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iR ANCHORAGE AREA BORr'~GH
Department of Environmental quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TAN
DISTANCE
FROM WELL
MAILING ADDRESS
MANUFACTURER MATER,AL
PHONE
NUMBER OF
COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH_
_LIQUID CAPACITY /'OOd GALLONS.
SEEPAGE PIT:
LINING MATERIAL CRIB SIZE: DIAMETER ~.DEPI'H DISTANCE FROM: WELL ,,Jl~ f
BUILDING FOUNDATION NEAREST LOT LINE ~' TOTAL EFFECTIVE
__ . ABSORPTION AREA (WALL AREA) ~/(~ SQ. FT.
ADDITIONAL ABSORPTION
TYPE CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION LOT LINE SEWER LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DEP-FH DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM
DISTANCES: '"- ! 7
INSTALLED BY:
PiPE MATERIAL:
C~CV
LOT SLOPE:
REMARKS:
Form No, EQ-031
DIAGRAM OF SYSTEM
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456 I
PERMIT NO,
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK / ~ SEEPAGE P T ., DRAIN FIELD OTHEr
FINANCED THROUGH TO BE INSTALLED BY ....
COMPLETION DATE ANTIC]PATED
FINAL INSPECTION: 2:4 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAl.. INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTNORITY WILL BE SUBJECT TO PROSECUTION,
FOUNDATION TO SEPTIC TANK
SEPTICTANK TO SEEPAGE PIT WALL_
SEPTIC TANK
TO NEAREST LOT LINE,
WELL TO SEPTIC TANK _
DRAIN FIELD
WATER MAIN TO BEPTIC TANK
TO RIVER, LAKE, STREAM.
ALSO DONS~DER AREA
SEEPAGE P,T-
CAS]' 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.
I;)IAGRAM OF SYSTEM
GRAV£L gAC:I(FILL
CONFORM TO BOROUGB REGULATIONS REGARDING INSTALLATION.
I DERTIF'Y THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
Performed For __/<___~rr__c_F__~__ ~,~,
Legal Description: L/ot Block
This Form Reports Soils Log ,~/_
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3S30 "C" Street
ANCHORAGE, ALASKA 9950S
Dated Performed
Subdivision
Case #
Percolation Test
- Soil Test Must Be Logged To ~' Below Proposed Seepage System
Depth
Feet
3~
4~
7--.
9~
]3~
14~
Soil Characteristics
Was Ground Water Encountered?
If Yes, At What Depth?
L_L L_J__L_J I 1Il]
L-J-.----I----L--I l___J__lJ___J
Reading Date Gross Time Net Time Depth to H2D Net Drop
Percolation Rate
Proposed Installation:
Minute
Seepage Pit
Drain Field
Depth of Inlet Depth to Bottom of Pit Or Trench
NTS:
Test Performed BY_ ~ ~ ~~ Date Certified BY:
I)a te:
Well Owner.
M-W
DRILLING, INC.
DRILLING LOG
Use of
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing Depth of Hole
Static water level : ft. (abOve)
Screen ( ); Perforated (
feet Cased to feet
(below) land surface. Finish o£ well (check one) open end (
).
Describe screen or perforation
Well pumping test at " gallons per (hour)
of drawdown from static level.
Date of completion
(minute) for : hours with
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
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