HomeMy WebLinkAboutPETERS GATE BLK 1 LT 13
, Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
N~me DISTANCES
Address ~ TANK FIELD WELL
Phone(s) Perm,t No. No. o~ ~e~roo.~ WELL
LEGAL DESCRIPTION
Township, Range, Section
AS-BUILT DIAGRAM (Shew Iocabon ol weJl, septic system, property hnes, foun~ahon,
Material No of CompaAments
TYPE OF SYSTEM
~ TRENCH ~ BED ~ W. DRAIN ~ OTHER
Dept" to p,pe Bottom from 7oral OeOlh ~rom or,~mal ~raOe
/
qll aOOeO a~ove on,mai ~raOe Gravel Oepth ~eneath p~pe
Gravel length Grav~m~th
7otal absorpt,on area ~%~ DSO FT i Distance between hnes ~ ~ FT
Installer Date I nst alCed '
¢ PRIVATE 0 OTHER ,Identify)
,~ -- Olassdicat'°n (A'B'C)--'= --' Z°ta' Depth I Cased to
SR B 196X
municipa, and State ,uidem,nes in e~~a,e: -- / '~ ~" , ~ ,
Health DepadmentApprova: ~ ¢ ~~ ~ :
72-013 (3/85)
A P F' L :[ C A N"I":
A D D R E S S:
C:: E)lq'T A C::"I" P H 0 I",I!E:
JOE MC I<IEI...I....AI:i'. / S&S ENG,,
5 7 5 0 G L. E I',.llq H W Y ,,
ANCHOF:'~AGIE, Al< 99504
LE::GAI .... DI::SCR :[ I:::': SUBD I V I S I ON: PE'I"ERS GA"i"E LOT: 13 BLOCI':::: :1.
'."3ECT 101".1: i :1. TOWIqSH :t: F' ,*. :[',::;N RANGE: .1. W
i.,..OT S I ",'r'", ....
.,:.,:: ...... :,. 2'7A (SQ,, F"T. OR ACRIES)
,¢ ,d
:1: c (.::.:, P t :i. ',:' y t. h a t ~',
:!.,, :1: am fam:i.:l.:i.,ar' wi'.l:.l"~ the r'e(::lu:i.r'ements rcm (::F'~....-s:i. te se~.,,,:.;:,r's and t,',::.:.:,:i.:l.s as set
f:' ,::::, F. th by the Mun:i.c:i. pal:i, ty c:,f Anchc, r'age (MOA) and the Stat(.:~.:, o{-' Alasl.::a.
:.::?.,, :1: t..',~:i.].:). :i.r'~s'l:..<'..'~<:t.~ '(.l'](a !E.'k'.c. Ft:.¢..'.:.:,r~'i :i.n acc:(:::,pdar"~c:,~:.:.:, ~..]:i.'l:.h a:[:l. I"IOA (::: (::)d 6: !~. ,.'.':'d'"~c[
and :i.n coml:::,liar'~ce ~,,,~:i. th the des:i, gr'~ cr'.'i, ter':i.a c¢,':" th:i.s pepm:i.t,
3,, :1: t,,¢:i.].:l, adh(.:.:.:,r'e 'Lc, a:t.:l. MOA and State c)'[' Alas.~ka r'equir'emerrt:.s f,'.:)r' 't'..he set back
d:i. stances fr'(:::,rn any exist:Lng we:l.l:, wastewater, d:i. spc, sa:t. system or'. pub:l.:i.c
sew6:.:r, age s')zs'l:..em (::~r"~ 't.'..h:i.s <::)r' ,:ar"~y adjacen't:, c:)p r"~eapl:::,'y lc)t,
:1: I=: A L.. I I="T' STAT :1: 0!',.I :1: ~!i; I N,~i'f'AI....I....I!ED I I',.I AN AI=;,'IEA COVEI::i'.ED BY MOA BU I I....D ]: I",tG [::;O)::)lii!:S :.
'T'Hli!i:N ( i ) AN ELtECT~ PEI::;,'I" :1: 'T' At",ID :I: I',ISI:::'I.ECT I 0t",1 MUST BE OBTA t NED !i (2) AS.....BU I I...TS
W:!:L1....,I',IO'I" BE (:.'d=' F:' R i:: D WI:"I"HOLFf' AN IEI....E:E:I'R :I: CAI .... :[ NSPE':E;"f' ]: ON RI:.EPC)I::;:T~ AI'4D (::!!;) "l"Hf:'i:
i,i!:I,..EC;TR t CAt .... W(:~: '" 'J~/.~OI',I[~3Y A _L.. :1: CIEI',ISli!!:D ti!!:I....lii!:CTF;,' :I: C :[ AN, '
m:.,....:,: m.,,.,.,. ;:',:'";:;,;,:;'""':'"::i;iii;'""'i";::;': ....................................................... ':/"'"' ..... '"
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Township, Range, Section: "TI~'Q.~ (~.-~ ~ SLOPE SITE PLAN
_/'
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT q O
DEPTH? p
E
Depth to Water Alter
MonilorinD? 1 Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
t ~-t-r- s~, Lq_ p, ~ q. ~,/+- .----
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN__"~ FT AND __~ FT
COMMENTS
ACCORDANCE WITH ALL STATE ~-~~~~HIS DATE, DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ~.-- ~ t~
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Township, Range, Section:
SLOPE
_ /
SITE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT
DEPTH? (~ p
E
Dale: _~ ~J"~
.~ Deplh to Water After
Moniloring? ~:~
.Ak
/
Reading Date Gross Net Depth to Net
Time Time Water Drop
~ ~, ',o.'5'~ h~" ~'~1~." ~/'6"
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER (~' q
TEST RUN BETWEEN__~" ~' FT AND __ ~ '~ FT
COMMENTS ~_~ .~,....5
ACCORDANCE WITH A LLSTATEAND MUNICIPAL GUIDEL O NTHISDATE,
72-008 (Rev. 4/85)
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:~
DATE PERFORMED: "~ -- ~{~) -- ~;;~{~:)
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
~;;;~-~l-~K ~ Township, Range, Section: '-r" t~'l~ , ~_.~..~
SLOPE SITE IP[.AN
10
11
12
13
14
15
16
17
18
19
20
t I
WAS GROUND WATER
ENCOUNTERED? ~,~
IF YES, AT WHAT ~ ~ I
DEPTH? ~. pO
E
Dem Io Water Alter .,~ l/1,, f
Mmlltortng? Olte: 'B,:,
Gross Net Depth to Net
Reading Bate Time Time Water Drop
'" "lA
I'
PERCOLATION RATE __
{mmutes, mch) PERC H~LE DIAMETER
TEST RUN BETWEEN __ FT AND --
COMMENTS /~,
PERFORMED BY:
ACCORDANCE WITH ALL~~I~E~ EFFECT ON THIS DATE.
72-~ (Rev,
FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: k~^q ! Q l(30R
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
LEGAL DESCRIPTION: b ['~ ~ ~ "~~
1
2
3
4
5
6
7
~l~.,Township, Range, Section: "'~___j,~ . [Z_~V,~,' ~.~;.~.~_ ~
SLOPE SITE ~LAN ,
10
11
12
13
14
15
18
17
18
19
20
fl /-
/
/
t
t
~ WAS GROUND WATER
~;~ ENCOUNTERED?
IF YES. AT WHAT
~ i Wa(re' ~
bl~ 1447.1
Reedll~ ~ Gross Net Depth to Net
' - Time Time Water Drop
PERCOLATION RATE __
(minutes/tach) PERC HOL~DIAMETER ~
TEST RLIN BETWEEN FT AND
COMMENTS ~
PERFORMED BY:
ACCORDANCE WITH ~
72-008 (Rev. 4/~)
FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
EFFECT ON THIS DATE. DATE: ~A¥ i 9 i~8~
.5
S & S ENGINEERING
SRB 196X
EAGLE RIVER, AK 99577
S & $ ENGINEERINO
$RB 196X
EAGII: RIVER, AK g~577
'N
LO7' /~
SULLIVAN WATER WELLS
P.O. BOX 670272 CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE - Started Ended
PERMIT NUMBER
I)EI'FH OF ~'ELL
ST-\TI(' LEVEL OF WAI'ER
I)RA~' DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From Ft. to Ft,
From . . Ft. to Ft.
From Ft. to Ft.,
From~Ft. to Ft.
From Ft. to Ft.
From, Ft. to ~Ft.
From_~Ft. to__Ft.
From__Ft. to__Ft.
From__Ft. to Ft.
From__Ft. to __Ft.
From Ft. to Ft
From , Ft. to Ft.
From _Ft. to__Ft.
From__Ft. to__Ft.
From__Ft. to__Ft.
From__Ft. to__Ft.
From~Ft. to _Ft
Froln .__
From
: From
From
From
Fronl
[ro1!1
From
From
From
From_
From ~
From ~
From __
From
From
From ~
Ft. to___ Ft.
____Ft. to Ft.
____ Ft. to Ft,
Ft. to____ Ft.
Ft. to____Ft.
Ft. 1o .... Ft.
Ft. to____ Ft.
Ft. to
Ft. to__
Ft.
Ft. to
Ft. to Ft.
Ft. to__Ft
Mi$CL. INFORMATION:
DRILLER'S NAME