HomeMy WebLinkAboutSUE TAWN ESTATE #2 BLK 1 LT 15
MUN,C,P^L,TV OF ^.C.ORAaE ¢'5"/-',-¢'¢ /-34;
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 %" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
SEPTIC ABSORPTION
^ddr~,~ FROM ~ TANK
, AS-BUILT DIAGRAM (Show Iocetio~ o~ we~l, septic system, property lines, foundation,
~[~ -~ ~l~ ~ ~ ~ driveway, waterbod,es, etc.)
~ SEPTIC ~ HOLDING
Ma u~cturer ~apacity in gallons
Material No. of Compadments
TYPE
OF
SYSTEM
original grade ~ FT
Total absorption area~ ~,FT Dis,ence between lines "t.111 1 ,'
Number of lines 8oil rating Pipe mcterial
~RIVATE n OTHER fldentifv) I'-~1
REMARKS: t
I ~~: ~ cedify Ih~ this insp~ion was pedormed according [o all /
72-013 (3/85)
by
SULLIVAN WATER WELLS
P.'O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
ADDRESS ~/90 ,/5
LEGAL DESCRI~ION
DATE- Started Ended
PERMIT NUMBER
DEl'TH OF WELL .f)~"~ ~fi:i [' C,/
STATIC LEVEL OF WATER FT. / ~; c/-
DRAW DOWN FF.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From (') Ft. to
From ~,, Ft. to Ft.
From. dj Ft. to ~X2 Ft.
From~'T~T Ft. to--,3 ? Ft.
From_¥!~' 7' Ft. to '~)~;~ Ft.
From_ ') C~ Ft. to [,.) .Ft.
From __ Ft. to Ft.
~ ~,V d From
~'t /~ .... l From
Fronl
From
From
Frotn
From
Ft t~o [~& From
Ft. to ., " ' ~' :
From
From
From !-76 rt. to 1(~:'~ Vt. /'(z~z~d /O,q,,.~ From__
From_v,- ~F Ft. to ,?;)~ Ft. - r
MISCL. INFORMATION~:
Ft. to Ft.
et. to Ft._
et. to Ft.
Ft. to__Ft
Ft. to__Ft..
Ft. to Ft,
Ft. to. Ft.
Ft. to Ft.
Ft. to____Ft.
Ft. to_ Ft.
Ft. to Ft
Ft. to_ Ft._
Ft. to_ Ft
Ft. to Ft.
Ft. to Ft.
Ft. to ~ Et,
DEPT', OF HEALTH &
ENVIRONMENTAL PROTECTION
NOV 2 0.1990
RECEIVED
DRILLER'S NAME
I
15 B :L c) c: I:: x
!:!iJ }? J' ][ (3 "}'AI',II'4:~ H~.Jl:LniLuli /'.oLal ~;ei:)'t. ic: Canl.:: c:apaI:::L'i:.y,', ], :, ,':iiOO gall(::!n~!!~,, ELac:l'i
(,2('!'t:. f'(-~)(;:jLt:i.P~:i)¢, :LF~S!.~]..~'i'i::i.c)Fi (:)¥0:¢P '(.aFiJ.:: (!~3) ,,
must. !:)~:~ --:u_.d::ml:L'L1:.¢ed t.o I'lLu"t:Lc:~.j:)a].~.'ky of Ar~c::h(:;~r'ag6;, D~pa?t. mi{~)r'vL c)f Hea.,'.Ch
:i C:E:F::df'J:f:'Y 'f'Fl(~1 l~
S :i, gr'hSd:
(Eli,,,¢nex")
........ : ......... __..
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
O,,t s,oPE
2
3-
4
5
6
7
8
9
10
11
12
13
14-
15-
16-
17-
18-
19-
20-
iownship, Range, Section:-'~l~'"/~ , ~-Ii...~ ~ IS
DATE PERFORI
WASGROUNDWATER
ENCOUNTERED?
SITE ~)LAN ~
S
L
IF YES, AT WHAT O
DEPTH? p
E
Oeplh te Water Afl~
MonitorinD? L'~/F~ Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __ (minutes/inch} PERC HOLE DIAMETER __
COMMENTS ~ '"~'. ~/~j ~,,~,~ ~..~L~;UN BETWEEN~ AND __ FT .~.
PERFORMED BY:l_ _: . . ' r Loop Eon,.l_~j^ .~,.~. y / ~ CERTIFY THAT THIS TES~. WAS PERFORMED IN
72~008 (Rev. 4/85)