HomeMy WebLinkAboutCLEARVIEW LT 5
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
I~---,./~/..,~ P-~ ~'d ATH. I ~ ~ SEPTIC ABSORPTION
Address TANK FIELD WELL
~ O. ~ O~Perm,tL~ 0 ~ ~ ~No. of Beerooms WELL
Phone(s)
CEGAL DESCRIPTION LOT LINE '
Lot I Block I Subdiwslon
Township, Range, Sect,on I g ~~ ~ FOUNDATION
AS-BUILT DIAGRAM (Show Iocahon of welt, septic system, property hnes, foundabon,
-- ~ L~N , ~ ~, ~ C ~ dnveway, water bodies, etc)
TANKS
~ SEPTIC g HOLDING /
Manulactu~er Capacity ~n gallons
Material No. ol Compa~ments
TYPE OF SYSTEM
Depth to p,pe bottom from I Total depth from original grade ~
or,gmal grade ~ FT I O ~ /
:dl added above origmat grade Gravel depth beneath p*pe a~
Gravel length' Gravel w~dth ~,,
7~ FT ~ FT
J
Total absorption ~re~ DIstance between Jibes
JOO~ SOFT FI/
Numberolhnes ]Sodrabng j P~pematerial
Installer ¢ - ,~ -~* Date ~
WELLS
~ PRIVATE ~ OTHER (Identify) J
~ ~ ~ FT FT /
tnstahei Date Installed:
REMARKS:
I ~ p ~ I ~O I Scale: "~,;ENGINEER'S SEAL
~ inspections PeHormed by; ~: ~
~ ~ ."'
I ~~ c~dily thai l~is i~pemi0n cas ~edorme¢ acc0rdin~ t0 all
¢ -
Health Depa~menl Appro~al: ~ - Date:
72-013 (3/85)
WATER WELl.: RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division-of Geological ~ Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Pleole complelo either Io, lb or lc.) ' A.D.L. No.
T~:l. IBorough /)$ubdivieion ~ Lot Blook I-~.I . ~/4qlre. Soefion'No. Town~hlPNr~ Rongo' EI-~ Merldlort.~
~ DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS ' $. ~WNER OF WELL;~
Street Addres~ end Area of Well Locetlo~
Material Type Top Bottom
~ ·. 0 .~ 6. . ~Cabl. tool' ~otary ~Driv.n~ .~ . . . ~Du,
t~ ".' /~ dium~ ' :'.1;. ID""': it. Depth Stickup ~ ft.
' .' ..' ~t ~t1~, ' ' ,:'.' fl. ,nd fl.
~ ' ~,~fllllnl~ ~r,~l p,~
· . ~ ',
' ,: .' I1: PUMP~'LEVEL bll~ I~nd ~,rfo~e ,nd YIELD
,,... .' . . ,... , , .: ,,.. ,- .~. :,., . , .,, . .. '..", fl,. uft~r hrs. ~umpl~j ~.p.m.
Othlr:
. . I~,P~IPJ (1t ~l~llo~l~)
HP
:. L~it~:~l D~p Pip~ fl, ~p~ll2 ' ~.~.m.
,. .. , · , '>:":. , ,' .... ,
. .' ' ." : ' "0:""-:0 c,,',,,,--, 0
16.. WATER WE~L CONTRACTOR'S CERTIFICATION:" ' ~' - --~ '" '
~ ,. . 15. Woler Temperature o ~ F ~ C
This well wos~drilled~de~ j.Or[~dlctlo~ ~ t~report Is true ~o the ~s~Of .~ knowledge and belief;
~egistered ~siness'Nam~ ~ '__.. '/ Contact LIcenee N~mber
Aulh~rlzed Rj~e sonic tl'~
Form OZ-WWR (11/81) .Copy D. istribulion; '~WHIT~-Sfol~ DGGS~ PINK-OHIle~ CANARY-Cuslemer
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
2
4
5
6
7
8
9
10
DATE
SLOPE SITE PLAN
~r~ ~r' e· A 'e
I".. ee.. o~.,,~='~'~'~e ..H~'. . · ~/
~~ ENCOUNTERED?
S
1
1
IF YES, AT WHAT
DEPTH?
E
Depth tO Water Aller
13 ~~ Monitoring? Oate~
14
15
16
17
A
I-
" Se.-" '(.
/' ,!?'
/
!,
~L
19
20
Gross Net Depth to Net
Reeding Date Time Time Water Drop
PERFORMED "¥:
^CCORD^NCE W~T~ ^LL ST^~E AND ~N~C,~AL ~U~DEUNES ," EFFEC~ ON ~H,S D^~E.
PERCOLATION RATE a~--.~ (minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ / -'~' FTAND 7 F'r
DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEErS,SEAL)
DATE PERFORMED:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Township, Range, Section:
SLOPE
WAS GROUND WATER . t
ENCOUNTERED? ~ (~)
S
L
IF YES, AT WHAT O
DEPTH? p
E
T ~.N:~-StY.,,, ..q~-.C_
SITE PLAN
Depth to Waler After
Monitoring? Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
?.~/ - o - -. -- ? -- _
1.. iz. /: lz. ~ -.~ ~5_._
~:oo l:¥& 7
PERCOLATION RATE ~ (minutes/inch) PE~RC HOLE DIAMETER ~:
TEST RUN BETWEEN ~ FT AND ~-~ ~/~FT . ,
'7~.-z.. k./¢ · -., ' , ~ ·
PERFORMED BY: I ' -~ I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE
AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'~-
WITH
ALL
STATE
72-008 (Rev. 4/85)
,:2'
EL~.GT UTTL t
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
, Tobben Spurkland P.E.
, Tobben Spurkland P.E.
.. W&TER WELl. RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Oivllio# of GIolo~Icol & Geol~hl~$1¢ol Survtyl
Orilll#g Permit Me.
'II~.IILL'';~ ;" (Pleele 4l~f4~e ell~ee lc, Il #le.) &.O,L. Ne. ' '
,""--"--~-- '0 '0
~'~d.&~..~r~v.1. brow.- ~.4o~t -'~t~, 1:'. ~0 ~a..., 0~ O~ 0o.~,~
.. .... ~ ~.,, -.. ~ om.= . ,
. ' . ' . '" - I. cIIme, ~.~ ~d~ ·
,,,,,, ,~m., .... u ~., ~ lt,7 .,h~,,, w,~pt 1~
I'~ ~o.. ~.~'. ~-~,:. ~'.~ ~ ,.,,.,,.o,.,~.,o~-. ~. ..
Y~:,
~d'~'~"C;r' vel: ~r~n, '~:Lt': 7~,te-.; :.~6 ~? ~t.,/u..h Sin: k.~:,,,
Oet.
I .:' ~ ~t~' 0 A~ ., O ~'.- I.~ ..,f.~
m _ :~, ' m ,, ~_ , ft. I1~ J ' LH' tllkl - I.l.l. *
' -' · II, ~M~ { If I~11111~{ Mt_
I ' ' D '""- D '"' ~ C.,r,,,., D
I 14. IIIlffll: .....
Ad~l~4 ~t~l~ ~ "-
.,,,~,,~. v
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
~2~ L ~ A.~'k(mlge, Ah, Mm g~501 2~4-4720
SOILS LOG - PERCOLATION TEST
PF RCOLATION
TEST
HH
~'
DATE PER FORMED: ~.~..~
SLOPE
SITE PLAN'
i~ ~-,\
\
\
15.
~, 14
?.
16
19
SA,NI~
F
ENCOUNTERED?
O
P
IF YES. AT WHAT E
DEPTH?
Rmdk~ Dete Grme Net Del]th 1o Net
Ti~ Time WIltS' Droo
~'~" '
·
f, .~.e
~.~..., ..... ~ .... ..~..,
PERCOLATION RATI (~
TEST RUN BETWEEN , ,, FT AND FT
CERTIFIEDBY., ~, ~
4,4~/,~,~'1~g,..~ 4~A~,~//IF YES. AT WHAT
OEP, TH'~
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological ~ Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Pleoee complete either la,'lb or lc.) A.D.L. No.
'a.lleoroush S.~=di.i,ioa Lo, B,ock~ '/,qtre. S,,Io. No. To-,.hi,,l::3 R,O. Er-']
Street Address and Area of Well tocotlo.
~. W~LL LOG Feet Below
Surface 4. W~L~ DEPTH: (final) 5. ~TE OF COMPLETION
4,"~ ~'/ ~ ~'' /~ ~ ~ 7. USE:~DomesIIC OPubllc Supply
.~,/~.,*..-:6 .... ~'" ~- ~ ~/ O ~','"." O o.~.,: , _,"" "'
x ~ / ~ ,./ 9. FINISN OF WELL: ~ ~
~'~ ~'~ '~ Diameter:
~'~,;_~, ~+ e-~" ,~ ?') / ~.'~ /~ ,/ 0 ~ Slot/Mes'h Size: Length:
.~ ;.-~_ ~. ',~%~ ,. ~/.i,'~, {z~ .'/'/ /'l)~/ /(?. Z.~ Backfilling .... Gravel pack
· ~ , . ~x ~ /~ ~/ ;./ ~,/ ? , ~,,..~ IO. STATIC WATER LEVEL: ~' C./ ft.
,"~"'~'~ / 1~.:) t ~ 0
.,-.~ ........ * ~ II. PUMPING LEVEL below lend lurfGce Grid YIELD
'~'(:.'/ ~ ff. Qfltr hrs. pumping
,.?*' Moteriol: ~ Neqt Cement ~ Other:
· ~ .~.- -* I~. PUMP: Cif ovolloble) HP
Length of Drop Pipe ~ft. copocity ~O.p.m.
~- . ~ ~1 ,
16. WAT[R WELL CONTRACTOR'S C~'IFICATION: '--~"V~/O~_ 1'~-- //,~ ~
~5. W;ler TempeToture _ o ~ F ~ C
Thi& wetl ~ol drilled pn~e~ my ]u[isd~cl on ond Ibis reporl ts Irue Io the best of m knowled · on
~''~ .' · /Ii ~ -/ // ~ . ~ Y g d belief;
~,,,,,:.,.: <:... ~.~-~,.- //~/~ ~,~,~ _ ~ ~.:] .
Authorized Re~'~nta/ive . -- ~'
.Form O~-WWR (11/81) Copy Distribution: WHITE-State DOGS, PINK*Driller, CANARY-Customer
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10.
11
12
13
14
15
16
17
18
19
20
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
. Lro'"T
~ IL.T'
DATE PERFORMED:
SLOPE
Reading
SITE PLAN
u ~ ~ ~o~ ~4 WAS OROU.D WATER
ENCOUNTERED?
IF YES, AT WHAT
DE.T.;
PERCOLATION RATE
TEST RUN BETWEEN FT AND
COMMENTS
PERFORMED BY, CI:::RTIFIED BY: ~/,~
Net
Time
Depth to
Water
Net
Drop
(minutes/inch)
FT
72-008 (6/79)
DATE: