HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 2 LT 9
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH 84 ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT
lPR°NE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
_ ¢,.
F- ;~ Manufacturer
~1- Liq. IF HOMEMADE: Inside length 1~1
DISTANCE TO:
No. of lines .
/
L.ength of ea ~)ine
Top of tile to finish grade/~ f~
Length Width
Type of crib Crib diameter
Well
DISTANCE TO:
DISTANCE TO:
Depth
Building foundation
Material beneath t,j~e
Depth
Crib depth
Building foundation
Driller
Sewer line
Nearest lot I' e
NO. OF BEDROOMS
PERMIT NO.
No. of ~artments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Distance between lines
inches
Total effective absorption area
PERMIT NO.
Total effective absorption ar0a
Nearest lot line
Distance to lot llne
Septic t nk
I~O ~ ~'
Absorption area(s)
OTHER
-~-I P E MATERIALS
SOIL TEST RATING
tlt6.
~LLER
REMARKS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
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egal Description: Lot__c{ __Block
his Form Reports Soils Log 1~
Soil Tes( Must Be Logged To 4'
Depth
Feet Soil Characteristics
Case
GRE, ,iR ANCIIORAGE AREA BOROUG.
DEPARTMENT OF EHVTROHMFqTAL O['ALITY
3330 "C" Street
.ANCttORAGE, ALASKA 99503
.~
i. Dated Performed
~ Subdivision
Percolation Test
Proposed Seepage System
Be 1 ow
Ground Water Encountered?
If Ye<.;, At What: Depth?
Read i n g
Date
Gross Time
Net Time
ercolation Rate
Proposed Installation: Seepage Pit Drain
Depth of Inlel: .... ~ .... Depth to Bottom ~}--2it Or
\
OHMENI S:
est Performud UY $¥ALLACE ENGff!EFRING CO, _Date Certified BY:
F'EIq:MIT NO. (
I)EF'FIR"I'MENT OF' IdlEI':iL_TH FII",IB~ EI",IVII~?.OI",IHIN",t'f'I:::IL_ I:'RO'I-ECTIOI",t
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:l. Eu;~l FEEl- I::OF;r I':t F'F::'.IVI:::ITE 14EL. L OI;?. 2:_'~:iI~!l F:'EET FOR F:I F'LIBL_]:C 14ELL
141:ii:L.L. LOG'J:~; FIF.?.E P. EL::!LI ]: IREDI::~i",11)I"IUS;T BE I:~'.ETUF;~NED TO ]Idle DE:F:'I::IF;f'I'MI.:-'NT I.,.IITHIi",I :~i:EI DI::I'-r'S
OF THE I.,.IIELL COMF:'LIETIEII",I.
OTHEIR F;?.IEQIJ I F;~:EI"IEI",I1-S I"ll:::l"r' I:IF::'I':'L"r'. SF'EE: I F ]: CI::IT I ON'.'5 F:IND CONSTF:IJCT I O1",1 [:, I F:IGI;?.F:Ii"IS F:II;?.E
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I CIZI:;~:TIF:'"r' THFIT'
:1..: ;t: FIf'l FI::IMILIFIF.~: 14ITH THE f:~:E:6!UIF;?.EMIEI'q"I'S F:'OI::,~
F:OF::TH El"r' THE MUI",IIC]:F'I::'IL):'T".r' OF:' F:INCHOF;?.FIGE.
2: I 14]:LL. INSTFIL. L THE S"r'STEH IN FICCOF;:'.DFINCE I-'.IITI'] THE CO[:,IES.
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ON-.SITE %EI.4ERS FIND NELLS
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