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MUNICIPALITY OF ANCHORAGE
i/_ 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 / ~NEW
M A I.i~'~ ADDRESS '
Zzq C HOOtA ACURA
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
Well AbsorPtion are~ Dwelling PERMIT NO.
DISTANCE TO: ~O/
~ ~ Manufacturer Material ~o. of compartments
I kiq~ c~a~t~® IF HOMfiMA~fi: Inside length ~ ~idth ~ Liquid depth ~
0 ~ ~ Manufacturer~ Material Eiquid capaciW in ~allons
Q Well , Foundation ~O+'
~ ~ Z No. of lines Length o~h, l ine Total le~o~ lines Trench width Distance between lines
~ ~ /~O ~O 30 inches
; Q~ Top of tile to finish grade~. ~, Material beneath tilez~'' O~,~, "~ ~ .0 'i--s Total ef~~t, ion area ....
Length Width Depth PERMIT ~
~ Typeof crib Crib diameter ~ Crib depth Total effective absorption area _,'' ~
m Well Building foundation Nearest lot line
m DISTANCE TO:
Class Depth Driller Distance to lot line P~~
~ DISTA~C[ i0: Buildin~ foundation Se~er line Septic tank
PIPE MATERIALS I ~ P ~
SOILTESTRATINg /R
REMARKS ~ ~l
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
MUNICIPALITY OF ANCHORAGE
Department f Health and Environmenta~ Protection
825 Street, Anchorage, AK. 9501
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit ~.~,?~-~C~ ~~ 0N-SITE SEWER PERMIT
APplicant:
Location:
Phone Number
Legal Description: ~o~,~
Type of Soil Absorption System Is:
Trench: ~/ Drainfield:
Maximum Number of Bedrooms:
Lot Size:
Seepage Bed: Holding Tank:
Soil Rating(sq.ft/br) ~
The Required Size of the Soil Absorption System Is:
~ WIDTH
DEPTH /~/ LENGTH ~ GRAVEL DEPTH ~
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 SEPTIC(HOLDING) TANK SIZE = /~O 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 departmeni
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee~
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 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements 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 bedrooms.
Signe~: _ /- Issued by:
Applicant Date:
SWP/024 (1/81)
MUNICIPALITY OI- ANCHORAGE
MEMORANDUM
Date
From:
Signed
91-015 (Rev° 1/81)
7125 Old Seward Hwy. Anchorage, Alaska 99502
349-6561!
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:~ .....
LEOAL OESC..T,ON:.LO 7-
1
2
3
-4
5
6
78
9
-10
11
12
13
14
2. T .ocK ooA
SLOPE SITE PLAN
'H
WAS G~OUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH7
Reading Date
Gross Nel Depth to
Time Time Water
Net
Drop
15
16
17
18
19
2O
2248-E
VJ 6. L L.. C. L, ~ .'~ S C - u N)_~--~R LI !-c"~
DATE:
72-008
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of /¢)''/~ o~, '~)J ~/~ ~4:2C)A
~. approved.
public water system located
Alaska, submitted in accordance with 18 AAC 80.100
q' ~ cr"~"Y//-~-~---''J have been reviewed and
are
[] conditionally approved (see attached conditions).
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
~.nange (contract order no,
or descriptive reference)
~pproved 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 completion date.
BY TITLE DATE
As-built plans submitted during the interim aPproval 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