HomeMy WebLinkAboutBRUIN PARK FIRST ADDITION BLK 5 LT 16
MUNICIPALITY OF ANCHORAGE
D~ ,RTMENT OF HEALTH AND HUMAN SEF, ,;ES ! / !
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 0/ ~2 - ?/
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
Address
l l~&c~ L~2II_LENE ~P_I vF--'
LEGAL DESCRIPTION
Lot I B~ ~Subdiwsion
Township, Range, ~
TANKS
,~¢ SEPTIC [] HOLDING
Manulacturer Capacity m gallons
Material No, of Compadments
"~ TYPE 6F SYSTEM
,[~TRENCH [] BED [] W. DRAIN [] OTHER
Depth to p~pe bottom from Total depth lrom original grade
original grade
,,~ FT
Fill added above original grade Gravel depth beneath p~pe
~L II FI
Gravel length Gravel w~dth
Total absorption area Distance between lines
SO FT ~
Number of lines J Soil rahng Pipe material
i J Iz 5'" SOFT
Installer Date Installed
WELLS
[] PRIVATE [] OTHER (Identilv)
Class,ficat,on (A,B,C~,~~%tal Depth FTI Cased to
I"~sta~e ~,~~ Date Installed:
REMARKS:
FT
FT
FT
FT
FT
DISTANCES
WELL
LOT LINE
FOUNDATION
SEPTIC
TANK
'>' 1 I0' .
Z4~
ABSORPTION
FIELD WELL
jO~
AS-BUILT DIAGRAM (Show location of well, septic system, property lines, loundat~on,
driveway, water bod~e etc.)
IScale: I --
Inspections Performed by:
J J¢~.,'
¢ ~, ~ ~,~ A.~,~,,,,~,~, I Date:
1,4~)~ z~,_ Iqa'l
"~ ~,'~ cerlilt/lhal this inspection was performed accardin§ to all
.A-:,.h.
Municipal and Slate guidelines in eflecl on this date:
Health Department Approval:
72-013 (3t85)
ENGINEER'S SEAL
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:4~__../~P ~J
2
3
4
5
6
7
8
9
10
11
12
5LJ
13
Township, Range, Section: T/~-- J'J ~ ~/~ .~ ~ ED
SLOPE SITE PLAN
14
15
16
19
WAS GROUND WATER
ENCOUNTERED? J~ ~_...,.)
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth to Water Alter
Monilorino? Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
~,~ ~/za!~7 ? : ~'1 .6,0
20
PERCOLATION RATE ,2;' (minutes/inch) PERC HOLE DIAMETER
M o G',ec,,u,,,jD
iSt E.N ~ t3p/{f4_.I,.iT, TEST RUN BETWEEN ~ FT AND ~ ] FT
72-008 (Rev. 4/85)
Municipality of =~.Or~ ~ "/y/,l~~~ '.-. ' '
DEPARTMENT OF HEALTH & HUMAN SERVICES
A n~, Si~~m~iAN t~,,~--.~ · ,.-~---~ ~=~=~--~ , ,,~,. ,~,.. }~ ~ 4.~.~.~ / ~ll~ll]/.l~ I/ ~ '.,'
825
"L"
Street,
so.ts -'
PERFORMED FOR: ~ , DATE
LEGAL DESCRIPTION:~ i~ ~L[ ~ ~Township, Range, Sect'on:
~ o~N~c, L~v&~ SLOPE SITE PLAN
ENCOUNTERED?
11 s
L
IF YES, AT WHAT 0
5~. DEPTH? p
12 ~ u.T,/ $~.NO E
Depth to Wale~,}l
Monitoring,
Reading Date Gross Net Depth to Net
Time Time Water Drop
o..5o' g//4/e'--/ /o ,~ ,'~, J o ..,',. O. 4/' o o~f'
14
15
16
17
18
19
2O
PERCOLATION RATE ~.O..Z~- (minutesnnch) PERC HOLE DIAMETER k./o H
COMMENTS ~"r~ ~51c~'l~-,e.'O TEST RUN BE~EN/~ AND ~ ~ FI
IFY AS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE~ EFFECT/O~THIS DATE. DATE:
72-008 (Rev. 4/85)
I
~ 0
; W~"LL
~1~ ~' D~I u~ l~' =' ~O~
SEWER SYSTEM LOOATION PLAN
Lot:~oT /~ J Biock: ~c~
~:i'i~:::~:~i' i~lii::il:i~i : '~ ......... ~
GR~:A?ER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
!
DISTANCE FROM WELL ///~
LIQUID CAPACITY /// ~ GALLONS.
NUMBER OF
MATERIAL ~ COMPARTMENTS .)
INSIDE LENGTH INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM:
NUMBER OF PITS /
LINING MATERIAL
NEAREST LOT LINE ~
SEEPAGE PIT:
OUTSIDE DIAMETER
DISTANCE FROM WELL //~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
f
!
LENGTH Z 7 , DEPTH
BUILDING EOUNDATION.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANOI~FROM WELL ...-------:,..~OUNDATION NEAREST LQ,.T"LI'~ ~ , OF LINES --
JJN~'OTA L EFFECTIVE
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILI~TO FINISH GRADE~r "'~''-'~'~' DEPTH OF FILTER MATERIAL BENEATH. TILE.
WELL: .,r,,'x ~ . ..,.,~. .~.~ DISTANCE FROM WATER
Typf ~///~/L~,~--'~'Z) D~PTH ~_~ , BUILDING FOUNDA]'IQN. ~;)/~-- SAMPLE
! / / NEAREST ..~'~_/~ SEPT C .~.~-,'-t"'-.- SEEPAGE
LOT LINE //~\ //" , SEWER LINE -/"" --'f"~..:;_T. ACqjC"'7! 0 -/" , SYSTEM //O , CESSPOOL
)~'~ J//J~/.-L~ ~.t~'~q DIAGRAM OF SYSTEM
IN. ABOVE TILE
NEAREST
OTHER ~
, SOURCES__
DISTANCES:
,&
DATE
APPROVED
GREATEF .kNCHORAGE AREA ? ~)ROUGH CaseNo.
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
APPLICATION TO INSTALL: SEPTIC TANK /~ . , SEEPAGE PIT ~ .,DRAIN FIELD ,OTHER
FINANCED THROUGH
PERCOLATION TEST RESULTS.
TO BE INSTALLED BY
(/ ·
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
.. SEPTIC TANK SIZE
DISTANCES:
TYPE SEEPAGE AREA .. TYPE
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I certify that I am familiar the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLICANTS SIGNATU RE
'REATER ANCHORAGE AREA BOROUGH
HEALTH DEPAkTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
Performed Fox, Watts Excavating -- Date Performed June 5, 1970
, 'o' ~ .... l~: ~ .... --~ ~ · ..~,~m,.~,.~,,.~.~ - .-
LegalDescription: Lotl6~ BiOCK~'~UD~,v~slOnBruin Park '
This Fomm Repomts a: S~og ~ ..... ~---~ .........
· PePcolatzon FesI
Depth
Feet
2__
6
10
Soil Chamac+~eristics
j'~W 'n ' 's%~d~'- silt (~
!Br. own~ and Gray silty clay(CH)
Gray and brown silt and fine
sand,· intermixed (ML)
12 feet
Location Sketch
Was GPound Water Encountered?
If Yes~ ^+ Yba~ Depth
12__
Reading
G~os$ Time Net Time Depth To H20 Net Dmop
PropoSed !nstaliaf:~on: Seepage Pit DPain Field
Depth Of: Inlet Dep~'h 'T° Bo~to~ O'~' 'Pit Or T~enc~-
COMMENTS. 275 s ua£~'-feet' e~ '6ed~6om ,qr 550 squ~re feet. for a
Test Performed By: R. E o Carlisle
