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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 RI=PORT
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
Well
D,STANCE
Manufacturer .~:~~
Ii_iq. capacity in gallons
Well
I nsid~ length Widtl?~"~ r~ct~-~
Well
No. of lines ~ Length of each line
[
Dwelling
PHONE 1 ~. NEW
~,~ Y "~ ~:/~- [] UPGRADE
IMaterial
inches
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
DISTANCE TO:
Manufacturer Liquid capacity in gallons
DISTANCE TO: [ "~ ~ Foundation
Material beneath tile
Depth
Top of tile to finish grade
Distance between lines
Total effective absorption area
Length
Width
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TE~T RATIN~
INSTALLER
DATE LEGAL
::IF:'I:::'L.:[C:FIi",I"I' [)[i:l:ll",l .J'. I::i:FIi"I[E[;.'.T ~(:[;:: E~:O',:':', ::~;12'~l.J~ E!:. [:~:.
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I""r't:::'E~: Cfi:" ~H:O Z L.. I::IE:~;E)~'.E:T Z CIN %~r'~:TE:I'"I :[ :~:: TF~:[CNC:H
I"I~I[E 1:4:E(~:H.J :1: [~:[~:[) S Z ;;:~1~ Cfi:' THE :~:O Z L. I::IE:~:O[(:F'"I' ]] Of'~ :~"r'~:"I'[:EP'I ]: ~:S:
'1"HE: LE:I"4(:~TI'I D Z PI[~I",IS; :[ ON Z ~; THE: I,.E~htC~i'l"H ':: Z lq [:'[:[~T ::' OF' 'I"FI[~ "I"I;i:[/NC:H ()~: DIRI:I Z I",11::: Z [Et,.E:'.
THE: [)P~[::'TI'q O1::' I::1 Tt~'.ENC:H O[;~: F':[T Z~]; "I't"IE: D Z~:]'I:I~'~C:LE E:E'I"I4[~[[Chl "I"H[E SU[;i:F"FIC[Z O1::' "I"HIJE
(3t~:CII..If'4E:' f::llqE:' "FH[E [~:OT'I"CII"I OF' THE
TI'"tEJ (~il:;i:F:t',/[~l..., DE:I::"I"H ]:~; "I"HE: PI:[hI~I"IUI'q [)E:F:'TH OF' Eil;i:F:I",,'EJL.. E:E't"HE:E:hl THE: OI_IT[::'[:IL.L. I:::' :!: F:'I~:
I::t~qE:' "I"H[E [/:CIT'FOhl CIF' TI"I[C []::':;C:I'::I","Ft'i" ]: ON ':: :[ ht F:'E:ET ::'.
C:[J~: I:;i: T ]: F' "r' T H Ft 'T
.: :1: F:II"'I F:Fli"i]:L.:[I::II;.: HITH THE:
'OI:;i]'I"H [:'., ~' "FHI~] FIUI",I ][ C: :[ F:'I::I[~ ]: T'~"
'.' :[ H:[L,.L ]:i",I::~;"I~I::ILL. "I"HIFJ: ~J;"r':~'l"D:f"l
:' :1: I..li"~[)[E'.'F~:~?FF:It",I[) "I"HI::IT THE: (' l",l '" ~; ]: 'f [~: :i'~;[EI.,.IEI~'. :F~;"r':~-::T~i'"I P'll::l"r' I~:[E~]:!I..IZf~'.E: [!EF,It_,.F:It::?.~;:!i[~:P'tEEi",IT ]]1:::' THE
:E::E; ,'1: D[Ct",IC:E :1: ~; I'(:["::I"IOI:)[:~I.,,E[) '/"O :[ HC:L,.I~I[::'[E f'lO[(:t!E "t"HFliq ::~: E:I~[)I:~:C~CH"I'.:~:;.
I:::II:::'F'I.,. :...................~.~.'l'~ll"~"f L': [?.l::llq .,]'.
F~"/SOl LS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-G50, Anehora§~, Alaska 99502 276-222~'
SOILS LOG -- PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIP'rlON:
2
3
4
5
6
7
8
9
10
11
I2
13
14
15
16
17
18
19
2O
SLOPE SITE PLAN
,
I
WAS GROUND WATER
ENCOUNTERED?/"~l
IF YES, Al' WHAT
OEPI'II?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
-rEST
COMMENTS '~'//~"w/ ,¢;7'~ .~.Y~]~¢'¢~,/("~.'~' .... -~
4839 TAM?A CI~Ct.E e 333-,1787
ANCHORAGE, ALASKA 99504
FT AND
(minutes/inch)
Fl-
December 29, 19711
t~780425
Cleo Ramer t
1526 Bannister Drive
2~nchorage, Alaska 99504
Subject.~ Tract 5B R & R Subdivision
A permit issued by ~hLs department for well and/or
sewer system has expired°
Permits are issued on a calendar year basis~ as stated.
on the permit~ by authority of Municipal ordinance~
/.f you have drilled the well~ a well log should be
sent to this department to document the installation
date o
If there are any further ques'hions~ please contact
this office at 264~4720~
Sincerely~
Les N. Buchholz~
Senior Environ~ental Specialist
LNB/ljw
enc: copy of pezn~lit
PEF..'.b'I I ] iSlO.
FtF'PL I C:FINT
LOCflT I ON
LEISFIL.
CLEO RFIMEf'~.'.T
I"l I C'MLFIND ROFID
TRFtCT 5B R&R SUP,[:,IVISION
~526 BflNNISTER DRIVE
LO'[' SIZE
S03825 SQUflRE FEET
MINIMUM [:,ISTflNCE BETMEEN R 14ELL RND FtN'¢ ON-SITE SEWRGE [:,ISPOSRL SYSTEM ~S
iOO FEET FOR fl PRIVRTE WELb OR
~L.50 TO 200 FEET FROM fl PUBLIC WELL DEPENE:,fNG UPON THE T%"PE OF' PLIBLIC WELL..
WELL LOGS FIRE RE6,!UIRED fiND MUST BE RETURNED TO TIdE DEP~RTMENT WITHIN ~0 DFP'r"E;
OF 'TNE WELL COMPLETION.
OTNER REQUIREMENTS MR"¢ RPPL'¢. SPEC!P"ICflTIONS fiND C:ONSTRUCTION DIt31]RflME; fiRE
RVfliI~RBLE TO INSURE PROPER IblSTFtLLF4T:~ON.
:[ CERTIFY THFIT
:1.: ); FIM FflMILIFIR WITH 'file REt.:.IU'rREMENTS FOR ON-SITE SEWERS RND WELLS tis SET
FORTH BY TI4E f'IUNICIPflLIT~¢ OF flNCHORRGE.
2: t M~L.L. INSTf~LL '~}~ SYSTEM IN flCCORDRNCE WITH THE COl)ES.
' FtPPLICRNT CLEO RAMERT
I ~z, ~ ED -D~TE.
V]:. 2