HomeMy WebLinkAboutSOUTH LAKEWOOD HILLS BLK 2 LT 6rio
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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
NAM E~. P~F~ION E NEW
MAILING ADDRESS
LEGAL DESCRIPTION ~-. ~ /~/~
LOCATION NO. OF~DROOMS
~ ~ Manufacturer ~ i~ ~ ~ Materia~-~ ~ ~ N°' of compartments
~ ~ OO ~" HOMEMAD.: ......
Liq, ca acity in gallons Inside length Width Liquid depth
, ~ Well Dwelling PERMIT NO,
~Z DISTANCE TO: ___ - ) ,~ - ..
O~ Manufacturer. ~¢-~''
% -- ~ ~ - -- ' Material Liquid capacity in gallons
~ Well Foundation ~ ,~ (~ Nearest lot line PERMIT NO.
~ No. of li~e~. Length of each line Total length of lir~ Trench width .p Distance between ,ines
Total effective absorpd rea
=~ ~ Top of tile to fin,sh grade ~. ,~ Material benea~tile f/ ~i~ 'T
Length Width Depth PERMIT NO.
~--~ ~ Type of crib Crib diar~eter --~- . Crib de~th Total effective absorption area ~. .
~ DIST~'~E TO: Well Building ~unda~ion~ ~-~ Nearest lot line
~ .CI~~/'/~ ~ ~2'" Depth Driller Distance to lot line PERMIT NO..~
~ Buildingfoun atio~ Sewer[ine Septictank~ ~
~ DISTANCE TO; ~ 4;~ Absorption area(s) ~
OTHER
PIPE MATERIALS
SOIL TEST RATING ~ ~lO
INSTALLER ~ )~n ¢
APPROVED ~ DATE LEGAL ~{(~ ~0~
72-013 (1~1 v. 3/78)
F'[iBq:M Z '1-
FtF'F:'L ): CF::IN I'
LOC f:[ T :[ ON
L E:GFt[.
E:,FIV I [:,
2:...'.i/;i;:_' Ft:[ O'MR[..L.E"r'
L/::; [:i',;:?. ;i!;OUTHI.,.K]O[)
L.OT SIZE
't'r'l'::'E OF' E;Otl.. F:IE:SORE:I'):ON S'.r'?rE]',l IS: "fRENCH
f i. ,., t- [ I l ['.,IUI','tt~E]:E: Of:: t!!:[!~[)[[]:]OJ','[:]~:; ~ ~
I]..IE REQL.I ]: RED S I ;ZEi OF' THE SO I L FIE~E;(]RF:'T :[ ON :E;"r'S'['EM
THE: L.ENG'TH [) i MENS I O1',1 ]:E; '1'HE L..I:~:BII:3'T'H ( I N FEE"[') OF:' 'T'I'JE TRENCH OF~: [)RFI ! NFI E:'I...[:,.
['fie E:,EPTt't OF FI r'RENCH OR F:'ZT Z::.:: THE: DZS'T'FINCE E:[~YFI, IE[~},I THE: SUI:RF:'FtCE OF' THE
GR(:)UN[:, FIN[) THE: E',OTTOM OF THE E',:.::C:F:IVFITION ,::]:N FEE:]').
'I'I. IEI.,~:E I'Z; NO :E;ET t.,.ItC, TH FOR TRE},ICHEE:.
'THE GI:~'.F[VEL DEF'TI-I I[~:; TIlE MINIMUM [)EF:"!"H OF GRFIVEL E',ETt,.IEEN THE: OUTF]=II..t.. I:::':[[::'E:
[:]P.,i[) rilE: E:O]-]'OM OF THE E',:'::C:FIVFIT I ON ( t N FEE'[' ).
PE!.RMZT Fff::'PLICFINT F'II::IE; 'THli~: RE:E;F'ObI:E;I[3I!-ZT'T' 't"O ZI'4FOB'.M THIS [:)EPFqRTMENT [)lJl:;i:):N(}i TI"!fE
INSTFIL.L. FITION INE;F:'ECTION'~!; [:Il:: FINM 14EL..LE: F:ID.:IFIC:ENT TO THIS F:'ROPERT"r' FIND THE:
Nt.IPIE:ER OF: RE:!!;If)EI",ICE:S THFIT THE' I,.1ELL NI!...L E;ERVE'.
................ - F' Ib'..l! H'_'Z~ 'C: ::; ~'.: 3:"]:: P",tl :!E~; IF:::' Ei}iE E:]: -IF' :1[: ~CZ~ ~'",~ :E~; IF:II F:~'~:: EEi:: I[XE:~ E!E: E;;::~ E.Jl ][ II::E'.: EE: IE:) ....................
E:FK:::KF:I!..LINEJ OF FIN,"/ E;k'E;I"EM t.'.I:[THOUT f:'II"~l::ll.. INSF:'IZC'FIO!",I F:II",I[)I:::IF'PROVf::II.. E:~'~'
[)EPF:tI~::TMEt",IT I']ILL. E:E E:UE:.~fE]]:T '1"O
h'l): N I MLIM E:' i :5'rf:~N(::E 8E'['NEE:N I::i N['::L.L FINE:, I:::tt",!"~' OP',I-'S I ]'E f.;E:NIRGE[
:I..EE~E) I:::'E[:'[' FOR I::I PRI',,,'F:I'rE NELl..; OR
!.SCl TO Ff:E~Zi F:'[:E'I" F'ROM [:1 PUE:L. ZC NELJ_. [:,EF'ENDINEi UPON THE '['~./F:'t.E OF PUE:[.:[C: I.,.IEL.L..
NELL I..OG::~:; I:::IRE RE:QUIRE:f) FIN[) MUST 8E RETLIF~fNE:[) TO THE: E)EF:'I:::IR]'ME]qT
CIE:: THE P~E:[L COMPLETION.
[]['HER F::E);:~LI I REf'i[~N]'E~ I'"ffq"r' I:a[::'[::'E.."F. E;PEC I F= ]: CFIT I ON?; FIN[) C:ON::~;TI:;~'.L.ICT
I:::P/[~ILF:IE~[.E TO ZN:Eq..IRE~: PROF'E~R
I C:Et:RTZ[F"r' I'I'"IFIT
:l: I I:::tM F;'t=ih1ILtFIIR NI'TH '['HE RE:QUIREZME]"Ef'E; F'OR ON'-SITI;:: SENE:R:~; FIND 14E[.L..E; FIS ~E;E:T
t:::OIRTH E',"? THE: ML.INiCIF'FIL. tT'"i' Ot::"' FINCHORF:!GE.
2: I NII.J.. ZNE;TFII.J_ THE E;*'r'::~:;TE}'I ZP,I F:IC:CC[RE)FiNCFf NZ"I'H THE
]:: I UN[)E~REqTFff',I[) THFtT THE ON'"'E;ZTE SE],.I[:::R :~:;?E;TEM Mt:::l"r' I:~:EQLII!:RI~: ![::NLI::'!F~rGEME:},IT :I:F:' THE
RE:~::;):[)ENCE :[E; P.E:MODELE[) TO :[NCLUC, E MORE TI..'ISN 4
I' I t L.I, ,., U1 [:'I:':tVII) ~ [...
~.~ ,
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6~650. Anchorage, Alaska 99502 276-222~
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
13-
14-
15-
16-
17-
18-
19-
20-
SLOPE
DATE PERFORMED:
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN
COMMENTS
FT AND -- ft
0
72-008 (7/76)