HomeMy WebLinkAboutTURNAGAIN BLK 2 LT 2O IQ--1 9,- 0-ooo
^NC.OR^OE ^RE^ BOROU,
~' :' , : HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N? 68
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS
,EGAL DESCR,PT,O.
SEPTIC TANK:
DISTANCE FROM WELL. MATERIAL C~ ~ ~ ~//q .~' NUMBER OF
COMPARTMENTS
LIQUID CAPACITY /~-~) ~ ~ GALLONS. INSIDE LENGTH INSIDE WIDTH
PHONE_
LIQUID
DEPTH__
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
SEEPAGE PIT:
J _OUTSIDE DIAMETER OR WIDTHJ~/
,
C~.Y/Cpffg~c F ~ I')~/(~ . DISTANCE FROM WELl
7~ ~' ] TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH 2-2 / ~--~
· , DEPTH
· BUILDING FOUNDATION ~ /
9-9- so. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL , FOUNDATION
ABSORPTION AREA SQ. FT.
TOTAL LENGTH
~T L~ , OF LINES
TRENCH WIDTH ~i
LENGTH OF EACH LINE
EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
WELL: ..~.~.. ,,,~,/~ ~),c"f]g]C/4'¢)l/~,.~l
TYPE /~-t/ ~b~.O~4 . DEPTH /~' ~
LOT LINE / ~ ' NEAREST in/ SEPTIC
., SEWER LINE~/~ ,TANK.
.DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
DISTANCE FROM .~C-~/ WATER ~
, BUILDING FOUNDATION. SAMPLE NEAREST
/ /~ SEEPAGE I ~L~' ! OTHER
, SYSTEM , CESSPOOl ~ , SOURCES ~
DISTANCES:
.7 /
DIAGRAM OF SYSTEM
APPROVED
HEALTH AUTHORITY
GREATER',i iNCHORAGE AREA -')ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT '~ ,' : · MAILING ADDRESS ' 'i'.
RESIDENCE ADDRESS ' "~ '=' LOCATION OF INSTALLATION
LEGAL DESCRIPTION :' ~ ,'
APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT ,DRAIN FIELD
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ·: ~ .,TO BEINSTALLEb BY. '
PERCOLATION TEST RESULTS ~ i ,,',: :! , ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
PHONE NO
,OTHER.
THIS IS TO SERVE AS "':!"~ , PERMIT TO INSTALL A ' "" '
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED '
· SEPTIC TANK SIZE ': TYPE "' ""' ' SEEPAGE AREA ·
DIAGRAM OF SYSTEM
TYPE
DISTANCES:
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I certify that i am familiar with the requirements of Greater Anchorage Area Borough Ordh~ance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLI CANTS SIG NATU R E
EAGLE STREET
A~{CHOR~0E, /~LASKA 99501
CAS?:
Pe**foPmed For Buck Hight '
This Form RepoPYs a; S...,.~;
Depth
1--
2--
3~
4--~
9~
10--~
tau sandy silt (ML)
loose clean sandy fine to
medium gravel (GW)
loose clean gravelly sand
(sw)
w/6" silty sand seam
7.5' ~ 8'
Was Ground Water EncotmtePed?__/%o
if Yos~ At %~hat Depth
Date
Location Sxe ~ch
COH'-!KN TS:
~ ..... ;%~~%~ ~ requzred per bedroo~
Tes~: ~emfo~med b .... .
· ~, Natzonal Testln Servzce
....................... ~ ............ S, Inc.
R. E, Carlisle