HomeMy WebLinkAboutT12N R3W SEC 15 LT 122Aug 22 20 12 15p Anchorage Well & Pump Se!
E,07245.0742 P.1
bevelopment Servires bepartnient
Building So-Fety bivisron
OM -Site Water 11 Wasl'awater Procram
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4700 Elmore Stree-,
P.O. Brx 119665(
Markanchorage, AK 9,95-19-665C S A F r r
"'9W) 34-79CA
Pump Installation Log
Well Drfllin.,-, Permit Number: Date 01, ISSIA C:
Parcel Identification ?° umber: - q82- 6
-
'Feg—al D v S C ri P 1,ion —Block- Lox i Propc-Vty
Owner barn e & Address.,
T law R - Q Sec 15, r Lw--4-
/�52 f 9 fc
Pvrav Instillation Date: _q,
Pump Inrake T)ept.b Below Top tjWell Czsing:
�e- feet
PuffmP 10-mufacturer's Name j y //
Pump Model:
F"ump Size hp
Fifless Adapter Burial Depth: / 2- — feet,
Pitiless 4d2pier Nlaflufacturttr'--, Narut:
PftleEs Adapter Insuiler:
Web' Disinfected Upon Cconj;pjrti,-)n? 5KYes -D No
Method of Disinfection:
co-m-nieuts:
Pump Installer N
awne;
Company:
Mailing Address:
- C)r F 0
City:-
State: —zip" -2
Arteution: f'hepijrrp irist-JIey sliall prcovide a pump installation log to DSD %vifhin 30 days of pump instal',atiorj..
NAME ~['~ ~' ~
LOCATION
ANCHORAGE AREA BOR,.
Department of Environmental Quality
3330 O Street
Anchorage, Alaska gg503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
/~,~l~ r MAILING ADDRESS ~C4~_ ~. I~/~/- t~ _ PHONE ~'~
LEGAL DESCRIPTION &~T /L,~ S~o,/~ TI~ ~3~
SEPTIC TANK:
DISTANCE
FROM WELL_
INSIDE LENGTN
INSIDE WIOTII. __. LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY /~0~ GALLONS,
~J~~e~'~l'):'~'~-~i'lC/z'/ /~- I TOTAL L_ENGTH
DISTANCE FROivl WELL FOUNDATION ,/~_ NEAREST LOT LINE '~l~liii~ OF LINE'S-
DISTANCE BETWEEN LINES _TRENCII WIDTFI~,~--~ IN. TOTAL EFFECTIVE
NUMBER OF LINES
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILYERr~t
MATERIAL BENEATH TIt_E ~ __ ~. ABOVE TILE
WELL:
EODNDATION LOT LINE SEWER LINE
OEPTN
SEPTIC SEEPAGE
TANK __, SYSTEM
DISTANCE FROM:
CESSPOOL
OTHER SOURCES
APPROVED __DISAPPROVED
REMARKS
DIAGRAM OF SYSTEM
INSTALLED BY: ~.;II~'P,. ~' ~ (...
SEWER LINE DEPTIh ~/
LOT SLOPE:
REMARKS:
Form ED-032
~JlI
G.A.A.B.
tX. NC -IOIRAGF2 AiREA t'3C)IR JGlq
GREATER ANCHORAGE AREA BOROU¢
Department of Environmental Qua l,ty
3330 "C" Street
Anchorage, Alaska 99503
SOILS LOG --. PEROI,ATION TEST
Performed for /Y//~'~-~cF2~_-. ~//_~._**~-Lcc.~
Date
Performed
Legal Descrip~T~n.-~_/~-~ ..... i~/_c_~ ~ ,~:~ '~/
Ih~s form reports: So~ls Iog~ Percolation ~est
Depth
Feet
3 - / ~
4 ......2,/
10-
'11 -
12 .....
13-
Was ground water encountered?
___~/~ .......... If yes, at what depth?
Rea<ii ng Date Gross l'ime
Net Time Del)th to Wate]' Net Drop
Proposed installation: Seepage Pit Drain Field
:)cp~h of Inlet ........... , DeptiT-~{'~-[~i~'~fit or ~rench
C01.1HEIITS: ............................................................
~ >~ , .....................................
.............. = ......... ;?:;~:~7" ...... ~-: ~' -" ~ · lJaL~:
EQ 040 (6/74)