HomeMy WebLinkAboutSUSITNA VIEW ESTATES BLK 3 LT 15ustTt:A
M
LST
Well Drilling Permit Number: SW_ Date of Issue:
Parcel Identification Number:_
Legal Description Property Owner Name e & Address:
.S vs j 0. V I�i ' L✓ E' s7- n r'( I /up 1) 9 I c 06L4
l 70, 14 &t � r e s < - F •Q 1-s- !I
Pump Installation Date: 310, j .Z 0 t3
Pump Intake Depth Below Top of Well Casing: 22 d feet
Pump Manufacturer's Name: .1 u cf«-E
Pump Model: 7 S C 2 1 FS l
Pump Size 31V hp
Pitless Adapter Burial Depth: to feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion': xYes ❑ No
Method of Disinfection:
Comments:. a
Anchorage Pump & Well Servi6e
Pump Installer Name: 330 East 76th Avenue
Anchorage, Alaska 99618
Phone: 907-243-0740
Fax: 907-243-0742
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
neat
tjevelBuil nt Services Department
_ \
2uiid:ng Safety Civisioii
b
Or, -Site 'r atcr I& Wastewater Fr'ogr _m,
4700 Brogow Street
P.O. Sox 19.5650
Mark Begich
Anchoroge, .4K 99519-6650
Mayor
na.muni. ,rg, onsite
(907)343-790}
Pump Installation Log
Well Drilling Permit Number: SW_ Date of Issue:
Parcel Identification Number:_
Legal Description Property Owner Name e & Address:
.S vs j 0. V I�i ' L✓ E' s7- n r'( I /up 1) 9 I c 06L4
l 70, 14 &t � r e s < - F •Q 1-s- !I
Pump Installation Date: 310, j .Z 0 t3
Pump Intake Depth Below Top of Well Casing: 22 d feet
Pump Manufacturer's Name: .1 u cf«-E
Pump Model: 7 S C 2 1 FS l
Pump Size 31V hp
Pitless Adapter Burial Depth: to feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion': xYes ❑ No
Method of Disinfection:
Comments:. a
Anchorage Pump & Well Servi6e
Pump Installer Name: 330 East 76th Avenue
Anchorage, Alaska 99618
Phone: 907-243-0740
Fax: 907-243-0742
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
MUNICIPALITY OF ANCUUHAUZ
Hea h and Environmental Prote on
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
ffJ5PECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM — -----
----- -----
_� _`_F
---. NON
NAME ADDRESS PADDRESS
LOCATION Q , � _70( LEGAL DESCRIPTION--
SEPTIC
ESCRIPTION_
SEPTIC TANK
DISTANCE�) __ MANUFACTURER _TF RIAL
FROM WELL _W-/� _
INSIDE LENGTH_` - — INSIDE WIDI"H LIOUID DEPTH -__ LIQUID CAPACITY / GALLONS.
T1t_4-=D--FEL-D: "TOTAL LENGTHPk
/
c>- .-OF LINE __--
.___FOUN._. -._ _ _-NEAREST LOF LINE _ --
DISTANCE FROM WELL L6�- DATION//
Of Lines ----, --- DISTANCE_ BEIWF_EN LINES __._4 -./4 --TRENCH WIDT3A6_ IN. TOTAL EFFECTIVE
ABSORPTION AREA __�__�---- "—�- SQ FT. LENGTH OF EACU LINE
I DEPTH OF I II ILR
DEPTH: TOP OF TILE 10 FINISH GRADE _ +�----NATERIAI_ BENEATH FILE .._.-"-----IN. ABOVE TILE �° _ _IN.
NUMBER OF
COMPARTMENTS �y
SEEPAGE PIT:
DIAMETER ____OR WIDTH--_ LLNGFFI_—,
DEPTH--
Log
EPTH_Log Crib _Rings_ Crib Size: DIAMETER_--ADISTANCE FROM:
TOTLEFFECTIVE
ABSORPTION BUILDING FOUNDATION.--. NEAREST LOT LINE ION AREA (WALL AREA;
Well
Class: _ - Depth:
Well Distance To: Lot Line Lo I'
Bldg: Ap I_,-.-- Sewer -� Line: _^
Pipe Mater lals :1.,�jx, itiSTM 6
S of Bedrooms: _
Installer:
Remarks:
I
i
WELL
FT.
DATE .9` '_*31 APPROVED
DEPA IMENf`� HF - ALT H AND ENV IRONt•TENI-K, R4�' �
R�1 �� (�
n _'jlO E. 'TUDOR FD.. FINi HO?21fit�E, Nk::.
.2�.�
F'EI'.'T:f'T tdiJ, r' 75 ? i nn -
aANCHORAGE
n l�la� �l •lei l t�
.,. r•
HFF'L_IL_HNT E:ILL_ tdEl"I'HERI OHi 1._Git=i s"i_t.!Hf:`.(i FEET
I_.00:H'I .T.Ota HF:IES �: T DR _ LOT .`_:S'r,:.E:
I 1..ECiFII L_ 9. k. ._
:_di_ITNFi VIEW EST
I-f';F'E OF '.`•Lila Ht,.,UF:BI'IIIPd'
t•THi<;It9iJt'1 tJUi4E:EF: OF BE'DROCtI''Is =
SOIL RATING (SQ FT/B')=
k:L:G?i!af EU SIZE OF IHE SOIL ABSORPTION SYSTEM IS:
I'1iE
FEET:$ OF THE
OR
1 N
THLE
HE C�EFGT'HHitFItiF7F:Ef CaH1iiRfHE LENGTH PITIf�THE';C Iti1"ft dt:E E:E"fWEEFai 'THE HLIRFHi FHOF} "1"tlEf'
G1=:OUND Arx, THE BOTIOq OF THE EXCAVATION (IN FEET').
THERE IS NO SET WID"fH FOR TRENCHES.l L. BETWEEN THE OUTFALL PIPE.
T'HE GRFiVEL DEPTH I THE MINIMUM DEPTH OF Gk:H•r
Ht-AD "(HE BOTTOM OF THE EXGAVRTION CIN FEET). -A ._
:fF'"' 7L a "-F"P•F1 3. M F= j-e�-�
�ya e
BHC gj :L"-4"-�"EM WITHOUT- FINAL INSPECTION AND APPROVAL B THIS
FILLING OF HYJ;
DEPART11ENT WILL. BE :_•UB-tEC7 TO F'RCiSF_'l.tJllOtd.
t4):PJIMUYJ C: :I:`_"f'fihdCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL_ S';SI Y
1-00 FEET FOR H Pk:JVATE 14E'LL OR 200 FEET FOR A PUBLIC: WELL..
_F'ECIFIC:HTIOt-TS FIND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO It�_URE PROPER
INST'HLLH"f ION. F__�F' ::
F ` E=_ F=' rep :9 ° e-' FF !._ tl ^� g _=:_
I AM FAMILIAR
WITH
HL THE
REGIUI EMENG'S FOR ON-SITE SEWERS AND WELLS FIS
;
I CER I IF4' IHH"f
2: 1H E°T THE SYSTEM IN ACCORDANCE WITH THE CODES. I yFi
w'
1. tJIL.i_ ].Pa_"IHLL. T}IF: Y'S.
-( IItJDEF:S`1'HP•dl) 1'HtiT THE Citd-SI1E SEWER _.r��fEt'1 t'1F1'; k:EC!I_IIF*:E EPdI._FiF'..I:vt-'t'TEtJT
RESIDENCE I_: REMODELED "I"i_t INCLUDE MORE "MHN BEDROOMS.
i
SIGtdEI>:191� -
HPPLIC:R dT BILL/L�NEEIT Eh'CiiH"( / %s
o
'mak"-
ISSUED By
N o 4 i
We'to ql.R�,s\c_� /() �;()e i I so;ls 1`5 txsK
(70)2,,tauetion Sreit -fal
"One test is worth a thousand opinions"
2204 Cleveland Anchorage, Alaska 99503
Performed For 8i�� NePr6j Date Performed S -Lb-%(
Lenal oescrintion: Lot_jBloc4:_21_Subdivision.3uey2 _/E ,E/ rArCj
This Form Reports Soils Loq 1 Los Percolation Test_
tenth
Feet Soil Characteristics
a
2 — 715P S
4 - (2 LeiaN 6x64"(11 Slim]
6— CSP-
8-
10 —
13 ".NM4—
14_.
16
18— a0H
20—
Was Ground Water Encountered? ((Q
If Yes, At what Denth?
No Behack EN[ouNrE'AEP
����
1N=1;
-
Readinq Date Gross Time Net Time Depth to H2O Net Dron'
'r—
Percolation Rate Minute
Proposed Installation: Seenaae Pit Drain Field
Deoth of Inlet Depth ToBottom Of Pi�t�OF Trench
CO WAENTS: �2�t" �T�Z k
Test Performed By .TQM Data Certified By: `cou; 05 /�%I�
Date:
IFs n L_ I "r W ®: e F= r r -J r_ 8-9 r_e Q
DEPARTMENT OF HEALTH ARID ENVIRONMENTAL PROTECTION
2510 E. TUDOR RD., ANCHORAGE, AK 99507
276-2221
wF:rt_L F='EFRt-1 I T"
PERMIT NO. ( 76188 )
APPLICANT WILLIAM J NEITHERCOAT -IlreflOX X94 2714-1o�75
LOCATION ARIES COURT lxy D-°"oMe
LEGAL L1 E3 SUSITNA VIEW LOT SIZE SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
F=°EF;a'M I T 'w AL I G� F �e �t !E ar°EH�_ F iarrl I:E;S3UFE
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR.. ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
—_
SIGNEp. _ �kLL.M
_ �_______
APPLICANT ^4L J NEITHERCOAT III
ISSUED
B - --------- DATE
--------DATE / t
M -W DRILLING, Inc. `
P. O. Box 4-1224 • 1310C International Airport Road
(907)274-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner w1i•;i.;l_:>_dl(; iV_ J: Ghl Use of Well
Location (address of: Township, Range, Section, if known; or distance main road
-
J, -t, T.1:. So'. _Jtna
Size of casing 2" Depth of Hole 263 feet Cased to 65 22 feet
Static water level GO? ft. (abo've),� (below) land surface. Finish of well (check one) open end
Screen ( ); Perforated ( ).
Describe screen or perforation
Well pumping test at gallons per (1011f) (minute) for 1- - hours with 1 C 0°< ft.
of drawdown from static level.
Date of completion—_30 ';1"Y t of c)
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
TO _S
TO 62
?50
To
" 30 TO 2r..
4' i 11:�r Cit �.v�:1 ° Occ c:olil;t es
}�C'EivCJf �s CV'iI \i: C -T c •:pl: 1 i nCiar. r.
i3rstl :r(�<1, n �r
NWWA Certified Contractor
nvu�` - wT A7 d R- 0Tj
2 —STATE