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WATER WELL DRILLERS LOG 10
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Driller'`"'
'Well Owner
'- Location (address'of: Township,1
Use of Well O -
ge," Section (if known); distance from road:
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W,L'%�+ Size of.CR Depth of Hole
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e) Open end ([a °•.Screen ( ) Perforated ( t
�i:_(chheek eck onn
Describe screen or perforations.
Well pumpin test at �i` gallons per man or our wat
feeet'o' —drawdown from static level.
Remarks
WELL LOG
- —Depth in feet from Give details of formations penetrated, size or materaaa, jl
ground surface color, and hardness.
yd to 6
6a to.�70
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• Domestic Ord irdAlflol Psrnp sobs and Service • Water Well Service. Water Treatment and CondltlonN
1
(~G
REA,I~R ANCHORAGE AREA BOR~,dGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
, INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
.luZ MAILINGADDR~-SS ,~/~ Z~'~'~ /7Z~ PHONE
- ' ! '~,~" ~ ~ o~ g~+ - '
LOCATION ~ ~~7 g~l'~ LEGAL DESCRIPTION ~~, ~/ .~~~.//''~
SEPTIC TANK:
DISTANCE
FROM WELL 7g
INSIDE LENGTH
/~SIDE WIDTH ~ LIQUID DEPTH ' J~IQUID CAPACITY /~'~ GALLONS.
SEEPAGE PiT:
NUMBER OF PITS /
LINING MATERIAL
BUILDING FOUNDATION__
__ , DEPTH
CRIB SIZE: DIAMETER DEPTH__ DISTANCE FROM: WELL
_ _,~-TOT A L EFFECTIVE
, NEAREST LOT LINE _/?'~/¢~'. ABSORPTION AREA (WALL AREA) Z/~"'-~ SQ. FT.
/
ADDITIONAL ABSORPTION
WELL:
TYPE ,'~r"l'!/,~.~ -CONSTRUCTION.
BUILDING NEAREST
FOUNDATION __, LOT LINE
._~ ¢.,~. ,~,1¢~ r(~ DEPTH ,~,,~/~--'"" DISTANCE FROM:
NEAREST S E PT I C Z,i~"~, SEEPAGE /~)~/~___..~
SEWER LINE , TANK SYSTEM
CESSPOOL , OTHER SOURCES
APPROVED~~.~ DISAPPROVED X
DISTANCES:
INSTALLED BY:
PIPE MATERIAL: ~ ~
i -
LOT SLOPE
REMARKS:
DIAGRAM OF SYSTEM
J,X r
~'TE ~,///¢/7~--~ 'APPRovEE)~~~G.A.A.B.
Form No. EQ-031
O~--S I TE
PERMIT NO.
APPLICANT
LOCATION
LEGAL
MLIN I C I PRLI T¥ OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONtIENTRL PROTECTION
25i0 E. TUDOR RD.., ANCHORAGB AK. 9950?
276-2221
SEWER PERg~ I T
JUDY KOPLIN
F 'REST
L4 B2 BRUIN PARK SUBD
SRA BOX i?70K
LOT SIZE
4~200 SQURRE FEET
TYPE OF SOIL 8BSORBTION SYSTEM IS: TRENCH
MR~IMUM NUMBER OF BEDROOMS
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS~
DEPTH= i2 LENGTH= ~8 ORRVEL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCA¥ATION (IN FEET>.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAYEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE E×CAVATION (IN FEET>~
RE~2U I RED SEPT I C TANK S I ZE= i000 GF~LL']~-4S
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
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.
SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
PERM I T V~L I D FOR ONE YEAR FROM ISSUE
I CERTIFY THAT
l: I 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.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
PERMIT NO.
i~lU~ I C I ~RL I TY OF R~CHL~RGGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 E. TUDOR RD., ANCHORAGE, AK. 99507
276-222i
ON--S I Ti SEWER PER£4 I f
APPLICANT
LOCATION
LEGAL
JUDY KOPLIN
FORREST DRIVE
L2 B4 BRUIN PARK SUBD
SRA BOX i??OK
LOT SIZE
~44-~488
43200 SQURRE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS
SOIL RATII (SQ FT?BR>= i50
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I
DEPTH= 12 LENGTH= ~8
THE LENGTH DIMENSION IS THE LENGTH (IN FEET)
THE DEPTH OF A TRENCH OR PIT IS THE
GROUND AND THE BOTTOM OF THE
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM
RND THE BOTTOM OF THE ~>.
THE TRENCH OR DRRINFIELD.
THE SURFACE OF THE
iT).
BETWEEN THE OUTFALL PIPE
REQU I RED ~EPT I 6
$ I ZE= 1000 GALLONS
BRCKFILLING OF ANY
DEPARTMENT WILL BE
INSPECTION AND RPPROVRL BY THIS
ON.
MINIMUM DISTANCE BETW~
100 FEET FOR A
SPECIFICATIONS AND
INSTRLLRTION~
AND ANY ON-SITE SEWAGE DISPOSRL SYSTEM IS
200 FEET FOR A PUBLIC WELL.
DIAGRAMS ARE AVAILABLE TO INSURE PROPER
I. CERTIFY THAT
l: I RM FAMILIAR WI
FORTH BY THE MUNICI
2: I WILL INSTALL T
~: I UNDERSTAND THA
RESIDENCE IS REMODE
VRL I D FOR ONE YERR FROM ISSUE
H THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
~ALIT¥ OF ANCHORAGE.
~ SYSTEM IN ACCORDANCE WITH THE CODES.
' THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
,ED TO INCLUDE MORE THAN 3 BEDROOMS.
Performed For
Le,al ~escrintion: Lot~Block ~ubdivision~
This Form Re~orts Soils Lo~
"On~ test is ~or:h a ~hou~and o~inion~"
2204 Cleveland Anchorage, Alaska 99503'
Judy Koplin ~ate Perf0~med 5/5/76
Bruin Park Subdivision
Percolation Test Yes
PeDth
Feet
SOil Characteristics
Gravelly Sandy Silt
Wet (ML)
L
Silty Gravelly Sand
~ 8-- (,SM)
~10 Moist
12--
16
18--
Silty Sandy Gravel, Moist
Bottom of testhole
20--
Was Ground Water Encountered?
I~ Yes, At what Depth?
NO
I Readinq Date Gross Time Net Time Depth to H20 Net Drop
i '5/3/'76 11:0'0 AM 0 36" 0 .
515/76 '11:00 AM 48 hrs. 103" ... 67"
, '5/5/76 i1:10 PM ,, 0 ~.4-1/2." ~
J " 5/5/76 12.:10 PM 60 Minutes 54-]/~" .. ?0"
I 5/5/76' 1:10'' 120 Minuqes 65-1/2" 31"
I ........ 5/5/7~ 2:'10 180 M.in.utes ~.3~1/2'' ~9"
i '" i 5/5/76 , 3:1'0 240 Minutes 81." ..... 46.5"
Percolation Rate 1"'/8 )linutes
ProPosed Installation: Seenaoe Pit Drain Field
Deoth of Inlet . Depth To Bottom Of Pit Or Trench
C~!~ENTS: 150 Squar.e feet drainage"area required per bedroom
No bedrock encountered
Test Performed By .Janle$ D, ,JVlack
Data Certi fi ed B9 :CONSTRI~C~TTO~ m~qT LA5
D~_%~: 5/_6~76
DATE R E~CEIV ED
,~ INSPECTION APPOINTMENTS ~Y,
TIME TIME TIME '
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHO
I"'IFPT O.~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street-Anchorage. Alaska 99501 APR ? 1980
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be pr~ed. Please allow ten (10) days for processing.
1. PROPERTYO~E;~ ,' . I PHONE
P~OPER~Y RESIDEN~ {If diff~re~t from 8bove} PHONE
2. BUYER PHONE
MAI LING ADDRESS
L, o ,.ST,T N PHON
MAILING ADDRESS
4. RE~OR/AGE~T < PHONE'
~E~--SI NG LE FAMILY
[] MULTIPLE FAMILY
[] One [] Four [] Other
[] Two [] Five
~---3'hree [] Six
7. WATER SUPPLY
*I~NDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
8, SEWAGE DISPOSAL SYSTEM
* ATTACH WELL LOG. A wel log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTI LITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] I NDIVI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: !_~)~¢-~ If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
[] ONE
[] TWO
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
MANUFACTURER
MATERIAL
Septic/Holding Tank
NUMBER OF BEDROOMS
[] THREE [] FIVE
[] FOUR [] SIX
Absorption Area ~Sewer Line
[] OTHER
INearest Lot Line
5. COMMENTS
[~APPROVED FOR ~-~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must ac/~y
~'~ DISAPPROVED ~ /
DATE ~._~ ~ ~'8C~ BY ~_~
certificate)
72-010 (Rev. 6/79)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received March 25, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
voao
1. Approval requested by:
Mailing Address:
Property Owner: Daniel J. & Judy M. Koplin
Mailing Address: Forest Drive
Phone:
Phone:
344-9488
3. Legal Description: Lot 4 Block 2 Bruin Park Subdivision
4. Location:
See map on back
5. Type of facility to be inspected
6,
e
e
Single Family
Well Data: Individual
A. Type ~~
C. Construction
Sewage Disposal System:
A. Installed
C. Septic Tank: 1.
D. Seepage Pit: 1.
E. Disposal Field:
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
B. Depth
No. of bedrooms
D. Bacterial Analysis
On-site system.
B. Installer
Size 2. Manufacturer
Absorption Area 2. Material
Total length of lines
, Sewer Lines
, Absorption area
, Other contamina%ion
, Absorption area
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Re~ st for Approval of Individual ~ er & Water Facilities
'Description Lot 4 Block 2 Bruin Park Subdivision
Le§al
Comments
Approved
Disapproved Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I Certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
MUNICIPALITY OF AIx!CHORAGE
DEPT~ OF HEALiFt &
I~NVIRONMENI'AL
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Qual i ty 2, 5 1976
3330 "C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
Type of Inspection:
Property Owner:
Mailing Address:
3. Name of Buyer:
CMRO VA _ ~. . FHA CONV
Day Phone
Mailing Address:
Day Phone
Name of Lending Institution:
Mailing Address: Phone
Name of Realtor or Agent: ~
6. Legal Description:
Location:
7. Type of Facility to be inspected:
8. Water Supply
Type of S~pply: Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type ~of S~stem: Public Utility
If Individual, date of installation
NO. BdrmS. 6.
Individual (on-site)
4.1
you ~ any f'~er q{Os~~p~le ~ntaot ~l~ o~fice
276-2221, ext~sl~ 283,
HUFFM/~N
I~o/q D
172
163
171 ~)b-- 173
178
Rabbit Creek Area Reference Map-P13
('i'.') 19-, , J I I
Promissory Nntes should bo made in duplicate will] one copy for cus(3meh
To make a copy simply insert a carl)on between thc sheets-- or ~ etach
and fill out ~ch nopy separately.
PRQMISSO[XY NOTE
$ ................ Dat:~ ........... 19_ _
For Value Received, I,
Promis~ to pay to the order of
the sum of.
to be paid as follows
with interest to be paid, at tho ra;,_'}, of
per centum per annurn, from d ',.to payment is due
(AbDITIONAL ~q. lr~,l, rl IRE IF- A-~A~AB L E)
,~IGN,.;D AND SEALEI) !N PRESENCE OF:
609 - Av~-iiahl,~ from ,~'~-~_2/ · .. Grotcn, Mass.
SPECIFY 2 PART ~-~r 3 PART WHEN ONDER!NG
