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HomeMy WebLinkAboutT12N R3W SEC 33 LT 217TI2N R3W ec.33 Lo'l' 217 018-331 -14 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP121238 PID Number: 018-331-14 Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑■ New ❑ Upgrade Name: Michelle M Kern & Ronald P Joslin ABSORPTION FIELD ❑ Deep Trench N Shallow Trench ❑ Bed ❑ Mound Address Po Box 1710 Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 907-244-0089 4 JTotal 1.2 GPD/SF 9.8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.8 Ft. Gravel depth beneath pipe 4.0 Ft. Subdivision Block Lot 217 Fill added above original grade 0.5 Ft. Gravel length 50 Ft. Township Range Section 12N 3W 33 Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 500 Ft 2, 1 Ft. Well >100' >100' N/A N/A >25' TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Tank Capacity 11250 Gal. Surface Water >100' >100' N/AN/A Material Number of compartments Lot Line >5' 10' N/A N/A Steel 2 NA Foundation >5' >10' N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain None Noted Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer Owner Drainfield D3034 CO/MT D3034 Inspector Mike Anderson BENCH MARK (Assumed elevation) 100 ft Inspeection 15` 8/23/12 9/15/12 Location and description 2°° 3id 4th Bottom of siding South wall of house COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date • r k i ,•�•g�Q�• • ' �9��� *' AQ LTH ... .......... '. Benj in Schiller • ApprovedZ �� Date 1 i 9 j CE 12592 •4/ �1F°Yor_so'�`,:~ Inspection Report_9-1-12.doc T12N R3W SEC 33 LOT 217 PERMIT # OSP121238 PID # 018-331-14 i/ I SHOP D FC 50'x 5'WIDE x 4' EFFECTIVE DEPTH A O1N1 ......... ... •. Be ' min Schiller ��F •,. CE 12592 •�`�i , C�il'l •., Nov 28, 2017 .••Cj�Aw WELL �' FC01 \ 34.4 7.5 FCO2 11.5 08.6 SV1 51.2 34.2 SV2 54.3 42.2 2CO 57.7 49.4 1 C01 87.0 81.5 1 MT1 1 63.0 77.9 1 CO2 1 57.0 77.0 4 BDRM HOME C _ B FCC A — INSULATION UNDER DRIVEWAY i SV1 1250 -GAL SEPTIC TANK SV2 2C0 r. TH1 C –TH2 MT1 C01. • ALTERNATE SITE DORA AVENUE 0 50 100 FEET 1 LEGEND MT - MONITORING TUBE FCO - FOUNDATION CLEANOUT TH - TEST HOLE SV - SEPTIC VENT CO - CLEANOUT MH - PUMP STATION MANHOLE PT - PERK TEST T1 2N R3W SEC 33 LT 217 PERMIT # OSP121238 PID # 018-331-14 O F— U� 91.5 FINISH GRADE � 91.0 ORIGINAL GRADE 85.2 DRAINFIELD ROCK ~— 81.2 r 50'- 75.0 0'-75.0 c� 2 NO GROUNDWATER 4/08/11 PROFILE AS -BUILT (NO SCALE) 3 O U 85.2 g.• •9 I *: 49 TH •,* Benj min Schiller • •' f �`�� ••• CE 12592 No, 29.2011 V 1ll�FOPROFESSIONP�4► Alpine Drilling & Enterprises Well Log Permit Number: #SW 111204 Date of Issue: 8-19-11 Parcel Identification Number: 01833114000 Date Started: 8-12-12 Date Completed: 8-16-12 Is well located at approved permit location? x Yes ❑ No Legal Description: T 12N R3W Sec 33 Lot 217 Property Owner Name & Address: Kern Michelle M & Joslin Ronald P PO Box 1710 Chuqiak, Alaska 99567 Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To Stick-up 0 2 silt 2 4 cobbly gravelly silt 4 49 silt 49 61 silty cobbly gravel 61 121 silty water sand & gravel 121 123 bedrock 123 426 WATER QUALITY TESTING Collfonm N e_c COU1 OOML 11I a'1 11� Nitmtas 1 mg/L Ar a ug/L 12'3V1 S Method of Drilling x air rotary ❑ cable tool Casing type: steel Wall Thickness: .250 inches Diameter: 6 inches Depth: 124 feet Liner Type: _ Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 95 feet Pumping level: feet after 2 hours pumping 2 gpm Recovery Rate: 2 gpm Method of Testing: Air li t Well Intake Opening Type: ❑ Open End x Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite granules Volume: 2 bgs T'i--+I.. Qt art /1 Capt CtnnnPA 7 rapt Pump: Intake Depth feet Pump size hp Brand Name IIWell Disinfected Upon Completion? x Yes ❑ No II Method of Disinfection: chlorine tablets Comments: possible to perforate at 121 to 123 TOC 2 gpm. Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage AKAlaska Development Services Department Building Safety Division On -Site Water & Wastewater Program �G� �" 4700 Elmore RoadX P.O. Box 196650 " Mark Begich Anchorage, AK 99507 s A U T Y Mayor www.muni.ora/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW 111204 Date of Issue: 8/19/2011 Parcel Identification Number: 01833114000 ......-_.------ Legal Description Property Owner Name & Address: T12n R3W Sec 33 Lot 217 11 Michelle Kern & Ronald P. Joslin P.O. Box 11 Pump Installation Date: 7/12/13 Pump Intake Depth Below Top of Well Casing: 414 Pump Manufacturer's Name: Goulds Pump Model: 7GS15 Pump Size 1 1/2 lip Pitless Adapter Burial Depth: N/A feet Pitless Adapter Manufacturer's Name: N/A Pitless Adapter Installer: N/A Well Disinfected Upon Completion? ✓Z Yes ❑ No Method of Disinfection: Chlorine Tablets Comments: Pump Installer Name: Aarow Pump & Well Service, LLC P.O. Box 110496 Anchorage, AK 99511-0496 feet Chugiak, AK 99567-1749 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Permit Number: Tax Code Number: Work Type: Permit Effective Dates: Design Engineer: Subdivision: Site Legal Address: Owner/Add ress: On-Site Water & Wastewater System Permit OSPl11204 01833114000 WellSeptic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Initial August 19, 2011 to August 18, 2012 ANDERSON ENGINEERING T12N R3W SEC 33 T12N R3W SEC 33 LT 217 G:3135 KERN MICHELLE M & JOSLIN RONALD P PO BOX 1710 CHUGIAK AK 995671710 Site Mailing Address: Lot Size in Sq Ft: Total Bedrooms: 108900 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On-Site Water & Wastewater Program Mayor Dan Sullivan Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0i~5~i-i~¢ Property owner(s) /V},c..~I,~='" 144;;_~ ~ ~M¢ Day phone Mailing address ~0 ~ iTlO ~C,~ ~1~ Site address ~ ~ ~ ~ ~ ~ Legal description (Sub'd., Block & Lot) 'T I~,,~ Legal description (Township, Range & Section) Lot Size /~,~ ~O 0 Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: ([~ all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage THIS APPLICATION IS AN: Initial [~ Upgrade [] Renewal [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) ! e~/Rush Fees: '~ .~",c "- / ,'~C¢0 - Waiver Fees: ~ -- Date of Payment: ~ l t,~ ~ ~,t Date of Payment: Receipt Number: E ,~--~,-~'~© Receipt Number: Permit No. C:'~i:~ i ~t~-C'~ Waiver No. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 ) ANDERSON ENGINEERING P,O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 9, 2011 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: T12N, R3W, Section 33, SEl/4, Lot 217 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of the subject lot intends to construct a new four-bedroom home on the property with a shop. We are therefore requesting a permit be issued for the construction of a new well and septic system to accommodate the home and shop. The attached Site Plan and backup documentation identify the location and configuration of the proposed well and septic system along with the alternate site. No existing wells or septic systems are closer than 100' from the proposed well or septic system. The proposed house location is at the end of an existing road with no development in all directions. Drainage arrows are shown on the site plan showing the grade and direction of flow on the lot. The drainage pattern will not be changed as a result of this project. The test holes placed on the tract in the area of the absorption trench and alternate site indicated sand and silt (SM) with some gravel. The percolation rate of the soil was determined to be between 1 and 5 minutes per inch. No groundwater was found during the placement of the test holes and none was noted during the monitoring period. An application rate of 1.2 gallons per day per square foot was used in the design of the absorption system. We are proposing to place a new 1,250-gallon septic tank and a 50' long by 5' wide by 4' effective depth absorption trench to treat and dispose of the effluent generated in the house. The elevation of the distribution line in the absorption trench will be 6' below the surface and the total depth will be 10'. A minimum of 3' of fill or 2" of insulation and 2' of fill will be placed over the absorption trench and 4' over the septic tank. The ground surface on the lot in the area of the absorption trench slopes to the east at a grade approximating 10%. The new trench will be constructed parallel with the contours of the slope as much as possible in conformance with Municipal requirements. T12N, R3W, Section 33, SEll4, Lot 217 August 9, 2011 Page Two The new septic system will be constructed a minimum of 100' from all wells and any surface water and 10' from the proposed and existing water services in the area. If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments T12N, R3W, SECTION 33, SE 1/4, LOT 217 DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home 5' Wide Trench System Perc. Rate: 1-5 Min./Inch 1,250 Gallon Septic Tank Application Rate: 1.2 GPD/SF 4' Drainfield Rock 4 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 500 SF Absorption Area 500 SF/5 SF/LF * .5 (Red. Factor) = 50 LF Trench Length THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench at the Location Shown. Flow Line Elevation in Trench to be 6' Below Original Ground Surface. Total Depth to be 10' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Maintain 100' Separation from Wells in the Area. 1011 Natural Backfill Geotextile Fabric O__ 4" Perforated PVC (Holes Down) Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION (NO SCALE) ~-~.:...' , --..~-~, NOTE: Grade Area Over Trench to Drain Away. · Minimum 6' Separation From Bedrock. ~ Minimum 4' Separation From Groundwater. ~ Minimum 100' Separation From Wells in the Area. ~.~ MICHAELE. ANDERSON Minimum 100' Separation From Su~ace Water or Streams. - ~% No. 0~4~,~ Municipality of Anchorage ~, ~_~o°' . '.7,~ ~. i Development Services Department I ~'.'~., _ I~ -~ I Building Safe~ Division On-Site Water and Wastewater Program I~, , 00,,more.oa, . P.O. Box 196650 Anchorage, AK 99507 ~.ci.anchoraqe.ak.us (907) 343-7904 Soils Log - Percolation Test Pedo~ed For: osun and Michelle Kern Date Pedo Legal D~scripti0n: Section-33;-Bb. Mbot 2¢7 ................. -~- ..... TownshiP, Range, Section: T12N R3W Sec 33 .... Slope Site Plan 7- 8- 9- 11- 13- 14- 15- 17- 18- 19- 20- WAS GROUND WATER ENCOUNTERED? NO IF YES, AT WHAT DEPTH? X;XXXX Depth to Water After Monitoring? No Water Date: April 8 Reading Date Gross Time Net Time Depth to. Water Net Drop TH I 4/3/2011 PERCOLATION RATE 2 (minutes/inch) PERC HOLE DIAMETER inches · ~ '- 'TEST RUN BETWEEN 6.5 FT AND ..' 7 FT "J COMMENTS PERC CAVITY WAS PRESOAKED PERFORMED IN ~ACCORDANCE'WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: f,~ -il -i I Performed For: Legal Description: 10- 11- 12- 14- 15- 16- 18- 19- 20- Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road , _ P.O. Box 196650 Anchorage, AK 99507 www. ci.anchoraqe.ak.us . (907) 343-7904 Soils Log - Percolation Test Ron Josun and Michelle Kem Section 33, BLM Lot 217 Townshi Slope WAS GROUND ~1 /ATER ENCOUNTERED? NO IF YES, AT WHAT DEPTH? XXXXX Depth to Water After Monitoring? No Water Date: April 8 ~ , ~.~, CE - 438 ] .,~ Date Performed: March 29, 2011 ,, Range, Section: T12N R3W Sec 33 ., Site Plan - 0 P E Reading Date Gross Time Net Time Depth to Water Net Drop TH 2 3/29/2011 18:38' 7,5 inches ......... PERCOLATION RATE 4.8 (minutes/inch) PERC'HOLE DIAMETER 8 inches TEST RUN BETWEEN ~/'~'~ FT AND ~ FT COMMENTS PERC CAVITY WAS PRESOAKED PERFORMED IN ACCORDANCE STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'- ~ -/*! ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: T12N, R3W, SECTION 33, SEll4, LOT 217 GENERAL: The scope of this project includes the procurement and placement of a new 1,250-gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 50' long X 5' wide X 4' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 6' below the existing ground surface. Total depth of the trench will be 10' below the existing ground surface. The new absorption trench and septic tank must be placed a minimum of 100' from all private wells and any surface water in the area and 10' from the water service line on the lot. A minimum of 3' of cover is required over the absorption trench and 4' of cover over the septic tank. A cleanout must be placed every 50' minimum between the septic tank and the absorption trench. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department Building Safety Division On Site Water and Wastewater Program for system installations. Owners installing their own systems must receive prior approval from the On Site Water and Wastewater Program before beginning system installation. SEPTIC TANK INSTALLATION A new 1,250-gallon septic tank must be procured from an approved source and installed at the location shown. The cover over the tank shall not exceed 4' unless approved by the tank manufacturer. T12N, R3W, SECTION 33, SEll4, Lot 217 August 9, 2011 Page 2 of 3 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below the distribution line must be perforated. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. T12N, R3W, SECTION 33, SEll4, Lot 217 August 9, 2011 Page 3 of 3 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. OAAB-HD- I GRP'-~TER, ANCHORAGE AREA BOROUGH, HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION SEPTIC TANK: 3vY- .2 LEGALDESCRIPTION ,L~T Zl7 ~, ~~ DISTANCE FROM WELl ~LIQUID CAPACITY J ~ (..) 0 GALLONS. NUMBER OF J MATERIAL ~..) !,.) C,/4~ ~- ~'7~ COMPARTMENTS .~/~"-~{'"'~/~ ;~'~ LIQUID INSIDE LENGTH INSIDE WIDTH DEPTH NUMBER OF PITS LINING MATERIAL SEEPAGE SYSTEM: SEEPAGE PiT: J OUTSIDE DIAMETER NEAREST LOT LINE /,()~¥~'"~g OR WIDTH . DISTANCE FROM WEL[ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA} , LENGTH , DEPTH , BUILDING FOUNDATION SQ. FT. TILE DRAIN FIELD: , FOUNDATION DISTANCE FROM WELl ABS H LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILl' TQTAL LENGTH OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE WELL: LOT LINE J~/¢' ("/~ ~/' J'~/~/J-" / ~D J ST A N C E FROM TYPE L~-'LJ J(A~T[,'j)/~'J DEP1'H , BUILDING FOUNDATION. NEAREST SEPTIC SEEPAGE , SEWER LINE , TANK , SYSTEM WATER SAMPLE CESSPOOL ., NEAREST OTHER , SOURCES DISTANCES: DIAGRAM OF SYSTEM APPROVED ..~/ HEALTH AU[HORITY )ROVCU HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT GREATE NCHORAGE AREA NAME OF APPLICANT RESIOENCE ADDRESS MAILING ADDRESS~'~'' ~k-~q --~,~ ~-/~ PHONE NO. LOCATION OF INSTALLATION ZDggJ¢/C Z~/,~/d'/dg'/-~ LEGAL BESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~C- L-]---~ SEEPAGE PIT. / ,DRAIN FIELD TO BE INSTALLED BY ~-.Z~/~' .~RCO'L-~ION~T, EST RESULTS. ANTICIPATED DATE OF COMPLETION '~'": '~/'~ 4 Z~ ~/'~L~.,~RELOW TO BE FILLED OUT BY HEALTH DEPARTMENT , OTHER THIS IS TO SERVE AS /~, 7A , PERMIT TO INSTALL A Ag DESCRIBED BELOW. SIZE 0F UNIT TO BI SERVED :S ~ . SEPTIC TANK SIZE /~0 ~ TYP~4~SEEPAGE AREA '~'~n/ TYPE :~ ' : DIAGRAM 0F SYSTEM DISTANCES: ~{ealth Authority that ! am t'amJ]Jar with the ~equkeme~ts o£ Greater A~cho~a~e Area Borough Ordinance No, 28-68 a~d that the LaboYe described system Js Jn accordance with s~Jd code. DATE ~/,~//~' APPLICANTS SIGNATURE (~/~/ r~ ~// ~ ~('. / ]REATER ANCHORAGE ~REA BOROUGH HEALTH DEPAETMENT 32? EAGLE STREET ANCHORAGE, ALASKA 99501 · CASE Thzs Form Reports a: Soils Log._..~. i'__ ' :Percolation Test._._._ - ...... Depth . . Feet Location Sketch Was Ground Water Encountered? /1//~ If Yes, At What Depth Reading I Date Gross Time Net Time Depth To H20 Net Drop Prop)sed Instal~Seepage Pit / Drain Field Depth Of lnlet COMMENTS: Test Performed Data Certified By~~~ Date