HomeMy WebLinkAboutROBIN HILL #1 BLK 4 LT 1
Sec. 2718 1' 60a Anchor -age Afell & Pump Ser 9072430742 p.1
Development Services Gepartment
Building Safety Division
Ori -Site Water, c& Wastewater Program '�
4.700 rlraore Road
P.C. Bax 196650
Mark Begich A chornye, AK 9970' 5 0., t T Y
�907) 3; 3-79C4
Pump Installation Log
Well Drillitt$ Perinit Number: Soh - Date of Issue:
Parcel identification iNiumber:_t21 —372-03
Legal Desrriptium _—-- --�- — - Property 4)wne.me sddrVM -
Pump lnszallation Date:
4/
Pinup Intake Depth Below p of Well C Icing: feet
Pump Nfanufacturer's Name: r j
Pump iiodel:
Pukup Site La hp
Pitless Adapter Burial Depth: L veer
Pitless Adapter NIanufacturer'sName: �j.t`4,—
Pille.ss Adapter Installer_
14':11 1-1
Disinfected Upon Campletion'? •J YeslL ltic;
Merlon of Disinfection:
C,snmentS: L1
Putng it;stal[cr Name:�
U
Attention: The Parra installer shall prov id,e a pur.;,p installation log to tit; .DSD 'Min 30 days of pimp installation.
~'"'~, MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO'~ ~,~'TION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
iNAnE PHONE 15'7
MAILING ADDRESS
LEGAL DESCRIPTION
.~NEW
[] UPGRADE
LOCATION
Well
DISTANCE TO: I~ ~ ~
inufacturer
[Liq. cgpacity r ga ,
l ~ 0 0 F HOMEMADE
~..~ J DISTANCET~ ~®
~ Well
DISTANCE TO: ] ~ O ~
NO. of lines ] Length of eapb
~ I
~p Cti~ t~ f~ish grade
~ngth Width
T~p~ or ~ib ~.t.~
-~/
s ' ~ Depth
~ [ ;IS;ANCETO: Building foundation
NO. OF B.~)ROOMS
Absorption area Dwelling , PERMIT NO. _
Mate~l{ ~ ~ ( No, ~compartments
Inside leng? W dth - Liquid d~pth
Dwelling ~ PERMIT NO,
OTHER
Foundation Nearest lot line
Total length of I Trench width
~-~)~-~inches
PERMIT N.O~
~n lines
Material beneath tile te abs( area
Depth PERMIT NO.
~ % [ Total effective abso~ ~-----'~'
Building foundation ~ear~
Driller I D istancetolotline PERMITNO. ~
Sewer line I Septic tank Absorpt on area(s)
PIPE MATERIALS
SOIL TEST RATING
INSTALLER ~_~_ F
REMARKS
,DATE LEGAL
DEF'FIRTHENT~,~E~ HEFlLTH FINE:, EN',/IF:0NHENTFtL'~'='i:O'~EC:TION
,._,~.._':"'--:'.~ '~ ' '_:,TREET., FINCHFIRFtGE., ~k.':. 9i.-~.Crl~
. · iL.-_~ELL F~-~iE:. C~-~ .... 5 Z TE '-'"~ EIbJJEE. F.: PEF-:iPl 1- T
PER. f',IIT NO. ,' 8-.-':E~_--.':75
FIF'F'L i C:RNT
LC,-:FIT t r]l'-,I
LEGFlL
SO-iTT Fl. ,.."HFIF.:THFI Fl. FIFITC 4.41 F'INE '~2 FIi'..IC:H. FI.'-:::
LOT ± E:Lt-:.:: 4- RSEIN HILLS ~J. LGT SIZE
_.3:: _3:: 8 - 2:': :t 5 7
,a'a'~.'a'a'a ': .- i IR~",:' FEET
T"r"F'E GF SOiL FIE:SORF'TiON SYSTEM IS: ]'RENC:H
I"1FI::-:;iHLiFI NUHE:ER nF EEDF.'3]MS =
SOIL RFITING ,::SC! FT,.-E.F... = t:_--:9
THE F.:EQI_IRED SiZE OF THE SuIL FIBC_f]RF'TIGN S"r'STEM IS:
' [::,EF"TH:= 1£'~ LE~'-,~GTH= ,:-l-L:: ,--" "- "," [::,
THE LENGTH DIMENSION IS "FHE LENGTH ,:;IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF FI TRENCH OR PIT iS THE DISTFlNCE BETWEEN THE SURFRCE OF THE
GROUN[:, RND ]'HE BOTTOM OF' THE E;:.:;CR',,,'FITION (IN FEET).
THERE iS NO SET WIDTH FOR TRENCHES.
THE GRFI',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETI.,.IEEN THE OUTFFlLL PIPE
RND THE BOTTOM OF THE E',:-:',CFI',,,'FITiOt'.4 (IN FEET:).
.7. F-:F[:, :SEPT Z L--: T£-~l'-4iF:::] :=q Z ZE= .::L,-_=,~-=-~":-, ,]RLLC, tl'-.I5
PERMIT HFFL.[_.Hr~'f HRS THE RE_-,hUI4:,IE, IL. IT'r TO INFOF'.M THI5 [:,EF'RRTMENT DI_IRING THE
iNSTFILLRTI3N INSPECTIONS GF FIN'¢ WELLS R[:,JFICENT TG TI-lIS FF._FEF. T'r Fl[',l[:, THE
NUHBER OF RESI['ENZES THF~T THE WELL WILL ........ ',-.
~ tL,,.~ C-I ,.:: 2_" ::. I: ~ qt :, F E _- T t" Cl i'-,,tt '_----. F,~ F: E F:' E C~ U :[ F: E
BFIC:KFILI iN.3 OF FlN'.r' S"r'STEM 1.4ITHFIUT FINFlL INSPECTION FIN[:, MFFF._ ,ML , THIS
[:'EPRRTHENT WILL E:E SUE:JEC:T TO F'R]SEE:UTtFd",I
MII'.,iIHLIH [-,ISTP, NCE BETWEEN Fl WELL BND FINY ON-SITE SE!-'-IRGE DISPOSFIL S"r'STEM IS
:LE~E'~ FEET FOR Fi F'RiVRTE WELL OR :L5C'~ TO 2E'E'~ FEET FROH Fl F'UBLIC WELL DEPENDING
UPON THE T"r:PE OF PUBLIC WELL
MZI",iIMUH DISTFlNCE FROM Fl PRIVFiTE WELL TO Ft F'RI","FITE SEWER LINE IS 25 FEET RND
TO R C:OHMUNIT"r' SEi4ER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED FIN[:' MUST BE RETURNED TO THE [:'EPFIRTHENT WITHIN
OF' THE ['4ELL COMPLETION.
OTHER REL-';!UIRENENTS HR'¢ FIPPLY'. SPECIFICFITIONS FllqD CONSTRUCTION DIRGRFlMS FIRE
RVFIILFIE',LE TO INSURE PROPER INSTFILLRTION.
I C:ERTIF"r' THRT
t: I Ffi"i FRMiLiRR WiTH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS FlS SET
FORTH B'¢ THE MUNICIPFILiT'T' OF Ri",ICHORFiGE
2: I !-4ILL INS]"BLL THE S"r%TEH iN RCCOR[:'FINCE WITH THE CODES.
3-: :[ UNDERSTRND THFlT THE ON-'~iTE SEWER S'¢STEM l"'lR'-r' REQUIRE ENLRRGEHENT IF ]'HE
RESI[:,ENCE IS REMCC)ELE[:' TO INF':LUDE MORE THR;",I 3: E,'EDROOMS.
S ! GIqED: __~~..~' -_-- .......
FIPF*tCFINT '.:,U,_,T, ¢r'.~,-",-"'MFIRTHFI M. HHTJH
PERFORMED FOR:
LEGAL DESCRIPTION:
1
3
~4
5
6
7
9
10
11
12
13
14-
15-
16 ~E¢' t~/~ L
17
18
19
20
COMMENTS
PERFORMED ~3Y:
72-008 (6/~9)
"MUNICIPALtTY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
- SOILS LOG - PERCOLATION TEST
~"~'SO ILS LOG
~"~PERCO'LATION
TEST
LO T I L/C '-/
SLOPE
DATE PERFORMED: /~:~ ~").'~ (~
SITE PLAN
WAS GROUND WATER A~,:~ S
ENCOUNTERED? 'v~" L
O
IF YES, AT WHAT
DEPTH?
Gross N~t Depth ~o Net
Reading Date Time Time Water Drop
(minutes/inch~/ '
PERCOLATION RATE /~ ~& /,~ ' ~
TEST RUN BE~EEN 3 ~. FT AND ~ FT
n
0
,'4
0
u
P.O. Box 42
CHUGIAK, ALASKA 99567
PHONE 688-3199
DATE
NAME
ADDRESS
CITY
LEGAL DESCRIPTION
LEGAL OWN ERS
BANK OR LENDING INSTITUTIONS CURRENTLY HOLDING DEED OF TRUST
HOME PHONE WORK PHONE
DESCRIPTION OF WORK
MATERIALS
UNIT ] AMOUNT
PRICE
MATERIALS. AMOUNT
All charges shall be paid in full within
ten days unless other arrangements
are made prior to work. The customer
shall pay interest at the rate of two (2)
percent per month on any amount not
paid within ten days. Failure to pay
may result in a lien against the
property.
THIS IS A RIGHT TO L~EN SAID
PROPERTY DESCRIBED ABOVE
WORKMAN DATE
USTOMER SIGNATURE
OUT
MATERIALS (FROM ABOVE)
OTHER CHARGES
PAY TH IS AMOUNT
WELL NUMBER DEPTH COMMENTS
APPLIC'i""x IT FILLS OUT UPPER HAL"ONLY
Phone
P[?f~rty O~v~er ,
Mailing Address~I~;D'3 i '~ .'
Buyer - . ~ ' '-' L// t
Lending Institution Phone
Address t~.,/..~, L~. ,~ ~ i~(..~ Zip Code
Realty Co. & Agent Phone
Address Zip Code
Legal Description ·
Street Locati~
Type of Resi~nce
Single Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
Individual A~ACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
Community , For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer Disposal . . i~i ~
~. Individual Year nd vdual Installed: ~ · -
'~ Public Utility When Connected to Public Uti it~
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date
Inspector Inspector inspector Inspector
( ) DISAPPROVED
Soils Rating Date ~we, Installed Well To Absorption Area / 0 ~ ~ Well Log Received ~~
/HEMICAL & GE( OGICAL ~ ~
· TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
/ I ~.o. NO.
Water System Name Phone No.
Mailing Address
State Zip Code
City
MO. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no. ) [] Treated Water
[] Special Purpose [] Untreated Water
SAMPLE
NO.
1
Time Collected
I
66-1220 (b)
Rev, 1978
TO BE COMPLETED BY LABORATOF{Y
Ana, vsis sqows this Water SAMPLE to be:
~ Satisfactory
[] Unsatisfactory
[] Samole too long in transit: sample should
not be over ~ hours old at examination
to indicat~ reliable results. Please send
new sample
Date Received
Time Received
Analytical~ Method:
[] Fermentation Tube
~' Membrane Filter
Lab Ref. N~). Result*
I F-I-1
I l-FI
I r-FI
*No. Of colomes/lO0 mi. or No. of Pos~twe ooruons
Analyst
BACTERIOLOGICAL WATER ANALYSI.~ RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Date Collected Source
ab, No.
Presumptive 10mi Z0ml 10mi 10mi /0mi 1.0ml 0.1mi
.24 Hours
4a Hours
Conflrrnatow .'
24 Hours
£~B Broth 24 hours: Broth 48 hours:
Multiple Tube Rei)ort: t0ml Tubes Positive/Total ].0mi Portions
Membrane Filter: Direct Count Coliform/t00ml
Verification: L.TB BGB
Final Membrane Filter ReSults ~')
Collform/lOOml
Re,or ted By _.~'~'-'' ," 5~ 4'_-, .'.R*T''~l f'~';''~ .... Date --"/~ .