HomeMy WebLinkAboutTERI #2 TR D1
~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTN & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 9950'1 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LOGATION ~ h~' NO, OF B~OOMS
JWBII JAbso~tion ~reo Dwelling PERMIT NO,
~ DISTANCETO:____L___~
L
) IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Licluid capacity in gallons
: Well Foundation N~arest )ot line PERMIT NO.
Length Width Depth PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth Total 0ffective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distanco to lot line PERMIT NO.
~ DISTANCE TO: ~uilding foundation Sewer line Septic tank Absorption area(s}
OTHER
INSTALLER
72-013 (Rev, 3/78)
DEPEIF~FF'fqE:NT Eft= HERL. TH FINE:, t~':['.,]',,,'3:[~I~P.,II"IE:]'.,I"I'I=II... F ........... "I..." Z, TF:E::E:T., F:IF,ICHEI[~:FtGE;.,
f I [..
1.0CFFI' 1 3N
L.EEiFtL.
909 CHI If3REH I.,.IEI'¢
I.,.IEIL, T E R ~;F.IEFITHFIN .... F...
H I:ff~'.l[..EI [:,~',.
IFH .I E:,:I. TERO :,LE, 41,;:4:
I_OF 5:[,zr~ '1. ZIPlECJlZI :5(;:¢..,IF:IF;?.E_' FE:ET
"I~'¢F'E CIE ..... :,....I.L. N['...:uRF- "=" ' "1 .... 1UN '= '_, ~ "= '-..., fE.I't: ' IF: DRFI]:NFIEELI3'
HFD'C[hlLIh'I t lUII[.E.F. OF:' ELE R...JIl_. :~: i?
"['HE L. ENEFI"H [;, :[ HiEN:i~; I ON I ~; 'FILE: L~E':NEi-f'H ,:: I N F:EET [:, Of:' 'THE; 'I"RENE:H m3F~ DRR :[ NE':[ EL_[).
THE [:,EF"FH EmF El TRE:NE:H Eft;?+ PI1" lES THE [:,ItE;TRI"4E:E[ E:E'I"I,.IEEI'.,I THEE ~;U~i:FEiI::E: OF:' TFIE
GROLIND FIN[::, 'I-FIE: E:OT'T'OH OF::' THE: EXCFI'v'FYf':[CU",I (IN FEE:T:).
THE GF?.FIVEL. E:'EE'TH IS THE: HINJ:PIUM DEPTH OF GRFI'v'E:L BETHEEN THE OU'FFFILL. E'IE'E
Rh,ID THE E,:)'T'TCd'fl OF THE: E',:'::CRVF:ITIEIN (IN FEET).
F'EF:H]:T tlFF_~I..III'~I HR'ii; TH[::.' LE.....FCi'L. IE;[L.:[I r 'l'O 'I:F,IFOF:H 'I"FI;[:E; [:)EF'EIRTMEi'.,FI' I") F':l'i'..l':i THE:
.I. hL. 1 I._L. I.[..74 ]:fl..I E.....[1...N_. OF' FIN'¢ [.,.IEL..L'E; RE:,..]'FII:::EN'[ -FI3 'I"HZ'.~i; [F~...F[:FFr FIND THE
141...li'lEE.k. OF F.E......ZEE..fI...[_.. THF:IT THEE HEL..I_ HZL_I_ :SER',,,'E.
E',F:ICKE']:Lr.L.!I",IG ':'IF I::lN"r' :=..';'¢'_E;"I'Eh'I H]:THOU'I' E':[NFIL ZI",IZF'EE:T]:CIhl EIND flFFF -I. .,
[;:'EF'F~F:THENT H :1: LL_ L E. '_"~;UELTEC:T -f'O F [. _ :,[2 _.1_1 I .[ _
H :[ N :[ hlUH D :[ ?T'r':tNCE DETHEEN R HELL RNE:, FIN'¢ Ol'.,I-...'J5 1 TE E;EHFIGE D
:!.O.(:) F'E[E:'F' FOR F:I F'F4:;[',,,'FI'['I:~ HEL.L. OF?. :L.~!;(i) 'FO 2t~,i!l FREE1'' FF'.OH F:I F'UBIJ:C: I,.]EL[..
UPON THr..: l"-r'F'EE OF F'L.I[]:L.1ZE:
HtNIHL.IP1 E:,Z:E;TF~NE:E E'F:Eff,'I FI E'I:~:]:',,,'I':I'I"E: HELL 't"0 FI F'F:]:'v'FITE %EH[ER LINE ]2E; ;2'.~i; FEET EINE:,
'FEi FI I2:I/iIP'IP1L.IN:[T'.,.' 'SEHE:I:~: LINE ]:Z 7'5 FrEE'r'.
HEL. L LOE'JS [::lF4:[i~ I~:E:g!UIF~:ED FffqD HUS'I" DE: [~'.ETUF'.NE[::, TO THE [)EF'FI[;i:TI"IEN'I" I,.IITHZN
OF' 'THE I,.IELL COHF'L.ETION.
OTHE;F: F.:E:QI..I Z F:E;HEiNT'~5 f'lF:Fr' FIF'PL'r'. Z',F'E[:: Z F :[ CFIT I OIqZ F:INE:, C:Cd",f'.!CI"RLIC:T I ON E:' :[ laGRF:II"1% EIRE
FI'v'F:I:[LFfEtLE TO ]:N~SUF'~'.E; F:'Fi:OF:'EF~:
I CEE'.'T']:F'"r' TFIFI!-
t.: ! Fli"l FFII"IlL. IFff;i: HITH -HaE F;:E)21J]:RE:HENTS
F'Cff~/'['H B'¢ THE P'IUN:[CZF'FIL]:T'¢ OF F:INCHOr~'.F~[3E.
;2: Z HZL.I_ ZNFSTF!L.L THE :E;'¢r~;TEH
Z: Z L.IhlDE:F'.:E;TFIND THFIT THE: ON-"ZITE 2;EHEF: S'¢S"FE3d HI=I'¢ REtT4UZRE ENL.FIREiE:P1E:NT ZF' THE
~..E._,~[..E[IL.L. Z.., Fi:E:PIOI)E:LEE:, TO
....." ':":'1,_, ..................... Ir:T' EW... f~Ct d':',
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTIVlEHT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOt. ATION TEST
[] PERCOLATION
TEST
3
4
8
SLOPE
WAS GROUND WATER
ENCOUNTERED?
13-
IF YES, AT WHAT
DEPTH?
SITE PLAN
14-
15-
16-
17-
18-
19-
20-
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
72-008 (6/79)