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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 P~I ION E ~J~IEW
LEGAL
DESCRIPTION
Liq, capacity in gallon~~ ~O IF HOME.DE: Width
~ Manufacturer~ ~ Material Liquid capacity in gallons
-- Q~--~ Foundation Nearest lot line PERMIT NO.
~ Z DISTANCE TO:
~ ~ ~ No. of lines Length of each line Total length of lines Trench idth Distance between lines I
Length Width Depth PERMIT NO.
~ Type of crib Crib d Crib depth ~ Total effective absorption area
u~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ ~ass ~ Depth Driller Distance to lot line PERMIT NO.
m Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO'.
OTHER
~EMARKS
PERHIT NO.
DEPARTMENT OF HEALTH Rl"q~, EN',/~RONWENTI=IL PRO]'ECT~ON
825 "'L'" D;TRE~T, ANCHORFIGE, RK, 9950:1..
264-4720
I';[I~'F:'L I OAN'r
LOOR]'I ON
LEGAL
[>ONAL[:, [;'OSTER
JEFF CIRCLE
LE; %KYVIEI.4 ESl'
SRFI i764C
"F'.r'F'E OF '.=-;[)IL.. RBSORBTION 5Y~TEH I~: DRAIN[=IELD
L.OT S;IZE
,¢'" /:-.2-
]:49
±98S6 SL=.!URRE FEE'f'
i"IRX;[HUI,'I NUHBER OF BE[)[;~OOI,'1% = 3:
SOIL. RATING (E;J';! F'T.-.'EI¢:)= ]'..'.~:0
THE REQUIRED SIZE OF' THE SOIL RBSORF'TION 5'¢S"FEN
[:. E: P' ~[' t--tTM iF-~ L E-] 1'-.t IG 'T' F-I~=, :~L :-:[: ::;"., ;:2: f.]i ~ FI %." E IL. [::. E F:' -F In'nil:=: :Z:
TI,-IE LENG'T'H [:'IMENSION IS ]"HE LENGI'Iq (IN FEET) OF: THIE ]"RENCH OR DR[:tlNFIEL[:,.
TI-hIE DEPTW OF A TF:'.ENCH OR PIT IS THE DISTANCE BE'F!,.IEEN THE SURF'RCE: OF:' THE{
GI;40UN[.', FINI,) THE BOTTON OF I'HE E:,qC:A',/AT[ON (IN FEE'[').
II f",.Ei',IL-~- I I-'-! ][ [:"'IFFI1 Il
nl"l."llE UI,14 /EL DEPTH IS TFII'L' M INIMUH [:'EPTH OF GRAVEL... BETI'4EEN THE OUTFRI. n.L. PIPE
laND THE BO"FTON OF"'" THE E',:'.;C.'AVATION (IN F'E. ET).
PERI'qIT BPPLICRNT HFIS; THE RE'S, PONSIBII..IT'¢ 'FO INFORN TFIIS DEPAR-I,'MENT E:,LIRING THE
~NSTALLFrfION IN.2;PECTIONS OF FIN'T' WELLS FIDJABENT "['0 'f'I,-I[S PROPERT'¢ ANE:, THE
NI.JNBER OF [;.:ESIDENCE:L:; TH'I:TT TNE WELL !-4ILL. .C.;EF:'.VE.
E:FIC:I'::;FIL. L. ING OF AN"' S'¢s'rEN WITHOUT FINAL.. II"ISPECTION AND AF'F'ROVAL B'¢ THIE;
[}EPI=IRTNENT WILl,... BE. SUBJECT nFO PROSECUTION.
HINIMUN DISTANCE BETWEEN R WELL AND 819¢ ON-SITE SEWAGE DIS;F'OSRL SYSTEM
:[.00 FEET FOR R PRIVATE I,.IEI,_L; OR
i.SE~ TO ;:;~:00 FEET PROH A PUBLIC WELL DEPENDING UF'ON TI,nlE T'.r'PE OF PUBIn..IC WEIJ ....
OnFHER REC.]UIREMEN]'S i'qA'¢ RPPL'¢, SPECIF'ICRTIOi"IS AND CONSTRUCTION DIRGRRi'4'='.4
[:¢/A]iL..ABLE 'FO INSURE PROPER IN'-=;,TALLATIOi'4.
I C:ERTiF"r' THFIT
::L: I FIH FAMILIFIR WITH THE REQUIREMENTS FOR ON-S;ITE %EWERS Ri'eD WELLS FI'-':-:; SET
FORTH B'¢ TWE MLINICIF'RL..ZT'¢ OF RNCHORRGE.
2: I WILL INSTALL 'I,'FIE S'¢S'FEM IN ACCORDANCE WITH THE Or..'iDES.
2.":: I UNE:,ERSTAND THAT TI,-IE ON-SITE E;EWER S'.,"STEN f'lA'.r' REC41.JIRE E:NI,..RRGEHENT IF' TFIE
RESIE:,ENCE I'.5 REi"IODELEI,) TO II'.,ICLUDE i'.'IORE 'FFIF:~N ~ E:E[:,ROOMS.
APPL I CFINnr [:'ONALD FoS'rE:-'R
): 5;c_;I.IE[:, , .... ,~-.
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch G-B50, AnChorage, Almska 99502 276-~22'J
SOILS LOG -- PERCOLATION TEST
PERCOLATION
TEST
LEGAL DESCRIPTION:
1
2
3
- 4
5
6
7
8
9-
SLOPE
SITE PLAN
10-
11
13-
WAS GROUND WATER
ENCOUNI'ERED?
IF YES, AT WHAT
DEPTH?
14-
15-
16
17
18-
Reading
Gross Net Depth to Net
Time Time Water Drop
19
20
NO. 1823-E
PERCOLATION RATE
'rEST RUN BETWEEN
'~'~ , FT AND
-(minutes/inch)
COMMENTS
CERTIFIED BY:
DATE:
72-008 (7/76)
MUNICH:~ALITY OF: ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRQI\IMENTAL PROTEC'i, N
Telephone 264-4720
PRE-INSPECTION CHECKSHEET -- TYPICAL TRENCI'I ON LEVEl, TOPOGRAPHY
MINIMUM WELL
DISTANCES:
INDIVIDUAL WELL
TO I'ANI( 100'
TO TRENCH 100'
CLASS A,__B CLASS C
PUBLIC - OVER 25 SERVICE OR PUBLIC - UNDER 25 SERVICE OR
MORE THAN 15 CONNECT8 LESS THAN 15 CONNECTS
TO TANK 200' TO TANK 150'
TO TRENCH 200' TO TRENCH 150'
PUBLIC WELLS MUST HAVE DEDICATED PROTECTIVE RADIUS RECORDED
ON THE E/D PLA'r. ADEQUATE ENGINEERINO PLANS ARE REQUIRED.
MINIMUM 5' CAST IRON INTO UNDISTURBED SOIL (4"PIPE)
PLASTIC PIPE AS'I'M U3034 MAY BE USED
IN PLACE OF THE CAST IRON
~34"CASTIRON CLEANOUT
WITH AIRTIGHT CAP
CLEANOUT WITH AIRTIGHT CAP
[]ALL CLEANOUTS MUST COME AT
LEAST TO GROUND LEVEL
~PERFORATED PIPE INSTALLED LEVEL
[]SEEPAGE TRENCH INSTALLED ACCORD-
JNG TO SOIL TEST
E~JSEPTIC TANK MUNICIPALITY APPROVED
E~IINLET AND OUTLET OF SEPTIC TANK
WATERTIGHT
E-ITRENCH INSTALLED ACROSS SLOPE
~3PERFORATED PiPE LEVEL
~ LINE BETWEEN TANK AND HOUSE
2% TO 6% SLOPE
NOTE:
[]100'MINIMUM FROM TANK
AND TRENCH TO RIVER,
LAKE OR STREAM
//
MINIMUM
2X GRAVEL DEPTlt
PERFORATED PIPE
PERFORATIONS DOWN)
S01_ID PIPE WITH CAP
ABOVE TJOINT
PERFORATED PIPE
BOTTOM OF SEEPAGE TRENCH 4'
MINIMUM ABOVE WATER TABLE
AND B'MINIMUM AROVE BEDROCK.
EXCAVATION TO LOT LINE 10'
RAKE SIDEWALLS BI--FORE INSTALLING GRAVEL
., ~ ,?~. ?~ !:;:~, z...~' .",~,, ~ ,-....
M-";,~".~.' ..'.: '" .'. ':." .~',~'.;",~.'z~.",~,'.~
,, '~.. ."'~, . .'.. ,, .,...~ ~. , -
· .~ ':,'.'.'?.'~.::~.F . '~ '.?....~.~.~'.'.:>~.,',,
SC :l E E N E D G RAVE L ~:i.?...~.,.7:.,,' ~
DETAIL-SEEPAGE TRENCH
72-006 (Rev. 3/78)
GRE'
ER ANCHORAGE AREA BO"
Department of Environmental (~uality
3330 C Street
Anchorage, Alaska 99§03
JGH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME E~/
LOCATION
MAILING ADDRESS
DISTANCE ,~ /
FROM WELL ~] MANUFACTURER
INSIDE LENGTH
INSIDE WIDTH
NUMBER OF
COMPARTMENTS
LIQUID DEPTH
.LIQUID CAPACITY ~ 4:2('~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
BUILDING FOUNDATION___
ADDITIONAL ABSORPTION
OR WIDTH , LENGTH___, DEPTH
_ . CRIB SIZE~.~. DIAMETER DEPTH DISTANCE FROM: WELL
, NEAREST LOT~ ~,(~(~RLp~FIF(~I~!C~I~A (WALL AREA,
SQ. FT,
WELL:
TYPE~(~)'T)'` p.b//'(-.g __CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
DEPTH /~2/ DISTANCE FROM:
NEAREST SEPTIC SEEPAGE
SEWER LINE TANK SYSTEM
'/
DISTANCES:
INSTALLED BY:
PIPE MATERIAL' ]'~C 14
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
DATE
GREATER ANCHORAGE AREA BOROUGH
SEWAGE DISPOSAL SYSTEM --- APPLICATION ANI)
NAME OF APPLICANT ~ O~ MAIL. lNG ADDRESS
INSTALLATION LOCATION -- //~//'~- ~--~'~/~'~ ~ ~/~ ~/~
S"L"~'~ ~--T a N I( SIZE
SEEPAGE AREA SIZE
~lFff~ TANK ., SEEPAGE PIT - ' , DRAIN FIELD
TO NEAREST LOT LINE.
' SHEET NO,
· JOB NO;