HomeMy WebLinkAboutCROSBY LT 9B
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G£ iTER ANCHORAGE AREA BOROI~ ~H
D~:~ARTMENT OF ENVIRONMENTAL QUAL '~-~./~
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION ~,,~'~- ~,~ ~ ~,~"~.~';:~ '~-~
SEPTIC TANK:
(-~ '"~/~"~: J NUMBER OF
DISTANCE FROM WELL ~~ MATERIAL ~ ~~ COMPARTMENTS
LIQUID CAPACITY ./'~ ~GALLONS. INSIDE LENGTH ~ INSIDE WIDTH ~
MAILING
ADDRESS~ ~' .Z/'.,~ /j/, ,~..7-...J'~ PHONE·
LIQUID
DEPTH~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS. / OUTSIDE DIAMETER
LINING MATERIAL ~)~~
~ OR WIDTH ~ ~ ~ LENGTH. ~ / ., DEPTH
NEAREST tOT LINE -~"~-~' '~ ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL , FOUNDATION , NEAREST LOT LINE
NUMBER OF LINESmaN LINES WIDTH
ABSORPT~
DEPlH: lOP OF II[E 10 EINISH GRADE
TOTAL LENGTH
, OF LINES
~'~ENCH IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LiNE
DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL: ~~/z''''~':~-~-~''~ DISTANCE FROM WATER ~
TYPE.~'~,~'~z3-~z~---~-z:'z~, DEPTH ~ , BUILDING FOUNDATION ~ _SAMPLE , NEAREST
NEAREST SEPTIC ~ SEEPAGE ~ OTHER
LOT LINE ~ , SEWER LINE ~ .,TANK , SYSTEM , CESSPOOL ~ , SOURCES__
DISTANCES:
DATE
DIAGRAM OF SYSTEM
APPROVED~
G,A.A.B,
gR~2~Er ANCHORAGE AREA BO'A"JUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORage. ALASKA 99502
TelePhoNe 279.8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PeRM IT NO,
NAME Of APPLICANT
INSTALLATION LOCATION
LEGAL DescR,.T,ON
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
· COMPLETION DATE ANTICIPATED
SEEPAGE Pit //~ 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
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
DRAIN FIELD
TO NEAREST LOT LINE. ./
WELL TO SEPTIC TANK ,~': / , SEEPAGE PIT
DRAIN FIELD , ALSO CONSIDER AREA WELLS.
WATER MAiN TO SEPTIC TANK /~*~ , SEEPAGE P]T
DRAIN FIELD .
SEPTIC TANK, ~5-- / /
SEEPAGE PIT /g)~ , DRAIN FIELD
TO RIVER, LAKE, STREAM.
DIAGRAM OF SYSTEM
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 SEPT[C TANK AND SEEPAge Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
CONFORm TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORI~:
OR
I CERTIFY THAT ] 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.
GRE2~ER ANCHORAGE AREA BOROUGH
DEPAR~.ZNT OF ENVIRONMENTAL QUAL~
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
CASE
Performed For ~q~r ~y ~. Date Performed
Legal Descriptio'~ Lo~_~j[_Block Subdivision
This Form Reports Soils'Log ~ Percolation
Test
m
9:--
Depth
Feet Soil Characteristics
Was Ground Water Encountered?
If Yes, At What Depth?
Reading Date Gross Time Net Time Depth to H20 Net Drop
N
te
Proposed Insta'l"l ation:
Depth Of Inlet
es~ Performed'By I
nute
Seepage Pit Drain Field
Depth To Bottom Of Pit ~'~ Trench
~-,~.'~, ~.~1 ......... ~: 6~,~'~~
Data Certified By:
Date:
[RTME~JT' OF 'ENVIRONMENTAE ~QUAL!,? .:~ ~
WIDTH__ ,,~ D[PIH
LENGTH' ' '-;~'- -= ':.INSIDE " "·
EE AOE SYSTEM. -.. SEEPAGE PI?: - .... - . ~ -. ~ = . , ,:
'~-. ~,~ko~ ~T LI~E '~> ;-c:, c~'~ ,TOTAL EFFEC[IVE ABSORPTION AREA ~LL AR~ ~Z
:~'~-"';'~T.:- , [~ DRA N F ELD"r'.':P~':. .., ,. ~_.: _'- -': ':':- '. ?::¢]~ ~'-~. : ... --. . : 7..:~..-.:.:...:. ::._ -:.. , :-_ ..._: -.::,-.f :..~% ', . . :~ -/; :.
~"-~"~'"~'-:"-~ ~Sl~ ~:;' ~ ~C, CESSPOOL'~ : ;- '~ ', SOURCES~
'"-~;'~!~"~ 'i~:]~'/~?GREATER ,ANCHORAGE AREA BOROUGH
.:~'~' '"".~ _~,.:.. ~-' .9~^~r~?~:~OF ~,O,~:~A~ ~UA~'¥. 'cAS~ ~ -
~.. ' . ~'.~' ' 3500-'TUDOR ROAD
--:, :-A-;. . ~ ,-¢~ :. : A[~fiHORAGE, ALASKA 99502~ :... ':'_ <-' . .. _.- '
kega,'.uescnp.~iond Lo~-~,~Block Subdivision ' ' ''-?~-~- - .
/~?':..Th~s Form Reports: So' ls .Log -p - ~-]~f~-~;~ ..... ' '
Feet Soil Charactenistics '"
'?'":~4a'$ Ground Water Encountere~J?
'-. ~ If Yes,, At What'Depth~
Reading - Date
t
-:~ ?~ ' . .
.~ercoiation
7
7. Proposed~ InstaT-t-~)-On:-Seepage Pit Drain Field
/':; , ,D. epth Or Inlet ' _ Dep~-To BDt'tom '
_.; ~, .. . .. _ ~ ~ -- .... Of P~t.Or Trench
. COh,(Ed~S ~.~ ~ ~_~ /~ ~ ....
~,',: 1 ~ ~.~t~ Date :--'- '
Gross Time Ne~ Time Depth to H20 t(;'t Drop' '
60'§91
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