HomeMy WebLinkAboutKASILOF HILLS BLK 4 LT 17
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alasl<a 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
[] UPGRADE
NO, OF BEDROOMS¢ ¢¢..
~ Z/_/Z' Tf/w~,~ll /k..J ~- 3
Absorption area/
DISTANCE TO: J JAtO 7- / ~ ~--~--
kiel, ca acit ill almsI IF HOMEMAD(: Inside length
Manufacturer : /~eT~d~
Well
DISTANCE TO:
No, of lines Length of each line
Top of tile to finish grade
Foundation
~l/g~) f lines
Material b~ath tih;
[Material
[Ne~r~st lot line
[Trench width
Leng~.~
Type of crib
DISTANCE TO:
Class
DISTANCE TO:
Width~
Crib diameter
Well
Driller
Sewer line
Nearest lot line /~-- /
Distance to lot line
Septic tank
No, of comparZnt$
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
Distance between lines
Total effective absolption area
PERI, IT NO¢
PERMIT NO.
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL *EST~G~-c ~ ~ ~,,~0 ~L~
INSTALLER
REMARKS
I:::'t~T. RM I "1" NO:
[),efT'l~ii .[ ,: c LJIr"-J.),,
~-.ff' F I, .[ E,(41g 1:
I'd:.L~E.R l FI~IqE]IqD
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Al II.~HL)I.W4L'.~I=, Al<: c)<?~;;i 1 El
!3UI'3D :1: V I !31 ON ." I:::a,c,,l I LCIi::;' I'-I :1:L..L.!3
,..~L.I., I IOt I,, 24. 'f'I3WIxlL-~HIF;".' 12. N
, 75A (!3Q,, F:T,, E}F~
L.EFT: 1'7
i:~&NCgE.., :51~
BI...CICI<: 4.
I cept.:i. ~,'y 'Lha'L:
!,, I am t'ami1:i, ar, with t.l'lca r'equir,(:.~m~}nt.:~ i'*::)r' (:]rl.-..~iit. e E;ewer,~i arid w~:~l:l.s a~s sle'L
t'or"Lh by t,h~.',~ Muri:i,c,:Ll:)alit. y oF ~r'lcl-ior'c~g~:~ (VI(3~-)) <?~l"ld the) ~]t.~a'Lrz, c:)[
3. I wil:t. ~.:~dl"~.~r,e~ t.o ~]. I~J:]~.~ <T~<lll:J ~Jt.a'L~ cji' ~:J.~a~d.,:~'~ I"GIQL.!:j,p~:~IIIE.)I"I~.~ (CJI' t.J'l(~) ~S6'.')t.
any c?rl],~:~r'g(;em~;~rlt, w:i. ll ~eClu:i.r'r.;~ an add:i, ti(~rlat pemm:L'L.
'THtEIxl (:1.) Alxl EI,...~I2, TRIC~L. PERMI"F ~txlD IIXlSF'ECT~CIN MLJI3T BE OBT(.~]:NED; (2) (.~S-.BI,.III,.,T'i3
~I[...1_ NO'l" BE ~F:'I:::'REiVED NITHOUT ~N EL.ECTF~I:~I_ ]:N~;F'E:CT]:OIq IREF'ORT] ~ND (3) THE
DEPARTMENT OF HEALTH & HUMAN SERVICES ( ra ~
825 "L" Street, Anchorage, Alaska 99502-0650 ~
SOILS LOG -- PERCOLATION TEST , ~ ~,,~
PERFORMED FOR: ///~ ~¢~ DATE PERFORMED:
. ~ ' ' /7~JM SLOPE SITE
WAS GROUND WATER , ,,~
11 s
L
IF YES, AT WHAT ~ 0
12 DEPTH? p
E
1 3 Deplh to Waler Alter
~onitoring? -- ' O~le:
Reading Date Gross Net Depth to Net
Time Time Water Drop
14
15
16
17
18
19
2O
iuO&
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW970269
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:ALAN & GAIL PEZZNER
OWNER ADDRESS:P.O. BOX 232033
ANCHORAGE, ALASKA 99523
DATE ISSUED: 8/21/97
EXPIRATION DATE: 8/21/98
PARCEL ID:01513115
LEGAL DESCRIPTION:
~ISILOF HILLS BLK
4 LT 1'7
LOT SIZE: 30000 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
THE ATTACHED APPROVED DESIGN.
ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) .
THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SkME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:~ /"~'~'~,..,~
DATE:
DATE:
.00'(
ORAV~L ORFV£
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STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT
WATER WELl. RECORD
LOCATION OF WELL
BOROUGH
SECTION QTRS
SECTION I TOWNSHIP
I-Is
~NGE
[]E
[]w
MERIDIAN
LOCATION/SKETCH:
WELL OWNER:
DEPTHS MEASURED FROM:[]casing top []ground surface
BOREHOLE DATA:
Material Type and Color
Depth
From To
NOV 7 1997
Oopt, Health & Human Services
WELL DEPTH:"'_.
Depth of hole:.~
Depth of casing: ~_.:~.~
DATE OF COMPLETION
ft
DEPTH TO STATIC WATER LEVEL:
ft below ',~ top of casing
Date: /~ ///6./ ~
[] ground surface
METHOD OF DRILLING: ~]'air rotary [] cable tool
"R other
USE OF WELL: ,~domestic [] irrigation [] monitor
[] public supply [] other
Cas'g typ:.:;rl~_': ~//,,~ in. to
WELL INTAKE OPENING TYPE: [] open end [] screened
[] perforated [~ open hole
Depths of openings: ' to _ .~.
SCREEN TYPE: Diam: in.
Slot/Mesh Size: Length: ft
GRAVEL PACK TYPE:
Volume used: Depth~to top:
Depth: from '"
DEVELOPMENT M ETI-JO D: O.~
Duration: ;~_. ~/t~.~c. :: - ; '
PUMPING AND YIELD:
ft after '~/~_ hrs pumping
gpm
PUMP INTAKE DEPTH: ft Horsepower: __
WELL DISINFECTED UPON COMPLETION? .~"YES [] NO
CONTRACTOR INFORMATION: . ._' REMARKS: -
;~j~ .a??j ~:// ::,:~ .... .. ,~ ,, '~_~LEASE MAIL WHITE COPY OF LOG TO:
~X/~ :' ~~~ ~" 7 ~ DNR/DIVISION OF MINI~G &~TER MG~T
Signature of Aut~oF~¢d ~espre~tative Date 3601 C St, suite ~uu
ANCHORAGE AK 99503-5935
Phone {907)762-2538, Fax (907)562-1384