HomeMy WebLinkAboutSIEFKER TR 11(IN l-� \ MY I -)( A
GAAB-HD-I GV ITER ANCHORAGE AREA 13ORO1"1H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511
NAME
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
ADDRESS
-PHONE--
LOCATION ZtLV_Z6
PHONE
LOCATION/%_/!1 /L-' �>T LEGAL DESCRIPTION
SEPTIC TANK: (')
NUMBER OF
DISTANCE FROM WELL MATERIAL 4 C' Z /_COMPARTMENTS
LIQUID
LIQUID CAPACITY -GALLONS. INSIDE LENGTH I&IDE W DT ��/ DEEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS OUTSIDE DIAMETER �- OR WIDTH /Y LENGTH—/ DEPTH_ 6? r ,
f �
LINING MATERIAL .DISTANCE FROM WELL /��' ,BUILDING FOUNDATION_"e
JJJJJJ / ,.�
NEAREST LOT LINE ��' �� TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) a 7-- ' SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROMA-WELL_ , Louw TIO
NUMBER 5F LINE$ / DISTANCE BETWEEN LI
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
NEAREST LOT LI
H WIDTH
TOTAL LENGTH
OF LINES
DEPTH: TOP OF TILE TO FINISH GRADE _ DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL: ///JJ l�(_ej 2 DISTANCE FROM WATER
TYPE DEPTH BUILDING FOUNDATION.. SAMPLE e NEAREST
NEAREST i SEPTIC 5-,7/ SEEPAGE �//�� OTHER
LOT LINE /`"f= SEWER LINE G �" ,TANK SYSTEM_/, CESSPOOL ,SOURCESF
DIAGRAM OF SYSTEM
DISTANCES:
GA -11341D-2 GREATEf iI®1EHORAG E AREA
IiEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
)ROUGH
279.2511
a"0 SEWAGE DISPOSAL SYSTEM e APPLICATION & PERMIT
Case No.
NAME OF APPLICANT) 00I OAA MAILING ADDRESS fF PHONE NO.
RESIDENCE ADDRESS LOCATION OF INSTALLATII?O r'/opt,/ u{ a � /ham'
LEGAL DESCRIPTION- 1 �� = '� ✓ �� / �f../!� a
APPLICATION TO INSTALL: SEPTIC TANKS , SEEPAGE PIT— DRAIN FIELD , OTHER _
TO SERVE THE FOLLOWING FACILITY D B'b�'- iY TP
FINANCED THROUGH TO BE INSTALLED BY _w
PERCOLATION TEST RESULTS
ANTICIPATED DATE OF COMPLETION _��`` 11f'
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT rIAJ A &r -W :5,J-',
THIS IS TO SERVE AS //0 /0Al PERMIT TO INSTALL A F=)�woele—
of
DISC*ANCES:
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED., ?/
YT 4'.G -
SEPTIC TANK SIZE ��S TYPE ��r�ne' _ZSEEPAGE AREA TYPE 2*�' _ lel_
DIAGRAM OF SYSTEM
i
-� k? I t~S n... /
S /
r
H FhLTH AUTHORITY
OR
LICENSED DESIGNER S�
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ord' . ance No. 28-68 and that the
above described system is in accordance with said code. /U �- �_)c_}
DATE, %� APPLICANTS SIGNATURE
f-
mom
0
m
mom
mi
0
NO
0
No
OMEN
No
0
1000i
No
IN
ON
0
0
'01
No
NKOMO
II'm
IN
OR
LICENSED DESIGNER S�
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ord' . ance No. 28-68 and that the
above described system is in accordance with said code. /U �- �_)c_}
DATE, %� APPLICANTS SIGNATURE
f-
jRT; Ito no z
1001 -Th D",'"
,,7 EAj!j a r v
ANCARA01- ALMA
was Ground walor Encountevv&'?,
Reading
", , , e, ',' 1. 1, 1
'-� e C r, �k..� f ., 4, l.. ni .n.r,..
4
Tr
An, I A � e
performed 3,,,Z
10PA To Not Dro?
men 7ime I
A"
-OVA (,On
Date
Perforuad
Osiavk
for',;gip
6a Y-) 109,4 1
CUe-Re/ YlOv011
C")h I QI " }-1 rl e- af
YOU USUSS"!
.3 Ale � PzOvtle-1
Nl Tew
This Ycrm
RopoM S&A
Dept!-,
jKet0-.
was Ground walor Encountevv&'?,
Reading
", , , e, ',' 1. 1, 1
'-� e C r, �k..� f ., 4, l.. ni .n.r,..
4
Tr
An, I A � e
performed 3,,,Z
10PA To Not Dro?
men 7ime I
-OVA (,On
6a Y-) 109,4 1
CUe-Re/ YlOv011
C")h I QI " }-1 rl e- af
.3 Ale � PzOvtle-1
was Ground walor Encountevv&'?,
Reading
", , , e, ',' 1. 1, 1
'-� e C r, �k..� f ., 4, l.. ni .n.r,..
4
Tr
An, I A � e
performed 3,,,Z
10PA To Not Dro?
men 7ime I
"REATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE ALASKA 99501
CASE u
John Collum Date Per.ormed 7/15/70
Performed For _ ___ -
Legal, Descriptio Lot Block's Sub ,vision Siesker - Txac -
This Form Reports a: SoilsLot ercolation est a �'
Depth
Feet Soil CharacterisAr-S location Sketch
2 1 ! Brown Silty Fine Sand
10
Brown & Gray Silt &( Mand Mix
Gray Silty Clay (CH)
Was Ground Mater :'z -.countered?
COMMENTS: NeV
��P
O
-Seepage a,e Pi.t
!)rain Field
Inlet__ Dopth 7o Bottom o P.it Or '!ranch
Essar �Trairiage siii acc ar e�{. is s care feet ger bedroo4ii
Test Performed By: R. L. Carlisle
= N a4_on::l Iesting
Data Certified 13y:
Date