HomeMy WebLinkAboutKNIK HEIGHTS BLK E LT 8 MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES (~17 --771 - ~'~
Environmental Health Division
825 %" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
.a~ DISTANCES
Address TANK FIELD
Phone(s) [Permit No. No. of Bedrooms WELL
Lot ' Block Subd~ ~
Township, Range, Section AS-BUILT DIAGRAM (Show Iocabon ol wml, septic system, properly Jmes, loundahon,
TANKS N
~SEPTIC ~ HOLDING
,..
Gravel width
~umber of lines ~ Soil ra~,ng , P,pe maleria~
~PRIVATE ~ OTHER {Identify1
Installer Date Inslalled:
Inspections Performed by:
_ 5 & S ENGINEERING cedily that t~s inspection was pedormed ~ccording t~ all
Health Depadment Approval: I ~
72-013 (3/85)
.',: c:wl'.h }::i? 'l:he hh..u"~ :i.c: :[pa.~. :i.t.y o~' ¢:inchi::,r',:~.g~:-, (l'lCi¢~) and L. ho S'l'..,'.:'hc:.~
<'.: :l ::::c) :w:d<::,l'::::'Lar"~d 't'..i'"~a'{' 't'.he (:::,:,~.F)<'::~c::i'L't (:)J '{,l'~::) 't'.c)'t:.a.]. s::y:::'Lem :i::: 4 l::)(.::.)<::tl'(::)(:::¢'[::::: and
.,:r'~,>/ ,::,>n I .::,.:-.c.~c.?m~:ar"H'. ~:i :f :J.?,::.)qu.:i r'.(:, a. rl add :['t'..:i,c:na] I::,<.:,F. mJ.'L ,,
.:::: ,i. '.::! r': c.:',,::J :~ :~ : :~ ~ ....... ~', .................
SCALE
Municipality ot Anchorage
DEPARTMF_NT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Township, Range, Section:"~-I "~r~ ~ ~-- ~d.~. ~-'~
SLOPE SIT~ PLAN ~
10
11
12
13
14
15
16
17
18
19
20-
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? P
E
Depth Io Waler ~lter
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE i'~. ~ (minutes/tach) PERC HOLE DIAMETER __
TEST RUN BETWEEN FT AND -- FT
COMMENTS ¢~iJ~.~~ ¢~ ' ~---~( / ~ '~/~'./~r'
PERFORMED ~A.. GLE RIVER~ AK 99577 ~/ CERTIFY THAJ THIS TEST WAS PERFORMED
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN~N EFFECT ON THIS DATE.
72-008 (Rev, 4/85)