HomeMy WebLinkAboutFIRE LAKE #2 BLK 2 LT 5
MUNICIPALITY OF ANCHORAGE
DEPART.E.T OF.EALT. ^.D.UMA. SE.WCES 0>--I 3~--I I ?
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
N~.~e DISTANCES
A~,~ TANK FIELD WELL
LEGAL OESCRI"TION LOT LINE
~o, ~ l~,~k ~ s,,~,~,~ ~~ FOUNDATION
Township, Rat~ge,
AS-BUILT DIAGRAM ~Show Iocahon gl well, suphc system, property Ill,eS, Ioundat~oH,
OrlV(~way, Water bodies, otc)
TANKS _
TYPE OF SYSTEM ~
RENCH [~] BED [~ W, DRAIN ~ OTHER ~ ~
DepU~ to p~pe Uottom horn ]oral Uepth Irom original glade ~
Fdl added id)ore original grade ~avel depth beneath pipe
WELLS ~,~.~
~ PRIVATE ~ OTHER (Identify) ~ ~-~
REMARKS:_~n,~H~:T.,..,
Inspections Perfo,
........
17034 Eagle Riv~ L~ Road No. 2~ ~dily ~l this i~peclion was pedormed according to all
72-013 (3/85)
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E~rl g :Jn e(~,v, [)es i gr'~ed
O~,'or'u...,r. I',larne:', ,':i;[]O'I'F I::IAFll)AI,,,,I ....
[) a y I:::'h o ri e:
696,,,,568 1
o'L I.,ega .I.: 1%ul:l I::l :i v :i. S :i, ,,::)r'l: i':; ], Rlii!: I,,AI<E :~f.~::', I_,crl'.
~.3~:~,c t. J ~:)~i: ?J: i I own sh i p :', ].SN
I..,~',:)'1:.. ~:~ :i, ,.:~: (,,.~ I..1, 4 (4 (s q ,, [ 't o r a c: r' e s~ )
Bed r' c)oms ~ '1 h :i s I:.:'(~,~r' m :i t ~ 7,: lot a ], Cap ac :L t
] J:J.l,.(I :i.I;: Y I'I.,IA
~ , ;,~m i. ami :t. :Lar w:i t,h the r'eclu:i, r'(:::.)Mel"l'J:,~41 'Jc)p on'"'~;:i, te sew~:.H"s L~r'Jd We]. ,I,~[~ as set
~,,~ l.l"l by 'Lhe Muri:[i,::il::~aZi'l:,y of Ar'ichor'age (MOA) and the State of A:l,,',,:'~l.::a,,
2, .[ wi I,]. :i.r'lsta].]. {,he system :i.n a(:::c::c~Pdance with alt MI]~t c:(::)des and r'egu].a'Li.:::ir"~s~
and ii'/ cc)mp].:i, ar'lc::e wi'Lb the d(~(~s;J,C]l] c:r':i.'t, er'.:i,a of' tl'~:i,s per. m:i.t,,
J:, I ~,,~:iL], adher-(e I.'..o al.I, IIOA ar'icl Sta'Le (::)~ [41asl.::a i"equir'emer'rts for" the se't. back
~i~.: l,.u"l(::es~ fr'.om any exzst:i.r'ic] well, ~;,~astewa'('..ev d:J,[~il:~O~i~a], ~ys't, em of pub].:Lc
'":)l,',Jv,))l'"~)~J(~:,lE(f S'~/!:~'~,("~/JJ C)11 'J:..J'"l:J~]Ji C)I' i~[~I"YV ~'~lcl.:ii~:lc(.~:,)r'l'J'. o1" r'leaPl:~y ],crt
I uric:ler, sl:.arid~.l]a'( this j::)t::,)r'nl:i,t :i,s va~:l:i(:J J'oP a maximum
a.l. so L~r'l(::h:~,)r's~.~"ict 'Lhat I.l"~(~,:) c:apai:::i,'L,y (::)~ the t(::)ta~], system J,s 3 bedr'(:)c)ms and
( (:1 w r ~ r.~:.:, r' ~ '.~:;('.:',1.) I'I Ft f.:i hi ~} Al.. l
::1'1¥0~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502~0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~:~'t~"~
LEGAL DESCRIPTION:
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Township, Range, Section: ~. ~'i-~ ~; ~, g~ ~.~_~. b \
~ .~..~ SLOPE SITE~ PLAN t
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth Io Water ~ , /
Moniloring? ~ ,.~c? Dale:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ~ ~10 (minutes/inch) PERC HOLE DIAMETER
COMMENTS TEST RUN BETWEEN ~::~ FT AN/.. / /D 7 FT
S & S ENGINEERING _~ // .~"-
PERFORMED BY: _170.34_.EagI. ?.iv.er L.__o~_ Roa, NO. '0~/~/Z~----/~/~CERTiFY THAT THiS TE~ST WAS PERFORMED IN
7A2?0~:?RDe;N4~;5~ITH ALL STATE AND MUNICIPAL GUIDELINE~E~T ON THIS DATE DATE: ~ /"~/'/~/
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DOC Co. Oba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
Al)DRESS
LEGAL DESCRIPTION/ .
DATE - Started
PERMIT NUMBER _
? ~:: I)EI'IH OF ~4ELI_
;~, ~ ¢ ,.,: .... ~.:~,_ _ SI'~,I'I(' LI(VI:I, OF WAI'I.R 1.1'
' :' ~'-' ~ ~ ~ /'~' ':' I)RA~'I)OWNI:'I.
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KINDOI' ('ASIN(; ~ ' ~' :'"
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DEPT, OF HEALTH &
From Ft. to ~NV~R~E~A~PR~E~ION .
MISCL. INFORMATION:
RECEiVED, ,
DRILLER'S NAME ....