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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
NAM ' /~ PHONE
~ UPGRADE
~ Manufacture~~ [ ~¢ / No. of compartme~
Li~n~lons IF HOMEMADE: Inside length Width Liquid depth
, M ]Well Dwelling PERMIT NO,
~ O z DISTANCE TO:~~/
O ~ < Manufacturer
/ ch W~' th Distar~ce beJ~ee~
~ ~te~[al ben, aSh tile // rea
~ < Top of tile to Total
Length Width Depth PERMIT NO,
~ ]ding foundation Sewer line Septic tank ~e
/
i(Rev. 3/78)
264-4720
~ ~ * * * HANDWRITTEN PERMIT * * *
Permit ~~_~.~, . ....... ~A_ ON-SITE SEWER PERMIT
Applicant: Cd~4~/C~/ ~' ~' ~n~ Address:
Locationi Phone Number: ~7 ~_ ~O~
Legal Description: Lr /~ t
Type of Soil ~sorption System Is:
Trench: ~ Drainfield: Seepage Bed: Holding Tank: -__
Maxim~ N~ber of Bedrooms: Soil Rating(sq.ft/br)
The Required Size of the Soil ~sorption System Is: '
DEPTH ~ LENGTH ~ GRAVEL DEPTH ' ~ WIDTH
MUNICIPALITY OF ANCHORAGE
Department?~f Health and Environmenta,~?rotection /~
825 ~ Street, Anchorage, AK. ~9~501 /
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall ~ipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = ~- GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
'Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER ~1~ 1 9 ~ 3 * * *
Z certify that:
(1) I am familiar with the r~quirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I u~and that the on-site if
~~~ remodeled to ~d~Y~treq~oe~.rgement
Applicant) ~ Date: ~-- ~ ' ~
MUNICIPALITY OF ANCHORAGE rq ,~ ~ --,.~ ~- ~ - ~-~. ~
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ,J~ PERCOLATION
TEb--I' '
825 L. Street, Am~hora~e, Ala~ 99501 2644720
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3-
4
5
6-
7-
SLOPE
O,,.E,E. FO.',ED:
SITE PLAN
10-
12
WASGROUND WATER
ENCDUNTERED?
IF YES, AT WHAT
14-
17-
E
Gross Nat DePth ~o Net
Reading Date Time Time Water
~..~'~ IS 2, o7 ,7,,~
~. ~,,. ~ .~. ~. ~
PERCOLATION RATE (minute~/inchJ
9 /0
TEST RUN BE~EEN FT AND, FT
t, :,7~//~-z ~ ~ d~ +~.,.~. n ~.~ / r P~,
~~'- /
LOT
TH
1
2
3
4
§
9
10
11
12
13-
'14 -
15-
16-
17-
18
20
SubdivisiOn
LOT
~H
3
4,
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
A.E.C.S., INC.
1220 W. 25TH. AVENUE
ANCHORAGE, AK'. 99501
Supplemental Soils Information.
~H
1
2
3
4
5-
6-
7
8
9
10
11
12
13
14
~5
16
17
18
20-
LOT
TH
I
2
3
4
§
7
8-
14-
17
20
· :* V" CONTROL SERVICES, INC. s.;~r.o o;
·" 1220 West 25th AvenUer, -~,uite B ~^T~ /0- 7_.~- ~' ~
ANCHORAGE, ALASKA, 503 C^LCU~T~D aY ~7~/!''~ ~r..~ ~ r~
276-1361 279-2917
CONTROL SERVICES, INC. ~.EET.O..~.---~.~ ~'
1220 West 25t~ Avenue ?'~!ite B
ANCHORAGE, ALASKA ,. JO3 c^ccu~Ea a~ (/ ! ' ' (~/"~'~/? O^z~
276-1361 279-2917
CHECKED BY DATE.
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