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HomeMy WebLinkAboutSIEFKER TR 10ke.R Iro IlJ ,AAB HD -I GP"ekTER ANCHORAGE AREA BOROII 17H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM � J/ MAILING NAME /� « /- ADDRESS '1 5 PHONE_ LOCATION C+`�` LEGAL DESCRIPTION SEPTIC TANK: ._): ; rll�'Q CYJ DISTANCE FROM WELL MATERIAL`!ll,�f /1�1 NUMBER —COMPARTMENTS - LIQUID LIQUID LIQUID CAPACITY"' 4? � GALLONS. INSIDE LENGTH INSIDE WIDTH-DEPTH— SEEPAGE IDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT, NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE TILE DRAIN FIELD: DISTANCE FROM WELL_ OUTSIDE DIAMETER OR WIDTH DISTANCE FROM W TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH , DEPTH , _, BUILDING FOUNDATION , SQ. FT. AL LENGTH FOUNDATION � NEAREST LOT LINE {� r, OFTUNES— NUMBER OF LINES 15 DISTANCE BETWEEN LINES / TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE !it �/ DEPTH: TOP OF TILE TO FINISH GRADE > > DEPTH OF FILTER MATERIAL BENEATH TILE. �� IN. ABOVE TILE i WELL; DISTANCE FROM 1/ WATER TYPE DEPTH BUILDING FOUNDATION. c L—SAMPLE NEAREST 1c) / NEAREST el�rr'' / SEPTIC l7 SEEPAGE OTHER LOT LINE, SEWER LINE_, TANK n SYSTEM �`'� CESSPOOL t SOURCES_' DISTANCES: DIAGRAM OF SYSTEM 0 V, /r` \ _ DATE /�, /�-''f APPROVED HEAIiH AUTHORITY pp � / DIAGRAM OF SYSTEM 0 V, /r` \ _ DATE /�, /�-''f APPROVED HEAIiH AUTHORITY GAAB-HD-2 GREATE.. ANCHORAGE AREA JROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279.2511 SEWAGE DISPOSAL SYSTEM o APPLICATION & PERMIT Case No. _30— NAME OF APPLICANT �12� MAILING ADDRESS — . PHONE NO. RESIDENCE ADDRESS LOCATION OF INSTALLATION OFF- FFwWtpj LEGAL DESCRIPTION Lcyr I c) APPLICATION TO INSTALL: SEPTIC TANK '°-SEEPAGE PIT_ ��, DRAIN FIELD_, OTHER TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS TO BE INSTALLED BY ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS � IR& 16 « - – , PERMIT TO INSTALL A 5�wy AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED SEPTIC TANK SIZE '' _TYPE SEEPAC DIAGR DISTANCES: �AIiJ t o -N K N E u_ ro .4f—W N -,E Health Authority AREA _ti1�WgYPE � OF SYSTEM 7"ex o y I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No above described system is in accordance with said code. DATE � APPLICANTS SIGNATURE 28-68 and that the GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT CASE 0 327 EAGLE STREET ANCHORAGE, ALASKA 99501 Performed Forte%%%•t ar�Date Per ormed Legal Description: Lot(- Block Suhd visioC 'n , fir, This Form Reports a: Soils Lop; .-.--..Percolation est Depth Feet Sail Characteristics �CIUy .ihe su d s ne 77 �' IiPOiu vGl ih e par }it lC� o soi� lS 11"odel,aflV eon,paci wifti a h9w lv rnodevvale {��UlSlurG coi,,I evi+. 7hPi•e co&j no 5und 00/de,1ce 6,1 a wolef, 16e6le 3 cr7� f<,�s depfGi. N 5" 6 C�� 7 Was Ground Water Encountered?_ (� 0 If Yes, At -v't,at Depth Location Sketch a4l-VVACi 6.L l+1! i\(]4C: 1 1 3"1 A31U LCr Prop -)sed lnstall:at:aon Seepage Pit ? Drain Field 7 Depth Of Inlet �31/ '' ...,.,,.Depth To Bottom Of Pit Or Trench_ COMMENTS: 71, w) <o, �o t i / 4ac /c 1,,v �P ,� �c l ,-) e- -477c Test Performed By:, Data Certified By: Date:- Readin.- :'�,�e Gross Time Net Time Depth To H2O Net Drop a4l-VVACi 6.L l+1! i\(]4C: 1 1 3"1 A31U LCr Prop -)sed lnstall:at:aon Seepage Pit ? Drain Field 7 Depth Of Inlet �31/ '' ...,.,,.Depth To Bottom Of Pit Or Trench_ COMMENTS: 71, w) <o, �o t i / 4ac /c 1,,v �P ,� �c l ,-) e- -477c Test Performed By:, Data Certified By: Date:-