HomeMy WebLinkAboutDRAKE BLK 4 LT 4
MUN~C~PAUTY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIV~SION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-S~TE SEWAGE D~SPOSAL SYSTEM AND/OR WELL ~NSPECT~ON REPORT
NAME
PHONE
[] UPGRADE
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
J Well
DISTANCE TO:
Manufacturer ~ ~ ~ ~ Material
JLiq capac ty n ga OhS
Manufacturer Material
DISTANCE TO: L~-
NO. OFSEDROOCS /
No. of co/~tments
Liquid depth
Top of tile to finish grade
Length Width
Type of crib
DISTANCE TO:
Class
PERMIT NO,
Liquid capacity in gallons
Total ,e~h~lirJes Trenc~v~th inches Distance~.en lines
zMaterial~* g.~,~be, neath tile ~,~ ~'~ · ~:~ Total effective
Depth
area
DISTANCE TO:
Well
Depth
~ngfounda~p/ ~ J
Crib depth Total effective abso
foundation Nearest lot line
Driller Distance to lot Ii
Sewer line Septic tank
OTHER
PIPE MATERIAL8
INSTALLER
REMARKS
APPROVED DATE
LEGAL
RECEIVED
72-013 (Rev. 3/78)
[)EPFIR'E'HENT C HEFIL.]'H Fflq[:, ENVIRONHENTRL" 'DTECTION
8;~5 *L STREET, RNCHORRGE.,
F~PPL t C¢4NT
LOCE:FF I ON
8],O83:8 )
JOE4N BRCd',/BEREi
L4E:4 [:,R¢~KE
PO EOX i:i.J.:;LT'4 ANCHORRGE 995::Li 345--'ibS'?]i:
LOT SIZE: 'Sq~:q~995~ SQURRE FEET
TVPE OF: SOIL E~BSORPTION S"fSTEH tS: TRENCH
HR)..IIHL$1 NUtflBER OF BEDR. OOHS = ]. SOIL REEFING ,::SQ FT/BR>=
THE RECCJIRED St2'.E OP THE SOIL RBSORP'f:ZON S'¢E;TEH IS;:
THE: LENGTH DiEqENSION IS ]'HE; LENGTH <tN F:E:ET) [)F." 'T'HE TRENCH OR DRRINFIEL.[>.
THE [.,EPTH OF Ft TRENCH OR PIT :[2; THE [.,IS'TRNCE BETWEEN THE SURFrRE:E (]F THE
GROUND Fff4D THE BOTTOFt OF THE EXCRVRTtON (IN FrEE:T>.
'THEERE tS NO SET N:[E:"Tk~ FOR TRENCHES.
THE GRRVEL DEPTH IS THE HINtI"qUM [:,EPTH OF GRRVEL E~ETNEEN ]"HE (:)UTPf~LL PIPE;
F:~ND THE E:OT"E'OE'~ OF THE E;4CRVRTtE~N <IN FEET).
PERHZT RPPLICF:fi,FT' HRS THE RESPONSiBILITV TO tNPORH THIS DEPRRTHENT DURING THE
:[N:E;TFiLLFFFtON INSPECTIONS OF FIN"¢ NEL. L.S F~DJRCENT TO THIS PROPER'T'?' RND THE
NUHBER OF RESIDENCES THFKF THE NEL. L NtLL SERVE.
HT, NIHUM DISTRNCE BE'TFtEE;N Fi NE;L]_ Fff.,~D RNY ON-SITE SEWRGE DISPOSRL SYSTEH tS
:L00 FEET FOR R PRZVRTE WELL OR ::L58 TE] 200 FE, ET FROH F] PUBLIC NELL DEPENDING
UF'ON THE 'I'"'r'F'E OF' PUBLIC WELL.
H:[NIMUH DZSTf.:~NCE FROH f:t PRIVFFTE NELL. TO R PRIVRTE SEWER LINES IS ;25 FEET FIND
TO fl COHHUNIT¥ SENER LINE IS 75 FEET.
OTHER RECCJZREHEENTS HEYf F~PPLV. SF'ECIFZCFFFZONE; BNE) CONSTRUCTION BZFK3RflMS RRE
ED/StL. F~BL,.E TO ',ENSURE PROPER INSTE:fl.J,..F~TZON.
t [.'.'ER"[' t FrY THEFT
i: I FIH F:FIFIIL..IFff~: WITH THE REgK..IIF:EEHENTS FOR ON-SITE SE].4E:R:E3 RND NEL. LS RS SET
FORTH B'./ THE MUN.ICZPRL. ZTY OF RNCHORRGE.
2: t NtLL. INSTRLL THE /5¥STEH IN F:KSCORDRNCE NITH THE: E:ODES.
3: :[ UNE:,ERSTRND "FHRT THE ON-SITE: SEENER S"r"STEH i'"'ff:F¢ REQUIRE ENLRRGEMENT IE' THE
RESIDENCE tS RENO[:,EELE[:, TO INCL. UDE HORE 'I"FIEtN ]: BEDROOHS.
GAAB-HD- I
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
LEGAL
DISTANCE FROM WELL
L I Q~ U I~D~._C~p~A_C I_T~__. _ ~ ..... GALLONS.
NUMBER OF j~
____COMPARTMENTS
, C,. 7¢) L,QU,D
INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS ..... / OUTSIDE DIAMETER ' ...... OR WIDTH /~ ~ ., LENGTH /&2., DEPTH.
LINING MATERIAL DISTANCE FROM WELl ..... BUILDING FOUNDATION
NEAREST LOT LINE £ r~ ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ...... SQ. FT.
TiLE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL .................... '",~F~UNDAfION , NEAREST LOT LINE OF LINES ,,
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE__
WELL: __, DEPTH ~ DISTANCE FROM ir WATER
, BUILDING FOUNDATION ''~rC} ~' SAMPLE J"~/'¢~ , NEAREST
LOT LINE ,~"*;' ~ NEAREST SEPTIC .... ~ / SEEPAGE OTHER
~ ~ , SEWER LINE ~¢ ~.. . TANK__/~~. , SYSTEM , CESSPOOL , SOURCES_.
DISTANCES:
DIAGRAM OF SYSTEM
/7'
HEAL
AUTHORITY
GAAB-HD-2
GREATE
327 Eagle St.
ANCH@ AGE A EA
HEALTH DE?At~TMENT
Aaehorage, Alaska 9950~
OliOUGH
279~2511
Cass
SEWAGE DISPOSAL SYS?E~
APPLICATION TO INSTALL: SEPTIC TANK___~/ , SEEPAGE P[T___~X~
TO SERVE THE FOLLOWING FACILITY_."~-
FINANCED THROUGH TO BE INSTALLED
PERCOLATION TEST RESULTS
DRAIN FIELD , OTHER
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ....
AS DESCRIBED BELOW.
_, SEPTIC TANK SIZE
DISTANCES:
, PERMIT TO INSTALL A
SIZE OF U.N}T TO BE SERVED
TYPE _~ SEEPAGE AREA~~TYPE
tify that I am familiar with the requ~ements of Greater Aachorage Area Borough OrdNance No. 28-68 and that the
above__described system is in accordance with said code.
DATE. APPU CA~T8
7~50~d Seward H~.
SOILS LOG - PERCOLATION TEST
SO~LS LOG
PERCOLATION
TEST
PERFORMED FOR:~__~VE/~'''~ t.f ~) _
8
10
11
SLOPE SITE PLAN
12
13
14
WAS GROUND WATER
ENCOUNTERED? .~ --
15
16
17
IF YES, AT WHAT
DEPTR?
Gross Net
Reading Date Time Time
Oepth ~o Net
Water Drop
18
2O
(minutes/inch)
PERCOLATION RATE --
TEST RUN BETWEEN FT AND
COMMENTS
PER~ORMEO.~:~ ~. ____~ ~:'~'~ ¥-~:~-- CERT,F,EO"~:__ DATE:
GREATER ANCHORAGE AREA BOROUG~
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE~ ALASKA 99501
CASE #
Performed For ~/r ~/~/;~:'r~, Date
Lea'al DescrlD
Thzs FoPm Kepo~s a: bolls bog ~/ . 're~colation
Depth
Soll Chamac t eris~ics
Location Sketch
Was Ground Watem Encountered?~
If Y~.s~ At~ Wha~ Depth
Reading Date Gross Time Net Time
Depth To H20 Net Drop
Proposed Instal~Seepage Pit ~"~ .... D~ain Field
Depth Of Inle~ ~
Depth ~o B~~it Or T~en~
COMMENTS:
Test Performed BS~:~yjj~ ......
Data Certified By~ Da'