HomeMy WebLinkAboutBEEDE BLK 1 LT 5
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 REd'CRT
[] UPGRADE
LEGAL DESCRIPTION
Liq. capacityin gallons Inside length ' Liquid depth
/ ~O IF HOMEMADE:
~ Well Dwelling PERMIT NO.
DISTANCE
TO:
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ Foundation / ~ Nearest lot line . PERMIT NO. ~
~. 'o. of I,n.s k.n~th of e.~l~e ,. Total I.n,thz~o, I,~es Trench ~,dth~ ,riches Distanc. bet~..n Hn~s/~
' Total effective absorpt~-~re~
~ Q~ ~ Top of tile to finish grade--~ I Material beneath tile ~ / ~~ERMIT NO ~ '
Length Width Depth
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorpti6n area(s)
DATE LEGAL
72-0 (Rev. 3/78) ~'~ -
DE;F:"FII:;~:THE;I",IT O!:::' HEI:::t!...,TH FtI'.,tl.') i~!iil',,!',,: ]] I:;..:()!',.!I','I!E!'.,!"r'!::i! !:,':' l:;i: ('.) 'T i:!i)il]: ' t" ]i ON
',i!i',;ili'. 5 '" L ~'' :~:i; T I:;':'. [,!i; E:;'T' ,, t:::t!'.,IC: H Oi:;;'.t:::ll~!i!ii!;., I:::t!-(. iiilr ii~!i!!i ~i!t:;I..
2 6 ,::1-'"" ,::1-';::' ;..?.
tl.,,,.1! liE:i;; I! ........ il ....... !F':,~ t'..,,fl ii.L".:.
( 'i::' '..:.i[ l;!!l ;;..:'. 'i::' ;;;i:
f:::1t:::'I:::'!..., iii (ii:I:::!1",t"t"
:t:::r'f' iii 01",1
THE L. IEI'.,IGTH [::, .'[ HE!'.,!'_:ii; ]: Ot'.,I ]: S THE L...E.~I'.,IC.!iTH ,:: ]: I'.,I I:::'E:Ii~T ::, O!:::' 'T'HEi: 'T'F;::E:!'.,ICI.'.! O1:;;'. I'.)F, iIF:I :[ N!:::' :!: lii(L.D.
THE: [)E!:::'TH z:::ll:::' I:::I 'T'F;.:['~:I'.,ICI...! OF;;: I::':I:T ]::..'.'!; 'T'HE I) ]:. S"FI::I!'.,I(:::E liii',!ii!TT'!,.!E:!!!i]'.,I THE: Sl...ll;i'.!::'l:::!Cliii: ()!:::' TI...II!!i:
Gi:;i:(;:!I...II'.,I[) FIND "i"HIE l~ii:OTT(::ll"l ()t:::' THE Ii:~:::.::CI::I'v'FIT:[O!'.,I ,:: ]:1'.,1 I:::'E:ET).
TI...IEt:;i'.E :!:!ii..; I",10 '..:.'i;E:T I.,.I:[[::,TH !:::'OF;i: TI:;i:Ei:NCHES.
THE: GI:;i:F:I',,,'Ii!!:I .... DEI:::'TH :L'S THE t"I:[N:[HLIH [:,ET:'TH CIF'.':' G.F..:I::!',,,'r:!!:!._. E:I!!!:T!.,.IEtii!:I'.,! THE: C~UTF::'F:tL.I.. I:::' ]: !:::' E
F! I'.,! [::, ']"HE: E:OTTOH i::).l:::' THE: I!!~::.::(:::I:::I',,,'FrT' ]: ON (]:!'.,! I::'EI!::':'T'::,.
H ]: t'-,I :!: I','II...IH 1:::, :[ S'T'I:::It'.,!(:::Ei BEi!:"I'F.It~.~:EN f::1 I.,.IEiL..I .... FIND I:::ll",l"r' Ot",!-:~:!; :!: 'l'lli!: :~'!;!:!i:I,.!I:::IGIE
::!..r:ill~ii:.~ F::'tEET F'Cfl:;i: 1:::1 F'i:;i::[',,,'l:::lT!iii: HtEL. L.~ Cfi;il
:.'t..tS~i!:.~ TO ;~i:ii!i~:i:.~ I:::'E:E:T I:::!:;;:OH I:::1 Pt...lt.:iilL.]:('~': I.,.!EL.L. DIT::F:'EI",II)]:!",I(:ii t...l!.::'()l'.,! "f-HE: T"r'PE: O1::: l:::'lJ!iii',!... ]: (::: t.,.!Ei:L.f .....
i.'.IEI....L.. !....O(3S I:::tF;.':E I:;iiE:('::!LI]:Fi:I.:.i:[:, FII",ID HU:i!i;T E',E I:;.'IETIJFi:I'-,II:~:D TO THE':
OF THE t.'.IEM.... CC~I'"II:::'L. IET :[ O!",1.
()THli!i:F;.: I:;~'.I~EJ:.:.!I...~ :.[. Fi'.Ei:t"IENTS HFI"r' I:::ll:::'l:::'t...."r'. SI::'E:C: :[ F :t: (:::FIT ]: Ot",!:!!!; I:::ti",![:' COI",!?I"t:;iiLI(:i:T
I:::!VI:::I ]: L.!:::!liiil[...lli!: "r'() :[ t'.,l:!i;t...lt:;~'.l~E .i:::'F;i:(:)l:::'li.:.'l:;i~ :[ I'.,t'.:!i;'T'I:::iL..LI:::IT :[ CII'.,I.
:t: (::E:Fi'.T ]: I:::'.r' TFIFIT
:;L.: :I: FIH i:::'I:::IH]:L.:[t:::tt:;i: I.,.I]:TF! TI-..!I~ RI~ii:(;:!U].'!:;i:EHIL.:t'.,!TS I::'()F: Ol'.,I-....:iii;]:Tl!i!: :!..'.-;.r..~t.,.l!~:i:l:~::!~; I:::II'.,!P I.,.llii!:L.l...:!!i; FIS :!ii;ET
t::'OI:;i:TH 1E~"r' THE HUN :1: C :!: l:':'l:::lL ]: 'T'~'r' O1:::' I:::II",I(:::HCIf:;.':I::I(?Jt~!!:.
;;;i:: :I: !.,.I :[ M.... :[ !",IS'T'I:::It~.L. THE: S"r".iii;TEH :[ t",! :::::::::::::::::::::::::::::::::::::::: H :[ "I"H THE':
3:: ]: I...IN[:,E:~:STFti",I[) 'T'H. FIT THE ON'""S:[T'E ':'ii;!:!!:!.,.lli!!:!:;i'. S"r'STI!~:H l'"!l:::l"r' !:;i:Egt..t:l:t:;i:t~!i: !ENL. I:::II:;i:(:ii!i!!:i"IENT ];1:::' "i"HE
t:;i:E:i!!;]:!:::'EI",I(:::E ].':!!!; f:;;:E:HCft:)E':L.E:I.'::' 'T(:) :I:I",ICt....1JDE t'"iOF.:IE THFII",I ::i!:
FIF'i:::'L '[ C:FII",I'T l::!~ l:;~: O (]l l<: ?; 141:::I[: Iii!:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6.650, Anchorage, Alaska 99502 276-222~
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR: "~ il~O~:) ~--~ ~A~
LEGAL DESCRIPTION:
DATE PERFORMED:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
PERFORMED BY:
&
SLOPE SITE PLAN
WAS GROUND WATER ~
ENCOUNTERED?
I'~
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND ~ FT
CERTIFIED BY: DATE:
72-008 (7/76)
M-W DRILHNG, Inc.
P. O. Box 4122/1 - 1310C int(:.rn,d, ional Ail'pi)ti I~oad
(907) 274-46~1
ANCttORAGE, ALt\SK/\99.50D
DRILLING I,OG
Brooks Wade
W'ell Owne]:'~ ...................................................
~. u.NICIPALITY OF AN,CblOR~E,
DEPT. O,F ~; !Al_f;q/&/" [ /
.... "IRONMENT,'I. :, ;, :~ FSCTION
RECEIVED
Dom.
..................... Use o[ Well
Location (address of: Township, Range, Section, it! known; or distance maiu road Lot: 5 Block 1 Beede Subdiv±sZon, Anch. orage
Size of ca sing ...... ~) ..... Depth of ttole ...... i_05 .... feet, Cased to ...... J&-.-7 -_feet
Static water level__3_5 ..... fl:. (~ (below) land surface. Finish of well (cheek one)
Screen ( ); Perforated ( XX )'
Describe s~I,~x or perforation .... _parfc)rap~ c~,15 _fJzom 45-_44 '
Well pumping test at___l_O_gallons per (lzm~m) (minute) for___ .J. ...... hours
of drawdown from static level.
;Date of completion .... 7 / ~ ] / 79___
open end ( );
fk
WELL LOG
Depth in feet: from
ground surface Give' details of formations penetrated, size of material, color and hardness
2 T 3 0rganScs
Loose ~ravel
......... 9__ .. To 2 6
..... _2 6_ TO 43
50_TO 105
........... TO
TO
........ TO
TO
.............. TO.
........... TO.
......... TO.
.... !{_a_t p_r_ gr ave 1
Bedrock
I -- CUSTOMER
5OO2
87°5t
2.
49,600
1.15 9 ,~C.
$7°5/'
500.~5
i
II0,
2.531
ZO'x20~ ANCHOR
EASEMENT
J 118 $.F 15.5,1-
,~G O.P?G
J 0,77~
~ ~ 234.19
~ ~ BLi ICK !
EASEMENT
i0
/44~0R El'
'~
BLOCK
LOT
~ /I DATE RECEIVED
' INSPECTION APPOINTMENTS
~'~1~ S ' tiME ~ TIME
MUNICIPALITY OF ANCHORAGE MUNICIPALIW OF ANCHO~GE
825 L Street- Anchorage. Al,k, 99501 ~
o,v,s,o. -
Telephone 2~720 [ ~ ~
~l ~[~TlOffiS: Complet~ all ~am, on pa~ 1. Inoompl,t~ mqu~ ~ill not b~ ~roo~d. ~l~a~e ~. {~0) dags for
~. ~O~fi~T~O~ ~ ~ ~HO~
MAI LING ADDR ESS
PSOP~TY ~ID~T ~lf diff~n~ from ~bov~ PHONE
2. BUY~8 PHON~
'M~I LI~
~, k~NDI~ INSTITUTION
I
PHONE
MAI LING ADDRESS
~. ~LIO~/~NT I PHONE'
I
R~ILI~ ADDSE~
5, I~EGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
""'~. SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
~r---. Three [] Six
[] Other
7. WATER SUPPLY
~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
'8. SEWAGE DISPOSAL SYSTEM
~-;J;;;~- INDIVIDUAL/ON-SITE**
[] PUBLIC UTI LITY
E~ ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72~010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVI DUAL/ON -SITE
f--] PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: Io3._~1~ If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
NUMBER OF BEDROOMS
[] ONE [] THREE
[] TWO [] FOUR
[] FIVE
[] SlX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED ~,.~,~.~
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
MATERIAL
Septic/Holding Tank IAbsorption Area
ISewer Line
INearest Lot Line
OTHER
5. COMMENTS
~ APPROVED FOR ..~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
72-010 (Rev. 6/79)