HomeMy WebLinkAboutEARLES LT 3 (2)II
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
/
L~UPGRADE
LOCATION,/
~ Well !
I DISTANCE TO: I
I I- 2 I Manufacturer
I ~ Li~L~, cap IF HOMEMADE:
Absorption area Dwelling
Well Dwelling
Well
DISTANCE TO:
No, of lines Length of each line
Top of tile to finish grade
Length
DISTANCE TO:
Width
Depth
Building foundation
DISTANCE TO:
ot line
width
Foundation
(¢ / __
Total length of lines
Material beneath tile
Depth
-NO. OE BEDROOMS
'ERMIT NO.
~o. of compartments
~epth ~
PERMIT NO,
PERMIT NO.._7. 0¢_0¢~,(~? (
Distance between Jines
/¢/~
Total eff~.c~v~a67rption area
PERMIT NO.
Crib depth [ Total eff~orpti~
Driller I Distance to lot line PERMIT NO.
OTHER
PIPE MATERIALS
INSTALLER
REMARKS
IAPPROV ED.,/'"'
72-0~3 ~ev. 3/?8)
DA'rE LEGAL
'f'WF'E f;$:' SOIL f;~E':~!;O[R[:!:'TiON SYSTEH :[![!i;: 'fl;i'.ENC:H
THE LEi',f(3Tt.I [':,I i"[Ehl'.:~;:i: ON I f-i; TH[i!: L.EENGT!q ,:.' I N FEE'f' ) OF: THE 'TRI~:~:NOH Ot~: [::,f;~:F:t); F,IF:' I fi:L[::,.
THE
(~itROUN[::, FIND "['HE [~:OT'T'OFI OF THI~( E',:.:',f]FiVFIT :( ON ( I N [::'EE'F ).
'F["I[[
f'IN[) T'H[:: t]~:OTTO["t O[;:' THE: E~:XCFtVF'fTIf]N (IN FE[ET).
I:::'Et:~:['"I 1' T I::IF'F'L I d.'6INT HF:I:!~; THE
:( Nfi!;TFIL.L.FIT I ON I N:E,F:'EC:T :[ (]~',lff; ('.IF:' f::INM [,.lEi..L.t{~; f:tD3'F1CI!:]",)]' TC'I 'i"H 1' :!!i; F'EirCff::'Ei]:',i'.T"r' I:::tBI[) 'Fl'Il:{
THOU']' F:' t NFIL I Nf::;PEC:T I C'IN F~F,ID I:::ff:'PRCIYFI!.. !?'? 'T'H :t.' :i'!;
THE;. I;'Ft;L. II;iE~[) ::i; :t: ;;!il[,]: OF' TH[i: SO:iL.
THE L,l~::t",l[~i"l'H i) ;I: HENS i Of Sl '.t; 5 'H4E LENGTH ( I N F'EET) OF' THE Tt:;?JENC:H OR DF:ff::~:I: NF :(F~:L.D.
THE: [>E:F:q"H OF: Fi 'TI;~EI',,!C:H (::lf;~ P~:"i" :i:F TFIF:~: DtS"I'F'IiqC:E: 13ETHI:~I'~;:Iq THE: t~;I.II:~',F:'F:!C:~! ()F "i'1.'-11~:
(;~t;tOYNl) l:tN[) TI'IIi: BCFI'FOP1 OF:' THE: E',:':',(;)I::IVi::tT I ON ( I f",! I'::'Ii}}:ETT ).
'i¥1EF;',!F; :iS NO SET HJ:D"fH [::'O[~: Tf,i:iEhlC:I'-IE:S.
"t'it[~ (iF~ffrtVI'~:L, [)fi';:;PTI'I :IS Ti"If/: H ZNIFIt,II"! DIT:PTI4 CtF Gi4'.F:tVEL E:[T'FI,,I[~(E:Iq THE
1 ffl.:::, TI"t[~ ................ B I 1.. I ~I .... :[ NF'Oi:;?,H "FH t :!!i; [)EF:'I::It:;UfT"IF!:N"F DL.tR ' '
I ~, ~.t J.i F:II:::'F:'L i C:I:;:INT "' "' ·
1 iq :;TFII..I.,.f:::t'i~ t O1"4 .... "~ ' ..... "': "~ ........
. ]: t,I::,F' [:. ~ F 1 ~. t",t:: C 1'::' FIM"d H[',::L L.S l;;t[)3F:lC:lii;tqT TO TH 1 :iii;' ,, ~ ~ , F:II",t[) TI'
H Ji'"tli:: FY'? ()F:' i:;i:[:.::S f [)Ei",IC:ES THF:IT THIE .L,.l[!i:l .I.., H :i: L./. ,: t::.k,
Pi I N IFtl, JH [):[ ':'E;'Ff:INt3E B[:i:'T'NEEi:t:~I ' FI HEL,.I,, FIND
::L(JO i:::Eiii:T l:"Cil;?. I::'f PI;i:.'I:Vf::F'!'E: I,.IEL,,I,,..~ ['iii;'.
:LEiO TO ',.:'.::OO I:;:'EET I:::[;;:()H I::t F'UBt~iC: ['.IEL. I_
O'FI'IIi!!:F;: Fi:i!:L.:!U I F;:Eit"iL~:FITS P'IF:I"d FIF'F'L."~'L SF'EC:
qb-
2"204 Cleveland Anchorage, Alaska 99503'
.eoal qescrintion: Lot~j~__Block /_S;~-lvi~ion~--~J~L~~
Fhis Form Reoorts Soils Loq~ Percolation Test
nenth
Feet
Soil Characteristics
Was Ground Water Encountered?~O
Yes, At what Depth?__
-I
Readinq
i
Percolation Rate
Date
Gross Time
Minute
Net Time
Depth to H20
Net Dro°i
Frnposed Inst~on: SeeDaoe Pit Drain Field
' Deoth To Bottom Of Pit pr Trench
Deoth of Inlet · ~~r~_C~__~_~3j ~F_~_~.~-
Date: