HomeMy WebLinkAboutELMRICH VILLAS #3 Block 3 Lot 3
GAAB-,D' GRFA~TER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING *~X EqE7
ADDRESS
LEGAL DESCRIPTION LOT
SEPTIC TANK:
DISTANCE [RO WELL
CAPAC,T¥
GALLONS.
INSIDE LENGTH.
NUMBER OF /
COMPARTMENTS
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
,LENGTH jr,,~ ,DEPTH
BUILDING FOUNDATION
~'~ ~"'~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
. NEAREST LOT LINE
TRENCH WIDTH
FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE;
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE__
WELL: TYPE C ~+/ .
NEAREST
LOT LINE . SEWER JNE
DEPTH
DISTANCE FROM
· BUILDING FOUNDATION.
SEPTIC SEEPAGE
., TANK , SYSTEM
WATER
SAMPLE NEAREST
OTHER
· CESSPOOL. , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED
HEALTH AUTHORITY
~ .... · REATER ANCHORAGE AREA BOROUGH
HEALTH DEPAkTMENT CASE
327 EAGLE STREET
ANCHORAGE, ALASKA 99501 "
Performed ror~f~ .J-~i~f/~m¢~o ~a~/F~ Date Performed
Legal Description. Lot .__.~ 'Block .~c. Subdivlslon ~/,~gr, k~
Th~s Fo~ Reports a. So~ls Log ~ .... Percolation Tes~ - ...
Soll ChaPact erls~ics
/ovse
Was Ground Wate~ Encountered?
If Yes, At What Depth
Location Sketch
Depth
Feet
Reading Date Gross Time Net Time Depth To H20 Net Dmop
.
l
----.-4
u i a~e"l"/ Minute
Pl'oposed Installation: Seepage Pit t/ Drain Field
Depth Of Inlet /~//7/f'/;D~3/v. , Depth To Bottom Of Pit Om T~ench" ~.~L, '
COMmgaTe: ~ ' · · , ' ......
Data CePtlfled By: Or~ ~ T[~ .
~'-- INuiVIDUAL SEWAGE AND WATER FACILtT~£S
(Fill out in T~iplicate)
~.. Name of person requesting approval.
property, owner ~, ,
2.
~. Numb~. ~ b~dr. ooms in house
5.
Watez~.
b. Detemgent '
6. wail data:
a. 'iype
b. Depth
c. Casing Siz9
d. Distance from well to closest existing or proposed:
1. Sewer line .
2. Septic tan~ .
3. Seepage A~.ea._ .
g, Cesspooli_ . .
5. Property Line. .
Other sources of possible contamination, i.e., creeks, lakes,
houses, barn~ drainage ditch, etc.
Sewage disposal system.
a.
b.
Age of system____~.
Septic tank capacity in gallons
Name of septic tank manufactu~m
1. If "home made" show diagram on reverse ~ide of this form.
Disposal field or seepage pit size and type .... ~? X'~' /~' & t_~
Distance to property 1/ne ,
to house f~mdat~on .
Perco]~atlor~ Test '~esults
£. Percolation Test performed by
Use the reverse ,side of this form to show diagram. Diagram should include
· . '~-%he foJ&owlng informatiom: p~operty llnes~ ~well location, house location,
t~ptlc tank location, disposal area location, location of percolation test,
a~, direction of ground slope,
The ~w~o-~,~on on this form is true and correct to the best of my knowledge.
~O BE FILLED OUT BY HEALTH DEPAP, T~.~ENT PERSONNEL
The above described sanitary facilities are hereby approved, ~ubJect to the
......... ~6'l!owing cond~tions: ' '
Conditions: ~)--~_)
The above described sanitary facilities are disapproved for the followinK
re asons: -
· ' Approval is valid for one year following the date of approval.
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