HomeMy WebLinkAboutSUNDI LAKE BLK 1 LT 6
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kilding, scifety Division 11, &,o :RM
Water WcStewcter Pro
gram
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%wr Anchorage, AK 99RO.7
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'YVejl Number. SW MP 'nstallatiOn Log
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Parce"
L Leg
I'gaj Doscript:mn
u -n d F-operry Own,
er t
A-
PU
PUMP IA-U-1ke LePth 80ow Top cif ",ell Cpaj3rig: feet
Pull" hl"UfactLlrer's Name. pyit�,e_
mod.+
Punip size
/
P,de5l- Adalater Burjaj.Dcpth,
Fit""' adapter �Iarlufilcfurer's
PltIDSS Adapter
xtistaller:
WeR Disi.ri Ie
'Method of Disilifection.
Phi"
CoMmeuft.,
. �'Urall Jlpstalhr NP -nae.
iteHNOXI. Tire pc,,j)
Ic,9 to r�Ie DSIIf,ithir.of PVr
~,~ 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
NAME PHON~'
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
Well
Dwelling
DISTANCE TO:
~ ~ Manufacturer Material No. of compartments
~ ~ Liq. capacity in gallons Inside length Width Liquid depth
]~O IF HOME.DE:
O ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot linc PERMIT k~
~=,, DISTANCETO: NoT I~ FIoT IM I0'~
~ ~ ~ No. of li~es Length of each line Total length of lines Trench widtb Distance between lines
~~ Top of tile to finish grade Material beneath tile Totar effective absor tion area
Len.th Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot llne
~ DISTANCE TO:
~ Class Depth Driller Distance to Jot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
72-013 (Rev. 3/78~
, ,F, L.l,....h] ,! I
_. OCRT Z nN
L..EGF!L
DO LIL-~L FI'_:E; (3FiLL.F!~4T
T~ ~L,....1... ~d;d~. L~~C~'
FEET'
h'.RXTH.H NLIHE:ER OF EEE:,F'roH'.E; .... 3
]"HE REC!I...I !' RED_. **.._.':'; ~' -:,r..- Cfi::' THE St3 i LHL,_,,-'r ,c-- ........ B:,~:,'T' I' ON ........ :..-:..r,;_-..l lc.
THF: .................. LENEiTH I":,IHE'N:E;ZON IS THE L.E'",!..HF ,:'IN FEE'T> OF 'THE: TF'FN"'k -,'"'.~ [:,RRZNFZEL. D.
"rile DEPTH OF 13 TRENC:H OR I:';[T :I:S 'THE: L. Z: I,*hLE E:ETF!EEBI 'THE ~iI...IF::FrFiI[::E (3F E.
T'HE._~r.n.,,P";"-"*'c ..................... E:,EPTH Zq THF h"[HTH f,1 DEF'TH OF GRFI',/EL. EE~2T'i.,.ffZEN THE OUTFi:]LL. P]:PE
~i",r' THE{ ....... [] OF' THE; E;:',iC!:~',/FiTZCIN (TN FEET).
PEF.-.:H Z "i' FIPF'L l C:F!NT HFE:.; "F!.4E ,q:ES;F'Cd",]S Z E: :[ I.....T. T'¢ "to z .... ,~. gE [~'I-,'1 -"k,., ........................." ,::' [')FPF r-:.'T ',' P't'.4'T E:,I.JF~: I NE[ THE
f,L.'.. ~,._.!;.J 4 , TCf ~J r,:: '::' ;' ~:":'-';' '-' RNE:, THE
!?,!STFti._LRT'ICff'] !,L.[ E....! .[,..i',!... Ei-:' FII',I'T' HELLS a'"'"'-'""-:""~' ,,,.:, , !: ..... L,..T,
' -' ............": THE !.,.1EL.L i.,.IILL ...... E.-. L
i'-~iJi"IEIE[;'. OF f.rl::, 1 E Er,I.... E..., THRT ':: ' :" ":'
E:RL':!<;F'_[LL]:NCi r'lF ........... FIF,!'¢ S?s"rF_.'H !.,.K[THO!JT F'Z,NF!!... 'rN':;PFr-:Tznf'.,i 17NE:, F:II:::'Pt~:CCv'F:iL.. ,:.,':"', T.'--.]":, ........
DEF'F:IRTP!EFfT I,.lil [ E:E 'E' F"E"T 'T"" / .........
PIiI',!Zh'!UH E:, ]: .S'TF. INC:E E:E;TI4EEN Fl FiEL.L.. !:qND FIN".,' CS,l-SITE SEI.qFIG[::..' D!SPOSFIL S'¢S"FEH ZS
:t.~3(~ FEET FOR FI F'RI',,,'Fr'I'E klE[...L OR iSE! '!"O 2E~9 FEET F:ROH R F'UE',LZC i4ELL [:,EF'E:I'-,!E:,IN[3
UPON THE T'?'F'E OF' PUPLiC IqELL.
HINIHUH DISTRNCE F'ROH R PRi',,,'FITE HEI..i.. TO R F'RIVRTE SEHER L..ih!E ]:E; ;~'.F.~i FEE]' RI'-,E:,
TO R E:OHNUNi[T'-r' SE~qER LINE IE; 7'5 FEET.
NELL LOGS RRE REC~IjZRED FIN[:' HUST BE RETURNE[:, 'TO THE [:'EPRR]"i'IENT ~4ITHZN X:EI DR?S
OF THE 1.4EL.L COMPLETION.
OTHEF: RE(;:!LI~REh'IEI'4TS FtR'¢ RF'PL"?. SPECIF'ZCFITIOHS Rh!E:, CONSTRUCTION DZFIGRI::ih'iS RRE
ff,,,'FiIL, tqE~LE TO :[NSLIRE F'ROPER INS'T'RLLRTZON.
i C,ERT)EF? THRT
±: i RM FRMIL. IF!R FILTH THE REC!UIREMENTS
FORTH E'.'¢ THE I~!UNIC:IF'FfLZT'¢ OF FINC:HORF%iE.
2: I 1.4ILL INE;"r'R[..L THE S'¢E;TEH i?.4 RE:CC)RDFINCE; I4!'TH 'THE C:ODES.
F~:; ]( UF,IDEF;fSTFIN[:~ THFIT THE: ON-E;ITE SEI,.IER E3r'STEH HF¢/ REQUIRE IEi',iLF~RCJEh'fENT
hL.!~" Orm: Z IE E;E!,.!ERE; Ri",E:, P.IELL.:5 RS
]'HE
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:
LEGAL DESCRIPTION:
[,.oT&, SuNDI i~1~1~ No 2..
1
2
3
4-
5-
6-
7
8
9
SLOPE SITE PLAN
)/
G ~A v'~- L
Bo'rTo~-'[ or HoI-E
10
11
12
13
14-
15-
16-
17-
18-
20-
WASGROUNDWATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
.Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
--!
PERFORMED BY:
TEST.UNSE~VEEN __ FTA~ TFT/