HomeMy WebLinkAboutSIEFKER #2 BLK B5 LT 2Siefker #2
Block 5
Lot 2
#015-272-60
G"'WER ANCHORAGE AREA BORO' � aH
HEALTH DEPARTMENT NO 554
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME ;c%r.<f /�� /`�f %3" ADDRESS S'//t f/ .6i`S % �� /f� PHONE-
_LOCATION�rJ`�C f �i -t' f� C/Il-> LEGAL DESCRIPTION
SEPTIC TANK: �� ;�_��`^ 'A - Lo
NUMBER OF
DISTANCE FROM WELL Ak' MATERIAL '�/ / COMPARTMENTS
LIQUID CAPACITY GALLONS. INSIDE LENGTH INSIDE WIDTH
SEEPAGE SYSTEM: SEEPAGE PIT:
LIQUID
DEPTH_
/ jl is
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH% --' LENGTH DEPTH " /_,
LINING MATERIAL /'� �-- -- .DISTANCE FROM WELL � �-- BUILDING FOUNDATIONS �' ,
NEAREST LOT LINE -- f �I r A� TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) %C SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL / �t'" FOUNDATION (�( NEAREST LOT LINE OF LINES �(
NUMBER OF LINES / —DISTANCE BETWEEN LINES / TRENCH WIDTH / IN. TOTAL EFFECTIVE
ABSORPTION AREA—/ /�':'SQ. FT. LENGTH OF EACH LINE �` l �c —
DEPTH: TOP OF TILE TO FINISH GRADE ��� ��' DEPTH OF FILTER MATERIAL BENEATH TILE—IN. ABOVE TILE
WELL: j ,' �� S` ' DISTANCE FROM WATER NEAREST
TYPE�i( /'' DEPTH BUILDING FOUNDATION. Z/ SAMPLE ILC ;//%`
NEAREST SEPTIC SEEPAGE / OTHER
LOT LINE/j �r jC �' �, SEWER LINE TANK � — _, SYSTEM / CESSPOOL , SOURCES_
DIAGRAM OF SYSTEM
DISTANCES:
.lY;t�,,, /.
r ,
IVf r ill t�-, C)
I�
>irk4> !br-
l�hur.-
i
DATE APPROVED ---_ .� r ;
-� HEAL! "IHORIiY
GREA I ER ANCHORAGE AREA BoRJUGH �� /
; � 1 DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO./
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY�
SOIL TEST RESULTS �! %�la�/i�l NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
/
COMPLETION DATE ANTICIPATED
FINAL. INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
v
SEPTIC TANK SIZE �2._ TYPE !4 �'� � SEEPAGE AREA SIZE TYPE Q NIS
MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PITO DRAIN FIELD
i
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK 'J SEEPAGE PIT _fes DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK ` SEEPAGE PIT
DRAIN FIELD .�1 ALSO CONSIDER AREA WELLS.
J
WATER MAIN TO SEPTIC TANK _41/ SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, SEEPAGE PIT DRAIN FIELD eer
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN
ACCORDANCE WITH SAID CODE. f`�/',/, y
DATE � G �/ APPLICANT'S SIGNATURE --O- / J`
NAME OF APPLICANT ��/J CJ- lj(4
'X;f
MAILING
ADDRESS %,� �•� ��
PHONE
INSTALLATION LOCATION//,
_..L^L. ��/
ITSS.
Ol✓ ! �'.'g�/:�
�.
LEGAL DESCRIPTION 1. lN�i--�.�
/�
!� �s'� .'J
. ,-�//l ,,
INSTALLATION OF: SEPTIC TANK _
SEEPAGE PIT
DRAIN FIELD
OTHER ,
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY�
SOIL TEST RESULTS �! %�la�/i�l NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
/
COMPLETION DATE ANTICIPATED
FINAL. INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
v
SEPTIC TANK SIZE �2._ TYPE !4 �'� � SEEPAGE AREA SIZE TYPE Q NIS
MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PITO DRAIN FIELD
i
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK 'J SEEPAGE PIT _fes DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK ` SEEPAGE PIT
DRAIN FIELD .�1 ALSO CONSIDER AREA WELLS.
J
WATER MAIN TO SEPTIC TANK _41/ SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, SEEPAGE PIT DRAIN FIELD eer
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN
ACCORDANCE WITH SAID CODE. f`�/',/, y
DATE � G �/ APPLICANT'S SIGNATURE --O- / J`
MUM hN"00"OT Aw , jr ",
Nunn >-",7Y;YT
327 AAQ�N CTRVE''r
AH(' ORAnis ShOnNA 9950),
CASE
2 With silty sand seams
below 6' (SM)
3
4
5
6
7
81
9 -
was Ground water Encu mater) no
les, At Oat Dept)
atq Gross Time Non Time
PO - Oding u
F- ........ I . ......
J
Dept!]
Drop
Kate 1-Y
Drain Plow
Of
MMAMS:
265 squarefeet
_P
er bedrooW"
Test Performed By :"p
Do "s Certified Hy; National Testing Services, Inc.
Kendall
Lep a!
pere.orn;ed'
TIA
Siefker
Yorm
sc
, _. .
"
v i at jo n je
Depth
Teel:
SUH Chao
Gray and brown sandy
silt
I
(ML)
2 With silty sand seams
below 6' (SM)
3
4
5
6
7
81
9 -
was Ground water Encu mater) no
les, At Oat Dept)
atq Gross Time Non Time
PO - Oding u
F- ........ I . ......
J
Dept!]
Drop
Kate 1-Y
Drain Plow
Of
MMAMS:
265 squarefeet
_P
er bedrooW"
Test Performed By :"p
Do "s Certified Hy; National Testing Services, Inc.