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NAME
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
PHONE I [~NEW
~PGRADE
MAILING ADDRESS
L E G l~J.. DESCR I~T..I O N
LOCATION
] WeJ]~ / Absorption area !
o I DISTANCE TO'. ] ~O
~ ~ Manufacturer
~~-~lLiq' ~Pbtb~""°n~ IF HOME'A-DE: Inside, length
~ ~ ~sTANCETo: ~Wel, ~ /~ Dwelling
~ Well Foundati
~ ~ Z I No. of lines ~ I Length o~ea~li~e Total length of ~nes
~ I~ ~P ~i~ ~ fish grade ~ / Material beneath tile
w I Length I Width Depth
w~ DISTANCE TO:
~ Well / Building foundation
~ ~Class~ ~ _, ~ (~ __// Driller
Dwelling,~z_
Material
Width
Material
Nearest lot I~
NO. OFBEDROOMS3
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effective absorpti~J~ area
PERMIT NO.
Total effective absorption area
Nearest lot line
Distance to lot line
Septic tank
PERMIT NO.
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTAL~.ER"
REMARKS
APP'RO E
~Z-O,,I~ (Rev. 3-/78)
DATE
LEGAL
MUNICIPALITY OF ANCHORAGE
Department ~ Health and Environmenta? 'rotection
825 _ Street, Anchorage, AK. ..$01
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit ~
Applicant: X/O~~ ~ ~v~ Mailing Address/) ~
Location: - Phone Number: ~ ~~ ~"-'/,,~
Legal Description: / / ~/~ ~.~ Lot Size:
Type of Soil Absorption System Is:
Trench: ~ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
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.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
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 8 3 * * *
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~ence is~m~eled to include more th~~
Signe~: App'~ican~~ ~/~~ Issued by: ~
Date: ~./~ .~/~ ~
SWP/024 (1/81)
LOG
MUNICIPALITY OF ANCHORAGE
DI:PARTMI:NT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR: N ('~ ~--¥V~ tOc~,J
LEGAL DESCRIPTION: ~" O7
SLOPE
SITE PLAN
N
p"' r
10
11
12
13
14
15
16
17
18
19-
20-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE Al ~ (minutes/inch)
TEST RUN BETWEEN FT AND FT
COMMENTS -?..,
PERFORMED : , ~m ~ CERTIFIE
72-008 (6/79)