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MUNICIPALITY OF ANCHORAGE
t ' DEPARTMENT OF HEALTH & ENVIRONNIENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LEGAL DESCRIPTION
Liq, capacit~in gallons Inside length Width Liquid depth
~Oz DISTANCE TO:
~Q ' ' DISTANCE TO: Well ~ Foundation ~ Nearest lot lin~ ~_ PERMIT NO.
Length Width Depth PERMIT
~ ~ Type of crib Crib diameter ' Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class
. ~ ~ ~ffC I Distance to lot llne PER~ITNO.
~ DISTANCE TO: Building foundation Sewer line Septic tan~ Absorption area(s)
P~PE MATERIALS OTHER
REMARKS
AP OV DATE LEGAL ~'~ ~N~
/ ~, ~.~UNICIPALITY OF ANCHORAGEr.,
'~-~/ Department/ ~ Health and Environmenta,--?rotection
,~ -% 825 ~ Street, Anchorage, AK. ~9501
264-4720
~//~ * * * HANDWRITTEN PERMIT * * *
Permit
,~LL AND/OR ON-SITE SEWER PERMIT C,~ f'
Location: Phone Nu~foer:
T~pe of Soil Absorption System Is:
Trench: Drainfield: ~_ Seepage Bed: Holding Tank: ~_~
Maximum Number of Bedrooms: ~ soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH LENGTH GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
d~epth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall ~ipe and
the bottom of the excavation(in feet).
· * REQUIRED SEPTIC(HOLDING) TANK SIZE : /~/~/C9 GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
ofl residences that the well will serve.
· * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
o'fZ public well. Minimum distance from a private well to a private sewer line
is]~ 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
· * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I wi~3~ install the system in accordance with codes.
(3) I ~d~nd that the on-site sewer system may require enlargement if
t~~ ~'~d~e ~s remodeled to include more tha~ 3 bedrogr~s.
SWP/024(1/81)
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
PERPORMED EOR: <~'m~ ~--O~: C%~,a.m, DATE PERPORMED:
· EG^LDESOR,PT,ON: /YE J ~V~ J 'S~C, 2S ~--~*~ ~
SLOPE SITE PLAN
10
11
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19-
20-
DEPTR7
COMMENTS
F "-~ 3;::;---
72-008 (/6 79) '~'~' .... -
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~'//~
(minutes/inch)
TEST RUN BETWEEN FT AND -- FT