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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 ; , PHONE
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
~' Mater' ~ No. of core.merits
~ DISTANCE TO: J~% /~ Absorption a~ Dwellin~ ~ PE~I~ U~, /
~;Z Manufacturer ~~~ --
~ [Liq.z~a~)~ ga Ions E W dth
I y~ ~ IF HOMEMAD :
I
~--~ ~ Manufacturer
~ I No. of,~.s/ I L.~gth~cMi.e
~ ~ Top of tile to finish grade
~ I L~,th W,dth
~[~ i Tvpe of crib Crib diameter Cr~e pt~ Total effective absorption area
~ Well Building ~oundation I Nearest lot line
~ I DISTANCE TO:
~ ]~Cl s ~ /~ ~ Deg~h ~, ~ ~ ~Driller ~, g~/~([//Distance to lot line I PERMIT NO.
~ DISTANCE TO Building foundation Sewer. line ~'~ ~'1~ Septic tank/~o / ~1 Absorption~ area~s)~z
.,~NEW
I~UPGRADE
Inside length Liquid depth
Dwelling r / PERMIT NO.
A'////~g' Material Liquid capacity in gallons
Found~o~. ~ N ea rest.l.~t(.~q e('
Total te th f Nnes
¢~ ~ Trencc'~l~th '/ inches
Material beneath tile /~ irinches
Depth
Total effective §bsorption area
PERMIT NO.
OTHER
PIPE MATERIALS
SOILTESTRATId~'~'/) C
/44,c
REMARKS
.5- :Tg~7
APPROVED
. 8RB 198× .
' P~. 694-~2979
PERMIT NO:
DOTE ISSUED:
l"'iLii'-] I £: I P':iL I T%-' OF
DEPFIRTMENT Ck~.~HEFILTH RND ENVIRONMENTRL k.~JTECTt0N
M.'.,.~ L STREET., RN_.HORMoE., RK
C~l'-.I--S I TE SEI~,IEF-: ,~;.:: t-4EL~ PEF,:f-1 ][ T
RPF'L I CRNT:
R[."DRESS '
CONTRCT PHONE:
H I LFtRY MI_.HLIU
SR i BOX~._,.,=,-..'x ...... -.
C:HUGIRK, RK - L~.9.567
~,,=,c, =.40L~.
', '-t ..... SLIBDI'v'ISION: NR
LEGRL [:E=,_.RIF:
I'1, '-
· 'SECTION: 7 T_HN=,HIF. l._N
LOT SIZE: ~ ':";Q FT. OR RL-.RES.':
r,IRX BE[ ROut1=,.
LOT: 928
RRNGE: iW
ELOCK: NR
LISTED, BELOW RRE THE OPTIONS RVRILRBLE TO YOLI IN DESIGNING YOUR SEPTIC:
SYSTEM. CHOOSE THE OPTION THRT BEST FITS YOLIR SITE.
TRE~-~C:~
DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0
'GRAVEL DEPTH (FT.) 4.0 0.5 ~.0
TOTRL DEPTH (FT.) 8.0 4.5 ' 7.0
GRRVEL WIDTH (FT.) 2.5 14.0 5.0
GRRVEL LENGTH (FT.) ~2.0 28. 0 ~0.0
GRRVEL VOLUME (CU. YDS:)
TRNK SIZE (GRLS) i, 000.0
SOIL RRTING (SQ. FT.?BR) 85 85 85
:¢:+: TRNK MUST HR',,,'E 'RT LERST TWO COMPRRTMENTS
I' CERTIFY THBT:
±. I RM FBMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPBLITY OF BN~HORBGE (MO~) BND THE STBTE OF BL~SK~.
2. I WILL INSTBLL THE SYSTEM IN BCCORD~NCE WITH 8LL MO8 CODES ~ND REGULBTIONS,
'8ND IN COMPLIANCE WITH THE DESIGN CRITERI~ OF THIS PERMIT.
~. I WILL 8DHERE TO ~LL MO~ BND STBTE OF 8L~SKR REQUIREMENTS FOR THE SET B8CK
DISTRNCES FROM RNY EXISTING WELL, NRSTEWRTER DtSPOSBL SYSTEM OR PUBLIC
SEWERRGE SYSTEM ON THIS OR RNY RDJRCENT OR NERRBY LOT.
4. I UNDERSTAND THRT THIS PERMIT IS VRLID FOR R MRXIMUM OF ~ BEDROOM% RND,
RNY ENLRRGEMENT WILL REQUIRE RN RDDITIONRL PERMIT. ' '- - x
IF R LIFT STRTION IS INSTRLLED IN RN RRER COVERED BY MOP BLIILD. ING CODESi,
THEN (t) RN ELECTRICRL PERMIT RND, INSPECTION MI I'~T__ BE OBTRINED; (2) Hz,"--BUILTz,'-
WILL ~OT BE RPPRO~ED WITHOLIT RN ELEC:TRICRL INSPECTION REPORT~ RND (~:) THE
ELECTRICRL HO ...R~,~..,¢LI, ~ BE B*]NE ~Y R LICENSED ELECTRICIRN..
- ......
~ ) / o I ~ ,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 2~4-4720
SOILS LOG-- PERCOLATION TEST
SLOPE
PERCOLATION
TEST
SITE PLAN
10
11
12
13
14
15
16
17
18
19
20
~,~ ~ ~COUNTE~E~
~ ~ IF YES, AT WHAT
~ ~ DEPTH?
J,
I
Gross Net Depth to I Net
Reading Date Time ' Time Water Drop
.
PERCOLATION RATE (minutes/inch)
TF-J;T RUN BETWEEN FT AND -- FT
I
/
PERFORMED FOR:
1
2
3
4
5
6
8
9
10
11
( MUNICIPALITY OF ANCHORAGE (
DEPARTMENT OF ~EALTH AND ENVIRONMENTAL PROTECTION
S011..8 LOG - PERCOLATION TEST
13-
14
15
16
17
18
19
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTm
SOILS LOG
[] PERCOLATION
~ro$$ Net Depth to Net
Reading Date Time Time Water Drop
20
P,ERCO LAT IO N RATE [minutes/inch)
TEST RUN BETt':EN __ FT AND -- FT
SUBJECT
472
SIGNED J~..-,..,~
SEND PARTS 1 AND 3 WITH CARBON INTACT
PART 3 WILL BE RETURNED WITH REPLY.
DATE