HomeMy WebLinkAboutMUNSON LT 3"*OS t-- 0 (t.- 9,.'3
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmenlal Health Division (~)--/ ~ /
825 "[." Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SFWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
27
Address
Phonejs) J ~)ernuJ No No of Bedrooms
/~-- SEPTIC
Manutact[,er
[] HOLDING
TYPE OF SYSTEM
TRENCH ~BED [] W. DRAIN E~ OTHER
Fill adoed above original grade
Gravel width
~/~. FT
SOFT (,~ F'
WELLS
PRIVATE [] OTHER (Identifv)
FT Cased to
FT
~:'"~'--- TO
FROM ~
DISTANCES
SEPTIC ABSORPTION
WELL
-- LOT LINE
TANK FIELD WELL
AS-BUILT DIAGRAM (Show Iocahon el well. sep,c system property hnes. Ioundabon,
drweway, water b~dtes, otc}
REMARKS:
scale: ~ .9,
Inspections Pelforrned by:
Date:
$ & $ ENGINEERING
I -1-7034.-Ea-gie-Eq~er-l-eeP ~J-E~. 204 cerlily thai l~ inspec~n was i)eflormed according Io all
Z2-013 (3/85)
D N !5 I T Iii[ S E kl E I:? P E R M I 'T.
Own e J" N,~m(.:,'.:, ~: L.O I !5 I"ILJNSON
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~:0"~y en :l.~ii-g~)ment t,~:i. 1 ].r'equi r.~.~.:, an addit:i.c,"h~t pc~,r'm:i.t,,
',- .................
SCALE
Z
/ ?0. 70 ·
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PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DA'rE PERFORMED:
LEGAL DESCRIPTION:
10
11
12
13.-
14-
15
16
17
18
19
20
Township, Range, Section: ~-~¢f,~ ~\~,,~ ~, ~
SLOPE SITE ~LAN ~'
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT 0
DEPTH? p
E
Depth to Waler Alter
Monitoring? ~
Dale:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ~
---- (minutes/inch) PERC HOLE DIAMETER __
~ TEST RUN BETWEEN ~FTAND FT
: .... ' Y' I ,' ~ ~ CERTIFY THAT~IS TEST~AS PERFORMED IN
Eagle River~Alas~a ~zz ~ /' ~ ~ -
ACOORDANCE WITH ALL STATE AND MUNICIPAL GUIDEL~FEOT ON THIS ~ATE. DATE; ~ ~
72-oo8 (Rev. 4/85) ~ ~ ~ '