HomeMy WebLinkAboutGATO DEL SOL LT 2
OF HEALTH AND HUMANSERm~ES ,,,' ~:"'~
D[~
· ' Environmental Health Division \
825 "L" Street, Anchorage, Alaska 99502. Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
~ C~/~Za.-~j ~ 5 I~5 ~ StPTIC ABSO,PTION WELL
AdU~ TANK FIELD
Pho,e:s) Pe¢~itNo- NOLO' ~d 0~ WELL / ~7' 2OO
L[eAL DESCmPT:ON
Lot J Block J Subdivision
Township, RangelSection% J ~ ~ ) %~ , ~,'~ ~ driAS'BUl[IDIAGRA"(Sh°wl°cab°n°fwell'septicsystem'pr°perlylylwaterbodies, etc) ..... foundat,on,
~ SEPTIC ~ HOLDING
TYPE OF SYSTEM
~RENCH ~ BED ~ Wi DRAIN ~ OTHER ~
original grade ~.O ET /0.O FT ~ ~
Gravellength 5q.O FT Z'~ FT d ~O~,
Total absorpt ..... ea Distance between lines ~ ~ ~, ~ ~ ~ O ~ ~ ~/
Installer ~ Date 'nstalle~ ~
WELLS ~ ~
~ PRIVATE ~ OTHER Jldentifv) ~ ~r'(~'- ~
~lassdicat~on (A,B,C) ' Total Depth F~ Cased to ':
FT ~;' Lo~ L ~
REMARKS: .,'" "
· ~. ~;I
I · · :., :? ,: ?3
., , r / 2 ~ ..'..-:~
~ ' . ~ *~kuP~?n,-~eo~,'
Health Depadment Approval' ~.¢ ~ Date: .¢ [ ~'~Y~'~,Z~
72-013 (3185)
MAX BEI}ROE)MS::
ACR[EAGE SYS'T'EMS l!q[:,,
60:L !E. NO,, LIGFiTS BL..VD,
ANE::HCH::~:AGE, AK 9':750:::.;
276-6552
...... "';""" ]:ON: '~
SL it{ID ...... ,::
-,-- - mwNSkm:,:
SECTION: 24 .'1. ,=.N
9c,<)Cx} (SQ ,, F']" OR "'~'"'"-""')
SW1/4 SW1/4 qE:l./4 NWi/4
:3
/
?
RAI',IGE: 3W
N / A
' .- ' ........ ' ,..I._, vc) J. :i.i] de:,si(~r"~:J.r'ig your' sept.:Lc
,, ,/ ~::, c a, m,. Choo~e t. he opt:i.c)n that be~:,u fits y::,Lp site.
'T' F;: Ex_E: P',,.!I t}'Z::; ~...~ :lEu EC ]E) B,~g ~ .E~. ,- ~.. -, "F
DEI:::"TH '1"0 PIPEi: BED""I'OM (1::'I'.
(:{~F;:AVEL DEPTH (1::'"!".
T'OTAL. DE~:F:']"H (1:::']",,)
E';'RAVEL W ]: lyf H (I::'"I',
GF;'.AVEI... !.JENGT'H (t:::"{'.)
GRAVE]_ VOLUME (CU.YDS.)
TANK SIZE (GAL.,S)
SOIL RA'!" I NG
I...l:::.i'.tlc:~ i TI,-'.I[] F'x"ff'IPARTHENTS
.~>;i- "¢ .... !.h Jcl HAVIE A"I ...... ' '"""
il: atli ¥ c:u~].,.; i,:~:i1" ~.'~.. u! 'l.'J"le r'equil ~:... L., {'cra ' · : ' .... sewer's anti ¥9ei 'i.s ;:~= set.
fol-t.h by the Municipality of Anchc:,r-age (MOA) and 'Lhe ~Cate of A].aska,,
I w:L].l inst. all t. he system in accopdanc:e with a].l MOA cocles and negu!at:i, ons,
ai"H:l in cc)f¥1j:)].ialqc:i.E, wit. h t. htq.:, desii~u"~ cr'J.t.(~,r'ia c,{' this pepmi'k,,
Z v,~:i, il adher'e t.c:~ al! MOA and St. at.e of Ala~ska r'equir'emer'YLs fop t.h(.ze siet. batik
dJ.s'[arlce~; fr'om any exis'Lir'19 wa].!, wastawata, p disposal sys'Lem OP 9Ld3IJ. C:
sea(.):.H-age system iL}F! t.h:i.s op any adjacer'lt of r"~ear'by lei, t,,
]: LH'ider's'[.arld that. t. hJ.s pE, Pii]~.'l:. :i.s valid fop a fi'i.~'i::.t:i, fllL[fi] C::,F 3 bedr'ooms arid
any enlspge?ment, wilt r'equir'c.~ an addit, iona], per'mit.,
iF:' A L..iF:']" STATION IS ;[BI.%'T'AL.L..ED !'N AN ARIEA COVEF.'ED BY MOA BLJII_D!NG C.:,'.')DES,
]']-{EEN (i) AN IEI_IEC:Yf'FRICAL.. F:'IEFd"II'T AND INSF'EC]"]:ON MUS]' BE OBT'AiNED~ (2) AS-'BuIi_TS
W I L..L NOT )i'.',i!ii: Ai-::'F'F;~CIVED W I THOU'F AN EI_EC-!-'F.' :I: CAL :[ NSPEC';T I ON REI:::'C]RT~ AND (3) THE
E:LiECTIRiCAL. I,'..!ORI<MUST BE DC)NE BY A LICENSED ELECTF';.'tC!AN.
' :'T GNE.U ..,m[ I:::.:
ISSUED },3Y L)A'T Ii::
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
~ !
· EGA' DESCR,PT,ON: ~ W V~ ~C.Zq T/~ Township, Range, Section:
8
9
10
11
12
13
14
15
L~S Ob WAS GROUND WATER
q ~,~/~/~' IJ~ENcouNTERED? /%
S
L
IF YES, AT WI-IAT
~--- O
16
17,
18-
19-
20-
DATE PER FORM~D~
SITE PLAN
DEPTH? p
E
Deplh to Water .A~ter _
Monitoring? /~!o ~'?~ Date:
Gross Net Depth to Net
Date Time Time Water Drop
PERCOLATION RATE --
(minutes/inch) PERC HOLE DIAMETER __
-- ,' ' t TEST RUN BET~/VEEN iFT AND -- FT
PERFORMED BY: ~J~ ~,~ / ~ ~ERTIFY THAT THI TEST AS PERFORMED
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELi~S IN EFF THIS DATE. DATE:
72-008 (Rev. 4/85)
I
SEWER'SYSTEM LOCATION PLAN
~[....? % ,>. ~ T~ ACCURA~ OF LOCATION OF
~J,~[~;'{,[ .............. 3. NORTH ~Fd DIMENSIONS INDICATED HAME BEEN