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:-