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HomeMy WebLinkAboutSHIRLEY LT 1GRE "ER ANCHORAGE AREA ROr",UGH Department of Environmental Quality 03330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME s /// = , ',.. �'%i MAILING ADDRESS --j y'% ' v PHONE: LOCATION LEGAL DESCRIPTION ham' SEPTIC TANK: DISTANCE NUMBER OF i s�:; jl'j✓i _%:-'. "G'� s vc FROM WELL/—MANUFACTURER'" MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY,- -2z 5 ('' GALLONS. SEEPAGE PIT: NUMBER OF PITS- %/ DIAMETER Z,'� OR WIDTH—; LENGTH—, DEPTH LINING MATERIAL< ,L,21-- /. CRIB SIZE: DIAMETER -f DEPTH• DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION .:C NEAREST LOT LINE - li ABSORPTION AREA (WALL AREA) ,`l SQ. FT. ADDITIONAL ABSORPTION WELL: i TYPE CONSTRUCTIONDEPTH '?SDISTANCE FROM: BUILDING i NEAREST =' '" " NEAREST SEPTIC SEEPAGE , FOUNDATION ''� LOT LINE -5 SEWER LINE; -'{ TANK - SYSTEM CESSPOOL�L-:� ` ; -. OTHER SOURCES. APPROVED DISAPPROVED REMARKS" -"- DISTANCES: z is=' DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE. REMARKS: DATE Form No. EQ -031 APPROVED G.A.A.B. �i �• � V� ti �� IC p � !I+ DATE Form No. EQ -031 APPROVED G.A.A.B. GREATER ANCHORAGE, AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274.4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH MAILING ADDRESS l /'? / q9HC SEEPAGE PIT TO BE INSTALLED BY DRAIN FI OTHER A SOIL TEST RESULTS. �,?."l�/L�i'1� NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED C� / 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 010Q`7 ,`�� 'TYPE 'L% % %'CApV� SEEPAGE AREA SIZE ll MINIMUM DISTANCES, REQUIREMENT'S FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL , SEPTIC TANK .¢7 SEEPAGE PIT �`-� DRAIN FIELD /" TO NEAREST LOT LINE. MM WELL TO SEPTIC TANK L' / SEEPAGE PIT DRAIN FIELD /_C11� / ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK !©/ SEEPAGE PIT /0 DRAIN FIELD //^� /0 SEPTIC TANK, 1/-Y. SEEPAGE PIT V(J / 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. V, G.A.A.B. OR LICENSED DESIGNER TYPE 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. DATE 11A4 � J APPLICANT'S SIG NATU RLT FORM NO. EQ -016 GF "ER ANCNORUJi: P.:J !'•. BOROUGH HEA"'Ji DE;PAJ?T.'.i:N' CAST; it 32"! ;n ;Lr c.TRFET ANCHORAGE, ALASKA 99501. _ C,r Datc Per�orID@d r Pel�rormEd For or `. I i- r., _. � ,l � ,.,. ` -_�• :,egal Dvscript1C7n: L01 it, -2 `31OcC�� This Fcr-m Re^yOrtS a: Snil.s Lor m� � mM Ft'ercola'c cr 'es, Location S7i',Tch 1 s� Was Ground 'crater ) ncountered'? / ') 0 If Yes, At What Depth rrv_bscd Installation: Seepage i'EC'L SO.1, � .._�.,,/,.— �ati,T j ��'i' ;cam L S'✓} � ..� ._ .. o g _ 69 Zt Location S7i',Tch 1 s� Was Ground 'crater ) ncountered'? / ') 0 If Yes, At What Depth rrv_bscd Installation: Seepage Pit Drain Meld Der", -i" Of inlet 7 Tc: -;t crformcd B,;""ti, Data Certified I .Date . N L R-/\\x °ON/1Jd39 dO /✓/°J/SO - DlJI SH7d YO: 7,1 KZ S 8Zg686 rVBf✓B Sp� Flpn Pp O� 0 h O m ti Ir N I h m N C a n U 0 96 601E 0 ° i V! b l Lo y �. 0 u pto 1-0 1� pQ W ti 4 V V n ry a 2 y H bo , Q 3 ul c e 0 �ti N 600114 � Q m •Zz < 4 ao e YX e x % L a1 T ° LQ b i N aT q h.b o E Y Q °ON/1Jd39 dO /✓/°J/SO - DlJI SH7d YO: 7,1 KZ S 8Zg686 rVBf✓B Sp� Flpn Pp O� 0 h O m ti Ir N I h m N C a n U 0 96 601E O ° i V! b l Lo y �. u pto 1-0 1� pQ W ti 4 V V n ry a 2 y H Q 3 ul 0 �ti 609 600114 yam < e YX e x B ® u 0 T ° O ° i t C •tiw h ro m �� �m L i R '<C a: ry a 2 y H o,7o/nioenSNn i t C • � � � 8 - L i R '<C < e W < e YX e x B ® u 0 T ° LQ b i N aT q h.b o E Y