HomeMy WebLinkAboutT12N R3W SEC 27 LT 13
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~UPGRADE
DISTANCE TO: Well
Manufacturer
NO, of lines ~ Length of each line/
I Top of tile to finish grade ~ 7
Type of crib Crib diameter
inside length
Total ~g,t,L.~f I~es
Material beneath tile
Depth
Crib depth
Building foundation
Driller
Sewer line
W dth
IMaterial
Nearest lot lin~/~ /~._
Trench widt~ ~ches
inches
NO.~EOROOMS
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.~.~/,t~ ~ 7~
Distance betw~)l//~
Total effective absorption area
PERMIT NO.
Total effective absorption area
Nearest lot line
Distance to lot llne
Septic tank
OTHER
PIPE M~.~.~L~ ~ ~ '~
SOl L T EST RAT~/~..~- ¢/
REMARKS
72-013 (Rev. 3/78)
PERMIT
RPPL I C:RN]'
LOL-:RT I ON
LEGFIL
DEPF~RTMENT OF HEFtL. TH FIND ENVZF'.ONHENT~L PROTEC:T~ON
825 '"L'" STREET., ~NCHOR~GE., ~K.
264--~72Ei
( 8;tC~678 >
THJM 4.:, F~FI~
F.' Ft', ' l :,-:: RE)
T_~.NR~...W
_ _=.,1,_, G L-,RM
EIF'I::':', -;', 6, - -
___ ,
T'gF'E OF c'II FtBSORPTION _=_TEM
f'IR::'::IMUM NUMBER OF EEDR33H$ = 2: qF~IL RATING ,::5~ FT,.'BR::,~
THE REQIJIRE[:, SIZE OF THE SOIL FIBSORF'TION S'gSTEM IS: / ~:/&.'.
THE LENGTH DIMENSION IS THE LENGTH <IN FEE?, OF THE TRENCH O,R
THF DEPTH IqF R TF'ENRH FiR PIT I'5 THE DISTRNL. E BETHEEN THE SURFFIC:E~~
GRQUN[:, laND, THE BQTTOM OF THE E).(C:RYRTION ,::IN FEET::,.
THE ~F ~ EL DEPTH IS THE MINIMUM DEPTH OF .... ~',-'~:"1 EETWEEN THE OUTFRLL PIPE
Rf'~[:, THE BOTTOM OF THE ENCRVRTION (IN FEET:).
F'ERMIT RPPLIC:RNT FIM.:, THE RE_-,FuN.:,IBIL.T~ TO INFORM THIS [)EF'RRTMENT [:,IJRING :'FIE
tNSTRLLFtTIQN IN._-,PECfIuN.=, OF FIN¥ NELL_, RDJRCENT TO :HI_, FF_FERTT ~gNE) THE
RE.=,IEEN~E_ THFFr THE HELL WILL SERVE.
NLIMBER OF' ,-' · F' q .
1HI_,
E:f~C:KFILLING QF RN'9 _-r_TEH t4ITHOLFI' FINRL INSPECTION RND RPF'RO',,¢RL B'? " '--
[:,EF'Ri:r:FTNENT WILL BE '::1 E:.fEF:T TO FRO_-,EL. LITI_N
MINIMUM DISTRNCE BETWEEN R WELL RN[:, F!N'¢ ON-SITE SEWFtGE DISF'OSRL S'gSTEM IS
ZOO FEET FOR R PR I ',,,'RTE WELL OR :t5C4 TO 2E~E~ FEET FROM R PUBLIC HELL DEPEN[:,ING
UPON THE TYPE OF PUBLIC WELL.
MINIMLIM ['.,ISTRNCE FRoM R PRI'¢FITE HELL TO Fl PRI',,,'RTE SEHER LINE IS 25 FEET RN[:,
TO R COMHUNITV SEWER LINE IS 75 PEET.
14ELL LOGS RRE REI].:!tJIRED FIND MUST BE RETURNED TO THE DEPRRTMENT t.,.IITHIN 3:E"i [:,R'gS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MR'.r' RPF'L.Y. SPECIFICFtTIONS RND CONSTRUC:TION DIRGR. RMS RRE
R',,,'FIILRBLE TO INSURE PROPER INSTRLLRTION.
F"EF-:["'I ]: T E.--.F ]: F--.E_--. E:,E,Z:Ef"IE:EF]-" ]::iL..
I -EF'fIFr TNRT
WELL-, SET
..... E WE F,'_, RND H--,
J.: I R,~'I FRMtLIRR WITH THE REQUIREMENTS FFR UN-_ITE
FORTH B'¢ THE NIJNICIF'RLIT¥ OF RNE:HORFIGE.
=':". I WILL IH_]HLL THE _9_[EH IN RF:C:I-IRF,FIN~E_ .... HITH THE UU[.,E=,.
=,~_,IEH f'lR'¢ REQUIRE ENLRRGEMENT IF THE.,
2:: I LNB, ERSTFIND THRT THE QN-SITE SEWER ~"'¢'
RESIDENCE IS RENOE:,ELE[:, TO INC:LUE:,E MORE THRN ]:BED, ROIZ~H$."
.................................................
FtF'F'LICFINI" TFIOM~ PEF'IC W~ ,' ~ O~ ~t~:[A ro 0 .-
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
{~]/SOI LS LOG
PERCOLATION
TEST
PERFORMED FOR: ~ ~'~ ~'~ ~ ~'~ '~ C~'~ ~'~
LE~A' ,~ESCR,PT,ON: y--/Z '~ /2 ~ '~'-' ._.C' ~ 7
1
2
3
4
5
6
7
8
9
SLOPE SITE PLAN
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER I~
ENCOUNTERED? '~ ~-~ pO
E
OEPT,? ~ £"¢
Gross Net Depth to Net
Reading Date Time Time Water Drop
DATE:
PERCOLATION RATE (minutes/inch)
· ,~.~ ' TEST RUN BETWEEN , FT AND FT
/z~-,~ ~ W~¥. ~,/.;~'/