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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
PHONE
NAME
MAILING AD~S
~LEGAL D ESCRI P.TION
LOCATION
Liq. We]] f~. Absorptio
gallons [ IF HOMEMADE: I~t~iside,length
DISTANCE TO: Welt Dwelling
Dwelling ~1~/~1~
Material ~ ~ L
W dth ~
DISTANCE TO: Well /,~O /~
NO. of lines / Length of eac~,~,(~ '
Top of tile to finish grade
Length Width
Type of crib Crib diameter
Well
DISTANCE TO:
Material
Foundation ~/~ Nearest lot ,,ne~) ~
Total length of lin~ Trench wi
*",',~ 0 J (:~0 inches
Material beneath tile
Depth
NO. OF BEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO. ~, ~
Distance between lines /V'/~
Total effective absorp~n area
PERMIT NO.
~rib depth Total effective absorption area
Building foundation Nearest lot line
Driller
;lass Depth
lation Sewer line Septic tank
DISTANCE TO:
Distance to lot line
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
REMARKS
3/78)
DATE
MUNICIPALITY Of ANCHORAGE
Department f Health and Environmenta' Protection
825 ~ Street, Anchorage, AK. J9501
264-4720
~r~ * * * HANDWRITTEN PERMIT * * *
Permit ~
W/ELL AND/OR ON-SITE SEWER PERMIT
Location: Phone Number: ~ ~ ,-Z ~ ~ } /
Legal Description: ~f V 7Z~/U/~'/~J ~/Z ~r¢ Lot Size:
Type of Soil~sorption,System Is: ~m~/~
Trench: ~, ,, Drainfmeld: ___ Seepage Bed~ __ Holding Tank:
Maximum N~ber of Bedrooms: ~ Soil Rating(sq.ft/br)
/
The Required Size of the Soil ~sorption System Is:
DEPTH /'~ LENGTH ~'~ GRAVEL DEPTH /~ WIDTH
the bottom of the excavation(i~ feet). There is ~o 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).
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 a~d approval by this departmen'
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 $ 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~ bD4rooms/ / ,~/
S igne~ : i ~' ~ ~/L~ Issued by :
Date:.
SWP/024 (1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~' SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
4-
6-
7
8
9
SLOPE
DATE PERFORMED:
SITE PLAN
10
11
12
13
14
15
16
17
18
19-
20-
COMMENTS
PERFORMED BY: v ~-~ ¢;f;~ ~Q~3f~ .
72-008 (6/79)
WAS GROUND WATER h/ ~
ENCOUNTERED? ~ 0
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
!
PERCOLATION RATE
TEST RUN BETWEEN