HomeMy WebLinkAboutDAVID LEE LT 2
GRr-~TER ANCHORAGE AREA BOROUGH ~ ~ HEALTH DEPARTMENT t ~
327.EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPFCTION REPORT ON-SITF SEWAGE DISPOSAL SYSTEM
NAME
LOCAT,ON
SEPTIC TANK:
DISTANCE FROM WELl ~"~) ·
LIQUID CAPACITY /'"~)'~'"~--~ GALLONS.
..~.~,~ NUMBER OF /
MATERIAL ~'~'~ COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF P,,S / OUTS,DE D,AME,ER- OR W,DT~'~ ',~//', LENGTH
LININO MATERIAl ~ISTANCE FROM WELL /~ /
., BUILDING FOUNDATION~
NEAREST LOT LINE / I IOIAL EFFECIIVE ABSORPTION AREA ~ALL AREA)
TILE DRAIN FIELD:
DISTANCE FROM WELL .,~'~'-.-~OUNDATIO~ NEAREST LOT LINE
NUMBER OF UNES /"~'"'/ DISTANCE BETWEEN LIN ES ~,.....~.~,~ ~
ABSOR~ SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
'.~",BUILDING FOUNDATION. SAMPLE//`-.' . NEAREST
,...__...-- NEAREST SEPTIC ~-~-'~., /' SEEPAGE /_~.~-~/ . OTHER
LOT LINE , SEWER LINE ., TANK/~-'/ , SYSIEM ~ ~"~ , CESSPOOL . SOURCES
DIAGRAM OF SYSTEM
DISTANCES:
DATE~ APPROVED~
o~-"~-~ GREATE~'~ANCHORAGE AREA I~.;ROUGH C~No. /.~/f
HEALTI! DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
''~ "~' ~/: ~c
APPLICATION T0 INSTALL: SE~IC TANK~, SE~GE PIT
BEL0WT0 BE FILLED OUT BY HEALTH DEPARTMENT
DISTANCES:
!
Hearth Authority
[ certify that ! am familiar with the requirements of Greater ^nchorage Area Borough Ordinance No. 28-68 and that the '~
above des~bcd system is in accordance with ~id code.
~'X,R£ATER ~C.O~ AREA
HEALTH DEPART)lENT
32? EA~
ANCHORAGE, ALASKA 99501
CAS£ #
Performed For ~,,fn~ g~,'.~n~
Legal Descrxpt~on. Lot .~ '~loc
This Fcrm Re~orts a: So~ls" Log
Depth
Feet Soil Characteristics
(G),,II~..~ Date Performed
· Subdivision O~ ,,,'A L Cc
, k/ .... Percolation Test
Was G~ound Water Encountered?
If Yes, At ~hat Depth.,,
.t
Reading Date
Cross Time
Net T/me
Frcposed Instal~Seepage Pit.. /
Depth Of Inlet 1'- ~ Depth To Bottom
COMMENTS: ·
Location Sketch
Depth To H20 Net Drop
Drain Field
Of Pit Or Trenc~
Test Performed B):_ [~Ft~
Data Certified By-'__ ~)~,~ /~ ,~
~NSP~CTION RE~O~T ON-S~T~ SEWAG~ D~S~OSA~ SYSTEM
D,STANC~ FRO,~ WE'~ ~d
U(~U~D CAPAaTY ! 2.
.~DDRESS ~ ~/"~'" / I. /*' ~ PHONE.
SE~IlC TANK:
MATERIAL COMPARTMENTS
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS J OUTSIDE DIAMETER
LINING MATERIAl
NEAREST LOT LINE
OR WIDTH / ~ , LENGTH // ~-- , DEPTH
DISTANCE FROM WELL /'~'~ , BUILDING FOUNDATION
· TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMB~
~PTION AREA
DEPTH~ TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
NEAREST LOT LINE , OF LINES
J ' FSt'~~TN TRENCH WIDTH --
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN, ABOVE TILE
WELL: riPE'''/,/~'"= ' I~ '~/DEPTH DISTANCE FROM WATER
· BUILDING FOUNDATION· SAMPLE o NEAREST
NEAREST SEPTIC(:~L/~'/"~ · SEEPAGE ~ ~ OTHER
LOT LINE SEWER LINE ,TANK , SYSI~ , CESSPOOl ~ , SOURCES
DIAGR~ OF SYST~
i'~DIS/ANCES:
DATE
,... _ _ _ , ~ ~ RT/ .,.,,..,,,.o,,,,,,
GREATER ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
INSTALLATION
LSGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK f SEEPAGE PIT ~ I).~L~ .~t+~~-
TYPE AND SIZE OF FACILITY TO BE SERVED
F,NA.CEO'r. ROUG. -.~,~zF TO BE ,.STAL'.ED .Y /~//)///~¢~ ~',~'T,
SOIL TEST RESULTS NOT[t THIS PERMIT IS NOT VALID WITHOUT ~IL
FINAL. IHSPECTIOHt 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYST£M WITHOUT FINAL INSPECTION BY THF'
SE"lC TANK SIZE / ~ '~ ~' TYPE ~~ SEEPAGE ARSA SIZE TYPE ~
DRAIN FIELD
DRAIN FIELD
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2S-6S AND THAT THE ABOVE