HomeMy WebLinkAboutTract A (11)T
.~~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE '~NEW
MAILING ADDRESS I
LEGAL DESCRIPTION
~ ~ NO. OF BEDgOOMS~
~ ~ Manufacturer G~r Materia,~.~[ No. of compartments ~
"¢ . Liq. o~p~i&gallons IF HOMEMADE: Inside length ~ Width Liquid
depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O~ ( Manufacturer Material Liquid capacity in gallons
Q Well~ Foundation Neares~ lot line .~1 PERMIT NO.
No. orlines [ Length of each linoq~ Totallengthoflinesq~ Trenchwidtl'~,nches Distance between lines
* ~ ~ Top of tile ,o finish grade Material beneath tile Total effective absorption~e~ ~
Length Width Depth PERMIT
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
m Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
INSTAELER
APPROVED DATE LEGAL
72-013 (Rev, 3/78)
PERM I '1" NO.
F~,P F'L I CFINT
LOCFIT Z ON
LEGRL.
CENTURY 2::L-HERITFtGE HOM
ER
TRRCT FI EFfGLEWOOD
LOT' S ! ZE
1.00000 SQUF~RE FEET
T'¢F'E }F :BOLL HB.=,~l:..r TIU. 4 9'YST'EM t$: DRFIINFIELD
MFI:,:;'[J*'I..i',1 NUHE;EF.: OF BEE:,ROC]H'.:.L'; =. ~.t~-"~ E;I:]tL,. RF~I"ING (:E;Q I:' J". E,F:.. = ;.J;
F-hz. IE:EQU I I:;::E[, :5 t ZE OF 'THE !.E;O~_ F:E:::S;OF::'F'T' i ON E;.,'-/:~:;]"EH I :E;:
THE LENGTI:,~, DIMENSION tS :"NE LENGTI:..I ,::IN FEE'T) OF TNE TRENCN OR DRFIINFtELD.
TF-!E DEPTF-t OF Ft ]"RENCN [:iF,.': t":'I'T ZE; TNE D!LZ;TFit',ICE BETI.,.IEEJN 'I'F,tE :E;URF:'I:aCE O1::' 'THE
Gi::-i:Oljh![:, laNE::, THE E:OTTOM OF TF,!E E,':.::CFI',,,'F!TION ,.':IN FEET).
THE: GRFI',?EL, DEPTH Z9 TH.E I'flIN!NI:JH DEPTH OF' GRF!VEL., BETHEEN THE OUTF::FtL. L PIPE
,f:If',!D "[NE BC'ITTCIJ'"t OF' THE EXci:aVRTION (IN FEET).
PERHI'T' thPPL IC:!aNT HI:aS 'THE RESF:'ONSiBtL Il""/ TCt INFORM THiE; DEF'FiI:;::THEN]" [)UR:[BiG TNE
I N'.E;T'FIL. LRT I ON I NSPEC:T I ON:.T:, OF F:kN'Y HELL:F5 R[:'JRCENT T'O TH I :~]; I::'ROI:::'ERT'¢ FIND THE
NUHBEF:: OF RESIE:,I:ENCEL5 TNF:FI:' TNE HEI..J._ WIL. L SERVE.
.................. 'T' _~..,..~ ,C:} ,:::: ;;D:.': :::* :E IPd! ~J:.:.'; F" EE EZ: T' $: ICZ* ~'-,,] %:;; IFZ~ F;.r.'~" EE ~j:;h:.". [Fi C-;:~ L_tt :]:: IF;;;:: tE:_":: ~:;;.::,, .........
BFiCKF:' i' L.L. I NG OF FIN'./ SYSTEM I.,.!I'THOLFf' F I NRL I N?;PEC:T I I:]N FaF,E) RPF'R(]',/F:IL I:.:;"r' TF'II S
I:.':,EF'FaRT'MENT [,.l IL(.. E',E LE;UBJ'ECT' 'TO PF.:OSECL!TZOJ'.4.
HINIt',!UM DIS"f'.~:iI',!CE BETHEEiN F:I 1.4ELL. R.ND FiB,lb.' ON-SITE SEHFaGE C, tSPOSF!L S'¢STE:M IS
:1. OO FEE'T F'OI:;i: I:::1 F:'RI',/FfTE HEL.L Eft;:: ±50 T'O 200 F'EET FROt"! Fl F'UBLIC HELl.... [.':,EPEND!NEi
UPON THE 'T'YI::'E.' OF' PUBLIC HELL.
M!NZHUM [:,ZSTBNCE: I::'F;,:OM fi PRi',/FiTE: F. IEL..L TO FI PRI'v'R'TE SE:HEI:;:: LINE
T'O F! C:OMHUNIT'f SEHER LINE: ILq 75 FEET.
O'T'HEI:;:: REE:!UIF~:EF!EF.iTS HF¢?' FIPF'L"¢. SPECtF'IC::RTiONS laND CONE;TRUI::YT'ION E)IFaGRFIMS
Fq'v'F.I I LF~.BLE: 'TO ! !'.4SURE: P.ROI:::'ER ! NSTI'hL.i..,.FiT I ON.
I CE!Z-.:T' i F'"r' THRT
1: I RM FFff'!ILIIqR HtTH 'THE REQUIREMENTS FOR ON-E;tTE %EF.IER'.E; FIND HELL. L::i; I:::1'_::.:; :[:';ET'
FOR't"!"! E:"/ THE J"tUN i C I PR[_ Z T'¢ OF RNCF-IORI::IGE.
:.:2:: Z HILL iNE';TFIL!.... 'TN[ :F.:;'-¢f._";TE:M Ih,! E~.C:CORE:,FINCE HZTH TF.IE c:Or}E:E;.
]:: I LJF,I.!.')EF::S]"I:aNE) 'Tl:-ffaT' TNE ON-SITE E;EBiEI:';~: :E;'.r'~-~;TEP! Mi:::t'Y RET.:.:¢JIRE I:~:NL.F:!F,..:GEMENT tF ]"HE
REF.'..E;IDENCE I:~]; REMODEL. E[) TO iNCUJDE HORE ]'HF:!N 3 BEE)ROOMS.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9-
10-
11
12
13
14
15
16
17
18
19
2O
.;
DATE PERFORMED: ~ /7.-~/~. ,~
SLOPE
SITE PLaN
WAS GROUND WATER NO p.
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
+ ~..~.o
PERCOLATION RATE
TEST RUN BETWEEN ~/~-~ . FT AND
(minutes/inch)
FT
PERFORMED BY:
ALASKA ENVIRONME~.TAL
CONTROL SERVICE~ ~C.
1220 West 25th Avenue
ANCHORAGE, ALASKA 99503
Phone 276-1361
SHEET NO. OF
CALCULATED By ~_/~~1~ (~ ~:~ ~ ~{' j~j ~? DATE
CHECKEO BY DATE
SCALE
~'"'"'"'~"'~ ~ i i i ...... i ......... i ~ i ....... i ........ .......
....... ~. ~ . ~o ~,~ , , , , ~ ~ ~ .............
.......... ~ ~ ....... ~..~....~.~.~ .~.~.~/~.. ........... ~~ ~ ~~ .........
· ~ ~ ............ ./=~ ~ ~..~....~ ~ ~ ~ ~ ~ ...................... .~..~....~
~ ~~ ~; ~ ~ ....... ......... ~~ ....... ~ ~ .......
~ ~ x~- ~ ~ [ ............ ~ ........... ~ ~ ? ~ ~ ................... ~ ........
?'7~ ~ ......... ...................... ~ ~ ~ ~ ....... ~ ...................... ~ ~ ~ .......
......... ~ ~ ~' '~ ~ 2 ~ ~ ~ ............ ~r ~ :. ~ .........