HomeMy WebLinkAboutLot 2001 - 3V2-
G ~TER ANCHORAGE AREA BORO~'~-H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N.o
6O8
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
N A M E ,/~ ~ .~ ~
LOCATION '2// 9 ~ J,~)jTvlOt~/) ~'>,/I.,',~). LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELL'-~'~Jv?~/
MAILING
ADDRESS
LIQUID CAPACITY
GALLONS.
INSIDE LENGTH
NUMBER OF
COMPARTMENTS
INSIDE WIDTH
LIQUID ~,--/~//
DEPTH ~
SEEPAGE SYSTEM: SEEPAGE PIT:
LINING MATERIAL . DISTANCE FROM WELL BUILDING FOUNDATION
NEAREST LOT LINE. TOTAL EF~ALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL~'~'/v,('
/ / TOTAL LENGTH ~ .~
, FOUNDATION ~3 , NEAREST LOT LINE 6~/'? /~/J'C) , OF LINES gl
DISTANCE BETWEEN LINES ~ ~ /
~RENCH WIDTH ~
IN. TOTAL EFFECTIVE
,
LENGTH OF EACH LINE ~ ~ ~
DEPTH OF FILTER MATERIAL BENEATH TILE
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
SQ. 'FT.
/
IN. ABOVE TILE
WELL: Ty p E ,~'~'/v)/P~' ,~/~ ¢~ .~ DEPTH ~
NEAREST -- SEPTIC
LOT LINE ~ SEWER LINE ., TANK
DISTANCE FROM
., BUILDING FOUNDATION.
__~1~) ~ SEEPAGE
, SYSTEM
WATER
SAMPLE
~'/~'~", C ES S PO O L ~
, NEAREST
OTHER
, SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PHONE '~i¢~t"/ II.~'i~
INSTALLATION Of: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIl- TEST RESULTS
COMPLETION DATE ANTICIPATED
SEEPAGE PIT ~/ DRAIN FIELD
OTHER
TO BE INSTALLED bY
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.
, DRAIN FIELD
MINIMUM DISTANCES, REQUIREMENTS
£,
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT Wall.
SEPTIC TANK ~ ,SEEPAGE PIT , DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK SEEPAGE Pit
DRAIN FIELD ALSO CONSIDer AREA WELLS.
DIAGRAM OF SYSTEM
WATER MAIN TO SEPTIC TANK
DRAIN FIELD ,
SEPTIC TANK, , SEEPAGE PIT
TO RIVEr, LAKE, STREAM.
SEEPAGE Pit
DRAIN FIELD
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 CAP~S.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALT~H AUThORit~Y
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 ~//4~ /'~/ /~:*T/ APPLICANT'S SIGNATUREX~y ~(~ ~ _ _
GREATER ANCHORAGE AREA BOROUGH
HEALTH DEPAkTHENT 'CASE # -,.
3~7'EAGLE ETREET
A~CHO~AGE~ ALASKA 99501
Performed
This Form Re,orEs a' S~Log
..... ~._ · ' e colat~on T~ .... ', ,'.~_
Depth
Feet
els cs. 6pt~/ "
Was Ground Water Encountered?_~ ~o
if Yes, At What Depth
Reading
Date
G~'oss Time
Net Time
Location Sketch
Depth To H20
Net Drcp
F"~°Pgs ed I n st ail~t i o'n':-~See pa~e
Depth 0 .~-~nlet
COMMENTS: <~c'o~~ '' /~/~e~r~ ~o ~ottom_O~ Pit O~ Trenc~ ....
Test Perfor~d
Data Certified By: '~~.~ ~/_.
