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MUNICIPALITY OF ANCHORAGE _
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 264-0720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
NEW
b/i FLGI G/
b�Y'37�
❑UPGRADE
MAILINGADDRESS U
3
`•
LEGAL DESCRIPTION
L2
LOCATION
EDR
NO F BEDROOMS-/
O
4000.
l7
Well
Absorptlo ar
Dwelling
P�/�CAC�"�A�['
U Y
DISTANCE TO:
d¢
~
Manulxt
M; e �
No. of comp IS
N
Liq. ap 'n Ilons
IF HOMEMADE:
Insidelength
Width
Liquid depth
d Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Jvz
_? f
Manufacturer
Material
Liquid capacity in gallons
Well
Fountla - t
Nearest Ip► e
P Xr'fiF//r.G.G1j
Z
DISTANCE TO:
t j
2
N o. of lines
length 6fXch
n h i Total Ias
Trench 'di
Distance
H w
•_
inches
'
f
Top qj s ? t inj• grade
Mit . iy+bepya t"
S
Total of fedi absorption area
ri .�
L % inches
Length
Width
epth
PERMIT NO.
W
41-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
W
N
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
Building foundation
Sewer line
Septic tank
Absorption area (s)
DISTANCE TO:
OTHER
PIPE MATERIALS
.
SOIL TEST RATING
INSTALLER
17
ILI
REMARKS
RalliedA. Shafir wet
No. 1457•E ?W
\p
i
APPH E DATE LEG "'",
SRI]
/ �.• .- 577
7CA 1:
LAST
iV` 69S
2
72 13 Rev. 3/781--
MUNICIPALITY OF ANCHORAGE
4 Department i`� Health and Environmental votection
825 .. Street, Anchorage, AK. 99501
264-4720 J 0-i L--) LD
* * * HANDWRITTEN PERMIT
Permit
WE�4filD/OR ON-SITE SEWER PERMIT
Applicant: U C Mailing Addre
Location: Phone Number:
Legal Description: rn // P1 %c V
Type of Soil Absorption System Is:
ss:�crka3U �-P.
. (4 a,4
Lot Size:
Trench: _� Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms k" "oil Rating (sq. ft/br) PS
1 �..
The Required Si7fp f the Soil Absorption System Is:
DEPTH ( y .LENGTH -4'f— .. GRAVEL DEPTH 9 WIDTH
The length dimension is the length(in feet) of the trench or drainfield. 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 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.
* *.* TW0�2) INSPECTIONS AMC REQUIRED
Backfilling of any system without final inspection .and approval
will be subject to prosecution.
by this department
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 * * *
I certify that:
(1) I am 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 codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that nnms.r4 C,
Signe3: �% � Issued by: n r n77`JJ_
Applidant ivy w
lidan Date:
SWP/024 (1/81)
PERFORMED
MUNICIPALITY OF ANCHORAGE
.DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street. Anchorage. Alaska 99501 2644720
SOILS LOG — PERCOLATION TEST
LEGAL DESCRIPTION: f—
Date
Gross
Time
DEPTH
Depth to
Water
Net
Drop
W
SET)
1
n
2-
n
3 -
3
ILP
V
4
t
5-
so
6-
6lo-8s�
P/Z
7-
8
8J
-
It
�(
c�
10
11 G �L WASGROUNDWATER /)0
ENCOUNTERED?
12 r— +� OF .4 t 5D(FYES.ATWHAT
13 air i Gj�Q �C
�L/ 1 % tR x •• t
14-
.
4 r•
r
15 t k4trf'A• Shof.r «
t• Of No. 1.117.E Ste.• .•
16 j�qf••.,• w w••••�
OF S1
17 �`��\
19
19
KSOILS LOG
❑ PERCOLATION
TEST
DATE PERFORMED: U x4J
11
iding
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
W
n
20
PERCOLATION RATE I v (minutes/inch)
TEST RUN BETWEEN T AND / FT
COMMENTSe::�) 4 �!
PERFORMED
72-008 (6/79)
CERTIFIED
DATE:
TO:
FROM:
Municipality of Anchorage
MEMORANDUM
SUBJECT:
..,�7 jWt
"00% 8 Emlronwwtol Prot dim
Environnantal Sonttallon Dhblon
80S L Street, Fourth Floor West
Anchorage, Alaska 99501
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