HomeMy WebLinkAboutHOLLY HILL BLK 2 LT 2L I&L
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE [] NEW
)
LOCATION~~~/ ~ ~ B ~ rptionarea Dwelling PE-MITR NO
(oo ' qn
~ ~ ~ Manufacturer ~ ~ Materia~ ,. No, of co~part~
~-- ~Liq capacjtvin qallons[ ...... I nsde ength I W[dth' L~qu,ddepth
' ~ 0 0b F HOMEMADe: ~ J
~ZZ : I ~ .... I Material ~ ' Llqu' 'ldcapacltyln'
gal~
~ I ~ Well ~ Foundation ~ I Nearest lot line PERMIT NO.
~ ~ ~ No of lines_ ~ _ Length of e~ ~e' Total length of line~ ~ Trench wide_ ~ Distance between lin~s~
~ ~ ~ Top of tile to finish grade { ( Material beneath tile ~ . Total effectwe ab~r~o~rea
a ~ ~ O inches ~ U
~ ~ ~ Type of crib ~ ~meter Crib depth /Total effective a~o. ~r.~
DISTANCE TO: 1
~ Clas~ ~ )e~ ~ Dr er I Distance to lot line PERMIT NO.
~ ......... luilding f~u~dation Sewer line I Septictank ~ ( Absorption areajs)~
OTHER
PIPE MATERIALS
SOl L TEST RATr~G
INSTAF LE~.
REMARKS
AP~(// ~ ~ DATE LEGAL
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SOILS LOG
. MUNICIPALITY OF ANCHORAGE
· [] PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
Pouch 6-650, Anchorage, Alaska 99502 276-2221'
SOILS LOG -- PERCOLATION TEST
3
4
5
?
WAS GROUND WATER/L,~(~
12 IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
14
15-
16-
17-
18-
19-
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN , , FT AND FT ~
GAAB-HD-I
GiP.~,TER ANCHORAGE AREA BOROP-~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME '~iJCJ~J J~) ~'~ I~J.C'H ADDRESS MAILING
LOCATION ~00~-- ~~*~ ~*~LEGAL DESCRIPTIONL
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY ~ ,,,~ ~i' ~ GALLONS.
MATERIAL ~J~J~
INSIDE LENGTH
NUMBER OF /
~ COMPARTMENTS
INSIDE WIDTH. 'f"t/j DEPTHLIQUID
SEEPAGE SYSTEM:
SEEPAGE PIT:
NUMBER OF PITS j OUTSIDE DIAMETER ~ OR WIDTH /'~
LINING MATERIAl J'~ ~'"~ DISTANCE FROM WELL J~-~ i
NEAREST LOT LINE ~ TOTAL EFFECTIVE ABSORPTION AREA WALL AREA
LENGTH /'~ (
, , DEPTH
· BUILDING FOUNDATION
"~ ~ ~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER GE LINES
ABSORPTION AREA
FOUNDATION //~. N~A~EST .OT LINE
TOTAL LENGTH
, OF L NES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE.
WELL:
LOT LINE
TYPE DEPTH
//~ f NEAREST ~'~' !
, SEWER LINE
DISTANCE FROM
· BUILDING FOUNDATION.-'~ ',,
SEPTIC ~'~,~ ( SEEPAGE /'
TANK SYSTEM
WATER //~ NEAREST
SAMPLE
OTHER
· CESSPOOL "'""- SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED
GAAB-~'J)-2' '~
GREATE[
g27 Eagle St.
SEWAGE
ANCHORAGE AREA ) OUGH
HEALTH DEPARTMENT ~ , ~ ~
Anchorage, Alaska 99501 .4' //~?~d 27%2511
DISPOSAL SYSTEM - APPLICATION & PERMIT
Case No. --
NAME OF APPLICANT ~fl Vi~ -.~z';£,,~:J/EJ~
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ~ e L_ f~
SEEPAGE PIT , DRAIN FIELD
TO BE INSTALLED BY
MAILING ADDRESS d04~ f()Z~/(?Y~- PHONE NO.
LOCATION OF INSTA'LLATION ~ ~ ~ ~'~¢~-'
, OTHER
PERC:>ObA-T~q3N~TEST RESULTS z I/~4~V ~J A"~,T~.~'r, ANTICIPATED DATE OF COMPLETION
3q~/'~:~/~¢4.~,9~/~77- 7//~ELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /~,~-' ~-~xa~) ~/'~ l (-~\ PERMIT TO INSTALL A ~¢~ '~ -'
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED '~
. SEPTIC TANK SIZE /0 0 0 TYPE Q Q_~-~]~EEPAGE AREA TYPE ~'/~
DIAGRAM OF SYSTEM
DISTANCES:
oo--V %olc_
-~ 0" ~H~alth Authority
I certify that I 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. ~
n A'I'C APPl I~AIMTR RIR~IATIIRI=
· ~!iREATER ANCHORAGE AREA BOROUGH/ '\
,* HEALTH DEPARTMENT CASE
. 327 EAGLE STREET
ANCHORAGE, ALASKA 99501
Performed For Mr. David Goodrich Date Performed 11/3/69
Legal Descrz ~ BLock ~dz% ~s~on Holl Hill Sub-Division
T {s r'orm ReporTS a: Soils Loa An .-rercolatlo~ TeSI AA
Depth
Feet Soil ........ ' '
I ~ ~;y silt w/occasional gravel
Silty fine to coarse sand
inter~ ixed w/gr ave 1
Clayey silt w/scattered
fine gravel
Location Sketch
Was GroUnd Water Encountered?
'if Yes, At What Depth
-.-.----- ,"
~rcola~ion l a~e 1 / ~ Minute"
ProPosed I ' '
nstallataon: Seepage Pit X Drain Field
Depth Of Inlet
'- -~-°mmen_d us-~-~a-~ a See'page it to be back filled wi o",. ~.i ~_?_e_t.
coM~,m~f3 we-~DepthT~it Or Trench--
Data Certified By:~~~f~ ~. E. Carlisle ....
Date: , _.,_, -. , .... --