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. , t"~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
J ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
,ON-SITE SEW/~ DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTION
LOCATIO~ U NO. OF BEDROOMS
L~ I~allon$ IF HOME,DE: Inside length W~dth Liquid depth
~ -- ~ Manufacturer Material ) Liquid ca,city in ~llons
~ Well Foundation Nearest lot hne PERMIT NO.
No. of lines Length o Total length of lines Trench width Distance ~t~en lines
inches
~ ~ ~ Top ol tile to finish grade Material beneath tile Total efl~ti~ absorption area
m Building foundation ;e~r llne Septic tank AbSorption areals)
~ DISTANCE TO:
REMARKS
.,7
"' ' ' '5. _.,~o~¢ " ~- I1'
' '~._ ~/d~~
Rev. 3/78)
PERMIT NO.
MI_I~I I [~: I AL I TY OF A~l¢l-. .~RAGE
DEPARTMENT OF HEALTH AND EN¥IRONMENTAL PROTECTION
625 'L' STREET, ANCHORAGE, AK. 99501
ON--S I TE SE&dER PERM X T
( 8209~ )
APPLICANT
LOCATION
LEGAL
ROBERT POOLE
T15NRIW S8 L8
TYPE OF SOIL ABSORPTION SYSTEM IS:
BOX 994 WASILLR 99687 376-5472
LOT SIZE 999999 SQUARE FEET
DRRINFIELD ~--~ ~
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= 5 LENGTH= :1_05 GRAVEL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND A~qD THE BOTTOM OF THE EXCAVATION (IN FEET>.
THE TREI'4C:H t~IDTH IS 5. 000 FEET.
THE GR~VEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (Itt FEET>.
REQUIRED :~;EPTI¢ Ti=INK SIZE= 1750 GRLLO~I$
P. ERMIT 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 > I ~ISPECT IONS ARE REQU I RED
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 i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I T EXP T RES DECEMBER ~-. ~-~c~$2
I CERTIFY THAT
i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
S I GNED: ....................
ISSUED BY_____.___~' TE___ ~
V4. 0
~ SOILS LOG
,/-
MUNICIPALITY OF ANCHORAGE
r-I PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
825 I.* Street, Anchorage, Alaska ~9501 264-4720
SOILS LOG -- PERCOLATION TEST
6
7
8
9
10
11
13-
14-
-15-
16-
17-
18-
19-
20
SLOPE SITE PLAN
WASGROUNDWATER ~ ~"~ 0
E.COUNTEREO,
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~%//~.//~ (minutes/inch) .'
TEST RUN BETWEEN ~ FT/~.~ FT
....
'~' ~ ~ -- ~ ' DATE~
PERFORMED BY:'" _.~[~ ~.,~ '~ CERTIFIE
72~08 (6~9)
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION.
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of.
public water system located
- , Alaska, submitted in accordance with 18 AAC 80.100
by.
,have been reviewed and are
approved.
BY
[3
conditionally approved (see attached conditions).
DATE
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (contract order no. Approved by Date
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE
The construction of the ,public
water system was completed on. (date). The system is hereby
granted interim approval to operate for 90 days following the cpmpletion date.
As-built plans submitted during the interim approval period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
final approval to operate.
BY TITLE DATE