HomeMy WebLinkAboutSOUTH LAKEWOOD HILLS #1 BLK 3 LT 5Lo'('
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
GAAB-HD I
G, ,TER ANCHORAGE AREA BOR(...,,
DEPARTMENT OF ENVIROBII~IEBITAL 0. UALI1Y
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
DISTANCE FROM WELL ~?~'L)./~.~r''~'~''~
LIQUID CAPACITY ~ ~Z2 GALLONS.
ADDRESS
PHONE
MATERIAL -~-~-~- NUMBER OF -.~ ..
COMPARTMENTS ....
LIQUID
JNSIDE LENGTH_ ~'~ INSIDE WIDTH_ ~ DEPTH
SEEPAGE PiT:
SEEPAGE
SYSTEM:
NEAREST LOT LINE
~ OR WIDTH . LENGTH , DEPTH
DISTANCE FROM W~ELI
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WEL~''~-~'~ ~'-::L~:'~: , FOUNDATION__
NUMBER OF LINES
DISTANCE BETWEEN LINES
ABSORPTION AREA ~ ~,.--/~/.~]~ SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
NEAREST LO1 LJNF~/~
TRENCH WIDTH
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH~-~
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
TYPE.
DISTANCE FROM WATER
, BUILDING FOUNDATION ..... ~;-~'~SAMPLE
NEAREST
OTHER
'~-~ SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
APPROVED / - ' "G.A.A.B.
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6*650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
INSTALLATION LOCATION
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
PE.M,T NO,
PHONE
NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 2g HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUDJECT TO PROSECUTION.
SEEPAGE AREA SIZE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIt
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT
TO NEAREST LOT LINE, ~
WELL TO SEPTIC TANK
WATER MAIN TO SEPTIC TANK
., DRAI FIELD
, DRAIN FIELD .
, SEEPACE P,T /~?~ /
ALSO CONSIDER AREA WELLS.
SEPTIC TANK. , SEEPAGE Pit , DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEETINTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
'):;.. '..).,.,/ /:1 / //
TYPE
I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
ER ANCHORAGE AREA BOROUGh
DEPARIMENT 0!- EN!/I~n~'~''~' ~,
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
CASE #
Performed For John Gnagy
Legal Descrip~-~on:
This Form Reports Soils Log__X
Date Performed 9/27/71
~)Subdivision $. Lakewood
P e r c 6°T~-~-.T~ n~'~-~'
Depth
Feet Soil Characteristics
Brown sandy silt (ML)
Gray sandy gravel (GW)
and sand (SP)
silty sand to sandy silt
Was Ground Water Encountered?_~ves _
If Yes, At What Depth?_ 7'
Reading
Gross Time I Net Time
Date
Depth to H20
Percolation Rate ~l~Fi-~-u t e
Net Drop[
Proposed Instal'T~-~i-~-~: Seepage Pit Drain Field x
Depth Of Inlet__ Depth To~o--~tom Of Pit b-~ Trench
COMMENTS.· --
__~square feet_of drainage area is re~uir~bedroom iq~t__his drainfield.
~~ By. R. E. Carlisle -~Fi'i{'ied By: Nati-~a--l--~&~n~ Nvs. Inc.
Date: