HomeMy WebLinkAboutT12N R3W SEC 33 LT 121
NAME
MAiLiNG ADDRESS
LEGAL DESCRIPTION
LOCATION
~L~q. ~apaciW m flallons/ IF HOMEMADE Inside langth
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH 84 ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchora~]e, Alaska 99501 Telephon~ 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE : ' ~']' NEW
..... [] UPGRADE
Well
DISTANCE TO:
Nm. of lines of each line
/
[ Dwelli~g~,~ /
Width
~'~, I '~',~ ~ inches
NO. OEBEDROOMS
PER IT NO.
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Material bcneaLh tile
~/ ~ · inches
Length Width Depth
Total effective absorption area
//~3-
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot tine
DISTANCE TO:
Class Depth DriHel Distance tq lot line PERMIT NO,
Building foundation Sewer line Septic tank Absorption area(si
DISTANCE TO;
OTHER
P~PE MATERIALS
S.OI L TEST RATING ~
(I Z..¢ I~? z.t'¢ ~CFo~-~)~t~ "~-
INSTALLER
f ~-/-, e~7
REMARKS
APPROVED
DATE
LEGAL
t.4,=_,,
DA'TiE 111SSUED: ~ 6/,~: ? / :h~
AF:'PL I CAN]
CONTAC]' F:'IaONE ~:
HARY A[-,EX ANDER
147 11 SNOW L. AlxlE
AN[]IqORAGI~, Al< 995 i6
34','5-7358
I: I. (.JCl', ,,
L i sted be ]. ow axr e t I'le opt i on s ava i 1 ab le 't.c~ you i n ties i gn i n g yc)ur sept i c
system,, Choose 'I'.I'H:~ Ol::d:.iorl that best fi{s your' site,
.~.1~.DEP'f'I'I 'TO F'II::~E BE]'I'"I"E}Iq < :.5.5 F:'T. F~EE[;!LIIRES INSULATION
· ~.,l(. DEP]TI TD P~Pli[ EI[]'I'TDM '::: 4.0 F:'T,, HAY REDIJIRE A L:(FT !BTATION
,;I.¢~. E')RAVEI... I...l!ii:lqG]"H > '75 F:'T,, RE[:;!UIF(E'S MULT:I:I::'Lf~ RLH'.IE~ (NOT EXCE:EDIIxlG 7L5 F'T. EACH)
'~'~ TANK MLJD'T I"IAVE AT LEAST TWO COMI::'ARTMEIxlTB
c:(~!l' '1:. i f y 'Ll'la'L:
J.,, I am {'ami. ]. :Lap w:i. th the re!r:lUj, l',E)illerrL!i~
for' on..LsJ. C[~ smwers and wr~.~:l, ls as set
for-th by the Municipality of Anchorage (MOA) arid the St'.ate c:)l' Alaska.
;~-~. I will :i. ns'Lall the sys'Li[~m in a~:c:c:mdance with all MOA codes ar'id regulat:.ic)nsh,
and'in compliance with the design criteria of this permit.
3.. I wi].1 adhere to all HOA and Stat:.e of Alaska requirements l'c,' thc) set back
distancec~ f'r'om any et¢isting well, wastewater dJ. sposal sy~)~tem or pub].ic
sewc~rage sysLem on this {31', any al:l.j~liglF~nt op I']E.)a]Pby 1c)'}.,,
any erl:LargemenL wi ]. ]. I'(al::lL(J. r'(e an addit:[c]rla], permit,,
L..:[I:::'I" STATION 1,a INS]'AL..LED IN AFl AFcEA COVERED BY H[]A BLIIL.D!IxlG [][)DES,
(1) AN I.I...L.E,I[~].C~L. PERMIT AND iNSPEC',T]:ON MLIST BE OBTAIIxlED:. (2.) A,.~u"'"'
NO'f' BE AF'I:;'ROVED WI'I"HDU'T nlq I::.I-.EE,[I'~].CAI.. IN~I-E.L,I.I,E,IN REF'OR"I'~ AND (3) THE
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Ancl~orage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
SiTE PLAN
ASO.OU DW^TER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
(minules/inch)
COMMENTS
TEST RUN BETWEEN
CERTIFIED BY:
FT AND ~ FT.
72-008 (6/79)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of GeologJ¢ol 8~ Geophysicel Surveys
D?illing Permit No.
A.DL. No.
~ A.ger ~defte. ~Bored ~Other:
~ irrigation ~ Recharge ~ Co~motio~
diam.~ , to~- It, Depth WeJghl ~.lbs./f
STATIC WATER LEVEL: ft, / /
~ Above or ~ Bolow land surfoco Dote
Equipment used: