HomeMy WebLinkAboutT13N R1E SEC 10 E2SE4SW4SW4 & SE4NE4SW4SW4
/'--% MUNICIPALITY OF ANCHORAGE ~
DL .RTMENT OF HEALTH AND HUMAN SER ,;ES
Environmental Health Division
825 'L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
Address
Phone(s}
LEGAL DESCRIPTION
Township, Range, Section
DISTANCES
i~ SEPTIC
TANK
WELL
LOT LINE
FOUNDATION
~,"f
AS-BUiLT DIAGRAM
ADSORPTION
FIELD WELL
of well, sep[~o system, property hnes, foundation,
/~ SEPTIC
[] HOLDING
Manulaatuler Capacity in gallons
Mmenal No. el Compadments
TYPE OF SYSTEM
aTRENCH [~ BED [] W. DRAIN [] OTHER
Depth to p~pe bottom from Total depth from odgmal grade
original grade ~", ~) FT I'~-, 0
Fill added above original grade Gravel depth beneath pipe
I~,O FT ~,D FT
'¢2 '{~', '0 '2. ,~'"Ft
Total absorption area gJslance between lines I~
(42 0 '~ SQFT
Number o] hnes Soil rahng Pipe material
WELLS
'¢~PRIVATE [] OTHER ¢ldentifv)
Classdmat~on (A,B,GI
Total Depth FT Cased to FT
REMARKS:
Inspec~,~med by:
913 (3/85)
AF'F'I..,I[)ANT: SOUTH F:'ORK COI:IST'
Agl)~:i:J:::~:~::~: F:'. [} ,, BOX '770567
E::AGLE RIVE~, Al< 9VS'T7
CON'FACT ~.H[ NJ:: 694---435 :t
LEGAL DESCRiP: SUBDIVISION:
SECTION: :1.() TOWNSHIF': 13N
L.O'I" ~:~ I z.l=.: 7.66A (Sg~. FT. OR ACRES)
MAX BEDROOMS: 3
LOT: NE 1/4SW :t I: L.[)E,F.: NA
I~ANGE 1E
Listed below ape the options avai:Lable to you in cies:i, clning your' septic
system. Chc)ose the op'Lic)D that bes'L F:L'Ls yOL.H' site,,
Z)EF'TH TO F'IF'E E[F'F]"OM (I=T,,) 4.. 0 4.0 zl,~ 0
'f'O-FAL DEPTH (F'i". ~ 12.0 4,,5 7.5
F F' './E:]..,W: D'I"H (J:'"J".) ,= ,, ~-:; ~,= ,, (]) ..~=. 0
(:R~..:vI=.L. I,..ENGTH (FI'.) ..:,B. 0 4 :L. 0 6~-~., 0
GRAVE:L VOL. LJME (CU,,YDS,, ~ ="' 0 :"-:' 5
_. }., 48,, 2
]'ANK ,~ .. Z,: (GAL. S ) 1,0()C). ") ~'~' :I.'~ (-)00,, () ~..~ 1, "C F). 0 ~.~
SOIL RA"FING (,JC.FF ..... R) 2-'} 197 2('0
· x-.~. I"ANK MUS]' HAVE AT LE.A..~I TWO COMPAF:~TMENt'S
1,, 1[ am Fami].iar
wit. h 'Lhe requirement.::~ For' on-site !sewer's and wel].!s as set
f'orth by the Municipali'Ly oF Anchol~age (MOA) and 'Lhe State oF Alaska.
I wi:l. 1 :Lnstatl the sys't, em in accordance wi'Lb all MOA codes and r'egulat:i, ons,
and in compliance wii:,h the des:~.gn cri'Ler'ia oF t.h~Ls permit,,
I will adhere 'Lo a11 MOA and State cH' A].aska r'equir'ements for' the set back
distances Fr'om ~ny existing well, vJastewa'ter disposal system or public
s(,:~{.~]E~l'a~g(:~ Sy:~>'~,E~til CHI this or any ~djaceKyl:.
:[ t,JFId~P~stalqd tJla'~_ this pE, Pmi'~.. i~$ v<A].i[J ~'[)p a m~;~,mL~rll oF :~: bedr'aclJ?ls and
any en],aJ"gemeFJt will. pequire an additianal permi't,.
]:F A L..IFT STA'T'ION IS INSTALLED IN AN AREA COVERED BY MOA BUIL. DING CODE:S,
THEN (I) AN [:]L. ECTRICAL PERMIT AND INSPECTION MUST BE [}BTAINED; (2) AS--.BUIL. TS
WILL NOT BE AFI='RC)VED WITHE)U'T AN ELECTRICAL INSPECTION RE]:'ORT; AND (3) THE
EL. ECTF:~]:CAL WORK MUS"F BE DONE BY A LICENSE:D ELECTRICIAN.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ~-1~"~-/~:;iJU~,~ ~__~1/~ ~ ~'~'-~lt Township, Range, Section: ~ ~,
~) 5W )~) ~ ~ SLOPE SITE PLAN
8
9
10
11
12
WAS GROUND WATER . ~
ENCOUNTERED? ~ I~
IF YES, AT WHAT ~
DEPTH? ~
E
Oeplh to Water, ~r
Monitorino? ~ ~ Date:
13
14
15
17
18
19¸
20-
Reading Date Gross Net Depth to Net
Time Time Water Drop
?
PERCOLATION RATE . [minutes/inch) PERC HOLE DIAMETER __
S & S ENGINEERING TEST RUN BETWEEN __ FT AND __ FT
COMMENTS~*~ ~;a ~ '. ~,'~;v! ~A ~ ~
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN~FFECT ON THIS DATE. DATE: ~U~ ~ 5 ~
72-008 (Rev. 4/85)
DEPARTMENT OF HEALTH & HUMAN SERVICE~."//-~'"~.~,~/
825 "L" Street, Anchorage, Alaska 99502-0650 ~'~~
1
2
7
8
9
10 WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
12 DEPTH? pO
E
l0
Wator~ltor t, .
13 Monitoring? J,,.LO \/J~F~]ale: (o '~ ~ ~
Reading Date Gross Net Depth to Net
Time Time Water Drop
'~ ~'-~ ¢' t~ " . I /,~
14
15
17,
18-
19-
PERCOLATION RATE ~ ~P (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FTAND 7 FT
COMMENTS
SR B 196X ,
PERFORMED BY: - . - ///~~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ea.~Ll~ RIVER, AK 99577
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUJDELI~L~g~ EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85}
SGALE