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GRED ;R ANCHORAGE .AREA BOF JGH
Mab DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
3330 "C" STREET ANCHORAGE, ALASKA 99503
S TELEPHONE 274-4561
SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OF: ��L"^ '' & IL -
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
E PIT
PHONE n °"".',-
DRAIN FIELD , OTHER ,
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE
TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT.
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEEPAGE AREA SIZE TYPE -
DIAGRAM OF SYSTEM
DRAIN FIELD
DRAIN FIELD
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
SEPTIC TANK, . SEEPAGE PIT DRAIN FIELD ,
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
G.A.A.B.
OR
LICENSED DESIGNER
1 CERTIFY THAT 1 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.
DATE APPLICANT'S SIGNATURE"" •".s'"- ^r'
FORM NO. EQ -01 6
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1 CERTIFY THAT 1 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.
DATE APPLICANT'S SIGNATURE"" •".s'"- ^r'
FORM NO. EQ -01 6
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