HomeMy WebLinkAboutST INNOCENT LT 6B
Gi'~'TER ANCHORAGE AREA BORO,"-=~'TI
DEr~RTMENT OF ENVIRONMENTAL 0. UALI.,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
MAILING
ADDRESS
SEPTIC TANK:
,/ NUMBER OF
DISTANCE PROM WELT ~'~ ~ MATERIAL L'~/~/-'~"" COMPARTMENTS.
LIQUID
LIQUID CAPACITY_ ~'~'/~//~' · GALLONS. INSIDE LENGTH /~//v//~/' INSIDE WIDTH ~'/v'/~'~' DEPTH
SEEPAGE SYSTEM:
NUMBER OF PIIS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER ~"~/'~/J~'~' OR WIDTH
DISTANCE FROM WELL ~'/~/'/~/~ '
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREAI
., LENGTH~'~'/~c'~' , DEPTH
BUILDING FOUNDATION
~'~/"'//~" SQ. FT.
TILE DRAIN FIELD:(~,~)
DISTANCE FROM WELL -¢~'~ / , FOUNDATION
TOTAL LENGTH ~
NEAREST LOT LINE /~/~//~"- , OF LINES
IN. TOTAL EFFECTIVE
NUMBER OF LINES_ // DISTANCE BETWEEN LINES ~ IRENCH WIDTH
ABSORPTION AREA ,/~2 SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
.DEPTH OF FILTER MATERIAL BENEATH TILE ~" IN. ABOVE TILE
WELL:
LOT LINE
DISTANCE FROM / WATER
TypE/~?~'~'~'~' ~ DEPTH ~'/~/~, ,BUILDING FOUNDATION.~~ ~--_SAMPLE_ /~'/~'~'~, NEAREST
NEAREST ~ ,/ SEPTIC ( SEEPAGE~ ~ ~/ OTHER
SEWER LINE/~'; ~ -~'~ ~ , SYSTEM~/~ ~'~'/~-~, CESSPOOl /, SOURCES
, TANK
DISTANCES:
DIAGRAM OF SYSTEM
DATE
GRE:ArE:R ANCHORAGE: ARE:A BO,~u'UGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
NAME OF APPLICANT ~/~'''~2'~2/'~''~/~ ~--~/~'"'~//'~//~/ MAILING ADD~ESS ~ ~ ~/~ PHONE
INSTALLATION LOCATION '~//~ ~ ~
LEG AL DESCRIPT[ON ~ ~~ .
iNSTALlaTION OF: SEPTIC TANK ~A/~ ' seePAGe PIT ~ ,DRA]N FIELD , OTHER
TYPE AND SIZE Of FACILITY TO BE SERVED ~/~ ~/~/
FINANCED THROUGH TO Be INSTALLED BY ~/ ~~ ~ / C {---~
SOil TEST RESULTS ~ ~ /~~~ NOTE= THIS P~RMIT 15 NOT VALID WITHOUT SOIL
COMPLETION DATg ANTICIPATED / ~ ~/ '[//~/~//~/--
FINAL INSPECTION= 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE ~//f~/~ TYPe ~/~/-~/~'~ SEEPAGE AREA SIZE /~ TYPE /~/~
FOUNDATION TO SEEPAGE Pit ~ ~ / ~
SEPTIC TANK ~,, SEEPAGE PIT ~ ~ · DRAIN FIELD
TO NEAREST LOT LINE. f~/~/~//~-- ~ ·
WELL TO SEPTIC TANK .
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
, SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
· SEEPAGE Pit
/~ DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION ~ FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL EACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
GR ANCHORAGE AREA BOROUGH ORDINANCe NO. 28-68 AND THAT THE aBOVE
3~7 E/,(L~E 81'REET
AY(HOP, AGE. ,~7 q<,~ 99501
Pe:efoz'~!ied ForSt. Innocent Orthodox Church
~ega! Des~z'~.otlon ~57~i-0~ ~(~r~,~:,~.~.~.w.~,~Dat-e Perfo~'med 8/26/71
~,~.t~ , ~p,:~ ~.e~.O~S ¢~: SeAls Lo~, X
De p t h
....... '~ ....................... Location Sketch
B~o~ clayey s[lt (~)
1
B~own and g~ay sandy gravel
to g~avelly sand
4~
5~
6~
7~
C~ay silt-Sand mix (~)
9~
u ..... Gross ~ ~ me Ne': ~ ~me Depth To H20 Net Dr,op
PPci3o:-aa ~?,stal,N~tlon~ ~mepage 'fit
aepzh Of" , .~ ............ ?PaJ.~ F]eJ.~] X
,~o, ~om Pit T~enc~
A drain field is recomme
· feet of draina · · ~~~-~.
Test perfomaed Bo....~.y~j~f~ ..............
Data CePtified By: National Tes6tin Services
Date: ...... ~=,,~e~r, ..... Inc,
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
person requesting approval ,t~K. .
d~cript{ on
~. Numberof~b~drooms in house
5. Wate~..Analysls: ~~5
a. Bacta~ial.~
b. Detergent "' '
Well data:
c. Casing Slze ~"
d. Distance f~om well to closest existing ov proposed:
1. Sewer llne
2. Sept[ c tank
3,Seepage Area
Cesspool'
5.Pmoperty Line
6. Other sources of p sslble contamlnation~ 1.e., creeks, lakes,
houses~ baPn~ drainage ditch, etc.
Sewage disposal system.
b. Septic tank capacity in gallons, /%--00 ~, .
c. Name of septic tank manufactu~,r ~/J~g~6M/
1. If "home made" show diagram on reverse side of this form.
Disposal field or seepage pit size and type
1, Distance to proper~y line. l ~l to house oundatlonl.~/
f .
e, Percolatio~ Text ?esults
f. Percolation Test performed by
Use the reverse ,side of this form to show diagram. Diagram should include
.'[[-~he following information: p~operty llnes~.well location, house location,
m~utic tank location, disposal area location, location of percolation test,
an~ direction of ground slopeJ
The info.marion on ~- ~//~o .best
this form is true~d correct to the of my knowledge.
'~ S~gfiature 'of Applicant ' Date Signed
\
TO BE FILLED OUT BY HEALTH DEPART!.JENT PERSONNEL
~he above described sanitary facilities are hereby approved, subject to the
con~¢~'ions:
Conditions:
The above described sanitary facilities are disspproved for the following
reasons:
Date '
'-{Ap~oval,~/ is valid for one year following, the date of approval.
.. · CPJ: cw
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
· of person requesting approval
o{ Droperty: owner
Mr. Arthur Chrisman
a. Bacta~,ial Neg.
b. Detergent~ "' '
Well data:
a. Type Drilled
b. Dept~ ..... 100 ft.
c. Casing Size__6 in.
dj
Distance from well to closest existing or pPoposed:
1. S~wer line
2. Septic tank 75 ft.
3. Seepage Area 84 ft.
4. Cesspool~
Property Line 18 ft.
6. Other sources of possible contamination, i,e., creeks, lakes,
houses, barn, drainage ditch, etc.
Sewage disposal system.
a. Age of system .... 8 v~s. ,.
b. Septic tank capacity in gallons,,, 1,500
c. Name of septic tank manufactu~,r
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type
Standard log cribs (2)
1. Distance to property, line to house foundation
Percoiatio~ Te~t '~esults
f. Percolation Test performed by ...... ,
~. Use the reverse.side of this form to show diagram. Diagram should include
- [~he foJ_lowing information: ~operty lines~.well location, house location,
~ptlc tank location, disposal area location, location of percolation test~
an~ direction of ground slope.
9. The l~fo~-matlon on this form is true and correct to the best of my knowledge.
'Signature of Applicant ~ bate Signed
T_O0 BE FILLED OUT BY HEALTH DEPAET~.~ENT PERSONNEL
~e above described sanitary facilities are hereby approved, subjec~ to the
.......... ~611owing cond~'ionsi
Conditions:~ ~
The above described sanitary facilities are disapproved for the following
raasons:
'- Appmoval is valid for one year following the date of approval.
CPJ:cw