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SFS
MUNICIPALITY OF ANCHORAGE
�l L)EPARTMENT OF HEALTH & ENVIRONMENTAL PROTEt, HON
I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITZ= SEWAGE DISPOSAL SYSTEM ANO/OR WFL.I_ INSPECTION REPORT
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MAILING ADDRESS _ U--—
LEGAL DESCRIPTION ------
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LOCATION � 101,
NO. OE BEDROOMSWellAbsorarea
Dwelh g PERMIT NO.
U Y DISTANCE TO. �,,oT - Lha
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Manufacturer Material
No. of compartments
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Liy-capa^ in gallons Inside len th Width
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Liquid depth
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DISTANCE TO: Well Dwelling
PERMIT NO.
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ManufacturerLiquid
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fVlaterial
capacity in gallons
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DISTANCE TO:
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Foundation
Nearest lot line
PERMIT NO.
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No. of lines Length of each line.
Total length of lines Trench width Distance between lines
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Top of the to finish grade _ E
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IVlaterial beneath tile ! Tot-al effer__tivc absorption area
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Length Width
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DepthA PCRM—IF NO
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Crib depth Total effective absorption area
Type of crib
Crib diameter
Building foundation Nearest lot line
DISTANCE TO:
_
Well
a
Class
DISTANCE TO
Depth
Building foundation
Driller
Sewer line �-
Distance to lot line PERMIT NO.
Septic tank Absorption a)ea(s)
OTHER
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PIPE MATERIALS tt n
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED DATE �e
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LEGAL
rll-lr-4 I I--,- I F='IL- I -Y--r' 1__117
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DEPARTMENT OF .EHLTH AND ENVIRONMENTAL P> /^ECTION `�
__-_-~_
825 'L/ 'L/ STREET/ ANCHORAGE/ HK. 99501 '-.-
264-4720
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PERMIT NO. ( 800146 ) -
APPLICANT CHURCH OF CHRIST POST OFFICE BOX 54 99577 694-3251
LOCATION MILE 15 1/2 OLD GLENN HIGHWAY
LEGAL ILOTj[BLOCK 2`SCHRSr^D] LOT SIZE 108650 SQUHRE FEET
TYPE OF 'FOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 05
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
30
E> E-: F:=" -Y- nlL0 -| E:xE-:i=--r"== 15.
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD.
THE DEPTH OF H 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 I.S. THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
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PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
JNSTRLLHTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY FIND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
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BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION FIND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON -S -ITE SEWAGE DISPOSAL SYSTEM IS
FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H 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 H COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE. \
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TQ INCLUDE MORE THAN ] BEDROOMS.
SIGNED:__~__��_~�_����~�--`~��-��-~^--��--~�-���
APPLICANT CHURCH OF CHRIST
ISSUED AL,
TYPE OF SOIL HBSORDTION SYSTEM IS� TREHCH
MHXIMUM NUMBER OF BEDROUMS � �� SOlL RHTING (SQ FT/BR)� 85
lHE REQUIRE� SlZE OF THE SOIL HBSORPTION SYSTEM IS�
�������� J K� r T , . IE F Q KTV.��� 30 ST 17, Q 40 "W V 10 FT F 1'1 +4= �
PERMIT HPPLICHNT HHS THE RESPOto; IrylLITY TO lMFORM THlS |)EPHRTMENT 0URING THF
INSTHLLHllON INSPECTIONS OF HNY WELLS H00HCENT TO 1111 PROPERTY HND T|fE
NUMBER OF RESIDEHCES THHT THE WBJ- WILL SERVE.
0Von NO 1-0 da Fl!!, F���
BHCKF[LLING OF HNY SYSTEM WITHOUT FINRL INSPECTIUN 8ND RPPROVH| BY TH[S
DEPHR[M£NT WILL BE SUBJEC[ TO PROSECUTl0N
MINIMUM DlSTHNCE BETNEEN H NB -L HHD ANY ON~SITE SEWHGE DISP0SHL SYSTEM l�
100 FEET FOR H PRIYRTE WELL/ 0R
FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NFL|
OlHER REQUIREVIII Tc; [%I /x. I , na, crc[; Ar.13n//unM FOO CI'M |xu'�/TVm o!141 HHnE
HVHILHBLE TO lHSURE PROPER INSTHLLRTIOHI.
WEAR two �� NF7 7-THIA F V 91E �s QEED ETMFn; v� 1, � :0 A, ��� 1 W, A, I n
Oor C 4c
GEG . ECHNI CALL Ef DEVELiPMENT CO.
BOX 90, Davis St., 6n010 Fiivor, Alaska 995T/
694-2714 or G88-2.280
Russe!/ oyetor Call Ellis
694 2774
Soils 5 Foundations �QIL LQI cm -22W
Land Development
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P:arfor d for: Elam®: ��/�C�: ,tv /I CflU>cr/ arL Tel. p�Q.�,..���
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Mn919ng address: Bo x 5r .17
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Ground dater Encountered: Yess No If yes, what depth��
Propesod Installation; Seepage Pit.. Dram Field..
Performed by: ��"-`��� Date:.e ���