HomeMy WebLinkAboutT15N R1W SEC 9 LT 67
Well Drilling Permit Number: SW
Parcel Identification Number:
Legal Description
T15N R1W SEC 9 LOT 67
Date of Issue
D59- 16q -y(
Pump Installation Date: 3-11-19
Pump Intake Depth Below Top of Well Casing: 79
11 Pump manufacturer's Name: F&W
11 Pump Model: 4F11PO5305S
Pump Size: 1/2
Pitless Adapter Burial Depth: 5
Pitless Adapter Installer: UNKNOWN
Disinfected Upon Completion? ® yes ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments: Pitless Manufacturer: UNKNOWN
11 Pump Installers Name: Sullivan Water Wells
Property Owner Name & Address
Dan VanBoven
feet
ME
feet
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
GRE~,ER ANCHORAGE AREA BOE~dGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ~
FROM W E L L '-'/c/
INSIDE LENGTH
MANUFACTURER ./~-/~---~
INSIDE WIDTH
MATERIAL
LIQUID DEPTH
NUMBER OF
COMPARTMENTS "~. __
LIQUID CAPACITY /~'~ GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL
TOTAL LENGTH
FOUNDATION NEAREST LOT LINE _ _ OF LINES ~'
NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION AREA '- SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE_. IN, ABOVE TILE ~ t¢ IN.
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED _
CONSTRUCTION DEPTH
NEAREST NEAREST SEPTIC SEEPAGE
LOT LINE SEWER LINE TANK_ SYSTEM
OTHER SOURCES
DISAPPROVED ...... REMARKS
DISTANCE FROM:
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAl ·
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
DATE
Form EQ-032
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GA~Y ?LAY~ VEi'~TUR~
CONSULTING GEOLOGIST
/
SOIZS LOG
----2--
-'12-
-q 6",---
-'18-
-20-
Was groundwater enootmbered ~,..(¢'~,. ? What depth
Depth to bedrock..>~0~
How determined ~
?
?
Respectfully submitted,
Ga "~ /'~ ~
Consulting Geologist