HomeMy WebLinkAboutT15N R1W SEC 30 LT 77A
x-- MUNICIPALITY OF ANCHORAGE
' DEl ~TMENT OF HEALTH AND HUMAN SER'~
Environmental Heallh Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Nameq / D'ST^"CES
~L~4~_/~ ~ SEPTIC ABSORPTION
Addres~ ' / TANK FIELD WELL
Phone(s) Permit No. '-- NO. gl Bedrooms WELL
~ ~ ~ ~ ~ ~ 0~ ~ LOT LINE
LEGAL DESCRIPTION
AS-BUILT DIAGRAM (Show Iocabon of well, septic systed , prope[ty lines, foundation,
TANKS ~P ~NJ
~ SEPTIC ~ HOLDING
Material~~ NO of Compadments~ ~j ~J~)~
g TRENCH g W. DRAIN ~ OTHER
Fill added above original grade G~avel depth benea[h pipe ~
~ ET ~,~FTj ~
Gravel lenglh Grave~ w,dth / ~
WELLS J
~RIVATE ~ OTHER fldentifv) 5
REMARKS: ..~, ~ ,. . , ~;' J
Scale: [ I
~ E~GINEERING~r L~P Road No. 204
I .... P~ 0g~77 cedil~at this in~clJon was peflorn18d according to all
Mu.icipal and State guidelines in ellen, on ,his date: ¢/~ ¢/ff ~
72-013 (3/85)
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Gi' ave I ........
D~., . (fl.) :',
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
DATE
Township, Range, Section:-.~,..~ '~..\\~_.~
SLOPE SITE i[LAN --
4-
5-
6 -
7
8
9-
13-
14-
15-
16-
17
18
19
WAS GROUND WATER
ENCOUNTERED?
iF YES, AT WHAT
DEPTH?
I]eplh to Water Alter
Gross Net Depth to Net
Reading Date Time Time Water Drop
2O
PERCOLATION RATE
T STRU BET EEN ~FTAND '-~ FT
PERFORMED BY: I ~4 ~,~le RI~ L~ R~ No. 2~1 /~ ( / CERTIFY THAT ~lS T~T WAS PERFORMED IN
iver Alaska
ACCORDANCE~""~ST~TEANDMUNICIPALGUIDEL~~HISDATE. DATE:
72-008 (Rev. 4185)
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Services Division
'l-elephone: 264-4744
ON-SITE SERVICES FEE DOCUMENTATION
Date Paid: ~"- '"~"=~- -- ~ ~'
Name of Payer: (Name,on Check)
Mailing Address: (Off of chec)
Legal Description(s):
Permit Number:
Receipt#:
Check #:
Type of Payment: (indicate Amount Paid
Health Authority:
Sewer & Well Permit:
Well Permit:
Sewer Permit: . ~2/L.~ ~
Copy Request:
72-O34 {10/86}
DISTRIBUTION:
Excavator Permit:
Engineer Permit:
Pumper Permit:
Well Driller Pe~'mit:
,Tank Manufacturer:
(Waste Treatment)
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