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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO"i ECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAMEANEW
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11 UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
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LOCATION
NO. OF BEDROOMS
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DISTANCE TO:
WellAbsor
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tion area r
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Dwelling
<3 1 K%Z
PERMIT NO .
a
F
Manufacturer
Material �c L
No, of compartments
to
Liq. capacity in gallons
>1
IF HOMEMADE:
Inside length
_—
Width
Liquid depth
OJ z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
2 Z F
Manufacturer
Material
Liquid capacity in gallons
y
DISTANCE TO:
Well/
JS`
Foundatio
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Nearest lot line
f t
PERMIT N
_ Q021?%' m
J LL Z
ti ui
No. of lines
l
Length of each line
/
Total le gth of lines
/C' '
Trench width
3 C inches
Distance between lines
¢ F.
O
Top of tile to finish grade
`c' `/ '
Material beneath the
Sf / i ncAes
Total effective absorptio area
/-/6 c)
LU
a
Length
Width
Depth
PERMIT' NO.
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w�
Type of crib
Crib diameter
Crib depth
Total effective absorption area
U)
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
CJgs tt
Depth
Driller
Distance to lot line
PERMIT NO.
w
R:DIST
ANCE TO:
Building foundation
Sewer line
Septic tank
Absorption areas)
OTHER
V
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PIPE MATERIALS
_
SOI l_ TEST RATING
'2'30(t
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INSTALLER
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APPROVVIED� s DA/TE LEGAL
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MUNICIPALITY OF ANCHORAGE
Department Health and Environmenta'
825 Street, Anchorage, AIC. _J
264-4720
Permit # HANDWRITTEN PERMIT # #
-WER ON-SITE SEWER PERMIT
Applicant: n ; �C�j i�, Mailing Address:
•otection �-
01 r,
41J, I
i i3
Location: _ Phone Number: ®�
Legal Description: Ll(, -7 71-6N R%U) Lot Size:
Type of Soil Absorption System Is:
Trench: ✓ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH _ I �,- LENGTH __ GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfiel.d. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE_ _u� D D ('� GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED # #
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a. public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 2
1: certify that:
(1) 1 am familiar with the requirements for on --site sewers and wells as
set forth by the Municipality of Anchorage.
(2) 1 will install the system in accordance with codes.
(3) 1 understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more t at/3`� bedr ms.
Signed: ' Issued by:
Applicant
Date:
SWP/024 (1/81)
���_d/J5�� ���
Russell Oyster
694-2774
® & E ENC.NEERING & DEVELG. MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOO
Performed for. Name: —
<' 61\4 H V%/
Mailing Address:
Legal Description: L 16 71
Depth (feet) Soll Characteristics
A
3
4
5
N
7�Al ! 'r,
10
11 __ L3 co t1j18 ; /-� '
12
Earl F1119
688-2280
_ Tel. No. (,-q y – `i (53 -:� -7
'�� r 1111
PL01'PLAN
13 —_ PERC. TEST
141��rr�ASI-- 6AliA-/ T
15
�y_y jam, r� .
16 7 -
tai A. ��tl
Ground Water Encountered: Yes-- NoZ If yes, what depth'. V® e
Proposed Installation: Seepage Pit_ Drain Field
Comments:
4�rP anA..:(.a a�ns .' onno icy q'.n •�
.A S7 "( y..e�s.n. .• •a�. �
4, Earl P. Ellis d `Q!
Performed by:
VPARTMEN l DF HEALTH AND ENVlKUNM[NTAL PROFECTlON
825 L STREB, ANCHORAGE, AK 99501
264�4720
4 7 1 1VT-~�. A. A Q ���. K . Mn� F � 1-1 A: ii
`ERMlT NO: 8600i5
}ATE lGSUED: 02/12/86
�PPLIFAN lRONALD SCCHWlGER
WDRESS: BOX 194 MERCY DR.
EAGLE RIVER, AK 99577
�3�TACT �HONE: 694~77:�!4
-EGAL DESCRlP: SUBDIVISION: SCHWIGER LOT: 2
SECTION: 8 TOWNSHIP: 15N RANGE: 1W
.OT SIZE: 53905 (SQ.FT. OR ACRES)
BLOCK: NA
I certify Lhat:
1. I am [amiliEa, with the requirements for on-site sewers and wells as set
{orth by Le Municipality o[ Anchorage (MOA) and the State of Alaska.
2. I wi1l install Lhe syste:l in accordance with all MOA codes and regulations,
and in comp]jance with Lhe design criteria o[ this permit..
J. 1 VA ] adhere to all MOA and State W 1)111ska requiremenis <or the set back
distancog well, wastewater disposal system or public
sewe,age system on this or any adjacsnt or nearby lot.
3 1 WITA <
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APPLICANT: RONALD SCCHWIGER ^' '
ISSUED 8Y DATE: -2-~/
-�~--..... -.~�~�-
LOCATION OF WELL (Please complete either lo, Ib or Ic.)
la. Borough Subdivision Lo178
Block
p1b. I/a ql re.
SChld:�g 2 of -of -of
I,I DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
Street Address and Area of Well Location
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a Geophysicol Surveys
Or 11 ling Permit No.
A.D.L. No.
Section No. TownshipN❑ Range E❑ Meridian
S❑ W❑
3. OWNER OF WELL: Ron S(,-hwlgo'r
Address:
711 1 Box 2477
ChuErl,q c, Alo.ska 99567
2. WELL LOG
Material Type
Feet Below
Surface
4, WELL DEPTH: (final)
147 ft
5. DATE OF COMPLETION
6 _ 1- _
Top
Bottom
1V2CJ 7t1 T
3
6, ❑ Cable tool ® Rotary ❑ Driven ❑ Dug
❑ Auger ❑ Jetted ❑ Bored E] Other:
Sand PC f x AV87-
12. GROUT ING Well Grouted: ❑ Yee ❑ No
Material: ❑ Neat Cement ❑ Other:
1 (�
l�irn TR
c%
7.UBE: 0, Domestic ❑ Public Supply ❑ Industry
Irrigation ❑ Recharge ❑ Commerical
❑ Test Well ❑ Other: —
•rnl
50
r
70
r n
f,"I
6. CASING ❑ Threaded Q Welded
dlam. in. to__1_4!7_ ft. Depth Weight 1'7 Ibs./ft.
diam. In. to__fI. Depth Stickup 1f.
—�'
o
'1 !,'}'
14. REMARKS:
o
9. FINISH OF WELL:
Type: ()p('J) ilU.1.8 _ Diameter:-
Slot/moth Slze;_ Length:
Set between ft. and ft.
Backfilling Gravel pack
—
10, STATIC WATER LEVEL: 125 ft. 6-1—L11�L
Date
E]Above or ❑ Below land surface
Equipment used: .n7UF3.{;.LC �1 1)(' -INET'
16. WATER WELL CONTRACTORS CERTIFICATION: I 15, Water Temperolure —e ❑ F
This well was drilled under my jurisdiction and Ihis report Is Irue to the best of my knowledge and belief;
Part Bullock' n 1101:1 i,r�i l Lint; Inc .1 ,/—
Registered Business Name Conlract License Number
Address:
Signed:
thorized Representative
Date: n— /—
Form 02-WWR (II/81) Copy Distribution: WHITE -Stole DGGS, PINK -Driller, CANARY-Cuslomer
❑ C
11 PUMPING LEVEL below land surface and YIELD
� f1. of for ;)� hrs, pumping 1_ 9.p.m.
ft. after hrs. pumping 9.1).m.
C
N
0
N
r
o
12. GROUT ING Well Grouted: ❑ Yee ❑ No
Material: ❑ Neat Cement ❑ Other:
..
13. PUMP: (if available) HP
Length of Drop Pipe ft. capacity 9 -P.M.
❑ Subm. ❑ Jet ❑ Centrifical ❑ Other
—
14. REMARKS:
o
16. WATER WELL CONTRACTORS CERTIFICATION: I 15, Water Temperolure —e ❑ F
This well was drilled under my jurisdiction and Ihis report Is Irue to the best of my knowledge and belief;
Part Bullock' n 1101:1 i,r�i l Lint; Inc .1 ,/—
Registered Business Name Conlract License Number
Address:
Signed:
thorized Representative
Date: n— /—
Form 02-WWR (II/81) Copy Distribution: WHITE -Stole DGGS, PINK -Driller, CANARY-Cuslomer
❑ C