HomeMy WebLinkAboutMURRAY BLK C LT 23
GAAB-HD-I
GREATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
- INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
LOCATION ,'~':z;',,,fZ?-?/ ,-r~r' f~
T AN :- )
DISTANCE FROM WELL ~/)-~ /'/~ _MATERIAL
ADDRESS f' ~/~': "
/ , PHONE
LEGAL DESCR, T, I';X
Z~ l · ~-~.. NUMBER OF
~COMPARTMENIS
INSIOE /ENOTH INSIDE WIDTH ~DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS OUTSIDE DIAMETER _ OR WIDTH
LINING MATERI ~-~'~' ?A-NGE~FR~M~/v~ El~-'-~
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA {WALL AREA)
., LENGTH , DEPTH
,,~_4~U 'LD N G
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl FOUNDATION. , NEAREST LOT LINE
NUMBE LINES S "~-'~'~ IRENCH..VVlDTH
ABSOR SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES
,..~-~1' '.I~T 0 T/~ EFFECTIVE
DEPTH: TOP OF rILE TO FINISH GRADE
WELL:
'~ TYPE DEPTH
NEAREST
LOT LINE , SEWER LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
DISTANCE FROM WATER
.t/7/~ , BUILDING FOUNDATION ~SAMPLE
'E~ P-T4 C--- - SEEPAGE
, TANK '-~ '~ , SYSTE~ , CESSPOOL
DIAGRA~ OF SYSTE~
IN. ABOVE TILE
, NEAREST
OTHER
, SOURCES.
DISTANCES:
DATE
~ HEAl. Iff AUTHORITY ()
GAAB-HD-2
GREATEr
327 Eagle $'t.
ANCHORAGE AREA
HEALTH DEPARTMENT
AnchOrage, Alaska 99501:
'-'OROUGH
279-2511
Case N o..~?~ ~
SEWAGE DISPOSAl. SYSTEM -. APPLICATION & PERMIT
RESIDENGE ADDRESS" 7~']~ Z~Z ~b/'~ / LOGATI0, 0F ,NSTALLATI~NZ~
APPLIGATION T0 INSTAEL: .$~ANK ~ .. SEEPAGE PIT . DRAIN FIELD , OTHER_
TOSERVETHE FOLLOWING~FACILITY ~ ~9~'~. '~L~ .
FINANCED TH,0UGH e~d~Z-f T0 BE INgTALLED BY_~] ,-~fi
ANTIGIPATEB DATE 0F COMPLETION/-~//4
PERCOLATION TEST RESULTS /~/~)/6'/g~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE A ~ .... , PERMIT TO INSTALL A ,
/ AS DESCRIBED BELOW. SIZE J~j UNIT TO BE SERVED ~-~-
/~ TAN K glZE ¢~TYP~ ~/~/e~ gEEPA.E A,EA ~ TYPE
.,~"~ ' DIAG'RAM OF SYSTEM
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.
DATE APPLICANT8 SIGNATURE
GREATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT CASE #~.~
327 EAGLE STREET ',
ANCHORAGE, ALASKA 99501
Performed For Charles Smith ~ ~ate P~rformed_~,L~~ ....
This Form Repomts a~ ~o.lis bog xx,~~*- ........... .~~_~
~pth
~, . Location Sketch
Feet ,,ozl Characteristics
b~n silt~ organic
4 ~ gray silty clay (CH)
8 ~ .gray sandy silt (~)
gray silty clay with sand
10 ..... pockets (CH)
12~,,
~as G~ound ?lator ~ncounteped? no .....
If Yes, At ~;hal: Depth
eadil:o [ >:,~e ~ Groos Time Net To Net Dpop
F~opor;ed In~taJ, ia,;.~oa: Seepage Pit D~ain Field
Depth Of lnlet Depth To Bo(~Tj.t Or Tpenc~
IS necessar er b d oom
These recommendations are computed
Test Perfom~d By:~,~~ ........ from visual observation and based
on the unified classification system.
Data C~rtifi~d By :~gt~o~al T~D~~ Se.~_=ryj~e~, Inc.
Date:
