HomeMy WebLinkAboutCREEKSIDE PARK #1 LT 39ACT'
I
GPe'ATER ANCHORAGE AREA BORO~'"~H
HEALTH DEPARTMENT __ N? 802
327 EAGLE ST. ANCHORAGE, ALASKA ~50! 279-25! !
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
~,/ . , - '-~'_./ ADDRESS '-.~,~ ~ ~ ' PHONE
SEPTIC TANK:' f --'
LIQUID CAPACITY.
COMPARTMENTS
GALLONS. INSIDE LENGTH ~TH~ DEPTH
OR WIDTH / '~ , LENGTH / ~' , DEPTH
~J-4~. DISTAN CE F ROM WELL C4~''~''' BUILDING FOUNDATION.__
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ ~ SQ. FT.
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PiTS ) OUTSIDE DIAMETER
LINING MATERIAJ ~
NEAREST LOT LINE
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL FOUNDATION, NEAREST LOT LINE. OF LINES
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
~"~ ~/~ D~P DISTANCE FROM WATER
WELL: TYPE TH , BUILDING FOUNDATION SAMPLE
NEAREST SEPTIC SEEPAGE
LOT LINE SEWER LINE , TANK SYSTEM , CESSPOOL
IN. ABOVE TILE
NEAREST
OTHER
, SOURCES~
DISTANCES:
c
DIAGRAM OF SYSTEM
t
GrEA er ANChORAge Area borough
QUALITY ~ PERMIT NO.
DEPARTMENT OF ENVIRONMENTAL6,°
SEWAGE DISPOSal SYSTE -- aPPLICaTIO PERMIT
'' SEEPAGE Pit DRAIN FIELD
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
P~ONe
OTHER
FINANCED THROUGH
TO be INSTALLED BY
NOTE:: THIS PERMIT IS NOT VALID WITHOUT ~OIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRE:D. BACKFILLING OF ANY SYSTE:M WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
FOUNDATION TO SEPTIC TANK
FOUNDATION TO Seepage PIT -('~(~ , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPtiC Tank ..SEEPage PIT ~ ~) , DRAIN FIELD
TO NeAReST LOT LINE.
DRAIN FielD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, ., SEEPAGE Pit , DRAIN FIELD
TO RIVER, LAKE STREAM.
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.
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF (~REATEI~ANCHC~'GE AREA BOROUGH ,~RDINANCE NO. 28-68 AND THAT THE ABOVE