HomeMy WebLinkAboutT15N R2W SEC 25 LT 24
NIUNICIPALITY OF ANCHORAGE
DEPARTIVIENT 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 REPORT
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
TM I
~>~ Liq. capacity in gallons
DISTANCE TO:
I Absorption area Dwelling
Material
Width
We;iF HOMEMADE: I IDnwS iel ii i~n g t h
Manufacturer
Total lengl~h
DISTANCE TO: IWell 'Jr i
No. of line~. I LT/)~(~ o~;~ch line
Top of tile To-finish grade ~.- I
Length Width Depth
Type of crib Crib diameter Crib depth
PHONE
Material
NO, OF BEDRO~S
Nearest lot mine
inches
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
inches
PERMIT NO.
Total effective absor tion area
PERMIT NO.
Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Depth Driller Distance to lot line PERMIT NO,
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
REMARKS
APPROV D * DATE LEGAL
2-~'13 (Re~3/78) /-) - I '
THE L. fZNGI"H [)IhlE'i",l::~,IOf',l IS TFIE L. ENdiTFI ,::IN F'EET) OF THE TRENCH OF:
T'HE DEPTH OF FI T?.ENCH OF]: F'ZI" I'_5 THE P I~;TRNCEi: BE:THEEN THE :SUF;:FROE OF THE
GI:;~H3UN[) FINE:, THE E~CFI-TOhl OF THE EF::C:FI'v'F~TiON (i'N FEZ[ET).
THE'ERE: I:E; ,NO SET HIE)TH F'OF?. 'T'RrZNCHES.
THE 131q'.F:l',,,'[i{L E)EF'I'H ]:fL:; THE HZNZHL.if,! [)EF'TH OF GRFI',,,'EL [.:.'[ET.t,.!ETEN TIdE CIUTF'FILL F:'ZPE
FiND "r'HE Ei:L)T'T'OP1 [)F' 'THE E;:.::CFIVFIT]: [:lf.,I ( I N F:EET).
F'E(.~:i"IZT F:IF'PL]:CF~I',I']' F'IFI~; THE F~ff:~:E;F'L3N~;:[E:]:L. ZTtr' TO ZhlFORFI '1'1-1i:~; D[='.I::'RRTi"I[EN-I- E:,LIt:RINC~ 'THE:
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NUi"IBE:F.:'. OF:' f:~'.[:£'.:_:iL':d:~.IqC:E:S; ThlRT THE HELL !.q.~L.[.. ~;EI:['.',,"E.
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,Fl F , L E,? T[-'tI~;
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I CEFi:T]:F:'T' THRT
:L: I FIb1 FRI'I:[LIFIR HITH THE REQUIF.:EMEN~[:5 I:=OIR ON-L:;iTE '.~'~EP.IEF~'.:~:; FII'C:, HEL[..~i; f:l:5 ~;_:;E-F
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RE'::!J;I[)EIqC:E I:5 Fi:['£f'IC[DI::3:LE:[:, -FEi :[NC:LUDE f"II3F:'.E "FHffli",!
Perfo~ned for ~,'~ ~ ~- ~
Legal Description: Lot ~? 'Block
This Form reports: SOILS TEST
/
CONSTRUCTION TEST L~B
"One T~r~ is .worth a Thousand OpiniOns''
2204 Cleveland~ Anchorage, Alaska 99503 ~77-0231
Date Performed ~/~i/~
Subdivision 5~o,~ 77~; ~RF~ ~'/~.
PERCOLATION TEST
Depth
Feet
Soil Characteristics
Was Ground Water Encountered /~
If YES, What depth?
Reading Date Gross Time Net TLme Depth to H20 Net Drainage
Percolation Rate Minute
Proposed Installation: SEEPAGE PIT D~AIN FIELD
Depth of Inlet Depth to Bottom of Pit or Trench
Te'st Perfo~ed by . _ Data Certified By:
':
DRILLING, INC.
DRILLING LOG
Well Owner ' DAy
Use of Well
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing
Static water level :1 ~'~
Screen ( );
Describe screen or perforation J,~one
Well pumping test at '.~ .gallons per
of drawdown from static level
Depth of Hole GO feet Cased to dC), ':, feet
ft. "(~b'6~$ (below) land surface. Finish of well (check one)
Perforated ( ).
open end
(minute) for .L hours with
Date of completion
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
_TO .I
TO. ~'
.TO :~:
);
TO
_TO
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2 --- STATE
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:. ,)//,~/~'~--
INSPECT: ~ mz7//~j~k
TIME: ?//o ~ w~
REQUEST FOR APPROVAL OF
INDIVIDUAL SE~ER AND WATER FACILITIES
FOR
APPROVAL
ADDRESS:
PHONE:
REQUESTED BY:
D. CONSTRUCTION ~.,/~.'
E. BACTERIAL ANALYSIS
6. SEWAGE DISPOSAL SYSTEM:
PROPERTY OWNER. /-/(~,~/?(~,/ /-/~:..:/ PHONE:
LEGAL ~ESCR~O,:~:~/ :V / ~ . ,~:~ ~:~/. ~:/:~-'-:.~
TYPE FACILITY TO BE INSPECTED: j~/~/~]jSTREET:
. ~ ~,
NUMBER OF BEDROOMS: .~ ~ ~/-/~'~/~, :W-.}~~~
DEPTH /.~> '
A. SEPTIC TANK (IF HOMEMADE, SHOW
1. SIZE .3, D:~: ~'~49)
/-/
3. NA~UFACTUE[E
DIAGRAM ON BACK)
4. INSTALLER
:' 'z 7 :~ , . ti ')
:': ~, ~'" %:" ~'":~C.
APPROVAL REQUEST .OR SEWER
PAGE TWO
& WATER
FACILITIE~
B. SEEPAGE PIT
1, SIZE
2. LINING
C. DISPOSAL FIELD
l, NUMBER OF LINES
2. TOTAL LENGTH
REQUI~ED~ME~SU~,EMEN~S
A, WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D, WELL TO PROPERTY LINE
E, WELL TO OTHER POSSIBLE CONTAMINATION
/
F. FOUNDATION TO SEPTIC TANK /2~~
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
COMMENTS:
^PPROV^L VA,ID FOR ONE YE^
DISAPPROVED:
DATE:
FROM DATE SIGNED.
GREATER ANCHORAGE
AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY