HomeMy WebLinkAboutGROH LT 1
Gr TER ANCHORAGE AREA BORO' H
DF. PAFITNIENT OF ENVIRONMENTAL QUALIqlY
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
iNSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC 'rANK:
DmTANCE fROM WELL__ .~
LIQUID CAPACITY_
_.GALLONS.
MATERIAL ('~/~' ~/~Z = '~"'~z' NUMBER OF
COMPARTMENTS
'-'~/~'/''~3~'~ LIQUID
INSIDE LENGTH INSIDE WIDTH. DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT: /~/"~"'~"~
NUMBER OF PITS .... / ODTSIDE DIAMETER_ ~ OR WIDTEI
LINING MATERIAL_L//~/LZ'/~'~'~';¢ ~'~"/K/ DISTANCE FROM WELt
NEAREST LOT L,NE ~ ~'
TOTAL EEFECTIVE ABSORPTION AREA (WALL AREA)
__, LENGTH ''¢''~) , DEPTH ~'
BUILDING FOUNDATION ~'~'')~ ,
SQ, FT.
TILE DRAIN FIELD:
TOTAL LENGTH
OF LINES
DISTANCE FROM WELL____ FOUNDATION , NEAREST LO! LINE
w,,,,,_
ABSORPTION AREA~ SQ. Ff. LENGTH OF EACH LI :~ ~"
DEPTH OF EILTER MATERIAL BENEATH TILE.
DEPTH: TOP OF fILE TO FINISH GRADE
IN. ABOVE TILE
/ DISTANCE FROM /./¢~ / WATER
WELL: TYPE/.~¢~,,~// DEPTH ,//,~ , BU LD NG FOUNDATION _'"'~'_ _._ SAMPLE _~/~:'~/u¢~ , NEAREST
NEAREST SEPTIC -' SEEPAGE ~- OTHER- ·
LOT LINE ,/(') "/O ,,~'/ , SEWER LINE .... , TANK "~' , SYSTEM ~/~' , CESSPOOL. ~" . SOURCES.
DIAGRAM OF SYSTEM
DISTANCES: J
DATE
GRP&TER ANCHORAGE AREA BOROUCH
HEAl. TH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELt ~"1~ !
LIQUID CAPACliY / '~" '~)
GALLONS.
MATERIAL u/~f~i~ ~/"J~- ]'~ NUMBER OF /
COMPARTMENTS
LIQUID
INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS__
LINING MATERIAL
NEAREST LOT LINE
~/ __OUISIDE DIAMETER
,~t I TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
OR WIDTH
DISTANCE FROM WELL
/S"/ X 2~' X' G/
, LENGTH , DEPTH 6
BUILDING FOUNDATION ~/~'"'~!
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL ~-¢~AIION , NEAR~gI--'L"~C'EiNI:. OF LINES
ABSORPTION AREA SQ. Ff. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE____
WELL: TYPE. ¢-,~J~///~'~ DEPTH f/,r~'/ DISTANCE FROM
· BUILDING FOUNDATION,
LOT LINE /~}~' SEwERNEARESfLINE '/,, ~'~'~ SEPTIC ~-.& ~' SEEPAGE
, , TANK , SYSTEM
WAFER
SAMPLE
CESSPOOL
, NEAREST
OTHER
, SOURCES
DISTANCES:
DATE
DIAGRAM/i~ ~_ OF~...S~,.EM
'Dj 'rz'
t
APPROVED ~-' '~
HEALTH AUIHORIIY
GREATEK ANCHORAGE AREA
HEALTH DEPARrI'MENT
327 Eagle St. Anchorage, Alaska 99501
.)ROUGH CaseN0. ~-
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
''--J /~.~;'(b,'/~'.~' ~-'1~ LOCATION OF ,NSTALLATION~.~~ J .- ..... ~) ~]~"
RESIDENCE ADDRESS ~;~/~,/ . c~ .- _ ~
.LEGAl. DESCRIPTION ~" ~ ]:/.( .~ ~,.(~/,~,~ ~?.-- ~:.'-~ ~ ~:~b,~.,
APPLICATION TO INSTALL: SEPTIC TANK ~.- ,SEEPAGE PIT ~- ,DRAIN FIELD ~ ,OTHER
TOSERVETHE FOLLOWING FACILITY. ~' (S,~ /,Z~,'-~
FINANCED THROUGH ~. ~ ~ ,~,~ /r~f~)BE INSTALLED BY~
PERCOLATION TEST RESULTS~ $~ ~"A~/~¢~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS";~,.' .~,Z....~-,,~-;-~-,,--:, , PERMIT TO INSTALL A .5¢~~A1- 5,..~,:._.;~ /,~.~r ~
AS DESCRIBED BELOW. SIZE OF UNLT~r.T~O~B~E. SERVED LT~ /~<~ W,.'~_~ /~/.,-~_e
SEPTIC TANK SIZE ~ ,~-C~ 'TYPE'~?~A-'~---~ACG EDIAGRAM AREAoF SYSTEM~ ~"~9~ ~tTY Z A~l¢'~ ("ff ~
Health Authority
'):-"D:/-::~ o¢- 0'~/~ 7-b ~, 0'7z Ze,.~
I certify that I am familiar with the reqUkements of Greater Anchorage Area Borough Ordh]ance No, 28-68 and that the
above described system is in accordance with said code.
/
DATE__ ~ APPLICANTS SIGNATURE d. (': :; .,.. '~ '/ .....
CREATER ANCHORAGE AP. FA BOROUGH
HEALTH DEPAkTHEI~IT
327 EAGLE STREET
ANCHORAGE~ AI,A[-tKA 99501
CASE
Perfommed For -" '"- ~ ' /' t' Date Performed ,~d 5 /-)~-~ /~'~?
Legal Description: Lot / Block Surm~v~sion
This Form Repopts at So~ls Log ........ ~ ............. JePcoJ. atlo~ lest
De pt h
Feet Soil Charac tepisti ¢.:s
~,171 '/cI,' C-¢ //*" ,'~c"~C'
~ltlg
Was Ground Water Encountered?
If Yes,~..~* ~':~'a~ Depth
Readin~ I
[~of)sed Ins.'al)_a:xon: Seepage Pit
G~'oss Time
Net Time
Location Sketch
Net Drop :
Drain Field
DePth Of Inlee ~ ............. '
. --~ - :~L~_dd ~Z2_L(d/2~. Depth ]o Bottom Of
. /; ,~~~,.~ '. , .,~ e -
Test
Pemfomm~d
Data CePtified By' , ~ '
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