HomeMy WebLinkAboutHIGHLAND PARK BLK 3 LT 6
GP" ~TER ANCHORAGE AREA BOROI""-H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? 626
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION C//] (~6" t)tO ~,-~'-/'
/
SEPTIC TANK:
MAILING
LEGAL DESCRIPTION
DISTANCE FROM WELL q~"~l/'~],
LIQUID CAPACITY //~(~ ~)
MATERIAL CO,//}Q. JCb:-~'[:'- NUMBER OF /
COMPARTMENTS
7~'/ LiQUiD[O`
GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH____
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS. / OUTSIDE DIAMETER
LINING MATERIAL XC).~G
NEAREST LOT LINE ~/'1/b .S2H. z'/J'~ .
OR WIDTH /~) . LENGTH__~'?/ , DEPTH
DISTANCE FROM WELL (J~/t/]/~, BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~,~? SQ, FT.
TILE DRAIN FIELD:
...~----~ T:TAL LENGTH
DISTANCE FROM WELL ,~./ FO , NEAREST LOT LINE F LINES
NUMBER OF LINES / DISTANCE BETWEEN LINES ~ TRENCH WIDTH
ABSORPTION AREA SQ. FT. LENGIH OF IA
DEPTH: TOP OF TILE ~O FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN, TOTAL EFFECTIVE
IN, ABOVE TILE
WELL:
.... DISTANCE FROM --~ WATER
TYPE ~_OIV~/~. , DEPTH , BUILDING FOUNDATION,, _SAMPLE /2/(~/UZ=' , NEAREST
~ NEAREST -- SEPTIC ._ SEEPAGE --- __ OTHER ._
LOT LINE , SEWER LINE ., TANK , SYSTEM , CESSPOOl , SOURCES.__
DIAGRAM OF SYSTEM
DISIANCES:
tO
DATE
APPROVED
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL. QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
NAME Of APPLICANT
INSTALLATION LOCATION
LEGAL DESCRIPTION
PERM,T NO.
Y
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT ![
~ * ,'. , DRAIN FIELD , OTHER
FINANCED THROUGH ~'W'~E~r4 / TOLE INSTALLED BY ~¢¢~' ~)~/Z¢¢~
COMPLETION DATE ANTICIPATED
FINAL INSPECTION= 24 HOIJR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
/
SEPTIC TANK SIZE 0~'~ TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT , DRAIN FIELD
SEPTIC TANK 3- I ,~} ~'
, SEEPAGE PiT
TO NEAREST LOT LINE.
WELL. TO SEPTIC TANK 5'~/--
DRAIN FIELD
., DRAIN FIELD
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
.. SEEPAGE PIT
SEPTIC TANK, _, SEEPAGE PI]'
TO RIVER, LAKE, STREAM.
, DRAIN FIELD
4 INCH DIAMETER CAST IRON SIPHON PIPES~:L_~.PTI~
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO ~OROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH THORITY
LICENSED DESIGNER
SEEPAGE AREA SIZE //¢~//~(~'~ /.~ TYPE
DIAGRAM OF ~YSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREAT/.~P~CHORAGE A.~Eh~OUgH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DATE ~// /, APPLICANTS S]GNATURE /
GREATER ANCHORAGE AREA BOROUGi
HEALTH DEPAF:THENT
327 'EAGLE STREET
A~CHoRAGE~ ALASKA 99501
Performed For ._~,'/7~/~4zZ~- ~/~,~'~ Date, ]~er. ormed .f~/F,c?/z?/
This Form Reports a: boils Log__~ ....... ~ercolatlon Tesz .............
Depth
Feet Soil Characteristics
Was Ground Water Encountered?
If Yes, At What Depth
Reading
Gross Time
Net Time
Location Sketch
Depth To H20
Net Drop
Installation: S,=e~age Pit / Drain
De th Of Inlet
........... ? -.
Test Performed B3:
Data Certified By:~ /