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Home My WebLink AboutSUNSET HILLS BLK C LT 15I..0 T' --- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONIVIENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT NAME P FI ~T~-~I' h-: Man ulacture~ ~ ~aterial No, of c~,p~rtments -- a W I) ~ Topoftil of'nish rade~j~ ~ Mateial ene htile OTHER S~IL TEST RATING iNSTALLER ~2~ ~ -- i/} ''~'-- -- __ 72-0 ~ (Rev. 3/78) • fN I.,,a�.f` M -W DRILLING, INC. 'yam . - GS SITE ID LOCAL NO. SeIQ-3 - ZPAA,4c. %/ DRILLING LOG Well Owner 1-4 " Plumbing Jr deal• STi r Use of well Vann Location (address of: Township, Range, Section, If known; or distance main road r Size of casing 6 epth of Cased Static water level LOA th (above) below land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated ( ). Describe screen or perforation .14 ! A Well pumping test at *4 per (MOO (minute) for —hours with 100 all) it of drawdown from static level. Date of completion ci % 8 17ir WELL LOG Depth in feet from ground surface Give detalls of formation's penetrated, size of material, color and hardness p TO�_ .3i•itKvp. • o mcm i c S y 1 i•.y q ravel Tp i14-1 at %XA y GobblY 1 L+ -S TOS 2 Ha ct� pa. f% 13� T01 tY7 wa c- .g1A�l c c N C7 TO N r TO TO TO TO T -TO TO TO 5033 _ 4+,La+�P4 f;rrY N aRf 3—CONTRACTOR DRILLING, INC. DRILLING LOG Well Owner Use of Well Location (address of: Township, Range, Section, if known; or distance main road ~,,)i: 'I~, 113] o,-'.]~. (', ,q~%;,.,qcfi; }i:l.! i[.~ ,qt![>,.[:[~zi.:;:L~l /',i~t~ b)~L',q;!? Size of casing Depth of Hole Static water level ; i~ ft. (~i~) Screen ( ); Perforated ( Describe screen or perforation Well pumping test at /~ gallons per (;I~5~) of drawdown from static level. ' f ( feet Cased to. 169, i:. .feet (below) land surface, Finish of well (check one) ). (minute) for ], hours with 1 )0%, Date of completion 9 / ~'/'/~!' WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness _TO ' ~TO ~ _TO / :~ _TO i 1 ~ ~.-,bbly _TO ~/-/~ _TO ! ': {cf' .TO .TO _TO _TO .TO .TO ~TO open end (::(:¢ ); ¸ft. 3 -- CONTRACTOR HI:::I?,]II"tlII'] I'.,1111'"t1:~F':? OF: I!:l:il)Fh3Cd"ll!il ? !:'I:'!::'I::IFi:t !'ll::i',ll i3'flFi::[ i:::'l:;?.()F:'li:f~:l"T~ ' [',!l. G,,EATER ANCHORAGE AREA BOROU~,, Department of Environmental Quality 3330 'C" Street Anchorage, Alaska 99!503 SOILS LOG - PEROLATION 'rEST Legal Descripti~'n.'~IOT I~/ ~¢c~ C_, 7~',/WJ"~T ~L~_c_J .~P~l~O ~ ~ff~ This form repo~s: Soils log __ ~ __ Percolation test Depth Feet 18- 20- Was groundwater encountered? If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop I Percolation rate minute. Proposed installation: Seepage Pit __ Drain Field Depth of Inlet . . D~pth.to botto.m/of pit or trench ~ "~ =D~TE RECEIVED INSPECTION APPOINI'MENTS ~ / TIME ~-ATE DAT~ DATLI ~-- <~/ ~ T~SPECTOR I NSP E(~R INBPECTOR ~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECJ]JklgJ~ONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION APR ? 1981 Telephone 264-4720 R E C E I V F D FJEQUEST FOR APPROVAL OF INDIVIDUAL WATFR AND SEWER FACILITIES ~-, PROPERTY D~NER ' ~HONE ~OPERTY RESIDENT (If different from above) PHONS ~'. BUYER PHONE ~AI LING ADDR ESS ~'. LE DING IBISTIT TION PHONE MAILING ADDRESS LEGAL DESCRIPTION 6, TYPE OF RESIDENCE s NUMBER OF,BEDROOMS FAMI :.YL ~1 One ~ Four ~/'SlNGLE El ~wo ~ Five ~ MUL.TJPLE FAMILY ~/ Tl~ree ~ Six Other 7, WATSR SUPPLY [~/~INDIVIDLJAL* ' ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 'l g75, For wells drilled prior to that date, give well [] PUBLIC UTI LITY aep~n (attach log if available I 8, SEWAGE DISPOSAL SYSTEM (~L~, YEAR ON-SITE SYSTEM WAS NSTALLED, [~/ INDIVIDUAL/ON-SITE** [] PUBLIC UTI LFFY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE P~:iOCESSING CAN BE INITIATED, ,~-o,o,,~.~,,e, /~¢,~,~-CL,g (~-~¢q 5-~-~C~- !~.~,./ - THIS SIDE FOR OFFICIAL USE ONLY , 1. TYPE OF RESIDENCE' NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [~] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX I PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~Septic Tank or E~]Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS I~"'~-APPRoV ED FOR .~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGE t:NVIRONMENTAL ~ ,.,~CI'ION 825 L Street-Anohoraoe, Alaska 99501 AP R ~ 0 10~'!:J ENVIRONMENTAL ENGINEERING DIVISION Telephone 2,4.4720 RECEJ~[D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND 8EWER FACILITIES DI FIECTH:)NSt Comolete al parts on page 1. Incomplete requests will not be processed, Please 8HOW ten (10) davs for processing. MAILING ADDRESS -- f/) f ~.~ ~ PROPERTY RESiDEN~d~nt from ~bo~e) ~~UE ~ BUYER J PHONE MAILING ADDRESS MAI LING AG DR ESS 4, REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTI(~N _ STREET LOOATIO ~ SINGLE FAMILY [] MULTIPLF FAMILY NUMBER OF BEDROOMS ~ One ~ Four [] Two ~ Five ~ Tnree -- Six 7, WATER SUPPLY INDIVIDUAL~ COMMUNITY [] PUBLIC UTILITY Other ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give wel depth (attach log if available.) SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** ~'lf individual/on-site, give installat on date If system is over two [2) years old an anequacy test's required [] PUBLIC UTI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010[3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS . TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVEDI~/"~4'~ 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~] I NDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER I []Septic Tank or []Holding Tank iSize: )~)(~O If Tank is homemade SOILS RATING give dlmensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 5. COMMENTS ~'"'~APPROVED FOR.~___ BEDROOMS LEGAL DESCRIPTION "~=..-- 72-010 (Rev. 3/78)