HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES BLK 1 LT 9 MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIVIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE ¢~ZNEW
MAI LING ADDR ES.S
· OCAT,ON NO. OEBEOROOMS
Well ..~ .I Absorption area [ Dwe Ing /~-/~d"~i~., PERMIT NO. -- ,
Manufacturer ~ ...... ~Material ~__ / Nc. of compartments ~
DISTANCE/~TO' ~We[I I Dwelling PERMIT NO.
' I I
Manufacturer ' ~ Material Liquid capacity in gallons
DISTANCE TO Well / ~ .. Foundation ~ I Nearest lot line
No of I nas Length of each line Total length of ] nas ~ Trench width DistanCe ~etween lines
Top of tile to finish grade ~ ~ Material beneath tile Total effective absorption area
Length Width Depth PERMIT N~
Type of crib Crib diameter I Crib depth Total effective absorption area
~~ Buildin~ *oundation ~
ICl~ Depth Driller Distance to lot line I PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
DISTANCE
TO:
OTHER
PIPE MATERIALS
SOIl. TEST BATING
INSTALLER
DATE LEGAL
"!'HE !....E:!",!Ei"I"H [::,i!: i'"IEI'.,I:E;:~r O.N :[ :~:.:; THE L..E.?.,!Eii"I"H ,:: .I: Iq F'ElJi:.:T 1:, ,".3F:~ 'T'HE: "FI;:'tE!",IC:FI CIl:;:: !::,I;'~:F:I:I: iqF' :[ E"_'I....[':,.
'TH[::: DEI::'TH OF:' FI TFiIE~',IC:H CIl';.'. F'ZT :!:'.~, '1"HIE _r:,.~t~:;Ti:::iF~C[::. ii!~l!!['['[,.!!}:!}~:':i'.J, THE
(:~I:;iiCiI...IN[) FII'.,t[) THE: i:ii',(:l"l"'1,'!:::lFI Ci[:' "l"H!i:[ [E;:.,ii::::i::'!',,,'FI"i"Z CiI',I ,:: :[ i'.,! f::'[~::t:'~'i'
'THE/~'.E :11 :-2; F,IO ~;[:~:"!" i,.! :[ F.:,TH F:OI:;i:
'I'HEi: C'iI:;?.FIVE::L. DEi:F'"I"H ].'iii; 'FHE t'ql[l'.,l:.r.l','tl..JP1 [::,[:-'.'F'TI-I OF:' C~l:;~:l::l',,,'[ii:l... EIE.::'T!,.![~:[;.Zi',I ff'!..!EZ OLJ'T'F'i::'iL.L..
i::!~-,!t:::, t"HE: [31:3"t"T[:ii','l O[:' "t"H[i!: E~:,"-',iC:I:::I',,,'FiT:[OF,! ,:: :[t',~
O & E ENC.NEERING & DEVELO, ,vIENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
894-2774 SOIL LOG
Performed for: Name:. ,/}///,/ -.-/,Ac,' ~-':. ~ ~ / ,:'""~'~ Tel. No.
Mailing Address: ¢ ..~-~ z~,'~ ~.:i ¢; ~ ~:~ ~,.z~
Legal Description:
Depth (feet)
0__
1__
2
5__
8__
Earl
688-2280
Soil Characteristics
10___
11
PLOT PLAN
13__
14__
15___
16
Ground Water Encountered:
Yes
No /f
If yes, what depth
PERC. TEST
Proposed Installation:
Comments:
Seepage Pit Drain Field
Performed by: t_..K. ~/~.~ ,;. ,-~-~,"?,P~
([er ifiell rilling
SULLIVAN WATER WELLS
P.O. SOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE. Started
PERMIT NUMBER
I)EIrHI OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING ,
KIND OF FORMATION:
From ~ , Ft. to; ' Ft.
From /,; Ft, to ': ' '~ Ft,
From · ,"-Ft, to :' ;' ~ Ft.
From, '; "' Ft. to--Ft.
From ;' ' Ft. to '4 Ft .... - ....
" to " > Ft.
From : i~i Ft, /~
From : x Ft. to Ft.
From .: : tFt. to Ft.
From.__ Ft. to
Froln.__ Ft. to_
From Ft. to
From__ Ft. lo
From Ft. lo
From__Ft. to Ft.
From.__Ft. to
From Ft. to Ft.
From__Ft. to
From Ft. to___Ft.
From__ Ft. to.--
From__Ft, to__Ft,
From Ft. to
From Ft. to Ft.
From Ft. to
From Ft. to Ft.
From Ft. to
From__Ft. to Ft.
From Fi. to
From Ft. to Ft.
From Ft. to
From Ft. to__Ft.
From Ft. to
Ft.
Ft.
Ft.
Ft
Fl.
___Ft.
Ft.
Ft.
Ft.
gECEIVED
1 2 !995
Mun~dipality cf Anchorage
Sept, I~e~alth & Human Services
Ft.
Ft,
Ft
MISCL. INFORMATION:
DRILLER'S NAME : ' ' '
0 0 0 0 0 0 . 0
0 0 0 0 0 0
APPLI(' ~IT FILLS OUT UPPER HAI ONLY
Address Zip Code
Realty Co. & Agent " t'~'-- ~ Phone
Address Zip Code
Street Locati~
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A well log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to lhat date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time TimL~...~/~(~
Date Date Date Date/
Inspector Insp~tor Insp~tor Inspirer
0'~¢.~ JUN 2 4 1983
( ~PPROVED BEDROOMS ~ 'CONDITIONS OF APPROVAL
( ) DISAP~OVED
( ) CONDITIONAL APPROVAL*
Well To Absorption Area Well Log Received
72.023