HomeMy WebLinkAboutSOUTH LAKEWOOD HILLS BLK 1 LT 5 W2South Lakewood
Hills
Block 1
Lot 5W2
#015-151 -05
Mark Begioh
Mayor
bevelopment Services Deportment
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore P. oad
P.O. Box 196650
Anchorage, AK 99507
www.muni.o~q/onsit¢
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW
Date of Issue:
Parcel Identification Number:
Legal Description
Property Owner Name & Addr.essi~
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing:
Pump Manufacturer's Name: ~g~ ~
Pump Model: ..~'~) L~ ~t.. ~
Pump Size/~ hp
Pitless Adapter BurialDepth: ~ feet
Pitiess Adapter Manufacturer's Name:
Pitless Adapter Installer: A) ~
Well Disinfected Upon Completion? ~Yes [] No
Method of Disinfection: ~-~[z-
Comments:
Pump Installer Name:
ANCHORAGE WELL & PUMP SERV,
330 EAST 76TM AVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days ofpmnp installation.
ANCHORAGE AREA BORuUGH
Department of Environmental quality
3330 C Sti'eet
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING ADDRESS--'~'~IJI~-- ~'~O~' ~"~'(g'~¢t/ PHONE ;;~ ¢'¢y/-'72..//
SEPTIC TANK~ t,A~?
FROM WELL'"'IL j'~ -' MANUFACTURER
MATERIAL
NUMBER OF
COMPARTMENTS_
INSIDE LENGTH_
INSIDE WIDTH
LIQUID DEPTH .... LIQUID CAPACITY [,C~'4~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL.~____
BUILDING FOUNDATION__
ADDITIONAL ABSORPTION
DIAMETER--OR WIDTH ~'-~,
CRIB SIZE: DIAMETER___
NEAREST LOT LINE____
LENGTH /~¢~ DEPTH lO r
DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
SQ. FT.
WELL~.4 ,'
~ ~ ~I~D I~G~t/~O N E~(~r~RUCTION NEAREST
FOUNDATION LOT LINE SEWER LINE
CESSPOOL_ OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DEPTH_ DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED B y:~~L"
pi p E MAT E R, A L: ~'~'~ C~¢...'~rC'
LOT SLOP~_.
REMARKS:
G.A.A.B.
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
PERMIT NO.
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
NAME OF APPLICANT
INSTALLAT[ON LOCATION
MAILING ADDRESS PHONE
INSTALLAT}ON OF: SEPTIC TANK
TYPE AND SiZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANT}CIPATED
SEEPAGE Pit , DRAIN FIELD , OTHER
TO BE INSTALLED BY
NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEEPAGE AREA SIZE TYPE
DIAGRAM OF SYSTEM
SEPTIC TANK SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE Pit
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
, DRAIN FIELD .
-, SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVAT]ON 5 FEET INTO UNDISTURBED SOIL.
4 INCH Diameter CAST IRON SIPHON PIPES ON SEPT]G TANK AND SEEPAGE Pit
FITTED WITH A]RTIGHT REMOVABLE CAPS.
I CERTIFY THAT I Am FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SA]D CODE.
DATE APPLICANT'S SIGNATURE
4.
5.
6.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
Approval requested by: /~ ?~
Mailing Address: ~Z~ ,~,~ ~ ¢¥:¢7 Phone:
Property Owner: ~]~. ~~¢_ Phone:
Mailing Address: ~ ~-~
Legal Description: ~- ~ ~ ~ /~/
Location: ~',)~ L~~Z ~
Type of facility to be inspected .~~ No. of bedrooms
Well Data:~ ~ ~ ~
A T e w ~~~ B. Depth
C. Const~ction ~~- ~ D. Bacterial A~alysls
Sewage Disposal System: /~ ~ ~~
A. Installed / :~ ~.]' B. Installer
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
Distances:
A. Well to:
1. Size 2. Manufacturer
1. Absorption Area 2. Material
Total length of lines J
Septic tank
, Absorption area , Sewer Lines __
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
P ~e 2 of two pages - Re., .st for Approval of Individual ~ )r & Water Facilities
¢
Legal Description
Comments
Approved /~ ~. ~~Disapproved Date o%/o~??
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/7~)