HomeMy WebLinkAboutDEARMOUN LT 10 · . ,~,,d~ MUNICIPALITY OF ANCHORAGE
· DE'?..ITMENT OF HEALTH AND HUMAN SER~..-"S
-- "' Environmental Health Division
825 "L" Street, Anchorage. Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
5't--, ,-,/¢ y ?,¢ A~ DISTANCES
^,:,,:,,~ "~.- TO SEPTIC ABSOBPTION
FROM~
TANK FIELD WELL
L[G,~ o[sc.,,.T,o. LOT LINE ~ O 'P / 7'
I°i ~ z::'e ~.,,,~,.~ FOUNDATION -
TANKS
SE"TlC [] HOLD,NG
G,-e.*- ,ooo ~. I
TYPE OF SYSTEM ~' ~
[] TRENCH [~/BED [] W. DRAIN [] OTHER ~'
~4 FT ~ 7-- FT
5' ~ ~ SO FT ,5' ~,'2. FT /
~"I /Z~ SOFT 2Y~-? ~o3¥ crud /,.,~
~o~./~ £x ~:," /?2.. /o-Z.'~- - oc'.V'
WELLS .,,-,, ,, j,f,.
[] PRIVATE [] OTHER [Identify) /
FTI FT // / / / × /
""~: iLL/
REMARKS: O
(3'85)
MUNICII-ALiTY OF ANCHbRAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
-~64-4720
PERMIT NO:
DATE ISSUED:
OI~i--S l' TE
850619
09/24/85
PERM
APPLICANT:
ADDRESS:
CONTACT PHONE:
STANLEY PICKLES
P.O. BOX 10-2900
'ANOHORAGE~ AK 99510
279-6525
LEGAL DESCRIP: SUBDIVISION: DEARMOUN LOT: 10
SECTION: 27 TOWNSHIP: 12~ RANGE: ~W
LOT SIZE: 1.OA (SO.FT..OR ACRES)
MAX BEDROOMS: 5
B~OCK:
NA
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site.
DEPTH TO PIPE BOTTOM (FT.
GRAVEL DEPTH (FT.) .
TOTAL DEPTH ' (FT.)
GRAVEL WIDTH (FT.)
GRAVEL LENGTH (FT.)
GRAVEL' VOLUME (CU. YDS.
,TAN~ SIZE (GALS)
SOIL RATING (SO.PT./BR)
** TANK MUST HAVE AT
'LEAST
I certify that:
1. I am familiar with 'the requirements for on-site sewers and wells as set
. ~orth ~y the MuniCipality of Anchorage (MOA) and the State of Alaska.
~. I will install the system in accordance with all MOA codes and regulations~
and in complian~e with the design criteria of this permit.
~. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adj~acent or nearby lot.
4. I understand that this permit is valid for a maximum of ~ bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
T~EN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILdS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT: AND (~) THE
ELECTRIC~G'd~3~MUSTBE DON~ BY A~.-LJ~CENSED ELECTRICIAN. '. X
S I GNE ~~~]~._ 'DATE: ~y~/~/
APPLICANT: STANLE~/~ICKLES --~ - ~- .... y ......
ISSUED BY _~___~. _~z~-~__~ DATE:
· ~. i i"~ ........ ~ ............... ...... = ........
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEE~
PERFORMED FOR:
LEGAL bESCRIPTION:
1
2
3"
4-
5
6-
7-
8-
9
11
12
13
14
15
16-
17-
18-
19-
20-
DATE PEREORMED:.
¸/.3
t/zo
COMMENTS
Township, Range, Section:
SLOPE SITE PLAN
WASGROUNDWATER
ENCOUNTERED? ~
IF YES. AT WHAT Iq' ~
DEPTH? ~
E
Depth l~WJter~er ~A
M~ni~ing?
Reading Date Dross Net DePth to Net
Time Time Water Drop
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN __ FTAND FT
PERFORMED BY: A~=C~ "~'' ~ ~=~" ~Z~?/ I ~ CERTIFY THAT THIS TEST WAS PERFORMED iN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
~)'. 72~-008 ( R er. 4/85,