HomeMy WebLinkAboutT12N R3W SEC 33 LT 220
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
NAME
MAILING ADDRESS
PHONE
[~UPGRADE
LEGAL DESCRIPTION
LOCATION
Absorption/~ ¢ area
Inside length
DISTANCE TO:
_o ~ ?OO
I- ~ Manufacturer
l Liq. capacity in gallons
We~lF HOME.DE:
Dwelling
DISTANCE TO:
Manufacturer Material
Well Eoundation Nearest lot line
DISTANCE TO:
No. of lines Length of each line Total length of lines Trench width
Top of tile to finish grade Material beneath tile
Width/~,
Crib
Well
Depth
Length /
~23 ./~
Typo cf
DISTANCE TO:
Depth
CKb dcpth
Building foundation
Ddller
Class
NO. OF BEDROOMS
PERMIT NO.
~ ~oo(I
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
Distance between lines
inches
Total effective absorption area
inches
PERMIT NO.
PERMIT NO,
Total effective absorRtion area
DISTANCE TO: ~uilding foundation Sewer Pine Absorption area(si
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
APPROVED DATE LEGAL
E:,EPRRTHEF,!T OF HF:.F~LTH Fff,iE:, EN'v'ZRE$1HEN-FF. iL. F'RO'FECT:r.E~N
825 "L' :S'TREE'f'., RNC:HORFIGE., Ri.(. 995Ed_
26¢-,472E~
LOT SIZE Z~EnZ;OEI SC!U
F1F'PL, I CRNT
FiT 1.: Z [",!
LEGFIi ....
'r [:¢"1 E S HOL'T
~.~ h, ,-: i I :;,:RF:E'r::'
LT. .... :2::;'~:* Tt;2N. RZ:H :::,z,..:,-'
"F'.,'PF OF =,.JiL R~S;Cff.-:'PTION '=;'¢5;TEM SS;: E:,P"-
CIF E:EE:.ROE)H%
-FI-ii: ................ F;?EZ] ZF;?F'F:, 'X; T :::='[: OF: -h~:~'"'- %(]IZ!L.
THE LENGTH [:,IP'!ENSION I'.S THE L.. ~ OF TFffE TRENCH
]"FLEE E:,EPTH OF R ]"RENCH OR F'!'T ). ~NCE: E:ETHEE:N 'THE :SURFRCE OF THE
r3ROUN[:, FH'.K:, 'FFiE: E:O'~-FOH'~ OF THE E:~N~ZJ",I FEET::,.
THE GRFI'v'EL L.~F ..... THE HINiP!UF! !..~.r ,~! ElF f'~mA',,'~:L ~E ~EE ~ THE CE.!TFFff_L PZF'E
FINE:, THE E:OT-~'OM "'IF THE E::gZF!',,,'RTZON (Ih! FEET::,.
F'ERHZ-f' Fff:'F't_:[CFINT F. Fr5 'THE mL-F ....... Z ......1, TO ZI",!F'OF:H "f'HZ% E:.EPF~RTHENT DLIRZNG THE
Eq:ii]:KFZL. L,:[NG OF RN¥ -, ,c ........ .
:,~...,TEII I.,.I:[TNCIU]" F':[NRL. T'.P:PE~TZ""t RNE:, RF'PRO'v'RL B'¢ THIS
DEF'RR]"MENT HILL E~E S_ 2 ~:2:] T TO F'ROSEC:LFF ! ON.
....... rem, FOR ¢~ F'RI'v'RTE uCE!. L OR ZSL~ TEl :...'HH FEET FROH R , I_.,...LZ .....
JF:'FIN THE TYPE OF F'UEH...ZE:: HELL.
HZNZPILIH D]:STRNC:E [ F ..... PRZ',,,'~TE HELL TO R F'RZ'v'RT.E SEHER L..ZNE ~c' ._.,:-, F'F'FT EaN[:'
OF THE HELL C3MF~..Li ZU L
i CERTIFY THFFF
Z: I F!M F'E~HILIRF: HITFI 'THE REQUIREMENTS FOR ON-SITE SEHERS RND HELL. E; FIS SET
FOR]"H B'¢ 'THE fdLINiC::[PRLZT'T' OF RNCHORRGE.
2: i HiL.L ZNS;TRLL THE: E;h"STEH IN RCCORDRNCE 14Z'TH THE CODES:.
:Z:: i i..!NDERSTF!ND THFFF 'THE ON-Si]"E SEF!ER S"¢E;TEH HR¥ REQUIRE ENLRRGEHEFEI" IF T'NE
RE.:,IDE,,IL:E I.S RE~[:.,ELEi:.. 'T3 INCL.z. IE.,E r!,.)RE rHhN ,5 E, EDRuuHE,.. ~
........... , .................................... , .................... ;"-"~4 ~ ~ ~ .....
........ ~-p,~ o~' ~ ~ la'~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
PERFORMEOPO.= /?
LEGAL OESOR,PT,ON: /~ / z z,~ ~'~,-~'
~3
Z
SLOPE SITE PLAN
10
11
12
13
14
15
16
17-
18-
19-
20-
WAS GROUND WATER SL
ENCOUNTERED? ~0 pO
E
I F YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE minutes/inch)
TEST RUN BETWEEN FT AND -- FT
72-008 (6/79)