HomeMy WebLinkAboutGRACE #1 LT 1A-1Onsite File
GRE ER ANCHORAGE AREA BOF-e UGH
' Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME //'~'~ ~-
LOCAT,ON
MAILING ADDRESS //Z/~'7
LEGAL DESCmPT ON
SEPTIC TANK:
DISTANCE /// .. NUMBER OF //
FROM WE LL2~.~MAN U FACTU R E R ~/~'~/~-~-~/~ MATERIAL ~-~ COMPARTMENTS
INSIDE LENGTH -- ' INSIDE WIDTH ~ LIQUID DEPTH -~ .LIQUID CAPACITY //,~-//(~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS DIAMETER OR WIDTH ~ LENGTH''~-T DEPTH
/
LINING MATERIAL(~/~//J~/%~/~' CRIB SIZE: DIAMETER /~? DEPTH ~ DISTANCE FROM:
.' ~/~ TOTAL EFFECTIVE
BUILDING FOUNDATION~'¢, NEAREST LOT LINE 36/ . ABSORPTION AREA (WALL AREA) :/~ SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE /~'~- ~/~" CONSTRUCTION /~ DEPTH - DISTANCE FROM:
B ~l-I-ED I~N~ NEAREST NEAR/E/ST// SEPTIC SEE_..PAGE
FOUNDAT/'O~....~ LOT LINE SE~/.ER LINE TANK SYSTE-%
CESSPOOL ,"~ OTH ER SOURCES /
APPROVED DISAPPROVED REMARKS
DISTANCES:
pipe MATERIAL:
LOT SLOPE:
REMARKS:
Form No, LQ-031
DIAGRAM Of SYSTEM
DATE ~-//~/Y~.//~.YY APPROVED
G.A.A.B.
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
GREAh-:'ER ANCHORAGE AREA BOROUGH-- ~ ~
DEPARTMENT OF ENVIRONMENTAL ~UALITY /~ '
MA,L'NG AODRESS /q-/ ? C
INSTALLATION LOCATION
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT
TYPE AND SIZE OF FACILITY TO BE SERVED -- .
FINANCED THROUGH TO BE INSTALLED BY
., DRAIN FIELD
PHONE .
· OTHER
FINAL INsPEcTION: 24 HOUR NOT'CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SlZe~00~ TYPe ~ ~ ~/~PAGE AREA SIZE ~ ~ ~/'~ ~ /~;~
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
septic TANK TO SEEPAGE PIt WALL
, DRAIN FIELD
SEPTIC TANK , SEEPAGE Pit ~/ DRAIN FIELD
TO NEA EST O'I~/~/NE.
~ELL TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD , ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK .... SEEPAGE PIT
DRAIN FIELD
/
SEPTIC TANKi , SEEPAGE PIT ~/U~/ , DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIS CROSSING GAP 0f
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
Gl~AVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-6S AND THAT THE ABOVE
DESCRIBF~D SYSTEM IS IN ACCORDANCE With SAID CODE. /~jjj /~ ~/ ~J