HomeMy WebLinkAboutBELLA VISTA #2 LT 7B
GAAB-HD-I
G.grATER ANCHORAGE AREA BOROI'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 27~-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
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SEPTIC TANK:
DISTANCE FROM WELL '7
LIQUID CAPACITY /
GALLONS.
MATERIAL "~" ~ .,, COMPARTMENTS
INSIDE LENGTH /"INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
/ OUTSIDE DIAMETER ...... OR WIDTH /~"~
~'~"'?~' ~-~ 4'-~7'~ .... DISTANCE FROM WELL / ~ '7 r
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH /'(' , DEPTH
BUILDING FOUNDATION
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA.
FOUNDATION ~E
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE,,T,'O FINISH GRADE
NEAREST
LOT LINE SEWER LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
DISTANCE FROM
BUILDING FOUNDATION
SEPTIC SEEPAGE
., TANK , SYSTEM
WATER
SAMPLE
, CESSPOOL
IN. ABOVE TILE
NEAREST
OTHER
, SOURCES__
DISTANCES:
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-? d =./.z ~
.:'.., fr .=/¢'"
-? i~' :;:'/¥ !
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DIAGRAM OF SYSTEM
DATE
APPROVED
GAAB-H D-2
GREATE:
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
)ROUGH
279-2511
Case N o.
SEWAGE DISPOSAL SYSTEM APPLICATION & PERMIT
NAME OF APPUCANT ;~-~"
RESIDENCE ADDRESS
LEGAL DESCRIPTION ~
MAILING ADDRESS ~ .~,'~ [ . PHONE NO.~q
LOCATION OF INSTALLATION F~' z/! ~,
/~' ~, B RAIN FIELD
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
,OTHER
SEEPAGE PIT
PERCOLATION TEST RESULTS ANTICIPATED BATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE ,~5~'/TYPE SEEPAGE AREA~TYPE
· ~'/ DIAGRAM OF
. SYSTEM
DISTANCES:
..~,~' - health 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.
~REATER ANCHORAGE AREA BOROUGH
HEALTH DEPAkTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
CASE
Performed For ~(.~ .~m/2/;~3 .......... __Date Performed ~/-)c ? /~/~ ? .. _
This Form Reports a. So~ls Log, _.~ ...... · __ ;zverco&a~on '~es~ ....... - . ::
feet Soil Characteristics
~ ~'/,,~,H F~'~- ~t~ ~ ~'.~t~ '
I]~1~ ?~t,
Was Ground Water Encountered?
. If Yes, At What Depth .....
Location Sketch
Reading Date Gross Time Net Time Depth To H20 Net Drop
I_
~"~'~t'. _~.----~ ~- ~' .... _ ........ ~ - ·
Frop.~sed Installation: Seepage Pit ~ Drain Field
Depth 0£ Inlet/j-' ~-.' ....... Depth TO BOttOm
COMMENTS:
Test Performed By :. :?~.Pd d.~ _ · ....
" REOUES? ~OB A~ROVA~ OT
INDIVIDUAL SEWAGE AND WATER FACILITIES
~ ~.~,~ (Fill out in Triplicate)
c, w~!3, data:
d. Distance from well to closest existing or
1. Sewer,line ~%- ~
2. Sept] c t ankh.
,~ 3. Seepage Ar.e a~.
4, Cesspool' .
5, ~ope~ty Line ~
6, Othep sources of possible co~tamlnation~ i,e,~ c~eeks~ lakes~
houses, ba~n~ drainage ditch, etc.
,~,~¢ ?, SewsBe disposal syste~,
b. Septic tank capacity in galJons._ /~-¢Z.o .
1. If "home made" show diagram on reverse side of this form.
1. Distance to property lin~ %LEi1
_ ~ . to house fo~mdation
f. Percolation Test performed by
Use the reverse .side of this form to show diagram. Diagram should include
"~;he foil.owing Jnfo~mation: p?operty lines;.well location, house location,
~:,,~l,'~';c tank~.o~ c-'~at~on', disposal area location, location of percolation test,
aud d~.ection of ground slope.
9. Tke ~,~,,.,,..~ ~,~ .on this form is true and correct to the best of my knowledge.
,~. SSgnature of Appllc~nt' Date Signed
~0 BE FILLED OUT BY HEALTH DEPAP, T~4ENT PEP, SONNEL
..........~-~'~6'll°win?'fhe ........ above._ cond,i, ifonsdescribed sanitary: facilities are hereby approved, _subject~: .to. _the
Conditiona:
The above described sanitary facilities are disspproved for the following
reasons:
__
one 'fear following the date of approval.''
valid
for
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INDIVIDUAL SEWAGE AND WATER FACILITIES /~_~_-~
(Fill out in Triplicate)
5. Water~ Analysis:
b, Detergent
6. We~ data:
c. Casing Size
Distance from well to closest existing or proposed:
Septic tank_ //0' .
3, Seepage Area
4. Cesspool' '~ .
5. Property Line 80; .
houses, barn, ra~nage ditch, etc.
Sewage disposal system.
Other sources of possible contamination, i.e., creeks, lakes,
b. Septic tank capacity in gallons ~/~F~/
1. If "home made" show diagram on revers ide of this form.
d.' Disposal field or seepaFe pit size and type .......
- 1. Distance to property line /~' ;~ to house foundation_
~.~ Percotatio~ Test
f. Percolation Test performed by
Use 'the reverse ,side of this form to show diagram. Diagram should include
'",~he fo]lowing [nformatior~: p?operty lines ~ .well location, house location,
~?:{c tank location, disposal area location, location of percolatior] test,
a~d, direction of ground slope.
9. The in'F-~t{on on this form is true and correct to the best of my knowledge.
Sign~ture of Applicant"
Date Signe~'
TO BE FILLED OUT BY HEALTH DEPAP, THENT PERSONNEL
[--~The: above described sanitary facilities are hereby approved, subject to the
........... [~'l!owin.g cond,i.'.%'ions: ..............
Conditions:
The above described sanitary facilities are disapproved for the following
reasons:
pp oval is~-va].id for one year following the date of approval.
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