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.... ~ TER ANCHORAGE AREA BOROI'
DEPARTMENT DF ENVIRONMENTAL 0.UALIT¥~
3§00 TUDOR ROAD ANC:HORAGE, ALASKA DB§07 27g-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
ADDRESS >:, ~,/' ~:~:.: +'"~'~'/J
;~ ~ r ~r PHONE"
..: ,:': .//:./. :~- / ' ;i .i .
LEGAL DESCRIPTION -------- _ .
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY -/' -;~ ':'~ .GALLONS·
NUMBER OF /
MATERIAL - ~ :'~"( ":" ~' -~" COMPARTMENTS
LIQUID
INSIDE LENGTH ~- INSIDE WIDTH. '- ~' DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS // OUTSIDE DIAMETER ' OR WIDTH
LINING MATERIAL-'-4"~"/ ~ -~ ' *' ' DISTANCE FROM W~LL
__., LENGTH /' ~' DEPTH
, BUILDING FOUNDATION
NEAREST LOT LINE ,./. ?,'~,..:"~.~,2~' A · ;Z' ' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) -'~:-"'z' /
~SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL .~~ ' ~ . NEAREST LOT LINE
NUMBER OF LINES ,/"/'~ISTANCE BETWEEN LINES ~'~. TRENCH WIDTH
ABSORPTIO~ SQ, FT. LENGTH OF EACH LINE ~ ......
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEAI'H TILE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
.IN. ABOVE TILE__
WELLi ";;:"
TYPE/- .* -: -:' ' , DEPTH ~"-';"
NEAREST -/ SEPTIC
LOT LINE '' ' ., SEWER LiNE :' ) '/ ' TANK·
DISTANCE FROM
,BUILDING FOUNDATION. /" ~" _
'." ~' / SEEPAGE
· ' , SYSTEM__// -'
· ' WATER
DIAGRAM OF SYSTEM
, NEAREST
..,¢/. '~/.--' .
OTHER ' '" '"
SO, I~R~E.S,'_'.4' ~ ~' ,-//
DISTANCES:
GRE:Al:iER ANCHORAGE AREA BOR,JUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK
TYPE aND SIZE OP FACILITY TO SE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
NOTE: THIS PERMIT IS NOT VALIID WITHOUT SOIL TEST
FINAL INSPECTION:
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
TANK TYPEj
MINIMUM DISTANCES, REGUIREMENTS
FOUNDATION TO SEPTIC TANK ~ [
fOUNDATION TO SEEPAGE PIT DRAIN FIELD
/
, SEEPAGE PIT ~ D~AIN FIELD
SEPTIC TANK
TO NEAREST LOT LINE.
24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
TYPE
DIAGRAM OF SYSTEM
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, , SEEPAGE PIT 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 REGULATIONS REGARDING INSTALLATION.
~ J ~ HEalth AUThOritY
OR
L]CENSED DESIGNER
I CERTIFY THAT IAM FAMILIAR With THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE aBOVE
DATE ,// / , ] APPLICANTS SIGNATURE -