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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTFCTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
LEG,~L DESCRIPTION
LOCATION /1
l W~ll/ Absorption area
DISTANCE TO:
t-~[~M Manufacturer ~ ~ ~
NO. ~BEDROOMS
ILiq' ~ IF HOMEMADE: Inside length Liquid depth
Well PERMIT NO,
DISTANCE TO:
Well
DISTANCE TO:
No. of lines
Length
Lengt~;~ ~hlfhle
Dwelling
Dwelling
I Material
Foundation ~ r~' / ]~e~res~'~'ot line
Total~..~.t~ ~' lines __]--- :l-~J~
Material beneath tih; yg
Depth
inches
Top of tile to finish §rade ~/. /
/
Width
No. of~partments
Liquid capacity in gallons
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distaece to lot line [ PERMIT NO,
t
Building foundation Sewer line Septic tank / AI}s~ ~rea(s)
DISTANCE
TO:
1
OTHER
REMARKS
DATE LEGAL
[] SOILS LOG
Steven A. Johnson
P.O. Box 76
Chugiak, AK 99567
Phone: 907-688-3085
SOILS LOG- PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
~4
5
6
7
8
9
SLOPE
-~iTE PLAN--
10
11
.... 12
13-
14-
15-
16-
1~-
18-
19-
20-
COMMENTS
PERFORMED BY: ~,~-~_.~ ~
WASGROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH7
__1',1 o
Gross Net Depth to Net
Reading Dete Time Time Water Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
QGREA';ER ANCHORAGE AREA BOROUGH
Department ~3~n~ir~;'~ntal Quality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL .-/_~-O
INSIDE LENGTH
MANUFACTURER MATERIAL COMPARTMENTS __
INSIDE WIDTH LIQUID DEPTFI LIQUID CAPACITY /~Oo / ~S~O° GALLONS.
SEEPAGE
NUMBER OF PITS__
LINING MATERIAL
BUILDING FOUNDATION_
ADDITIONAL ABSORPTION
DIAMETER __
CRIB SIZE:
OR WIDTH LENGTH__, DEPTH
DIAMETER___DEPTH -- DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE
ABSORPTION AREA (WALL AREA)
_SQ. FT.
WELL.:
TYPE ,~,~'
BUILDING
FOUNDATION
CESSPOOL
APPROVED
__CONSTRUCTION ~.~/~'-~J~V D EPTIt DISTANCE FROM:
NEAREST NEAREST SEPTIC SEEPAGE
LOT LINE SEWER LINE TANK SYSTEM
OTHER SOURCES
DISAPPROVED
REMARKS ..~
DISTANCES:
INSTALLED BY: &1,~ &~/..~-
PIPE MATE RIAL: ~)~-~~-
LOT SLOPE: ...........
REMARKS:
DATE
GREA. .,< ANCHORAGE AREA BOR
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 ' I C ' ] STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456 !
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO..
HAM,: APP.CANT Pt
TYPE AND SIZE OF FACILITY TO BE SERVED
SOIL TEST RESULTS
COMPLETION DATE aNTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED· BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMr~NTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTAN{::;E$, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATIDN TO SEEPAGE Pit
SEPTIC TANK TO SEEPAge PIT WALL
PAGE AREA SIZE
SEPTIC TANK , SEEPAGE PIT ..DRAIN FIELD
TD NEAREST LOT LINE,
SEPTIC TANK, ~, SEEPAGE Pit , DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIBcrosSING GAP Of
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILl
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION,
~CENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BorougB ORDINANCE NO. 28-68 AND THAT THE ABOVE
Russe# Oyster
694-2774
Soils 8 Foundations
E
GEOTECHNICAL 8- DEVELOPMENT
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
CO.
Earl Ellis
688-2280
Land Development
SOIL LOG
Performed for:
Legal
Description.',
0
1
Name:~./(''~t/~'~ d~'~ ¢'~(?"'~F/& ..._.Tel. No.
Mailing Address: ,I; ,Ch /~ 9/,~~, *": . ~' ' -
_S_o.i]. Cha~rac teri_s_tic)
4
5
6
8
9
Il
12
Ground Water Encountered: Yes No ~ If yes, what depth~
Proposed Instal latton:
Cor~tents:
Perfo~ed by:~~
Seepage Pit ~" Drain Field_=.___
MUNICI'PALITY OF ANCHORAGF
OF HEALTH AND ENVIRONMEN
L Street, Anchorage, Alaska
264--4720
PROI'ECTI ON
99501
Date Received: February 22j 1978
Time
Date
Insp
#2:
Time /'. ~) # 3: Time ,,
Date ~-. ~_~ (7~lt,c~S Date
Insp ~ Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Coast Mortgage Company
Mailing Address: Post Office Box 1200 99510 Phone: 279-0665
2. Property Owner: Jodine R/R~bert J. Tate
4:
]?hone:
Mailing Address: o~ ~,h A-Ac~- ~dm,~a (~_~%~_
Legal Description: T14N R2W Section ~1. Lot 3Al
Single Family Residence: (~ Number of Bedrooms: Six
Multiple Family Residence: ( ) Number of Bedroems:
Well System: Individual well ~w~ Conm~un~ty : System ~<)
Permit
Depth of Well
Well Log on File ( )
Construct{on
Bacterial Analyszs
Sewage Disposal System:
Permit ~
Septic Tank Size
Absorption Area
On-site System (x) Public Utility
Installed /~ Installer
__ ~ Manufacturer _ ~~,
?-76 Soils Rate ~ Material
7. Distances: Well to Septic Tank
to Absorption Area
to Sewer Line
Nearest Lot line
Absorption Area
to Nearest Lot Line
GREAI'I{R ANCHORAGE AREA P, OROUGtl
Department of Environmental Quality
3330 "C" St., Anchorage, Alaska 99503 - 27~I-4661
RE~'' 'F FOR
,~uES APPP, OVAL OF
INDIVIDUAL SEWER & WATER FACILIFiES
1. Type of Inspection: CMR0 VA ~ FltA
2. Property OWller: Jodine R. & Robert J. Tare
Mail ing Address: ~d of Mausel Ro~d, }~!~_~LZ_e RiYe~)a'/_ Phone
3. Name of Buyer: Elmer I. Willies & Carol A. Williams
C0;~V
Home
Mailing Address: 3334. Mt. Vernon Ct.~ Anch. Day Phone 279-996~
His business 26~-~48 Her business 26~-26~
Name of Lending Insti'Lution: Coas% Mor~ga~e__C_gml~ .................
Mailing Address: ?.0. ;Box 1200, Ancho~a_~_e, AK Phone 279-066~
99~10
Name of Realtor or Agent: ;Ba¥id Hart, Selective Realty 279-8624
Home 276-7191
Mailing Address: 1~1~ E. Tudor Road, Anoh. JLK Photle]Business 279-8624
6. Legal Description: Lot 3Al o£ the Subd. Lot ~.?16_~_~_2__-rJ~_~, ~_14N,
Location; Eagle RiYer~ Alaska
7. Type of Facility to be inspected:
8. Water Supply
Type oF Supply:
If Individual,
Il: Individual,
9. Sewage Disposal System
Six N o. B d rm s .
number of dwellin.qs presently served
depth of well ?
Type of System:
If Individual,
Public Utility
date o'f installation
Individual (on-site) _.Z-~:___
?
[[/-037 ,~l/Tfl)
sage Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water FacilitLes
]Legal Description: T14N R2W Section
Lot 3Al of Lot 3A
Comments:
Ayadavit At~ched: ~
Disapproved:
Date
Date:
Department Worksheet: