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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
LOCATION
DISTANCE
~UPGRADE
NO. OFBEDROOMS/~
IDwelling
Material
Width
PERM,T NO. ~, ~¢
No. of compartments
Inside length Liquid depth
Dwelling PERMIT NO.
Manufacturer Liquid capacity in gallons
Foundation PERMIT NO.
DISTANCE TO:
No. of lines / Length of each line ~.
Top of tile to finish grade ~ I
Total length of line~.~l
Material beneath tile
Depth
Crib depth
Building foundation
Ddller
Sewer line
Length Width
Type of crib
Material
Nearestlothne
Trench widt~.~Oinches
inches
Well
DISTANCE TO:
Depth
DISTANCE TO: Building foundation
Distance b~tween lines
PERMIT NO,
Total effective absorption area
Nearest lot line
Distance to lot line
Septic tank
OTHER
PiPE MATERIALSp2~,~-~t ~ ·
SOIL,TEST RATING
INSTALLER
72-O13 IRev.~73/78)
MUNICIPALITY OF ANCHORAGE
Department ~'f Health and EnvironmentaI-~rotection
, . 825 '¢ ~ Street, Anchorage, AK. ~ )501 '
264-4720
:.. ' ' * .ANDWRITTEN PERMIT ' ' '
Pewit ~ · ~/OR ON-SITE SEWER PERMIT
Location: ~. ~c~(;QJ ~. Phone N~er:
Legal Description: ~l~N f[~ ~c S ~ 3g LOt Size:
Type of Soil ~sorption System Is:
Trench: / Drainfield: _ Seepage Bed~ __ H~lding Tank:
Maxim~ N~er of Bedrooms: ~ Soil Rating(sq.ft/br) .% %
The Required Size of the Soil Absorption System Is:'
DEPTH ~ LENGTH (~"' . GRAVEL DEPTH ~ HIDTH
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 pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(h~G) TANK SIZE =' !~OC-~GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the n%unber
of residences that the well will serve.
* * * TW0(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection.and approval by this departmen'
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee'
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 31, 1 9 8 3 * * *
I certify that:
(1) 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 codes.
(3) I understand that the on-site sewer system may require enlargement if
is remodeled to include more that 3.bedrooms.
Signe~:~Issued by:
"~._d~ "/-0 -- ' Date: . ~,-(O--C:~ ~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage. Alaska 99501 ' 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED=
LEGAL DESCRIPTION: "T"' ~ '~ r~ ~_1. ~l..~ 5 ~' ~.,.. ~
3
5
6
7
8
9
10
11
13-
WAS GROUND WATER
ENCOUNTERED? '
DEPTH?
SLOPE
SITE PLAN
I I1~/ ~
,.~i
I I1 -.~'/ -
I II~/I
I/1_.11
I/~/I
14-
15-
16-
17-
18-
19-
20
COMMENTS
72-008 (6/79)
Gross Net Depth to Net
Reading - Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch)
FT