HomeMy WebLinkAboutUS SURVEY 3200 LT 19AO0
~ 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 'Z~ ~EW
NAME
MAILING ADDRESS I
LEGAL DESCRIPTION
Lin, capatit~ns I Well , ' Absor0tion area , Material
~ DISTANCE TO: [ DO I t ~ Dwelling
~ ~ Manufacturer
-- Wdth ~ Inside length
IF HOME.DE: ~
NO, OF BEDRO~S
PERM'T NO"'Tq 0 ! [
No, oS~..~mpar tments
DISTANCE TO:
Liquid dept.~h
Dwelling
PERMIT NO,
in gallons
DISTANCE TO: JWell "~ tOO, Foundation{~ ~_~O, Nearestlotline~ ~0 ' PERMITN~, ~ O~J ~.-'--
No. of lines~. J Lengt~o~/~_Tof each line Total length of Distance between ~e~
) of tile to fi~h grade Material beneath tile Total effecti~_~t_a~l~rption area
Length Width Depth PERMIT NO.
BuildMg
DISTANCE TO:
Distance to lot lin
Depth ~(~-- ~'~'l ~ iI ~)
Building foundatio
DISTANCE TO: ~2.~
OTHER
PIPE MATERIALS
SOl L TEST RATI~IG J
INSTALLER
REMARKS
.{~'~ Septictankt/O (~
PERMIT NO"~ q o J
Absorption area(s)
¢- /0o
DATE LEGAL
E:,EF:'Flf::'.TMEN'F OF' r-IF2FIL'FH F:lb![:, EI",IV I F.',I::INj."j[-~I~',jTjqL. F:'I,,.,_ITEC-i- Z O["4
FIF'F'L I
I..OC:F~'F Z
:,[-[.. J.~F..L E
E:,FIV I [:, '- '"; .......
'F","F'E OF ':; -s I I.. FIE:SOF:E:'f I r)iq =, t _, I j':.t I E)f~:R I NI:: I El_.[)
J.'J,FI',:.:;IMLIJ,'] I'.g..Ij."l[~.iE[~: 'jiF BE[::,I'q'.OOM~; = 2J:
}';OIL F'FITING (SL.] F:-I-,."BF~:::,=-': :1. O¢3
THE F?.Er..:!LI~J,~:ED SIZE OF -FF.IE SOIL_ FtE:~;Of~:F'"FIOiq SY'_-_;TEJ,"I IS:
[..:.. ~ -,,~ fi ~ --~ ....... ,~{; ::fi._ n~ F~. ~ ~ , IF: ~ 1[::" fi~'£: F" '"fi'"' fi"-'.l! ==
THE LENGTH C, IMENStON IS THE I_ENGTH ,::IN FEET) OF THE T[i:EI'.,ICH iDlE'. [:,F?.FIINFIEL.[:,.
THE DEF'"I'H OF' FI TRENCH O~: PIT IS THE DISTFINCE BETHEEN THE SURF[iCE OF THE
(~ROLIND RN[) 'FHE BOTTOM OF 'TI-I[i~ E',qCFi',,,'~TION (: ]N FEET).
THE GK:IqVEL. DEPTH l~5 THE MINIMUM DEPTH OF GF:FI'v'EL. E:ETNEEN THE OI...I'[FFIL. L PIPE
FIND THE BOTTOM OF' 'rile EXCFI'v'FiTION (IN FEET).
MINIMUM [)IL::;TF:IJ..aC:E E:ETFI[~L:J'-,I FI HELL FIN[) FIN"r' ON-SITE SEHFtGE E)I'.C,F'OSFIL ~;'~"_:.';"FEi'"I
::LOO FEE-I- FOR F~ I::'I~'.IVFITE I.,.Ij,~LI...~ OR
±f30 TO 200 FEET F[q'.OM Fl FtlE:LIC I.,.IEL. L_ E)EPENDIJ,',IG L.IF:'C~q TI."IL{ T't'PE OF' PUBLIC I.,.IELL.
klELL LOGS FII:~'.E
OF THE I,.IEI..L.. C:OJ."IPLETZON.
O'J,'HE:[~: F:EQU]:J,~:EME{NT£:; I"1f:t¥ FIPF'L.'~-'. SPECZFZCI:¥FIO[',IS FiND COJ.',I'.:i!:TP. LIC]"ZOi",I DZF:IGI~?.FIN'.E~ FIF?.E
Fl',,;l::t t L. FIE.'I.E TO I NSLIf?.E PROF:'E[,~: I NSTFILL.FIT I ON.
Z H':Z:TF~LL I:qT I Oj.',i 1 J,,L. F ~ ._./ff' I _. hL~, OF: FtJ',J¥ NEL. L..S FI£:,..$1':IL']:[£J,',IT T '] TH ] S ~ [..L F El. I 'r IFff',l[:' THE
J,lJJIlrc~. OF F.~z;~,ZL.[:d',IL.E ...... THFIT THE I.,JELL klIL.L. :,_F..,~..
~}~'ll.'::J'::iF ] LJ'- I NC~ O~: FiN? ~:ud';]':T~r~JvJ j"~[ )~ 'TI"IOLFF F I NFIL I NSF'EC:T I ON Fff',ID IzJPPF:i:OVI~'~J'- E:~T' 'tH .T. S
[:,[£F'F1F~TMEJ,.~T HILL E;E '..~;U.F_L~rEC:T TO F'F:O':3ECLITIOJ..,L
2204 Cleveland
Performed For Dave Sprikle
Le~al qescrt~t~on: tot 19A, B]OCk
Th~s Form Renorts $otls Lo. Yes
Anchorage, Alaska 99503
Oate Performed. 6-24-78
.~Ubd~¥~S~'O~ U.S. Surve~ 3200
,Percolation Test
Peoth
Feet
4--
10--
12--
14--
16
18--
20
Brown Sandy Gravel/
Gravelly Sand
Bottom of Test Hole
Was Ground Water Encountered?
3f Yes, At what Depth? 6.5'
Read,n; Date Gross Ttme Net Ttme Depth to H20 Net Dron
Percolattnn ~ate U1nute
Prnposed Installation: 'Seenaae Ptt Pratn Fteld
Deoth of ~nlet .Depth To ~ot~om Of Ptt Or
C~PENTS: 100 sq. Ft. dr.a~nage are~required per bedroom-
Trench
Test Performed
Data Certified
Dater 6-24-78
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