HomeMy WebLinkAboutELDON BLK 1 LT 10
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
J~HONE ~ I~EW
MAI LIN~DDRES~
LOCATION NO. OF BEDROOMS
We~ Absorptio~ Dwell~ / PE~~ ~ 7~
DISTANCE TO: "
~ Manufacturer~ Metal ~ No, of c~mpartments
~ ~ Liq. ca~ity Jn ~llons Inside length Width Liquid depth
/~j5~ IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
0 z ~ Manufacturer Material Liquid capaciw in gallons
~ DISTANCE TO: /~0 t~ Foundation~ r Nearest~i~ PER
-- ~ Len f each Ii
~~ No. of l ine~ ~ ~ Total l en~ ~es Trench w~ inches Distance between lines
~ Top of tile to finish grade Material ~neath tile Total effective absorption area
~ inches
Length Width Depth 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.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
INSTALLE~ · , t
REMARKS }~,;~ {
~~~~ DATE ~~~''EGA~ i
72-013 (Rev. 3/78)
GAAB-HD I
Gpf~TER ANCHORAGE AREA BOROLk~,H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 2~-':251!
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
N AM~ -'~ .~",~7"''
L
SEPTIC TANK:
MAILING /~/ -
ADDRESS ~/~'~'t/t~' ~:~//~'~' ''~''~'~'~'~' p H 0 N E
NUMBER OF
~ COMPARTMENTS ~
INSIDE WIDTH ~ DEPTH
OR WIDTH , LENGTH , DEPTH
DISTANCE FROM WELL /I~'~ ~
BU,LD,NG EOUNDAT,ON
FT.
/
DISTANCE FROM WELL ~,~ ~ MATERIAL
SEEPAGE SYSTEM: SEEPAGE PIT:'~,,~'.~/~--/4-'~'"'~2
NUMBER OF PITS / OUTSIDE DIAMETER '"--'~'
LINING MATERIAL /~'
NEAREST LOT LINE
TILE DRAIN FIELD:
~ ~ ~T..~ A L LENGTH
DISTANCE FR WELL ~'~'-UNdATION ..--rq~AREST LO~/LINE j.~-'~,, C~'LINES ,
(
ABSORPTION'"A,,,~A~ SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN ABOVE TILE__
WELL: ~/~ L ~ DISTANCE FROM ~
, DEPTH ,BUILDING FOUNDATION. · SAMPLE NEAREST
NEARESI SEPTIC ~O F SEEPAGE /~r~ / OTHER
LOT LINE ~ . SEWER LINE ~ ,TANK ~ , SYSTEM ~' CESSPOOL ~ SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
APPROVED
LT. Zg..) '~' '
E,L.I-.:_ ELE:,ON E;/D
'TH~:il: L..EHGTH [;:, :!1HE!..E!: t Obi.~." .::,'"' 'T'HE i....E.:N(:~TH ,". ......... 'f i'.,t :::'t::'ET ':, "¥:' 'T'I...IiE 'T'FtENCH OR I]:,1:;;:1::1 t I'.,tF:' I EL.I:,.
"."HE [:,E:I::'T'H OF F! 'T'RENC:H CF' PiT !5: THE D ZS?r'FIhi(}E E?ETHEEH THE :E;!...IF:FF:i(:::IE OF' THE
(:i~'FiiiI'.,ii":, FIN[)"r'Fq:: i:,-q""~ ....... ~ f:)F' THc. Ei:.::CFiV?:i"I"T ":i'.,i ," i!'-,! F't:FET':,
T'F.!F t.=r ..... LL F,FF:'""H I5; THE H'r
.., ~ C'EF'TH OF:' EET'FIEF'N TI'"E ()i.rT'F'FILt ....
F:fi'-4D THE P, '~ '¥'" m '"l OF TI...ff:' F ,-:: '" R'v'FI'T"r oN , J..~ i:::'F:'F'T':,
F'EFtH i T Fff::'F:'L. 1: r" F:d'-,U" l'..J:::d:5 'T'HE F:::E:i:SF%]?.,!:!51 Ei: ! L I 'T"?' TO I NF()I:E:M 'T'H 1 5; DE!::'.,cii:;:T'HENT E:,UR ! i'.,!G THE
" ................... i,.,lc:;"FF~. ! ,%i" :[ Cit'.,] "1,. ,:-i:, ,wl ................. ......... [ ']i',J':::. (}F:' ~::ff.,P.¢ ,.,~: ........... :' i:::I[:,..]'F:!C[:5, hFT' 'T'O TH t 5; r-, ! .L r'~:,:.F, t ~ l-:!l'.,t[:, THE
i'-.! ll','l!::;¢:',r.;' '"Il::' '" P' "'" '[ l" , :: l". - .:"::. 'TI'"I!::!T THE ,,.h::.,~..,...
F:' FI '" KF' 'r [ ~':I :., OF :5'.~':STE:H F' !:
........... fl , , , ,.. I i'-,!:i~;F:'ECT I Cd",} FIh,!l} F:ff:'PI:;;:O'v'I::!IL TH 1:7.,
DEF'FIRTHEHT H i: L.L. BE ':~ ! EJECT T ~" I:::'~;i' '.]':~ E 7 T i ] t'.4
iff i N ! HUH [::, ! 5;TFIi",!C:E E?E:TH_Eii.::?..! ?:t HELL. Ftl'.,![::, F!F,?.r' E~h,l..-:iil; ! TE :SEI4FC:iE C, i '.E;F'O:~i~;F:IL. 5h.':E;T.E]"!
::!..OO FEET F'Oi:;i: !::¢ F:'R:.,r.',,,',¢:t"!"IE F.!EL.L OR :Lt750 'T'O ;2'00 F'EET F'Fi:OH F:! !:::'I.JBLiC NELL.
UPON THE:: T'??:'E OF F'UI!!i~L. I C:
h! ! i"4 i HUH [:' t :5 7'Ff?',!CE l::'t:;:(.'ll'"! F:l PR ! ',,,L'q, TE F.!ELL -r'o Fi PR I 'v'F:tTE 5;E!.,.!ER L I hie :.r. 5.'; 2!5 !:::'EETI"
TO I::! COH?,'!U!'.,iZT? 5!;E.].4ER L. tNE ]:5i; 7!!5 F'EET.
HELL. LOGE F:hR.(.ii: F;:E(..]LIIRED F:IF,!D HUS;"!" E;E !:',;:ETLtRNED TO THE DEF'FIRTHEh,H" H].'"f'HIN
OF THE HEL. L.
OT HE:F: F'::E(;!U :!: F::E:]"iEHT:~i; i"!F%-' FIF'F'L?. :~;F'E:!:::: :[ F' i C:I:TT' :[ O!'.,E5 I:::!i'4i::, CON'_.ii;"I"?;i:UCT t Ot'.,! t.'.':, ! F:!GI:;;:FIHS; FIRE
FF,,'F!iL.F!BL.E TO Ii'.,t:SLiF;:E F'ROF'ER IN'.STFg...LF!TION.
:1: C:E!:;UFIF"./ 'FHF!T
::L: I Fill F'Fff"!:[L:[F:ff.::: !,.!ITH T,HE f;?.E(.:.!LI!Fi:EH,t.'~:NTS!; F'OF: ON..-:!~;Z'FE 5:.:;E'.'!,.!EF.:E: !::!h,ff.::, !.,ffL::L.L.S I:::!~:E; .'..:.:E'T
F:Or.;?.TH E','? THE
2: i !,.i ! L.L. I i'..i:E;"i"Fi!....I.... THE :Sh.':i::?!"EM ]: N F:CCOFd:::::;::ff::K::E i,.! I TH THE CODE.:.'F_;.
Z:: i LiF,!.i.'::,EFi::L:;TF:ihiC, THF!T T'HE ON-~!;i'TE :E~:Ii._"!.,.iER :~!;'¢Si;TEi',I HF:!"r' I:;i:!:.::i:;!U]:I:;i:E E:NL.F:IF;:GEHEI'.,!T ZF "['FIE
GREATEF '~NCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
~,~ROUGH
279-2511
Case No. /O~,,,'~'
...~: '~o-.~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
APPLICATION TO INSTALL: SEPTIC TANK-.---.---~--~, SEEPAGE PIT ., DRAIN FIELD ., 0 .
· ,-o
,~^NCED T.RO~'G" t-;' ' 4(', ... '~0 ~E .NST ~,~~ ,:!..'. '
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
OR
LICENSED DESIGNER .
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
ab°ve describT~s~ is in acc°rdance with said c°de' .~.~/~
)erformed for:
EN ; EERING & DEVEL - ENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Legal Description:
Depth (feet)
0
3__
4~
5
6~
8,
9__
10~
11
12 ~
13__
14__
SOIL LOG
Name: //~,~,
Mailing Address:
Soil Characteristics
Earl Ellis
688-2280
Tel. No. ~ ?Z.- ~,~'~
15__
Ground Water Encountered: Yes No
Proposed InstallatiOn: Seepage Pit
Comments:
If yes, what depth
Drain Field /
PLOT PLAN
PERC. TEST
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Div sion of Geologicol I~ Geophysicel Surveys
Drilling Permit No.
A.D.L. No.
;~Ti. che ]',~ldoT~ 10' BIl~k ~of~of~oflb'I I/4qtrl. ~ Section No. T°wnlhiP N~S~ Range w~E~ Meridian
lc.I DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS ~. OWNER OF WELL: JD.C~ ~-~
n.~.,: ~10 E, ?gth Ave,
· Anch., ~%k. 99502
Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION
M oterlal Typo Top Bottom
65 72 D Auger ~ 4etted ~ Bored ~ Othor:
S:~nd and Gravel: grey with watex , 1
' ' 7. USE:~Oome,tl~ ~ Public Supply
~ Test Well ~ Other:
8. GASING~ ~ Threaded ~Welded
' diam. ~ In. to--ft. Depth Weight 17 lbs./ft.
' . · diam. in. to ft. Depth Stlckup , ft,
,, : e. FINISH 0F WELL: o}.~en bottom
~ Type: ,,,
Slot/Mesh Size: . Length:
Set botween fl. and ft.
~ Backfilling GrGve pack
. I0. STATIC WATER LEVEL= ~ ,,.ft.
Dote
' ~ Above or ~Below land
I Equipment used: ~[d.
.... II PUMPING LEVEL below land $urfa;e and YIELD
' ~UNICIPALI~ OF ANCIf0,AGE ~O ft. after ~ .hr,. pure,lng
DFPT. OF ['~l-T~ ,% ~ ft. 'nfter hrs. pumping , .g,p.m.
Material: ~ Neat Cement ~ Other: natur~
Length of Drop Pipe ft. ~apocity g.p.m.
.RECr Vr n
' ~' ' m ~ ' 0 Subm. 0 4et 0 Ce.trific~l
14. REMARKS:
~6. WAT[R WELL CONtRACTOr'S CERT~F~CATtON: ~5. W~ter Temperature ~ 0 ~ 0 C
This Well wes drilled un,er my jurisdiclion ond this report Is true ~o the best of my knowledge ~.d bellef~
Foss Drillin~ AA O~D~
Registered Business Name Contract License Number
~,....: ~ 2 Box 7580 No~thWOods Dr., Chugi~, ~k. 99567
~ -~ Author(zed RepresentaHve , '" ~ / ~ ~ / ~
Form 02-WWR (11/81) Copy Distribution; WHITE-State DGGS, PINK-Driller, CANARY-Customer