HomeMy WebLinkAboutPROSPECT HEIGHTS #4 BLK 2 LT 11 MUNICIPALITY OF ANCHORAGE
D' ',RTMENT OF HEALTH AND HUMAN SEF ";ES
Environmental Health Division
825 'L" Street, Anchorage, Araska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Na,~e ~ DISTANCES
Address TANK FIELD WELL
Phone(s) I ~ermit No. ' No of Bedrooms WELL
'ZgG ~ ~ 5-5~ 8[ O0 ['> ~ ~ LOT LINE
Lot Subdiwsion.~ ~
Township, Range. Section ~
T I'Z N & ~ ~' ~C, /."~ Onveway.AS'" UILT
TANKS / N
~SEPTIC ~ HOLDING
F~anulact .... Capacity m gallons
Material No. of Compa~ments
TYPE OF SYSTEM
~TRENCH ~ED ~ W. DRAIN ~ OTHER
-
~opth to O~p¢ Doltom from loire ~epth from o~i~mal ~raOe
or,ginal grade , (~ FT I FT
_ . :/ /
t~O FT i p,stance between hnes
~ ~ I~'
L3 i~0 SQFT~pVC AST~ 3o~q ~ -
~ PRIVATE ~ OTHER fldentifv)
Classification (A,B,C) ' Total Oep[h FT Cased to ~ ~ ~ ~ ~ J
REMARKS:
Inspections Peflo~]ed by: '
.J~l.~v . Dale ~'
[ ~':'/~ // ..... *~ ceflJjy jhaj this jn, ecJiofl was peflorffied accordiflg jo all
Municipal and State es in effect on this date: ~e ~[~ [q~
'"
PERFORMED FOR:
LEGAL DESCRIPTION:
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2O
COMMENTS
PERFORMED BY:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT ~)
E
Depth to Water After ~ ~T' Z, "~, (O
Monitoring? Date: .
PERCOLATION RATE --
TEST RUN BETW,E/~
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFF
Gross Net Depth to Net
Reading Date Time Time Water Drop
(minutes/inch) PERC HOLE DIAMETER
__ FT AND FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
ON THIS DATE. DATE:
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW970183
DESIGN ENGINEER:DU~Y COMPANY
OWNER NAME:COMBS ALLEN C & ESTHER M
OWNER ADDRESS:10101 HILLHAVEN CIR
ANCHORAGE, AK 99516
DATE ISSUED: 7/11/97
EXPIRATION DATE: 7/11/98
PARCEL ID:01513245
LEGAL DESCRIPTION:
PROSPECT HEIGHTS #4 BLK 2 LT 11
LOT SIZE: 96560 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AJ~C72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SA~ME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~~
DATE:
DATE: 7- 2/- ~,
LOCATION OF WELL
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISlONOF MINING & WATER MGMT
WATER WELL RECORD
BOROUGH
SECTION
TOWNSHIPE]Ni__iS I RANGE[_iW[_]E I MERIDIAN
LOCATION/SKETCH:
WELL OWNER:
Material Type and Color From To
Depth of hole: ft
Depth of casing: ¢~,~ ¢Q ft
DATE oP COMPLET,ON
DEPTH TO STATIC WATER LEVEL:
· ¢~/ f ft below ,,~ top of casing
Date:/
[] ground sudace
METHOD OF DRILLING: ~l~'air rotary [] cable tool
[] other
USE OF WELL:/[~domestic [] irrigation [] monitor
[] public supply [] other
CASING STICK~UP.~ ~
Casing type: .~.~'~2., ~.'
ft. Diam: (:..~ in. t~o_~.~')ft
¢;~ in. to.;¢~_~ ft
WELL INTAKE OPENING TYPE: [] open end
[] perforated /~'open hole
Depths of openings: to ft
[] screened
SCREEN TYPE: Diam: in.
Slot/Mesh Size: Length: ft
GRAVEL PACK TYPE:
Volume used: Depth to .top:
GROUT TYPE: _~, ,/,~..~...~-~.(/zc~z-~V'ol~'~: ~
Depth: from ft to
DEVELOPMENT MET. HOD: f_~4.z.,4.~
Durat on ~ .~ _.~.e.~'.-~
PUMPING LEVEL AND YIELD:
ft after ~ hfs pumping .2~ gpm
PUMP INTAKE DEPTH: ft Horsepower:
WELL DISINFECTED UPON COMPLETION? [~YES [] NO
CONTRACTOR INFORMATION: REMARKS:
~egistefe.:d Business- N~me ' / . ./
///;,//,:,, . /// ..-/
,, (.~/~._ ..~--.~ . / .,/~ ~-~ PLEASE MAIL WHITE COPY OF LOG TO:
~i ne ur .. , .. , -- WATER MGMT
g t e of Authorized Respresenta. b~e Date 3601 C St, Suite 800
Anchorage, Ak 99503-5935
P~.OT PLA~ ~- , Aa BUH-T ~ ~C~-E 1",6~ ORrD ZG~.t
I Harcby c~rti~y that I h.w survay~d thc followin~ d~scribcd ~r~pcrty:
L~t Il ,~lock ~ , ~T ~l~ttT~ ~U~PlU~O~1 ~J~' '
~CH~ ~ R~o~ding Distfict~ Al~k~ ~nd that' thi improvlmints
within th~ propirty lines ~nd do not lncroach onto thl property adj~clnt
improvements on the propirty lyin~ edj~cent ~b~r~to encroach on
tha~ there are no roadways, transmission linis or other visible laSsmiuts
~xc~pt ~s indicitCd herzog.
D~t~d this ~h~ ~G~ Day of ~( ,, lg ~ . , ~t Anchor~, Al~sk,
]'OB No
1731 George Bell Circle
Anchorage, Alaska 99515 (907) 345-6475
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