HomeMy WebLinkAboutTURNAGAIN PARK Block 2 Lot 5 Hwy Runs Thru Here
) · / DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO'i=ECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME -- PHO.N~E ' NEW
MAI LING AD DR ESS
~ Manufacturer ~ ~ t o~
Mat ' No. of c
~ , Liq. capacltv in gallons IF HOME.DE: Inside length Width Liquid
~ ~ DISTANOE TO: Well Dwelling PERMIT NO.
~--~O~ ~ Manufacturer MateriaJ Liquid capacity in gallons
n F°undati7 ~/ Ne~s~l 9~n e PERMIT~~
~ No~;;~cETO: Wp~ ~ ~ Total ,¢g~l,nes Trench w~ inches Distance ~/gn?
~ Top of tile to finish grade
m PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Buiiding foundation Sewer line Septic tank Absorption area(s)
OTHER
SOILTESTRATINO/~ ~ ~
RF'F'L I C:Fff.~T
LOC:RT I ON
LEGRL
...I-I[.E._ E. .,., ..f.. .....
L5 E:2 TIJFd"4f:IC~FiZN
T'¢F'E OF SOZL FIE~SOF.:F'TION ..S'r'S-EM .... 'r,::.,. DRRINFIELD
LOT E,'L'ZE
!i::'E;CdE~ :.::;QL, RF.E FEE"Fy
II' ,,Ir ,[1 N i'".EEF~ OF: EEr,P--'M.:; ~3:
,,,E LENGTH E:,IMENSION
........
THE DEF'TH OF R ~kE.N .H C~' F'IT THE [..,ibTHI'.~L:b. BE"rl,.IE~:N 'THF- :5URrtlL:E OF THE
131;:O1..17.,![:, ~:ff'4[;' THE F L TT ] 2! OF THE E;*::r': FI',,,'FIT t l I', "'iq FEET ',
THE GF:ff,,,'EL DEF'TH .IS THE MINiMLIM DEPTFI OF GRF?,,,'~ ~. PIPE
FiND THE E~OTTCM OF THE Ei:4'¢R',.,'RTiON (iN FEE"r).
, E~.f._, F!PF'LICFINT l-thl_, IH,:, F~ESF'ONSIE:ILIT'¢ TO INFORM THIS C'EF'CK:TMEHT DURING
,= .......':-,'~' "i HI._, P'f'~:OPEF:T'¢ F..:.IE THE
]:1'~..I~_.,._,~, I,_!',, ):!qL:I::'E-"!':['.'_-'; (.'IF' FIN"r' HELLL5 FI[:,3FICC'jtgT Ti -' ': ....
t",!UME=ER OF F?P'q'[r:F'['J'~'f::'::; THFIT THF NELL bYt'! .::-',~;.,~'~,,,E.
THE
~H,...l'-..r'lLL¢.!~la OF F!I",IV .:,~'.: [~:. ! h. ITTH'" ........... T FiNF¢-.. ThJ'~F'FI-:TTI'"II'.~ F!F,!D hFF,*...I,HL r.:,~" 'r,, r'l!=, ....
[:,EF'RRTMENT H ILL E E ~';UEL)'EL]:T TO F'F,,:OSECUT I
h! ......... 1' l'-,! T r'!l IM [:, I S TFINCE E:E'I'!.,.IEEN iR. !4ELL
fEu2~ FEET F3R' FI PRZVRTE HELl_ OFf ~3 TO ;;::Ei2) FEET F'F:OM R PUBLIC HEL. L [;,EF'EN[:,!NG
P"'N THE "' '~-
...... I~F,.: OF F'.F_'~': HELL,.
I',!If'.,!IMIJM DISTFINC:E F'R:OM R F'RIVRTE HELL TO R F'RIVRTE SEI4FJR . ~NE !S ;?.:5F':F~-'r_..,_, .¢:~.,m. _
TO R COMMIJNiT'.? SE!.,.IEF: LINE_.TS '"'=,.._,
-,,H ..... REg!UIF:EMEN'TS MF¢.,' FIF'F'L"r'. SF'EC:IFIC:F!TIC[NS
....... t._,RU_ !,_.N .................. .
RVRIL. RE~LE TO INSUF;:E F'F:OF'EF: INSTRLLRTION.
'! ,-,E ...... IF ~' THRT
l: t HI"I FFff,!ILIFIr4: NITIJ, THE ,q:EQLI!F:EMENTS 12"l-IR FI'.!-.':iITF' :,r:_!..l-Lr,::, R~'4[:, ,.',.~L.L..: c'~-'r'
F'3F?TFI B'¢ THE MJNICIF'RL!'Fh" OF FIi'-!CF:r;'FI"3E
=":': _.~ !,.I!!_L !NS"I"FtLL TNE... S'¢:.:-;TEM iF,! RC'2OF:I2Ri',ICE [,.ii'1"14. ....... THE .... ,'E':
_---':: I LIN[. EF....,I, ,I.. 'T'HF!T TPIE ON'-'SZTE
..... IEZfI I"!Rb' ~:'P'".._.,.. ~,.'r~'P' .... ENLRF:GEMENT ..'[¢'. THE
FtE2;ZE:,ENCE ZS F:EHODELED TO ZNC:LUDE M(3~E TI"IRN 3: BEDROOHS.
'6
18
19
20
COMMENTS
~'~MUNICIPALITYO,-ANCHORAG} ~"'/
DEPARTMENT OF HEALTH AN[) E~VIRONMENTAL PRO'[EC¥10N
825 L. Street. A,chorage. AI;~ske 99501 2G4-4720
SOILS LOG -- PEHCOLATION TEST
SOIL:
PERCOLATIO'
WAS GROUND WA1 ER
ENCOUNTERED?
IF YES, AT WHAT
DEPTN?
SLOPE ~ SITE PLA~ '
[
/
:o?, 7
PERCOLATION ELATE
TEST RUN BETWEEN
PERFORMED BY: V~J '- H..~,1,~d,~/1~ 0 ~/. '~ ~", CERIIFIED BY;
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological 6 Geophysical Surveys
Drilling Permrt No,
LOCATION OF WELL (Please complete either In, lb or lc.) A.D.L.
I~. Borough Subdivision Lot Block ~ I/4qtrs. Section NO.
Township N E]
~' ' _ L~.~]~ ,~., ~ ~ --of--of--of S~J
Ic.JlDISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 5. OWNER OF WELL: ¥~.(.~0~;
~0[ ~ () 5 6. ~Coble tool ~Rolory ~Driven ~Dug
~ ~ ~ ~Above or ~%elow land surface Cate
15, Water Temperature __ ~ F ~ C
': ;' APPLI~.~,iNT FILLS OUT uppER HA~ -' ONLY
Property Owner
Lending Institution L~.~ ,~,:~ ; /-~z~;~ycL:- [~ z-~l ~,. Phone
Realty Co. & A~nt ~:;.(~:: i ~ ,~,.~ , ~' i &¢ ~,,, /~ ' '~' ( t",,I Phone
Address ~
Type qf Resi~nce
SewecDisp°sal
Time Time Time Time
Date Date Date Date
Inspeotor Inspector Insp~tor In s poc~.~. ~
Field Notes: I~ ~UNJCIPALI~ OF ANCHORA~
~ D~PT. OF H~ALTH
~NVIRONMSNTAL P~OTECTIO~
MAR 2
( ~ APPROVED~EDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
8oils Rating Date ~wer Installed Well To Absorption Area weir Log Received
~ ~O~ ~/ Well torank Septic T~kSize
12 023 (31~)
, CHEMICAL & G ,I~LOGICAL LABORATORIES ~.~' ALASKA, INC~
274-3364 5633 B Street
ing Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM: ~
' I1 LD' NO'~
/ Phone No.
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[3 Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE Time Collected
NO. LOCATION Collected By
I
TO BE COMPLETED BY LABORATORY
Aha ,/sis shows this Water SAMPLE to De:
[] Satisfactory
[] Unsatisfactory
[] Sample too long in transit: sample should
not be over 48 hours old at examination
To indicate reliable results. Please send
new san' pie.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
~;Membrane Filter
Lab Ret No. Result* Analyst
*No of colonles/] OD mi or No. of POSl[ive ~ortions.
06-1220
Rev. ].978
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE