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LEGAL DESCRIPTION
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENI'AL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~'~.~.~ I I UPGRADE
· !
LO~'-ATI O N '
DISTANCE TO:
Manufacturer
ILiq. capacity in gallons IF HOME[V~ADE:
D STANOE TO: IWe" 2 j.
Manufacturer¢ ~~ I Well
DISTANCE TO:
Top of tile to finish grade
Width
DISTANCE TO:
~Cl~ Depth
Building foundation
Absorption area
Inside length
Dwe ng i0
Foundation
Dwelling
~O. OF BEDROOMS J[~ I(~
PERMIT NO. -
Material No. of compartments
Width Liquid depth
Nearest lot line
PERMIT NO.
Total length of lines Trench width Distance between lines
inches
Material beneath tile Total effective absorption area
inches
Depth PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line PERMIT NO.
Sewer line Septic tank Absorption area(s)
OTHER
DATE LEGAL
Departmenti ~ Health and Envlronmenta3 ~rotectlon
825 '~' Street, Anchorage, AK. ~501 '
Location: ~- ~ ~'~-- ~ "Fq~
Legal Description: ~
Type of Soil Absorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms:
264-4720
* * * HANDWRITTEN PERMIT * * *
W~%~---A,N'B~Ng-ON-StTE SEWER PERMIT
'~].~ ~~ Mailing Address:
Phone Number:
Lot Size:
Seepage Be~: __ Holding Tank:
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
depth 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 pipe and
the bottom of the excavation(in feet).
* * REQUIRED S~=m~m~C(HOLDING) TANK SIZE = '~OCP(.-) GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of 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
of 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 1 9 8 2 * * *
I certify that:
(1) I am familiar with the requ'irements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3~bedr~s.
~ica~t ~
Issued by:
Date:
SWP/024(Z/81)
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION.
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of
public water system located
, Alaska, submitted in accordance with 18 AAC 80.100
by
have been reviewed and are
[] approved.
[] conditionally approved (see attached conditions).
BY
TITLE DATE
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (contract order no.
or descriptive reference)
Approved by Date
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE ~
The construction of the public
water system was completed on (date). The system is hereby
granted interim approval to operate for 90 days following the cpmpletion date.
BY TITLE DATE
As-built plans submitted during the interim appr~)val period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
final approval to operate.
BY TITLE DATE