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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: