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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
PRONE
NO. OF BEDROOMS
Dwelling r' P ERMITo~/ // 7
' Mater'al~) -- [ No, of co~artments
Inside leng¢.~ W dth Liquid d?~h
Well Dwelling PERMIT NO,
Foundation, ~( , Nearest Iot.~lme/~) PERMITNO~// /
LEGAL DESCRIPTION
LOCATION
~ DISTANCE TO: MDT
DISTANCE TO:
DISTANCE TO: ]I[W?II !-(~) ~
ND. of I~e~ ' I-L;{~gti; ~¢ eaddige, /
Top o ti e t fi~isl grade
Total )f, Trench width /
length o lines,
Material beneath tile . ~-: y ~ o ti n area
Length Width Depth PERMIT NO.
neter Crib depth olption area
DISTANCE TO:
Depth
DISTANCE TO: Building foundation
foundatior rest lot line
Driller Distance to lot line
Sewer line Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING
/4~ ~5
INSTALLER
REMARKS
PERMIT NO. ¢~//
Absorption area(s)
APPROVED DATE
72-013 (Rev. 3/78)
LEGAL
-?'11
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"!'HIE [..iENG1 H [;:,:[ !',!E:N~;]; Ol'.,t ]: :~; THI:~; !..EHG I'FI ,:: ~ I'..~ FE:E:T) Eft:: THE: TI~%hiC:H
'['HIE: DEF'TH OF FI !RENE:I-! OR F':~T ]:'5 THE; D~:E;TFINCE E~ETHEEN THE:
GF~'.OI...iHD F:INI) ?HE: E',EFF'FOH OF FI-lIE EF::E:FI'.,.'FF[:[CIH ,:: ]:N FEET::,.
THE G!:;:FI',,,'EL [::,E;F'TH :i::5 THE; H:[NJ;i',ILtH [:)EF'"!'H O!::: Gt:;i:FI'v'EL. BETI'i,.!EEh!
Fd'..E:, T!.IE E~OT'TOH OF THE; E::.0Z:FI'v'FI!* :[ O1'.,t (: 1: N FEE'!-
H :[ i'.! I: HUH !:':, :[ ?'['~::)i'.,)i:i::E!: E:!L-t'P.Ei:EN F:! HE:L.L FIND Ftl'.:!',~.' Cd'.F,,:~ ]: 'I"E ::::;E:HFIGE; C, Z :SF'OtE.-;FIL, ?CIE; IE!'! :[ t!::;
:t.gE~ FEET !::'O!;ir (::i F'F::['v'FI!"Ii~ !,!ELi_ OR :L?._'l TO ;:;i'.(i!fE~ I.::!i!:ET F'F:'Cd"! FI F:'UE'.L ;[E: !,.1~:!.i.
UPON THE: T"r'F;'E ()F l:'t...l!ii',[..~l_~: HE:L.!
I'"I]:N];HI..IY! [::' ]: ?t'I':!I",!CE F'F:Ed'"I I:I !::'RZ'v'F:r!'E: !,!E;L.L TO F:I F'I:~:]:',,,'FtT'E: ':~;E;F~E3;~'. L.;[NE: :i:'L-'; ;:_'t:~ FE:'-LT FIND
I'O F:I C:C!!','E,!I..!I'.,i:[T'¢ 'L~EI,.IE:R L):t'.,!E: :i:'--'~; ;:*'..:,; FEET.
NELL. LCICi~:: R~,~:E F;:EI;:!U;[REi[::, I::l~qC, h!f_.ESf' E',E: F:'.E:'t'I,.hFi:i'..IE!::, Y(:)THE
OF: t'!-!E: HEL, L COI'IF'L.E:T]:
OThlL.i:t;? 1:;;:!:~:i:~!1_.1 ]: I:~:E:.HE:.h!'I':i"_-: !',l!::l'v' I:~F:'F'L..'T' :i;I::'E[E: ]' F Z C!:::IT Z Oi'.,i:5 I':d'.~C, CCIi'.,!'_::;
F¢,,,'!:::!);L.I::IE',[.I!!; TCt :[i'-,IrSLIl:~:iE i::'I:;i:CIF'EI:;~:
PERFORMED FOR:
LEGAL DESCRIPTION:
THIS FORM REPORTS:
CONS i't:,..JC'T-tON
lZo LAB
18OC W 48TH AVE STE. 'C'
,ANCHORAGE, ALASKA 99503
Ester PersingeK
Lot 34 Block
Visual Soils Examination
Subdivision
DATE PERFORMED: 10-19-81
Sec 10 Twn 11N R 3 W SM
Percolation Test 81-1623
DEPTH SOIL
FEET DESCRIPTION NOTES
PEAT Pt
2'
Poorly Graded Gravel - GP
12'
Brown Silty Sandy Gravel - Wet
GM
BOTTOM OF HOLE
WAS GROUND WATER
IF YES, WHAT DEPTH
~=F~GF N~DD
,~ - Perc zone
,~S- Sample taken
~ -- Frozen zone
'~ -- Water ~obie
ENCOUNTERED
GENERAL SITE SLOP
READING
DATE
GROSS TIME
NET TIME
DEPTH TO H20 NET DRAINAGE
PERCOLATION RATE: DRAINAGE REQUIREMENTS: 125 SF/bedroom,
PROPOSED INSTALLATION: [3 SEEPAGE PIT [3 DRAIN FIELD O OTHER
~7~-~ ~ORMED BY: Ed Latkowski DATA CERTFIED BY-
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 305
DRILLED AT THE RATE OF PER FOOT,
t~o.,~ o.,,d~/ '/'9 S.te.e.,v~.e~ Co~4~. 27~-5055
PROPERTY OWNER
LOCATION OF WELL
DRILLER
WELL LOG:
0 .... 16'
16---24'
3/4 h.o/~e pimp ,~h. ouJA fie. Zn~2d2..e~ 20 .to 30 f~eat o~- bo.t.tom.,
DATE___
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
SERVICE CHA~GEOF I%% PER MONTH WILL BE ASSE ON PAST DUE ACCOUNT$.
