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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 ~/~ [~] NEW
LEGAL DESCRIPTION
Liq. capacity ig~allons Inside len~ Width Liquid de~
~ Well Foundation Nearest lot :,n~
No. of lines Length of each line , Total length Trench width Distance he,ween I~nes
, Material beneath tile ~ L/
~ Top of tile to finish grad~
~ ~ ~ Total effe veabs~rRtion~rea
Length Width Depth PERMITNO./~ ~
~m ~ANCE TO: ~ell - - Building foundation Nearest lot line
~ C~ Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PiPE MATERIALS
72-013 ~ lev. 3/78)
PE~.f~l I T ~N0.
tqlJ !'.~ I ,:: I PRL I TN' F-~F-- RI'-~cHoRRGE
DEPFtRTMENT / ', HERLTH ~ND EN,,, IEONMENTNL .~OTEC:'
~25 '~ _,TREET., ~NCHORRGE., BK.
264-4728
C~ ]E ~'E ~E~.~E~
.:.~1~6i~. )
_., ~:~ W. , oTH
RPPLICRNT
LOCRTICIN
I_EGRL
JOHN E. MICHRELIS
_.3:720 W. 78TH AVENUE
Tt2NR4WSi,/2NWi/4NW1/4 S. ~l
LOT
TYPE OF SOIL RBSQRPTION o"rz, TEbl I--,. TRENCH
flH~,.IflUM NUMBER OF BEDROOMS
=,OIL RBTING ':.:SQ FT,-BR.-
THE: RE;!JIRE[, SIZE OF THE =,UIL RBz,_RF rluN :,Y_,TENI:,'--.
'
THE 'LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFBCE OF THE
GROUND 8ND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTF8LL PIPE
8ND THE BOTTOM OF THE E~CRV8TION (IN FEET).
RE[:. -- EPT
PERMIT RPPLICRNT HR_'=, THE RE_-,PuNz, IBILITr TO INFORM THIS [EFRRTMENT DURING THE
tNSTRLLRTION IN_,PECTILIN_ OF ANY WELLS RDJRCENT TO THIS PROPERT'¢ RND THE
NUf1EER OF RE_,I[ENLEm THRT THE WELL WILL _,ERIE.
Tl..~l,:) (: 2 ::, I i'-tSPEL-:.T I C,l'-~S RRE F.'E i]-~L! I REC,
BRCKFILLING OF RNY _N_TEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEF'RRTMENT WILL BE SUBJECT TI] PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
t00 FEET FOR R PRIYRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIYRTE WELL TO R PRIYRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RYRILRBLE TO INSURE PROPER INSTRLLRTION. "
PEIn: f4 I ]" E::<P I RE----. [-~ECEf'IE:ER __~?.. -1¢ :I. YE:F~
I CERTIFY THRT
i: IRM FRMILIRR WITH THE RE;~UIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
]:: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRS' REQUIRE ENLRROEMENT IF THE
RESIDENC~ IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS.
: z .... ........................
~ / RPPLICRNT JOHN E, MICHRELI5
.......
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL
PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-222~
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORIV]ED FOR:
LEGAL DESCRIPTION:
1
2
3
5
oL
6
7
8-
9
10
11
13.
14-
15-
16,
17-
18-
19-
20-
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
BITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN
I.{~e ?Fb
PEREORr, EDB~: ~, ~;,//'z~.,,, ~
72 008 (7/76)
PERMIT NO.
~'.!L~ll'--i :I C: I PFtL ! T'-¢' OF
DEPRRTMENT OE. HERLTH FIND ENVIRONMEN'FFIL ~OTEC-f'ION
..... STREET., HNI_:HORRI]E,
264-4728
I~-.¢,Ebb F"ER[F-! Z T'
. i'tIL. HRELI ....... [~, ,:-, FH RNCH ......
RPPLICFtNT JOHN , -' "--' '~--'-'-,¢1 ~-' ,~,"4~.-4c,
LOCFtTIL-IN -.,-,.-, ;-1 ,7,-,
~.,. ~:~ !.~¢ oTFI
LEGRL T±2 NR4W SECT:.t'IS::I. J2NW1J4NW±,-'4 LGT _I,_E
24]: 0 5 }.'s3
~.'1, ,..,0 Sg!LIFIRE FEET
MINIMUM [:,ISTRNCE BETWEEN R WELL RN[.', RN'T' ON-SITE SEWRGE DISPOSRL SYSTEM IS
i00 FEET FOR R PRI',,,'FITE WELL OR ±50 TO 200 FEET FROM FI PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTFINCE FROM Fl PRI',,,'RTE WELL TO ~ PRI'¢FlTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY' SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED FIND MUST BE RETURNED TO THE DEPRRTMENT I.,.tITHIN ~0
OF THE WELt_ COMPLETION.
OTHER RE~2.UIREMENTS MR'¢ RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIFIGRFtMS RRE
R',,,'FtILRBLE TO INSURE PROPER INSTRLLFtTION.
F E.F..~I I T E::-'.P I F:ES [:.ECE~'IBEF: -:~.J-.- :t .....
I
±:
FORTH B'¢ THE MUNICIPRt_IT'¢ OF RNCHOR~3GE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
_, __
CERTIFY THFlT
I RM FFtMILIFIR WITH THE REQUIREMENTS FOR ON-SITE _,EWER_, FIN[:' HELL--'; FlS _,ET
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