HomeMy WebLinkAboutT12N R3W SEC 27 LT 11Development Services Department
Building Safety Division G� B
On -Site Water & Wastewater Program o
4700 Elmore Road
P.O. Box 196650 a
Mark Begich Anchorage, AK 99507 s a E T Y
Mayor www.muni.oro/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number: d i 8- OQ 2 -1 D
Legal Description
`r1Z1� K3
Pump Installation Date:
Sec .2 7 L 11
,. � _// 7 /i S
Pump Intake Depth Below Top of Well Casing: %7vfeet
Property Owner Name & Address:
1 3 6 qO koc 7DoN ••ALL
44.10 C11-7
Pump Manufacturer's Name: / Y M C_ 170N /0 +41—'D
Pump Model: 2 3o.s6 v 3 LB
Pump Size hp
Pitless Adapter Burial Depth: / U feet
Pitless Adapter Manufacturer's Name: 01AYt.7i.a Sd-J'
Pitless Adapter Installer: 4) nr
IWell Disinfected Upon Completion?'Ayes ❑ No
Method of Disinfection:
I Comments:
4LO
C S ANCHORAGE WELL & PUMP SERV.
Pump Installer Name: ' ? 330 EAST 76T" AVENUE
0,rr ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
~"1 U~'--~ Z C: .I PF'~L Z T'"-,r' F'_,F
[:,EF'RF.:TMENT ,"'~']HEFILTH FIN[:, EN',,,'IRONMENTFIL ~OTEC. TION
STREET., FINCHORRGE, FIK.
264-4720
_"~.E~---I E ~-': LIF'm]F"_R[:'"E F-EF:~'-I ]ET
L-.iL-¢_. D~. _ ,-~':'Jl IRF.'E FEET
LOT _ I,.E .....
'T"FPE OF :,L IL RBSORPTTON ':;'¢~TEM IS: TRENCH
HR>::IHUH NUi'IEER OF E:EE:,RGOHS =
_-,uIL RRTING "'=;-] FT,'"'E:R.:'= 'J-.~-.-
THE REC!UIRE[:' SIZE GF THE SOIL RE:SORF'TION .=,.J._,TEi'I lb-;:
-~ ' -- i ,Z.'~ L E 1'-,~ G Ti--J= "==' '":" -- -
E. EF TH-- .._..=_ (=F-:H',.,'EL [:,,EF'TH--- 5
THE LENGTH DIMENSION IS THE LENGTH (IN FEET:) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF ~ TRENCH OR PIT IS THE DISTRNCE E:ETHEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE E::.:',C8',,,~RTION (IN FEET).
THERE IS NO SET HIDTH FOR TRENCHES.
THE GRRVEL DEF'TH IS THE MINIMUM DEPTH OF GRR'¢EL BETHEEN THE OUTFRL. L PIPE
RND THE E:OTTOM OF THE EXCBVRTION (IN FEET).
PERMIT RPPLICRNT HRS THE RESPONSIE:ILIT'¢ TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RN'¢ HELLS RDJRCENT TO THIS PROPERT'¢ 8ND THE
NUME:ER OF RESIDENCES THRT ]'HE HELL HILL SERVE.
8RL. K. FILLIN.~ OF RN'T' S'T'STEM HITHOIJT FINRL INSPECTION FIND HFFR-/',HL THI_,
[:,EPRRTI'tENT HILL BE SI_IE:JECT TO F'R]SECUTION.
MINIMUM DtSTRNCE BETHEEN R HELL FIND RN'¢ ON-SITE SEHRGE DISF'OSRL S'¢STEM IS
]LO0 FEET FOR R PRtVRTE HELL OR ±50 TO 200 FEET FROM R PUBLIC HELL DEPENDING
UPON THE T'¢PE OF PUE:LIC HELL.
MINIMUM DISTRNCE FROM FI PRIVRTE HELL TO R PRI',/RTE SEHER LINE IS 25 FEET RND
TO 8 COMMUNIT9 SEHER LINE IS 75 FEET.
OTHER REC!UIREMENTS MR'¢ RPPL'¢. SPECIFICFtTtONS RN[:, CONSTRUCTION [:,IRF~RRMS FIRE
FtVRILRBLE TO INSURE PROPER INSTRLLRTION.
I C:ERT!F'¢ TNRT
±: I BM FRMILIRR HITH THE REQUIREMENTS FOR ON-SITE z, EHER_, RN[:' HELL-~] Mc, SET
FORTH B't' THE MUNIC:IPRLIT'¢ GF RNL. FIURH~E.
2: I HILL IN_T~LL THE z,~ ..... IN RCCORDRNCE HITH THE OO[:,ES.
2:: I UNDEF'.~TRND THRT THE EIN~C~ES~[~:~ ~'T~Ef';~ "~'~:F'.~:~Ii'~-~.'~E ENLRRGEMENT IF THE
RESIE:,ENCE~IS REMOC'E~;~
S I G N E [:': _ -~~ ..... ; ................
5
/ "'~'~ MUNIClPALITYOF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE [] NEW
MAILING ADDRESS
LEGAL DESORIPTION
DISTANCE TO:
I Absorption area Dwelling PERMIT NO.
~ Z Manufacturer Material No. of compartments
~ N Liq, capacity [n gallons Inside length Width Liquid depth
IF HOME.DE:
, ~ Well Dwelling PERMIT NO.
O Z ( Manufacturer Materla] Liquid capacity in gallons
PERMIT .
Q Well Foundation Nearest lot ~ine
No. of lines ~ Length of ina Total length ~f 'nas Trench width Distance between lines
~ ~ ] Top of tile to finish grade Material beneath tile Total effective abso~tion a[ea
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ 31ass Depth Driller Distance to lot line PERBIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANOE TO:
OTHER
PIPE MATERIALS
801L TEST RATI N6
INSTALLER
72-013 (Rev. 3/78)
GAAB-HD-]
G~'-~TER ANCHORAGE AREA BOROt~-'~I
DErARTMENT OF ENVIRONMENTAL QUALII ~'
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
iNSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING - ~L PHONE
ADDRESS~3 / ~,~.~4:) ,~/~-/~ ~ --'
LEGAL DESCRIPTION ~/~'"// ~¢re~Z. ,~ 7 '/1'~/~ .,4/.
SEPTIC TANK:
DISTANCE FROM WE. _
uQUJD CAPACITY
GALLONS.
NUMBER
OF
MATERIAL ~ ~:-fl .,4/~,./I'
~ COMPARTMENTS
LIQUID
INSIDE LENGTH ~ INSIDE WIDTH -- DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH
DISTANCE FROM WELL /O
LENGTH , DEPTH
· BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
TILE DRAIN FIELD:
DISTANCE ~FROM WELL
NUMBER OF LINES
ABSORPTION AREA
~, FOUNDATION
DISTANCE TWEEN LINES·
TOTAL LENGTH
· NEAREST LOT LINE. ,~~
TRENCH WIDTH IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: TYPE ~~)A~'//~ , DEPTH ,?
*1 NEAREST SEPTIC
LOT LINE /~) 7~ . SEWER LINE ~ TANK
DISTANCE FROM ) WATER
,BUILDING FOUNDATION. '~/~;~ SAMPLE ~ , NEAREST
~,~ ~' SEEPAGE J OTHER
, SYSTEM /'~) ~ , CESSPOOl '~ , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
DATE
.......... G,A.A~
GREA,,iR ANCPIORAGE: ARF. A BOR.-,dGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
NAME OF APPLICANT
INSTALLATION LOCATION
PERMIT NO.
INSTALLATION OF: SEPTIC TANK / SEEPAGE PIT--- ~_~, DRA N FIELD , OTHER
SOIL TEST RESULTS ~:>,~,Pt/~ //~/~"~ NOTE:: THIS PERMIT I~ NOT VALID WITHOUT
COMPLETION [DATE ANTICIPATED
pFRHfT VAI fib fINE YFAR
FINAL INSPECTION~ 24 HOUR NOTI~ REQUIRED. BACKFILLING OF ANY ~YBTI'~M WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE BUBJECT TO PROSECUTION,
SEPTIC TAN.: s~zE 1 ¢ ,5' o
TYPE
MINIMUM DISTANCES, REQUIREMENT~=
5
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT 20 f;6e DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL 15
tjTIC TANK 5 f~, SEEPAGE .IT 20
10 ft.
· DRA,N F,ELD l0
WATER MAIN TO SEPTIC TANK 10 fie SEEPAGE PIT 30
D"AIN FIELD 10 ft.
SEPTIC TANK, 25 ft. SEEPAGE PiT 100 ft. DRAIN FIELD
TO RIVER, LAKE. STREAM.
CERTIFY THAT IAM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 2S-68 AND THAT THE ABOVE
D 7 7:¢"-APPL,CANT'B SI"'"A'"".'.
!ATER ANCHORAGE AREA BOROL
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
CASE #
Performed For ~ro~k ~bmm~,,_rg
Lemal Description: Lotll Block__
This Form Reports Soils Log x
Date Performed
S u b d i v i s i o n Sec 27 T 12 NR3W Rabbit Oreek
Percol ati o~dd~b~n #1
Depth
Feet Soil Characteristics
1
2--
3--
5--
6--
7--
8
9
lO--
SW
well grade§ sand & gravel
(l~)
Was Ground Water Encountered? no ~?o^
If Yes, At what Depth?
Reading Date Gross Time Net Time Depth to H20 Net Drop'
Percolation Rate ~linute
Proposed Installation: Seena~e Pit Drain Field
Deoth of Inlet Dep~~-om Of Pit Or Trench
CnM~ENTS: ~ ]2-~__f~. m:I~ £or_s~e_~~oncr~et~ri~
Test Performed By, '~' Data Certified By:
Date: