HomeMy WebLinkAboutBIRCH HILLS TERRACE BLK 1 LT 1
6R[!)~"~ ANCHORA6E AREA BOR"~"~H
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATmON~"~/,~O ~'~ /-/~-~ ~'~Z~Y ~, LEGAL DESCRIPTION ~! '~
SEPTIC TANK: ~ {oC'"X ~',¥ ~"
D,STANCE _~e/tC NUMBER OF
FROM WELL - MANUFACTURER MATER,AL CZ~Z. COMPARTMENTS
INSIDE WIDTH
LIQUID DEPTH
INSIDE LENGTH
IIQUID CAPACITY J~? GALLONS.
SEEPAGE PIT.'
.UMBER OF P,TS / D,AM~ER ~' OR W.OT. J' LE.GT./J-~ DEPT.
LINING MATERIAL (~/D/Zf'~" ~L~_( 4.- ~ I,,.~.~. I
CRIB 51ZE; DIAMETER_~DEPTH "~ ! DISTANCE FROM.' WELL
f, TOTAL EFFECTIVE
BUILDING FOUNDATION '~ NEAREST LOT LINE ~' ABSORPTION AREA (WALL AREA) ~-
ADDITIONAL ABSORPTION
TYPE CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE SEWER LINE TANK __ SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. EQ-O31
DIAGRAM OF SYSTEM
L
(~I'.A.A.B.
GrEATer ANCHOrAgE ArEa BOrOUgh
SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT
PERMIT NO.
INSTALLATION OF: SEPTIC TANK I ~ ~ SEEPAGE PIT DRAIN FIELD
TO BE INSTALLED BY
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION I~Y THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION,
SEPTIC TANK SiZE
MINIMUM DISTANCES. REQUIREMENTS
FOUNDATION TO SEEPAG'E PIT ~ I
SEPTIC TANK ~, * SEEPAGE PIT · ~
DRAIN FIELD
SEEPAGE PIT laOr
DRAIN FIELD
TYPE
DIAGRAH OF SYSTEM
Performed For
Leaal
This
/]/)/'.f J'~/~ /~/~'~" Date Performed
Description: Lot / Block // Subdivision ~/~-~/~ ~//~
Korm Reports Soils Lo~
neoth
Feet
7~
Pefco1 at1 on. Test
Soil Characteristics
Was Ground Water Encountered?
Yes, At what Depth?
Readin.q , Date
Gross Time Net Time
I
Depth to 1~20 Net Drop'
I
Percolation Rate
Proposed
Deoth of
CAq~ENTS:
Test Performed
Minute
Insta)lation: Seenaoe Pit Drain Field
Inlet Depth To Bottom Of Pit Or_ Trench
Property ~wner
Buyer . .. -
Address
~ending Instl~tion
APPLI'"ANT FILLS OUT UPPER HI`.-`=- ONLY
Zip Code
Address
Realty Co. & Agent
Legal Oescrlpt ~n
Street
Type of Residence
%SM[ n g I · Family
ultlple Family
I-I Other
Water Supply
~.lndivldual
~'o// ,~/.~_.,~ /
.ii
NO. of Bedrooms ~'
Zip Code
Phone
Zip Code
ATTACH WELL LOG, A well log Is required for all wells drlled alnce June 1975:
For wells d~llled prior to that date, give well depth (attach log II available).
Year Individual Installed: / ~.~'.T~_~
When Connected to Public UtllJty:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE(~JEST BEFORE I~ROCESSING CAN BE INITIATED.
Inspector Inspector Inspector Inspector
Field Notes:
( · ) APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE
BY:
~o115 Rating I Date Sewer InstaIleq I Well To Absorption Area Well Log Received
I
Well to Tank Beptlc Teck Size