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Home My WebLink AboutSCIMITAR #3 BLK 1 LT 8Scimitar #3 Block 1 Lot 8 #051-132-75 Municipality of Anchorage Development Services Department • Building Safety Division On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.d.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO90042 PID Number. 051-132-75 Neme Charles Woodfin Wastewater System: []New ❑ Upgrade Ap P.O. Box 670473 Chugiak, AK 99567 ABSORPTION FIELD vnwM 688.9927 N~01Bea s 3 0 DW Tr..m O Siva. Tm p e.A O Ma O om.r LEGAL DESCRIPTION Sai Rwne T" DMn nwn wpiW peoe Gpa�Ff FI. Back 1 Lot 6 S� Open m Pp. ponwn earn pnp+W 711" G" apin o m ppe Scimitar No. 3 FL FL TowiNq Rwge se FA AepeC AEON on?iv 7a Grew Lwgln' Well: New ❑Upgrade Iw. www «nwwwwF Iuenauwesn rr. SEPARATION DISTANCES To From Septic Tank Absorption Field LM Station Holding Tank 'A'+ >100' >100' N/A NIA sdw,W" >100' >100' NIA N/A WL" >5' >10' NIA N/A Fw"dt,c" >5' >10' NIA NIA C~Drwn None Noted It n FL I Green General Contracting, Inc. 16116/2009 w Gra>a FL TANK 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other: �dKJPrnrete aavw pautr SewerUne Anchorage Tank 1,000 Gr Mitt" Numo WConiw >25' Steel Two (2) Septic Tank and Two Post Tank Cleanouts Placed Liner This Permit. Existing Septic Tank Pumped, Crushed and Backfilled On Site. Inspections performed by: S. Gilbert Dates: 1i1 6116109 2ne 6/16109 Development Services Department Approval Conditional Approval Date: Reviewed and approved by: pt.. ower Date: 4918 vL 100.0 FL 1111 L ANDBSON CE 481 LIFT STATION � w:✓w Ge 'Pvnp M' Mrw w �Punp plr Mw al n i %ry mM a MO Ei c inp.cooM wtt BENCH MARK Locum wa DFwipoon Bottom of Sidina. Inspections performed by: S. Gilbert Dates: 1i1 6116109 2ne 6/16109 Development Services Department Approval Conditional Approval Date: Reviewed and approved by: pt.. ower Date: 4918 vL 100.0 FL 1111 L ANDBSON CE 481 Municipality of Anchorage Permit Number: SWO90042 DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 LEGEND, 5 — Septic Vent FCO — Foundation Cleanout NOTE: Septic Tank Replacement Only Under This Permit. Page 2 of 3 PID No. 051-132-75 SCIMITAR SUBDIVISION NO. 3 BLOCK 1, LOT 8 Existing Absorption Trench �, Three Bedroom Home A I 43s 1 6 Sx N.r t7.e Existing Tank Pumped, Crushed and Backfilled. Existing GOJ Well J� Ja 0 PLAN AS BUILT NOTE Not a Surveyed As Built. Locations May Not be Exact. SCALE 1' = 40' Permit Number. SWO90042 Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report PID No. 051-132-75 X100.1 y / y UU Eawq a F.rnC 1,000 Gallon\3.4 Connect to Existing Septic Tank Absorption Trench NOTE: Septic Tank and Two Post Tank Cleanouts Placed Under this Permit. Existing Absorption System Connected for Continued Use. PROFILE AS -BUILT No Scale MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Apr 27, 2009 Expiration Date: Apr 27, 2010 Permit Number: SW090042 Parcel ID: 051-132-75 Legal Description: SCIMITAR #3 BLK 1 LT 8 Design Engineer: 0014 ANDERSON ENGINEERING Site Address: 019654 BELDUOUE CT Owner Name: CHARLES AND JANET WOODFIN Lot Size: 40035 SO. FT. Owner Address: PO BOX 670473 Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , AK 99567 - This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Receivec Issuec Date: S - R - 01 Date: L/ /2 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519.6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-132-75 Property owner(s) Charles and Janet Woodfin Day phone 666.9927 Mailing address P.O. Box 670473 Chugiak. AK Zip Code 99567 Site address 19654 Belduque Court Chugiak, AK Zip Code 99567 Legal description (Sub'd., Block & Lot) Lot 8, Block 1, Scimitar Subdivision No. 3 Legal description (Township, Range & Section) Lot Size 40,035 Sq. Ft. THIS APPLICATION IS FOR (® all that apply) Absorption Field ❑ Septic Tank Q Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms Three (3) THIS APPLICATION IS AN: Initial ❑ Upgrade El Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: .5.3 O Waiver Fees: Date of Payment: 3 —0 q Date of Payment: Receipt Number. 7 62— Receipt Number. (Rev. 11/05) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 FAX April 22, 2009 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 8, Block 1, Scimitar Subdivision No. 3 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The septic tank on Lot 8, Block 1, Scimitar Subdivision No. 3 is failing and must be replaced. We are proposing to replace the tank with a new 1,000 -gallon steel septic tank to serve the three-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new septic tank to serve the home. The attached Site Plan and backup documentation identify the location and configuration of the existing septic system and the location of the new tank. Also identified on the plans is the existing well on the lot. The new tank will be placed more than 100' from the well on this lot and those in the area. The existing tank on the lot will be properly disposed on the property. The drainage patterns will be maintained after construction. The ground surface on the lot is basically flat with a steep drop near the north property line. The new septic tank will be constructed near the location of the existing tank and as parallel with the slope of the land as possible in conformance with Municipal requirements. If the tank is constructed in accordance with our design the following statements apply: The tank, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The tank, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The tank, if constructed as designed, will have no adverse impact on reserve Lot 8, Block 1, Scimitar No. 3 April 22, 2009 Page 2 of 2 space, either surface or subsurface, on any lots located in the area. 4. The tank, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, wp'-� ZaAj� Michael E. Anderson, P.E. Attachments 1.a•n _%r I* VCFA;. t A%); 4SC% 6 30 29 Q Y 16 I 9 m �o Z" 15 10A 1 Y 13 12 AREA MAP .pa SCALE V = 100' 0 f^ . M[ONEL E. "VERSM J '�� +� No• CE �m tj�� SCIMITAR SUBDIVISION NO. 3 BLOCK 1, LOT 8 Pump. Crush and Abandon Existing Tank In Place. Place New 1,000 Callon Septic Tank, Foundation Cleanout & 2 Post Tank Cleanouts. Existing 26' Long x 5' Effective Depth Absorption Trench to Remain in Service. Co co `�Y LEGEND CO — Cleanout SV — Septic Vent FCO — Foundation Cleanout NOTE Septic Tank Replacement Only Under This Permit. 49th MICHAEL E. ANDERSON No. CE -4381 . SITE PLAN SCALE V = 30' ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 8, BLOCK 1, SCIMITAR SUBDIVISION NO.3 GENERAL: The scope of this project includes the pumping, crushing and backfilling of the existing septic tank on the property and the procurement and placement of a new 1,000 -gallon septic tank at the location shown on the Site Plan. Work also includes the verification of the integrity of the foundation cleanout and placement of two new post tank cleanouts. The new delivery line must then be tied into the existing absorption trench line. The new septic tank must be placed 100' from all private wells and any surface water in the area and 10' from the water service line from the well. A minimum of 4' of cover is required over the septic tank. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department Building Safety Division On -Site Water and Wastewater Program for system installations. Owners installing their own systems must receive prior approval from the On -Site Water and Wastewater Program before beginning system installation. SEPTIC TANK INSTALLATION A new 1,000 -gallon septic tank must be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Lot 8, Block 1, Scimitar No. 3 April 22, 2009 Page 2 of 3 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: - EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 1 00'away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. All pockets of unacceptable materials must be removed and replaced. Lot 8, Block 1, Scimitar No. 3 April 22, 2009 Page 3 of 3 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5' to 2.5' in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor or owner shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. 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 -,, +, 'r P NE ('�� NEW lloallf�,�'" ��frv' [ o `. ❑ UPGRADE MAILING ADDRES LEGAL DESCRIP N_� LOCATION - NO. OF BEDROOMS Well sorri ar-a, Dwelling P Uy DISTANCE TO: wH Manufacturer t No. of compartments / to Liq. c ,jgGity�. n,ga(Ion, r 6 IF HOMEMADE: Inside length WidthLiquid depth DISTANCE TO: Well Dwelling PERMIT NO. t = zz Manufacturer f Material Liquid capacity in gallons Well B . ,.� Found �hi{�Q Nearest lot line m DISTANCE TO: O (j �lj r'vl J w v -Jim w No. of lines Length e h Ii6e Total I th lilfe Trench idth G+ Distance b t ee lin v inches r HTop of tile to is grarlf: Ma r4l bgge� t�� /� K a Total at ' a r ' n area 4„� -1� inches Length Width Depth f PERMIT NO. w Q F- Type of crib Crib dia e r -_,n11 Crib depth Total effective absorption area Lu a w LU V) Well Building foundation Nearest lot line DISTANCE TO: Class ,ems �� Driller Distance to lot line PERMIT NO. J / C Lu Building foundation DISTANCE TO: Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALL , 11/e le. REMARKS k.vi" a n , 0 s O FM "° T e Robert A. C °P No. 1457-E =. 1;4, ___Jj APP DAT LEGAL SRB Saf41411VER9P�3-IWa��nV-7I�f'9 "fie 4alr8 y n .3 H. �y4-M, 72-013"(Rtv. 3/78) 1�� - --- "- �0-i-i q.3 B.'". -A Pt -T **F* C,_� 1=1 04 W! M 1: W KEE — A. 171 Not W �� PERMIT HPPLICHNT HAS 'THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESMENCES THAT THE NEL-L. WILL SERVE �� E Fw E, _'. RE BHCKFILL ING OF ANI -fl SYSTEM WITHOUT FINHL INSPECTION HND HPPROYHL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL DEPSRTMENT nc HEALTH HND ENYIRONMENTHL ~�OTECTIOM LA C23 100 FEET FOR H PRIVHTE WELL OR STREET/ HNCHORHGE/ FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC 264~4720 OF ANCHORAGE - "8�� 2: I WILl THE �� E ��K�� K FRM A'.. .7., H PRIVHTE PERMIT N(l ( 82066] ) TO Fl COMMUNITY SEWER LINE HPPLICHNT MYERS CONST PO B0X ]51 CHUGIHK 99567 694-4414 INCLUDE MORE LOCHTION WELL LOGS HRE REQUIRED AND MUST BE rRETURNED TQ LEGHL L 8 B 1 5CI1,1ITHR S/D LOT SIZE ]]]]]] SQUHRE FEET OTHER REQUIREMENTS MHY TYPE OF SOIL HBSORPTION S9STE1;1 IS: TRENCH HND CGNSTRUCTION 118XI10M NUMBER OF �EDROOMS = ] SOI� �HTIMQ (SQ F�/BR)�\ 85 THE REQUIRED SIZE OF THE SOIL SY�TEM IS: �� E R, � . dr! R, -, - -1 r, R, - - �f 7"- ��oil W M L.. to" -I- I -S no- 15 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUND AND THE GOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET NIDTH FOR TRENCHES. THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE AND THE BOTTOM OF THE EXCAYHTION AN FEET). �0-i-i q.3 B.'". -A Pt -T **F* C,_� 1=1 04 W! M 1: W KEE — A. 171 Not W �� PERMIT HPPLICHNT HAS 'THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESMENCES THAT THE NEL-L. WILL SERVE �� E Fw E, _'. RE BHCKFILL ING OF ANI -fl SYSTEM WITHOUT FINHL INSPECTION HND HPPROYHL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY OW -SITE SEWAGE-. DISPOSAL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL OF ANCHORAGE - 2: I WILl THE MINIMUM DISTHNCE FROM H PRIVHTE NELL TO H PRIVHTE SEWER LINE IS 25 FEET HND TO Fl COMMUNITY SEWER LINE IS 75 FEET INCLUDE MORE THHN ] BEDROOMS. WELL LOGS HRE REQUIRED AND MUST BE rRETURNED TQ THE DEP FIFO TME NT WITHIN ]G DAYS OF THE WELL COMPLETION OTHER REQUIREMENTS MHY HPPLA SPE CIFICHTIONS HND CGNSTRUCTION DIHGRHMS FRE.- REHVHILHBLE AVAILABLETO INSURE PR3PER INSTHLLHTION K F=_ Q, R--11 ]". K EEL lot W :1 Fit E> E.E. CD, EE'E 1 -U Q EHE: � ,. L/ I CERTIFY THAT K 1 HM FAIN ILIRIF: WITH THE REQIJ! REME FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MONICf. PA. LITY OF ANCHORAGE - 2: I WILl THE SYSTEM IN HCCORDHNCE WITH THE CODE... ]� I UNDERSTHND THHT THE ON�SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS. SI ......... RPP LICHNT MYERS CONST 1SSUED BY~ _ -_........ ---- .�DHTE ��^l ~_~~. V4.0 Permit,_ Applicant: Location: I'lulli .LrNl_1 I 1 Vr /'11V l.nv RHVC Department; Health and Environmenta% rotection 825` Street, Anchorage, AK. `g—j501 264-4720 # # HANDWRITTEN PERMIT # # # WELL AND/OR ON-SITE SEWER PERMIT n '� �° �/� �.� �GCCIpMailing Address: /S �3 Phone Number: 6dj Legal Description: Type of Soil Absorption System Is: Trench: V Drainfield: Seepage Bed: Lot Size: -- Holding Tank: Maximum Number of Bedrooms: _ Soil Rating(sq.ft/br) JI - The Required Size of the Soil Absorption System Is: DEPTH LENGTH_.. GRAVEL DEPTH WIDTH 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(HOLDING) TANK SIZE _ GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet 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 u 2 # # 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 the re idence is remodeled to include more that 3 bedrooms. Signed: Issued by: Applicant Date: / - SWP/024(1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �PR-I N Gross Time L. XCA"V.47JAI& DATE PERFORMED: -JULY' 10 IeI rBz Depth to Water Net Drop LEGAL DESCRIPTION: �QjrZE515 3- DEPTH - g. it SLOPE SITE PLAN 1 ` ri:Y A SANDS 51L7 14 15�®avy PNS' ,ac000rs�C` . apo 16 17 r 18 tiros P A, c � •�� S . Al19- n *Wu. t�� C Date Gross Time Net Time Depth to Water Net Drop 2 3- 4- 4 1) 4v 6 b 7 8 .- 9 10 11 a f7 V U. WA WAS GROUND W 0 b ENCOUNTERED? 12 �O� &P L.I&,Nr CLAY FYES,ATWHAT 13 17�J� DEPTH? (3UTTCVr1 OF I-oLE S L O P E i Reading Date Gross Time Net Time Depth to Water Net Drop 20 '•: PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AN FT COMMENTS A!r, 9nBft94M. I�� I HU ISO PERFORMED BY: ,piwi ?. AGA,'`` KA 9907 CERTIFIED BY: DATE: PH. 72-008 (6/79) ' RETUFM-TO: Division of Geological and C ysical Surveys (DGGS). STATE OF ALASKA 3001 Porcupine Drive (Teles,_ e: 277-6615) `_y,% DEPARTMENT OF NATURAL RESOURCES -Anchorage, Alaska 99501 Drilling Company Name LOCATION OF WELL WATER WELL RECORD Please complete either la, 11b, or Ic. U.S.G.S. Local No. Drilling Permit No. A.D.L. No. la. Borough Subdivision Lot Rlpck lb. Fraction Section No. TownshipRange N/S E/W Meridian lc. Distance and Direction from Road Intersections Street Address and Area of Well Location--` 3, OWNER OF WELL: Address: i. --- 2. WELL LOG - Feet Below Surface Material Type Top Bottom 4. WELL DEPTH: (completed) -. ft. Surface Elevation Date of Completion - - -' --- a - 5, []Cable tool ❑ Rotary Driven ❑ Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other: 6. USE: ❑;Domestic ❑ Public Supply ❑ Industry ' ❑ Irrigation ❑ Recharge ❑ Commercial []Test Well ❑Other; . .. 7, CASING: ❑ Threaded -,:❑ Welded (!1 in. to .-ft. Depth Weight lbs/ft. in. to ft. Depth 8. FINISH OF WELL: Type: ;,I Diameter: - Slot/Mesh Size: Length: Set between ft. and ft. Fittings: 9, STATIC WATER LEVEL: ft. ❑ Above ❑Below land surface Type of Measurement: 10. PUMPING LEVEL below land surface - ft. after hrs. pumping g.p.m. ft. after hrs. pumping g.p.m. r f ' il. WELL HEAD COMPLETION: ❑ In Approved Pit -❑Pitless Adapter inches above grade _ __., �:,_•-i1QU 12. GROUTING: Well Grouted: ❑ Yes ❑ No Material: [:]Neat Cement ❑ Other: 40'0. - - 13. PUMP: (If available) HP Length of Drop Pipe - ft. capacity g•p• Type:- ❑ Submersible ❑ Reciprocating ❑ Jet ❑ Other: 14. REMARKS. 15. WATER WELL This well Address: CONTRACTOR'S CERTIFICATION: was drilled under my jurisdiction and this report is true to Registered "Business Name - - the best of my knowledge and belief: i Contract License Number Signed: - Date: Form 02-WWR Authorized Representative Copy Distribution: WHITE - State DGGS, PINK - Driller, CANARY - Customer , APPLIF VT FILLS OUT UPPER HA[,—;ONLY Property Owner` Myers Construction, Inc. Phone Mailing Address a River, AK Zip Code 99577 6949633 Buyer Charles E., & Janet K. Woodfin Address 2130 Tonsina, Anchorage, 99503 Zip Code Lending Institution First Federal Savings & Loan Phone 813 W. Norhtern Lights Inspector Address Zip Code 274-6569 Realty Co. &Agent Commonwealth Totem Realty, Inc. (Jim Montague) Phone Address PO Box, 911, Eagle River AK Zip Code 89577 694-9494 Legal Description Lot 8, Block 1, Scimitar #3 Street Location NHN Beldqque Court Type of Residence 1k Single Family RECEIVE ( r1`APPROVED BEDROOMS ❑ Multiple Family No. of Bedrooms 2 ❑ Other Water Supply ( ) CONDITIONAL APPROVAL` C* Individual Lo Lo 3 _ ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community BY: For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility /✓`�l Date Sewer Installed Sewer Disposal - - Individual /� Zj �(Q[p(p,j Year Individual Installed: I Ann Well to Tank 412,0 �Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time a o Date Date Date Date Inspector Inspector Inspector Inspector i� Field Notes: - � i�, n RECEIVE ( r1`APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL` DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area �? r Well Log Received . Well to Tank 412,0 Septic Tank Size t„)C Q 72023 (3182)