~:~' S({~-~ NOTE, THIS PERMIT IS NOT VALIO WITHOUT ~OIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: Z4 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
I
NINIMUM DISTANCES, REQUIREMENT~
DRAIN FIELD
SEEPAGE PIT
ALSO CONSIDER AREA WELLS,
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF' GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2e.ss AND THAT THE ASOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ,
Det~,.~tment of llealth :,nd EnvironmcntgL,Protection
2516 E. Tudor Itoad
~ k.~ ~ Anchorage, Alaska 99507
,",;t)II,S I,()(; PEI:()I.A'I'I()N TI:ST
This for.t reports. Soils Io9 Percol,ation test -
Depth '~'
~,~or o.y,~..~ i I .....
2
I
.~ _ ~ ~1- ~. _ .~---.~.~ ........
10-
11-
12-
13-
14-
Was ground water encountered? ___,J/~ .... If yes. at what, des, th? __~.]~. ......
.... ..................................................... -,.---.
Z:LZ'_-X: fi ::-;
;L;Z :-:Z-_" ::"_:
............... J__,'_ .........
-Proposed installa~'l'~;f:''m~'~'~)7!le Pit Drain Field
Depth of i,,lel: . l~eptlF'tl)"bb'tk-&a-b'r'}
COI.111EI;~S: .............................. : ..............~ ....................................
Perforated I led By: ........ bate:
EQ- O40 (6/74) Z~,¢.