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Department of Environmental Quality
333OCStreet
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME /
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SEPTIC TANK:
DISTANCE ~ _/ NUMBER OF
FROM WELL Mxmu+*cTunen xxaTcnm��
� f^�/ coMpxRTMEmTS /
|NSI DE LENGTH ___-___-|mS|osvv|DTH _______uQu|oDEPTH ______L/Qu|oC*P*c|TYGALLONS.
SEEPAGE PIT: 2
NUMBER 0pPITS _L___. DIAMETER ____onw|oTn__-' LemoT*___. DEPTH .
LINING MATERIAL CRIB SIZE: o|xmsTsR___ospT*____DISTANCE FROM:
TOTAL EFFECTIVE
BUILDING FOUmD*T/ON__-_, NEAREST LOT LINE-. ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPEIL eucTiom DEPTH DISTANCE FROM:
eu|UD|ma me*nEsT ms*nEsT sspT|c ° ssEPAoEa-m�c ^
FOUNDATION -, LOT LINE ______'. scvvsnL|ms______. TAmn_�/`f_. 5YsTsxx .
oE35PooL________. OTHsnSOuncss
aPpnoVso________DISAPPROVED _-___REMARKS
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE: .
nsxx*RKS'
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Form No. EQ -031
DIAGRAM OFSYSTEM
Ja
C I-
C I-
LEGAL DESCRIPTION )- I, 1 / �' j-, sp'q'le /If s -/ V
INSTALLATION OF: SEPTIC TANKSEEPAGE PIT DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED T�;L " /,I c -:-x
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS 3 3 /AOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TIES'(
COMPLETION DATE ANTICIPATED 6-t' i- -/--3
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLIIIIG OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
)A— W V b7 '
zy-o XC V 6) Z -&x
'El � -
SEPTIC TANK SIZE / TYPE G SIZE TYPE
77ie 0/7 atV, by �,IJIe,,cl
MINIMUM DISTANCES, REQUIREMENTS D I
9. �AOIF, �YSTEEM
12
FOUNDATION TO SEPTIC TANK f A, 2��
z D
i.
— DRAIN FIELD
GREATER ANCHORAGE AREA E30ROUGH
SEPTIC TANK TO SEEPAGE PIT WALL
20
SEPTIC TANK —, SEEPAGE PIT
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DEPARTMENT OF ENVIRONMENTAL QUALITY
"C"
PERMIT
NO,
3330 STREET ANCHORAGE, ALASKA 99503
SEEPAGE PIT
DRAIN FIELD
ALSO CONSIDER AREA WELLS.
TELEPHONE 274-4561
vt 9 67 44 0
SEWAGE DISPOSAL SYSTEM - APPLICATION AND
PERMITj-,-
;2 q 0'�
:7
-Al jq ILI
NAME OF APPLICANT
MAILING ADORES/Li
PHONE
ql��
INSTALLATION LOCATION
LEGAL DESCRIPTION )- I, 1 / �' j-, sp'q'le /If s -/ V
INSTALLATION OF: SEPTIC TANKSEEPAGE PIT DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED T�;L " /,I c -:-x
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS 3 3 /AOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TIES'(
COMPLETION DATE ANTICIPATED 6-t' i- -/--3
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLIIIIG OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
)A— W V b7 '
zy-o XC V 6) Z -&x
'El � -
SEPTIC TANK SIZE / TYPE G SIZE TYPE
77ie 0/7 atV, by �,IJIe,,cl
MINIMUM DISTANCES, REQUIREMENTS D I
9. �AOIF, �YSTEEM
12
FOUNDATION TO SEPTIC TANK f A, 2��
z D
FOUNDATION TO SEEPAGE PIT
— DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
20
SEPTIC TANK —, SEEPAGE PIT
DRAIN FIELD
TO NEA RES LINE.
Z PT
-M ASE00 ASEPTIC
WELL TANK
SEEPAGE PIT
DRAIN FIELD
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT 1621
DRAIN FIELD
SEPTIC TANK, / 019 SEEPAGE PIT DRAIN FIELD /(57
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKIFILL 0 e /( W; ff
CONFORM To BOROUGH REGULATIONS REGARDING INSTALLATION.
AA...Z&
G.
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATECY%,APPLICANT'S SIGNATURE
aREATLR ANCHORMr AREIA BOROUGH
HEALTH DEPART.M.ENT CASE' d
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
Pcr-.:-ormed for NjrZ'5, I r1_1c 7 Date performed C,
Legal Dcscz,ipt ion: Lot ub 1. v s on
This Fcrm Reports a: Soils Log 1ercolati�657es-,
to /Qw
d5
10
r307, OF r -45r 7# --F
Location Sketch
L-17
-7"
Soil Characteristics
Date
Atel
<-> rz too
Net Time
Depth To H2O Net, Drop
66AJ�501-7 7
'Aim"
Certified By:
cite o4
Date:
p-206 Cali
P fo cpw
(Z AF i 0 rz rva c 6 172 .0- -t-0
17�
°L &'e ''., ....... . .
7
to /Qw
d5
10
r307, OF r -45r 7# --F
Location Sketch
Was Ground Water Encountered? 0
If Yes, At What Dept
GL
L-17
-7"
4
Date
Gross Time
Net Time
Depth To H2O Net, Drop
66AJ�501-7 7
D,�r,:4
Certified By:
Was Ground Water Encountered? 0
If Yes, At What Dept
GL
?reposed Instal-fa-71—on. Seepage Pity --;Meld
Drain
Delc,th Of lnle-#. Depth To bottom of pit Or Trench
-7"
Date
Gross Time
Net Time
Depth To H2O Net, Drop
66AJ�501-7 7
D,�r,:4
Certified By:
Date:
?reposed Instal-fa-71—on. Seepage Pity --;Meld
Drain
Delc,th Of lnle-#. Depth To bottom of pit Or Trench
-7"
c r f orwe d Bj
1771r�
66AJ�501-7 7
D,�r,:4
Certified By:
Date:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection 73
REgUEST FOR APPROF[AT, OF
INDIVIDUAL SEINER & INATER FACILITIES
FOR
/_21)��
1. Aoproval Requested By:
Address; Phone: 3 3 3 - 4 .5-'F'9
2. Prooerty Owner: { Phone:
3. Legal Description:�-
4. Location:
5. Tvpe of Facility to be Inspected:
Numh;jr of 3edrooms:
5. 'Nell Data:
A. Type B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disoosal System:
A. Installed B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Size 2. Material
E. Disposal Field: Total Length of Lines`
8, Distances:
A. i!i� li. To: Septic Tank , Absorption Area , Sewer Lines
Nearest Lot Line Other Contamination
B. Foundation to Septic Tank � '; Absorption. Area
C. A�)sorption Area to Nearest Lot Line
Requast for /approval of dividual Sewer & Water Faeilit' ,
P��ge Two
9. Comments
Anoroved Disapproved Date 3
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, Department of Environrr..ental Quality
DIAGRAM OF SYSTEM
I
r.e�-ti f 'that the information cont ,ined in this request for approval to be a true
ane' accu", ,i. s representation of the suhiect sewer and water facilities located at:
Signed Date