HomeMy WebLinkAboutLot 05
Gp~:,~TER ANCHORAGE AREA BOROIIGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
-- INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROU WELl.
MAILING ~
LEGAL DESCRIPTION/~f E~: ~ r~l
NUMBER OF
MAT E RiAL ~~~~' COMPARTMENiS
INSIDE EENGTH_ '~ .INSIDE WIDTH_
SEEPAGE SYSTEM:
NUMBER OF PITS_
LINING MATERIAL ~ c'''~2 ~'~"-S~
NEAREST LOT LINE ,~.2-~,~ /
SEEPAGE PIT:
OUTSIDE DIAMETER
/
OR WIDTH_ , LENGTH /'-~ /
..... DEPTH_ ~ --,
~' ?Z~L -,
DISIANCE FROM WELL_ -,,~ ~ /'2/''-~ ~ BUILDING FOUNDATION'~'c~c~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ ~ SQ. FT.
TILE DRAIN FIELD: /
~...~'~'~'~ TOTAL LENGTH
DISTANCE FROM WELL ......_~'~,,~FOUNDATION , NEAREST LOT LIN_~-''j~'''~ OF LINES ,
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MAIERIAL BENEAIH TILE IN. ABOVE TILE
WELL: typEd-~//~'z' ~'~/~, DEPTH. ~..-~" DISTANCE FROM ~ WATER
., BU LDING FOUNDATION. SAMPLE_
NEAREST ~'""~ SYSTEM ~ CESSPOOL
LOT LINE ~ , SEWER LINE ~,SEPTICTANK SEEPAGE
DIAGRAM OF SYSIEM
DISTANCES:
NEAREST
OTHER
SOURCES
DATE
APPROVED_ ~' HEAUH AUIHORnY
GAAB-H D-2
GREATEr'
327 Eagle St.
' NCHORAGE AREA
HEALTIt DEPARTMENT
Anchorage, Alaska 99501
'~'ROUGH
279-2511
'70
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT. , ,
RESIDENCE ADDRESSv
' LOCATION OF INSTALLATION
PHONE NO.2?? '-?'Y.//
APPLICATION TO INSTALL: SEPTIC TANK ~k/ ,SEEPAGE PIT 7 ,DRAIN FIELD ,OTHER.
TO SERVE THE FOLLOWING FACIklTY z*ff'~'/~__YL~~~ ~¢/¢"~£:Zk-;.~y c" ~ ,
PERCOLATION TEST RESULTS /'~M/~&~z~ ANTICIPATED DATEOF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
DISTANCES:
L~/~"~'~C"~'"z" , PER MIT TO IN ST A L L A ·
AS DESCRIBED BELOW, SIZE 0F UNITT0 BESERVED
. SEPTIC TANK SIZE ~/S-~I _TYPE ;¢~;~ SEEPAGE AREA
DIAGRAM OF SYSTE~
/ ?"*~- o%
I certi£y that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and thai the
above described system is in accordance with said code.
within ~v~nty (70) feet o[ th~ n~m*a~t lot }Jn~ o~
Od
CD
CO
SENT TO
P.0., STATE AND ~iP CODE
OPTIONAL SERVICES FOR ADDITIONAL FEES
N 1. Shovls to whom anil dMe delivared~.~...~.. 1S~
I~E1'URN ~'~ With delivery to addressee only ............ 65~
IIECEIPT J/ 2, Shows to whom, date ai~whoredelivered_
SERVICES ~ ~ With deliveryto addressee only ............ 85~
DELIVER TO ADDRESSEE ONLY .................................................. 50d
SPECIAL DELiVErY (extra ~o~ roquirbd) ....................................
PS Form J',JO IN$1JRANC£ COVERAGE PROVIDED--
Apr. 1971 3800
POSTMARK
OR DATE
(See other side!
FOR INTERfi^TIONAL MAIL * o~o ~9~s o-~0-~s
' Add :)our add~e$~'in th~ ~'RETURN TO" space on
1, The following servi~e is requested ,(check one).
[] Show to whom and'date delivered ..... J.=..~ 15¢
[] 8how to whom, date, &address of delivery_. 33¢
X~ DELIVEK--ONLY TO ADDRESSEE and
show to whdm and date delivered~ ........... 65~
[] DELIVER ONLY TO ADDRESSEE and
show to. whom, date, and address of
delivery....d: ...........................................
2, ARTICLE ADDRESSED TO:
3541 Raspberry Road (~, ~ '
A~oh., Ak. 99502
3. ARTICL'Z DESCRIPTION:
REGISTERED NO. Jf CERTIFIED NO. INSURED NO.
,] 744.~N~
(Always obl,lrl $igaatur~ of l~.rttellia~ ar $1~at)
I have received the article described above.
"/DATE OF DEL VERY
5. ADDRESS (Compfe~6 only lf requested) '
6, UNABLE TO DELIVER BECAUSE: CLERK'S
INITIALS
REATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99S01
CASE
Performed For Ed's~ j)ate Performed~2~2j2.._.~,_~
Legal Description: Lot 5 Blo us~n
This Form Reports a: So~ls Log ........... i-ercolat~on qest .....
Depth
Feet Soll .... , '~'-¢c~
I
(SM)
brown fine to medium sand,
poorly graded
(S~)
with occasional boulders
~from 8' ~-
Was G~ound Water E~;countered? no ,~
If Yes, ;* !';~at r, ,~.~
Readl~ g ; l~:~t,e G~oss Time
,-~,~,-~,- [nsta,1}:~Seepage Pit
Net T~me
Location Sketch
Net Drop
DPain Fi. eld
COMHENTS :~g~~zaJze sur~_ace_ area it% 150_ s~Kare~.fee, t_p_e_r_.' .b~9.i~XpJ~ ......
Test ?e~ormed By~ R.~. Carl±sle
Data Certified By: National Testing Services, Inc.
Date:
GREATER ANCHORAGE AREA BOROUGH
Code..
Ow/Ter..
DYE. TEST
ID~te:
Mailing Address..
User / Tenant:
Property Address:
Subdiw'sion:
DYE TEST; [] Pos/#ve
[] Negat/ve
Administered By..
PW-062(7-74)~ ~
(~ ~GRI~ATER ANCHORAGE AREA BOROUGH
Code..
Date..
Owner..
Mailing Address,.--
User / Tenant..
Property Address..
Subdivis/on..
DYE T~-$ T:
[] Positive
ADDITIONAI. _ INFORMA TI~_L,
Offic~:
/
Administered
PW-062 (7-74)