HomeMy WebLinkAboutLot 02
GREA,_R ANCHORAGE AREA BOR(,
Department of Environment Quality
3500 Tudor Road
Anchorage, Alaska 99507
GH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME/*I~t~ /~O~'.A//i/V MAILING ADDRESS ??/~
LOCATION //~g¢-~ ~',~¢'¢z..'~e~'~c~-'~f-x~'¢-~ LEGAL DESCRIPTION
PI-lONE
SEPTIC TANK:
DISTANCE
FROM WELL
MANUFACTURER
MATERIAL
NUMBER OF
COMPARTMENTS
INSIDE LENGTH ~ INSIDE WIDTH ~ LIQUID DEPTH
LIQUID CAPACITY /620OGALLONS.
TILE DR/~~
. TOTAL LENGTH/./
DISTANCE FROM WELL _FOUNDATION .NEAREST LOT LINE .OF LINES ,/
ABSORPTION AREA .... SQ. F% LENGTF'N~ EACH LINE ~
DEPTH: TOP OF TI~4 GRADE MATERIAL BEKTE-~eCD:L.TILE__.¢~'- IN. ABOVE TILE IN,
WELL:'
TYPE~¢/f/I,I'If~'IiIt~"~ CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION__ LOT LINE SEWER LINE
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED
DEPTH
SEPTIC SEEPAGE
TANK SYSTEM
REMARKS
DISTANCE FROM:
INSTALLED BY:
SEWER LINE DEPTH:
PiPE MATERIAL:
LOT SLOPE,
REMARKS:
DIAGRAM OF SYSTEM
Form PW~027
N¢
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
PERMIT NO. --
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PHONE
OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
2. ~ S'L''J/
SOIL TEST RESULTS
-~;~ . / .~,./ ,.~,,~ //~Tj,E, THIE$~PE]~I~IT IS NOT VALID WITHOUT ~OIL TEST
~IP~AL IJqSP~CTIONI J4 HOUR NOTICE RRQUIRED, BA~K~I~LIIqG O~ ANY SYSTEM WITHOUT FINAL IN~P~OTION BY TH~
HJm'ALTH ~EPARTM~NT AUTHOFIlTY WILL 8~ ~UBJR~T TO PROSEOUTION.
MINIMUM DIBTANCE~,REQUIREMENT~
5
FOUNDATION TO SEPTIC TANK
FOUNDATION tO SEEPAGE Pit 20 ~:~. DRAIN fIELD
SEPTIC Tank TO SEEPAGE PIT WALL 15 ~:~,
SEPt,c TANK 5
TO NEAREST LOT LINE.
WELL TO SEPtJC TANK
DRAIN FIELD
1.0 ft.
SEEPAGE PIT 4V , DRAIN FIELD
S-o~ SEEPAGE P, , __( v (
,~-~ ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK 10 ft, __-, SEEPAGE PIT 10 ~:t, ,
DRAIN FIELD 10
SEPTIC TANK, 25 ~t,~, SEEPAGE PIT 100 ~te , DRAIN FIELD
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF ..........
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAP~.
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
TYPE
DIAGRAM OF
40
CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF ~.,xaTER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received ~'/~:~ ~/
Time of Inspection
Date of Inspection
e
4.
5.
6.
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Approval requested by:
Mailing Address:
Property Owner:
Mailing Address:
Legal Description:
Location:
Type of facility to be inspected
Well Data:
\
A. Type
C. Construction
Sewage Disposal System:
A. Installed ~i'-i~'q')-- B.
No. of bedrooms
B. Depth
D. Bacterial Analysis
C. Septic Tank: 1. Size __~o ~_/
U
D. Seepage Pit: 1. Absorption Area ~"$~,
E. Disposal Field: Total length of lines
8. Distances:
A. Well to' ptic tank
, Absorption area +c)-~o , Sewer Lines ,
Nearest lot line
B. Foundation to septic tank
, Other contamination _
/0~ , Absorption area
C, Absorption area to nearest lot line '~J-~ ~
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Request for Approval of Individual S ,er & Water Facilities
Legal Description Z_~l- ~ ~ , ., ~
Comments ~ ~ Lx~W ~C~~J
Approved ~,~.. ?~b~'~S~- __ Disapproved
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
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)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "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:
3. Name of Buyer:
Mailing Address:
Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent: . ,¥'; ,~E.,~.& .......
Phone
Mailing Address:
Phone
7. Type of Facility to be inspected: ~
8. Water Supply
Type of Supply: Public Utility _~x~
o
No. Bdrms.
Individual
If Individual, number of dwellings presently served -/ --
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility Individual
If Individual, date of installation /'['~ .~ '/~2~" ' ....
(on-site)
E0-037 (1174)