HomeMy WebLinkAboutCORONADO BLK 3 LT 5 oron O
G"CATER ANCHORAGE AREA BORO"GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? 830
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
MAILING ,O/') ~OX /i~ff
ADDRESS I-,~'/' . _ _
LEGAL DESCRIPTION ~;~'~. ~--j /~" 3
PHONE
DISTANCE FROM WELL ,,.~O ' /~g26)Vlf:~'O
LIQUID CAPACITY /~00 GALLONS.
MATERIAL
NUMBER OF
COMPARTMENTS
LIQUID
INSIDE LENGTH. -- iNSIDE WIDTH "- DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATE RIAI//~(~-
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH
-- , LENGTH , DEPTH
DISTANCE FROM WELL /~9~DJ //~,~l/t~) , BUILDING FOUNDATION -_'~-~' ),
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~,_~ 3~"~ sq. FT.
TILE DRAIN FIELD:
DISTANCE
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
~- ~,~ATION NEAREST LOT LINE
DISTANCE BETWEEN LIN~,~,~ TRENCH WIDTH
SQ. FT. LENGTH OF EACH
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
, OF LINES
IN. T/AL EFFECTIVE
IN. ABOVE TILE
WELL:
LOT LINE
TY P
~//~7~ DEPTH DISTANCE FROM
· ~ , BUILDING FOUNDATION
NEAREST SEPTIC ~- SEEPAGE
SEWER LINE ,, TANK SYSTEM
WATER
SAMPLE
CESSPOOL
NEAREST
OTHER
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
HEALTH AUT ~RITY
NAME OF APPLICANT
GrEAl'Er ANCHORAGe Area BOROUgh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONe 279-8886
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
PHONE
INSTALLATION LOCATION
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT
TYPE AND SIZE OF FACILITY TO BE SERVED /
DRAIN FIELD OTHER
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS ~""~ ~' ~'~:~;~'~ ~¢~'~'~/~ NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK size 7~;) TYPE
MINIMUM DISTANCES, REQUIREMENTS
fOUNDATION TO sePtiC TANk ~ /'
FOUNDATION TO SEEPAGE PIt J ~ / , DRAIN FIELD
SEPTIC TANK tO SEEPAGE PIT WALL /~ /
SEPTIC TANK . SEEPAGE PIT ~ , DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK J~:) SEEPAGE PIT
DRAIN fIELD
SEPTIC TANK, .~/ , SEEPAGE PIT/~--~) , DRAIN FIELD.
DIAGRAM OF
ALSO CONS,DER AREA WELLS.
_/,.-,~
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,
HEALTh AUTHORITY
OR
LICENSED DESIGNER
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.
2.
3.
4.
5.
REQUEST
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate~
Name .of person requesting ~pproval..
L~ ~.a! deacmiptloq
Numb~-of, ,bedrooms in house .
~ate~Analysls:
' ~ / ;:'
We~ data: .....
a. Type
b. Depth .
c. Casin~ Size .
d. Distance from well to closest existing or proposed:
1.
2.
3.
4.
5.
6.
Sewer line
Septic tank
Seepafe Area
Cesspool'
Property Line . ,d~'q .';' ~, '.::; 4
,0-"t ~. f' '/ ,;" ~, Q, (/r ::., ,.
Other sources of possible contamination, i.e., creeks, lak~
houses, barn, drainage ditch, etc. .
Sewage disposal system.
a. Age of system .... ,..
b. Septic tank capacity in gallons
c. Name of septic tank manufactum~r,
1. If "home made" show diagmam on reverse side of this form.
d.' Disposal field or seepage pit size and type,
Distance to property line
to house foundation
e, Percolatio~ T~st '~esults .
f. Percolation Test performed by
Use the reverse,side of this form to show diagram. Diagram should include
['~.~he foJ. lowing information: p~operty lines~.well location, house location,
~e~r~t~c tank location, disposal area location, location of percolation test,
an~ direction of ground slope.
9. The lnfox-~.tion on this form is true and correct to the best of my knowledge,
$mgnature of Appl'ic'ant ' 'D[~e S~gned
TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL
~above described anitary facilities are hereby approved subject to the
following
Conditions:
above described sanitary facilities are disapproved for the following
AppPoval is valid for one year following the date of approval.
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