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GREA. _R ANCHORAGE AREA BOR, GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME Cl(' MAILING ADDRESS/ U % // U ( =� PHONE '-%' Lf_ C-- ' f- 14"
LOCATION 541v 51 Itl4leI11 1?0'LEGAL DESCRIPTION! B_F ��' `��D��'1)-S�c'f�.fp�Uel<-9 -S1_0
SEPTIC TANK:
DISTANCE< NUMBER OF
FROM WELL MANUFACTURER .5�iv5e � MATERIAL _/__��5�—� COMPARTMENTS -
INSIDE LENGTH _ INSIDE WIDTH LIQUID DEPTH _ LIQUID CAPACITY/1%—odGALLONS.
TILE DRAIN FIELD:
r ♦ TOTAL LENGTH
C�
DISTANCE FROM WELL L a), P_FOUNDATION � __NEAREST LOT LINE —OF LINES-
% `♦v
NUMBER OF LINES / DISTANCE BETWEEN LINES _- TRENCH WIDTHh IN. TOTAL EFFECTIVE
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE — -- -
♦ DEPTH OF FILTER ♦/ �y
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE�'_IN. ABOVE TILE N.
WELL: / %� / _
TYPE__ 4� //k0_ _-CONSTRUCTION -- � � �f � � / _DEPTH 3a0 DISTANCE FROM:
BUILDING `• NEAREST NEAREST SEPTIC LL t- SEEPAGE
FOUNDATION—/_ LOT LINE SEWER LINE '�� TANK a SYSTEM _-
CESSPOOL _?Q44—, OTHER SOURCES
APPROVED_— — DISAPPROVED----- REMARKS
DISTANCES: _.
INSTALLED BY: 4�
SEWER LINE DEPTH:
AA
PIPE MATERIAL:S'tL�
u)loq
LOT SLOPE:
REMARKS
Form EQ -032
DATE` U��DAPPROVED
TEM
rt) r.
G.A.A. B.
GREX, .R ANCHORAGE AREA BOR, GH .
PERMIT NO.
DEPARTMENT OF ENVIRONMENTAL QUALITY
'LJI 3330 "C" STREET ANCHORAGE, ALASKA 99503
5 i TELEPHONE 274-4561
�°�+uro uK`AJ
SEWAGE DISPOSAL SYSTEM�APPLICATION AND PERMIT
J `
^'--'�I/— 7/"-- PHtN
O
F
NAME OF APPLICANT a - MAILING ADDRESS
tl
'�
INSTALLATION LOCATION �
LEGAL DESCRIPTION
INSTALLATION OF:
TYPE AND SIZE OF
FINANCED THROW
SOIL TEST RESUL
COMPLETION DATE
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
SEEPAGE AREA SIZE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT _�.
- DRAIN FIELD —
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK dT SEEPAGE PIT DRAIN FIELD.
TO NEAREST LOT LINE. -
WELL. TO SEPTIC TANK SEEPAGE PIT —•
DRAIN FIELD FALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
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
9ENSED DESIGNER
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANC:H
DESCRIBEIA SYSTEMIIS IN ACCOR '#,NGE. WITH SAID CODE.
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APPLICANT'S SIGNATURE
FORM NO. EQ -016
DIAGRAM OF SYSTEM
AREA BOROUGH ORDINANCE NO. 26-68 AND THAT THE ABOVE
-441
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AREA BOROUGH ORDINANCE NO. 26-68 AND THAT THE ABOVE
Box W, Davi3 St., E aplu Flivor, Alaska VES!
fM-2 74 or M -P260
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5005 Et Founci_stiuns Land € e -mor" ttr
BAR
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CUv O dER'S ORDER NO. PHONE DATE
NAt�tE
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AODRC_'.:
SOLD t3Y y'�CASH —E0 D c I CHARGE ON ACCT. MDSE RC f D'i PAID OUT
� I�
QTY.
DE9CRIPTION
PRICE �
AMOL)NT
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RECEIVED Lir
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TAXI
TOTAL. '.
All claims and returned Goods -
MUSF ID,-, accOmpanied by this bill.