HomeMy WebLinkAboutT12N R3W SEC 27 LT 77 N2
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
MAILING ADDRESS
NO. OF BEDROOMS
I Well [ Absorption area Dwelling PERMIT NO,
*Z Manufacturer Q~e~, q.O~'~a~.~ ~L~ Material
~ Liq. capacity ,n gallons IF HOME.DE: Inside length ~q Width
~ ~ ~'(~) Well Dwelling PERMIT NO.
~ Matorial Liquld capacity in ~allons
qearest lot line ¢O PERMIT NO.
~ ~ DISTANCE TO: Well X X ~O S Foundation ~ Trench~d~ Distance between lines
Length of each line~ Total length of lines
~ No. of lines ~ ~ inches
-- ,~ Total effective abso~rea
~ ~ ~ Top of tile to finish grade 2 ~ O~t Material beneath tile ~ O inches
Length Width Depth PERMIT NO.
~ DISTANCE TO:
C'l~ t Depth Drg[er Distance to 1ct line PERMIT NO,
~ DISTANCE TO:
OTHER
PI E MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
('~
~aOVED ' ~ DATE LEGAL
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,~. ,EATER ANCHORAGE AREA BOROU...A
~ '¢'°""' "~' }~ DepartmentAnchorage,3330 of Environmental,,C,,Alaska Street 99503Quality
-- -- SOILS LOG - PEROLATION TEST
Legal Description:-~'~~----/~ 1~,"~, 'T',~- ~,~.1.~'~/_ .T~.. __-
This form reports: Soils log _.--¢( Percolation 'test
Depth
w
7-
10
12
14-
16-
18-
20-
Was groundwater encountered?
If yes, at what depth?
Reading Date Gross Time Net Time Depth to Water Net Drop
Percolation rate minute. [ ~1~o¢/~9~
Proposed installation: Seepage Pit -- Drain Field
Depthof Inlet ~~ , Depth to b~ttom,of, pi~o~tre~h,~ .-.
~rformed ~:~t)~ ~ ~¢~ ~~ ~~ Date: