HomeMy WebLinkAboutT15N R1W SEC 18 LT 205-B
MAiLiNG ADDRESS
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
[~'~EW
[] UPGRADE
LEGAL DESCRIPTION
· ~ NO. OF BEDR~MS.
Well Dwelling PERMIT NO,
DISTANCE TO:
Manufacturer
No. of compartments
Liq. capacity in gallons IF HOMEMADE: ~nside length
DISTANCE TO: Well ~ Dwelling O
Manufacturer ~ ~'~ E J~t
Well
DISTANCE TO:
No. of lines Length of each line
Foundation
Width Liquid depth
Nearest lot line
N°'? O 2"I Ej
~lJons
Total length of lines Trench width Distance between lines
inches
Top of tile to finish grade Material beneath tile Total effective absorption area
inches
Length Width Depth PERMIT NO,
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation
DISTANCE TO:
Class Depth Driller
DISTANCE TO: Building foundation Sewer line
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER'
REMARKS
Nearest lot line
Distance to lot Hne PERMIT NO,
Septic tank Absorption area(s)
DATE
LEGAL
a/aa/ 7
72-0~r~ (Rev. 3/78'~ ~) -
:IL I T'-r' ~3F
HERLTH FiND ENVIRC~Ht'IEHTFtL , ,<C~TECTIOH ,~.~j. ~. ~1,~-~
STREET, RNCHORFIGE.,
C~I'--I--S I TE SEI-,JEF.: F'EI~.:Pl I T
PERMIT NO.
RF'F'LI,::RHT )[V(-,~ KK~ ' ' ,
LrlCFtT I OH ,
LEGRL ,
T','F'E OF SOIL BBSORBTION SYSTEPt
MBXIMLIM NIJI,1BER OF BEDROOMS
LOT SIZE,
SC!UflF:E FEET
SI:IlL
_I,:.E ElF THE SOIL RE:SERF'TIEIH
THE RE~.'UIRED q "' _r.:.TEH IS:
[:, E F' T P-t--'
1__ E 1'4 f] T I-I=
73 -F-: Fi '...' E L [:' E F"' T t--t ---
THE LENGTH DIMEHSION IS THE LENGTH (Itl FEET) OF THE TRENCH C,R DRFtlHFIEIZD.
TI4E DEPTH OF fl TRENCH OR PIT IS THE DISTRHCE BETHEEN THE SURFRCE OF THE
GROUHD RHD THE BOTTOM OF THE E)<CR'v'RTIOH ,::Iti FEET:)
THERE IS NO SET NIDTH FOR TRENCHES.
THE QRBVEL DEPTH IS THE MINIMUM DEPTH OF GRR'.,,'EL BETHEEII THE OIJTFSLL PIPE
RND THE BOTTOM OF THE EXCRVRTION <IN FEET)
F-: E ~;! LI I E: E [:' $ E F' 'T I C: T Fi f"q I-::: :--% ~' Z E ~--- ~ ¢:t L_ L. t~, I'-4 S5;
PERMIT FtF'PLIC:.RHT HRS THE RESF'Oi'.ISIBILITY TO IHFoF:M THIS C, EPRRT/'IEIIT [:,l_lF:Illl] THE
IHSTRLLRTIOH INSPEC:TIOHS OF Rll'-r' HELLS RD..TIRCEHT TO THIS F'ROF'ERT"r' RHD THE
HUMBER OF RESIDENCES THRT THE WELL NILL SERVE.
TL.JCI '-'[ 2 -'-, I I'-4SPEC:T I L-~I"-4 ~ F-I F-: E F.: E tT!b! I
E, HL. NFILLI,"IG OF BNY _-~.:,TEM 14ITHOI.IT FIHRL IHSPECTIOH RI-ID RF'P~'OVFIL E:Y :'HIS
DEPFIRTHENT NILL BE SLIBJEOT TO PPEL=:ECUTION.
MIIlIMLIM DISTFINC:E BETHEEfi R WELL Fti'-lD FIH'.P OH-SITE SENRGE [:,ISF'OSflL SYSTEM IS
100 FEET FOR F~ PRIVFITE L4ELL; OR
158 TCI 280 FEET FROM R PUBLIC NELL DEF'ENC, IHG UF'CIH THE TYF'E OF F'LIE:LIC NELL
HELL LOGS RRE REQUIRED RND MUST E:E RETURNED TO THE [:,EF'RRTI'1EHT NITHIN 3G DRYS
OF THE NELL COMF'LETIOH.
OTHER REgUIREMENTS MRY RF'F'LY SF'EC:IFICRTIOHS RfC) COIISTRUC:TIOH DIRG~'RP1S RRE
R',/RILRE:LE TO INSI_IRE PROPER IHSTRLLRTIOH.
F'ERr.1 I T E)<F' I F4EL5 C, EIDEPlE:EE: ]:fl_ . 12TLg4
I CERTIFY THI.-3T
:L; I I~P1 FFtMILIBR I4ITH THE REQLIIREP1Ei'ITS FOFi OH-SITE SEHERS
FORTH BY THE MUNICIPFfL]TY OF Fd'ICHORRGE
2: I I4ILL INSTALL THE SYSTEM II.l FICCOI;'.DFiHL-:E I,IITH THE C:CI[:,ES
3: I LINDERSTRrID THFtT THE ON-SITE SEFIEP S'.r'STEfl P1Ff'P RE~PUIRE
RESIC,Ef'ICE IS REMO[:,ELED TI} ~tICLU[)E MORE THFtI4 :.:.', 8EDROOf'tS
FIHD I.IELLS tis SET
EHLRRGEMEHT IF T;~E
ISSUED B"r' ~, ..[:,RTE ....
I' f: I' .H.L I
'FF'IE: L.I!E!:i",II:ii-FI'I [:, I HE:N'.E;
. . ] I :[:E'~ THE I.J..,ll
'I"HI!ii: I:>Ii~:I:"I"H OF= I:::1
GI:~[:OI..II",II::, FIND THI!!!: I!:: "'l'TF'ff'l OF TH[!! F..... , ~1 I
I:::lf'J[:' 'I["IE~: E:CIT'I"CIH CIF:: "l'l"t[~:
,.~ ..... ......... :::.
}}"l':;t'l:::ll L.fi:ll' I:ff.,I .l~l...,I
: .............. '"
I.,II..1111:1.1. I:::11:::' [.I:.. ,.!. DI. II..[ ":'~ '=
'"F Ibql C:::~
I~:I:::II::~':::F= I I...L :[ f.,ll]i (::11:::' I:::lf',l"~' .:::, ~ .~ [:.! I I.,.I :!: THI:]LIT
t::d~:iF::'f::IF?.TFII~:I",T HILl.. $~:[~:
CFIHE:F;;: [:;;:[]:l:j:!l..I I F~:[~:I'"IE~:[",I I~II::I'T~ I=IF'F'L"I",
f ,I ,1.1 [.L.I- I'O fl .....
[I. li~rli~:'Fl.,.llii:lili:l",l 'l Hli~: r:'H..tTI::: I:::ll..I F::' :[
'CiF~'H l"H:l::i!i: [:,li!:t:::ll:::ll:;~:q't"l[~:~",lT [:ll..tl:~'.]:l'.,!l::ii
l'O Tli]::!!!; I F I [ I I I:::ff'~l[:,
[ 14 ,1' E . I ]: 01",1 F:It",II:> ' I"' I'- I,. t [.. I'Fi I :!~:
)l'q.
~J II._ t ..Ii I ii · ...........
::L:
F::'OI:;i:'I"H [igT* "l't . I"11 t1",I ]: C: ]: [::'[::11..
2: :l: H ]: I...L ]: I",I:i!!;'FF:IL.L. THE:
::ii:: I: LIl",lDEi~F;i::i.i;'l'l:::ff',H::' 'f'HF:IT 'i"1"1[!i:
I:;i:li":!:i;]:l:>lili:l",JC:l!!!: ]::!i; Fd!:i:I"IO[:'E:I,.I!E:I:> 'J'O
~teven A. Johnson
P.O. Box 76
Chugiak, AK 99567
Phone: 907-688-3085
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PEREORMED FOR:
DATE PERFORMED:
SiTE PLAN
10-
11
13-
14-
15-
17-
18-
19-
20-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
72.008 (7/76)