HomeMy WebLinkAboutCLOGIA Lot 13 & 14
GAAB-HD- I
GIt'--TER ANCHORAGE AREA BOROI"--'
D~ARTIVIENT OF ENVIRONMENTAL QUALll ~
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
ADDRESS PHONE
SEPTIC TANK:
DISTANCE FROM WELL ..~-0 /'J-'
LIQUID CAPACITY /~ C ('
GALLONS. INSIDE LENGTH.
NUMBER OF
COMPARTMENTS
INSIDE WIDTH
LIQUID
DEPTH __
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH
LINING MATERIAL ZO~ C'-r'//2 ~"~' ~'~' '~ DISTANCE FROM WELL /LO'~'' /
NEAREST LOT LINE
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH 32-/ , DEPTH ~'/
BUILDING FOUNDATION ~'~ t
~:~ -~(~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WEU FOUNDATION. ~
NUMBER OF LINES DISTANCE BET~~ TRENCH WIDTH
ABSORPTION AREA ..-/ SQ. FT. LENGTH OF EACH LINE
D~ILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
~~~TO TAL LENGTH , OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
LOT LINE
DISTANCE FROM
TYPE 6, '1 ~.7'~f-i'//~, ~./ DEPTH -- BUILDING FOUNDATION
~ / NEAREST SEPTIC ~ SEEPAGE
~ SEWER LINE ~ ., TANK ~'~0 t SYSTEM
WATER
SAMPLE. NEAREST
OTHER
, CESSPOOL ~ , SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
IL
.L
GREATEr ANCHOraGE AREA BoruuGh
DEPARTMENT OF' ENVIRONMENTAL GUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PHONE ~:~'~'~
INSTALLATION OF: SEPTIC TANK K/ SEEPAGE PIT ~ DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED 3 ~~F ~-~f~~
FINANCED THROUGH / TO BE INSTALLED bY
SOIL TEST RESULTS f/~'--~P~/~V~~'J NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILl. BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE /'~.~//~ TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK ~-- /~
FOUNDATION tO seePAGE PIT c~ / DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL /~/
, SEEPAGE PIT~~
SEPTIC TANK ~
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN Field
, DRAIN FIELD
SEEPAGE Pit
AlSO CONS,DER ^RE^ WELLS.
WATER MAIN TO SEPTIC TANK ~/~
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 RE{~LILATIONS REGARDING INSTALLATION.
H EAL4H AbT~ O~R ITY
OR
LICENSED DESIGNER
SEEPAGE AREA SIZE ~'~,/~'~-"-~/'~-- TYPE //~"~
.>-'--~--.j-:/---'
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMiliar WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINAN.~/NO, 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM iS IN ACCORDANCE WITH SAID CODE. ~ //
:/./z-'/:"- ' ¢?"/
DATE . ~ APPLi CANT'S $1GNATU~ ~--~'~' _.~-~ ~.~ ~'~
5
6
7
8
9
10
r 'ATER ANCHORAGE AREA BOROU
DEP/-~RTMENT OF_. ENVIRONMENTAL QUALt'I Y
3frO0. T{IDOR' ROAQ
ANCHORAGE, ALASKA 99502
CASE #
Performed For
Lemal Description: Lot 1:3 Bloc~?
This Form Remorts Soils Log
Date Performed ~
__Subdivision ~ [~l ~
Percolation Test
Depth
Feet
Soil Characteristics
Ground Water Encountered?
Yes, At what De~th?
IReading I Date I Gross Time Net Time Depth to H20 I Net Drop
" I
Percolation Rate Minute
Proposed Installation: Seepage Pit Drain Field
Demth of Inlet Depth To Bottom Of Pit Or Trench
Test Performed By
Data Certified By:
Date:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received J/~o,/~
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
5. Type of facility to be inspected
No. of bedrooms
Well Data:
A. lype'~~/_~.~
C. Construction
B. Depth
D. Bacterial Analysis
7. Sewage Disposal System:~~~
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
-~/1~/7~- B. Installer
-/ /
1. Size /~0 ~2~Z 2. Manufacturer ~0~~
/
1. Absorption Area /~ 2. Material ~~'~
Total length of lines
8. Distances:
A. Well to:
Nearest lot line ~/2~--, Other contamination
!
B. Foundation to septic tank "7 , Absorption area
C. Absorption area to nearest lot line
Septic tank ~--0~ , Absorption area /~--M , Sewer Lines
EQ-034 1/74) Page 1 of two pages
Page 2 of two pages - Re~,_.~st for Approval of Individual
Le~l Description
~er & Water Facilities
Approved ~~ Disapproved Date-~/~7/F~/~x
al Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
3330
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
"C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO
2. Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
4. Name of Lending Institution:
Mailing Address: ~DO
5. Name of Realtor or Agent:
Mailing Address: ~
VA ~--~ FHA CONV
Day Phone
Day Phone
Phone
Legal Description:
Location:
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings
If Individual, depth of well
9. Sewage Disposal System
Type :of S~stem: Public Utility
If Individual, date of installation
v~'~51del'lr~ No. Bdrms... ~.~
Individual
presently served
Individual (on-site)
e
3.
4.
5.
GREATF-R ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
t l
/- Date Received / !
Date of Inspection ~
Address: '~ ~ Phone:
Typ~ of Facility to be Inspected:~~ ~~
Number of Bedrooms: ~
6. Nell Data:
A. Type C'-~< b~
C. Construction C:,(~-,
7. Sewage Dtsoosal System:
A. Installed
C. -Septic Tank:
D. Seepage Pit:
B. Depth
1. IOt'C' 2.
Installer
Manufacturer
E. Disposal Field: Total Length of Lines
Sentic Tank ..~_/ ~, Absorption Area
, Nearest Lot Line :~ .~., Other Contamination
Foundation to S~ptic Tank -~ '~ AbSorption Area
Distances:
A. Well To:
Sewer Lines
C. Absorption Area to Nearest Lot Line
Request for Approval of i,,dividual Sewer & Water Facilitit
Page Two
9. Comments:----a,~ ,~ ~'~ ~ : 7~,~/~Ct ~ .~:~'f~[~'~.~,"-/~/"~"d.~/~'":".~.~i~:?~V~:2:~_ ~?/~/~]~7~-'
Annroved_ . ~'-~~~,, Disapproved Date
Ap~_~,.va? V*lid for One Year From Date Sl~ned
Greater Anchorage Area Borough, Department of 5nvironmental Quality
DIAGRAM OF SYSTS~;.
I certify that the information contained in this request for approval to be a true
and accurate representation of the sub~ect sewer and water facilities located at:
Signed Date