HomeMy WebLinkAboutUS SURVEY 3201 LT 1 T10N R1W SEC 9
?'~ MUNICIPALITY OF ANCHORAGE ~*'"~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
E
PHONE
LEGAL DESCRIPTION
~m I [Absorptionar~ , Dwelling. [0 ' PERM~
~ ~ DISTANCE TO: Well Dwelling PERMIT
.o. of lines Length of each~n~ Total length of 'i~ Trench Distance b~ne:
~ Top of ti[eto finish grade 5 Material beneath tile ~ ~i~ Total effec~Kve absorption area
~[" ~ Type of crib~ ~ib dia~ C~~ Total .... effect~so~tion~ area
~. C~ Depth Driller Distance to lot line PER MIT N O~
~ ~ Absorptio;a~
OTHER
PIPE MATERIALS
APPROVED DATE LEGAL
72-013
DEPFIRTtdENT C HERLTH RND E~I¢IRCNttENTHL , ...uTEL. TILN
o~._ '"L" STREET., Hr~L. tp..m..HbE. ElK. L~2~5
264-4720 ~ -
b-iEEE R~'aE:' C"~'a--~; Z T'E S~E~.4E~: PER,"1
F'ERHZT NO. ( 03C7~2 ',
FFL.] ...HN t BRFIE:,LEY flC:LEMORE BOX '- e, Sa.-¢ ~._,a.
L..OCF~T Z ON
LEGRL LOT ~ ': -' 9 '-'- _ _ '-
_,EL. TtON RiH LI=,=, ~:2Fl~ LOT .=,Z~E
TYF'E OF :,uIL PIB_,uRFTIuH =,Tz, T~J I.:,. DRRINFIELD
I'tR:qZHIJM NIJMEER 0F E:EDROOHS = Z; '- .....
THE REC!UiRED SIZE OF THE _,l_ltL HE,_,uRFTIuN _,TL~]'Eh I_,.
E:,EF'TH== 5.. 5 LE~-~,3TH= Z~ "3F~.R ,,, EL C, EF"TH= ':: .
THE LENGTH DII'"IENSIGN IS THE LENGTH ,::tN FEET) OF THE TRENCH JR [:,RFIINFIEL[:,.
THE DEPTH OF FI TRENOH OR PIT IS THE [:,ISTRNCE 3ETHEEN THE SURFRCE OF THE
GF'- N[, BND THE EuTIUH OF TNE EMCFI',/RTION (IN FEET). '
THE GRRVEL DEF'TH ~S THE MINIMUM [:,EPTH OF GRR',,,'EL~,.IEEN 'THE OUTF~LL PIPE
'- -' .~N FEET::,.
RND TNE ELITTuft OF TNB EXE:F4',/FITZON ....
....... ,--,- ,- 'T' FHI_,
FIEF4:I'IIT IdFFLI ..IIN HFIS THE c=,PuN_-,IE, T-- z,~ ~'F1" '--
tr~_,lldt~L.H I IUN It~z, FE...TI JN_-_, JiF F~,Nu .'___, FI£:,..~RCEN', 0 FHI=,
4UilEER ElF RESIDENCES TH: 'T'.-~:'' .... Lb HILL -,ER,E.
[:,EF'FIRTMENT DLIRING
FF._FEF. T,r FIN[> THE
THE
~l ' ' '1-1~' ' - BY '=
FFR_ , HL THI_,
i'IINiMUM DISTFINC:E BETWEEN Ft WELL -ID :""- ;,-'--SITE SEI.4RGE }ISPOSFIL SYSTEI4 IS
iEIE'I FEET FOR R PRi',,,'FITE WELL OR i5,:. ~.--.C FEET ~RC'~ '-' PUBLIC
UF'ON THE TYPE OF PUBLIC HELL ....
HINIHLIH DISTFtNC:E FROM Ft PRI',,,'FITE HELL TO R F~ cFITE "E'ER _ NE
TO FI COi"tFiUNITY SEHER LiNE IS ;x5 FEET.
.WELL LOGS FIRE REQUIRED :1ND i'"IUST BE RETURNED TO THE £:,EPf
OF THE WELL COHPLETION.
OTHER REQUIREMENTS I"iFIY FIF'F'L"/. SPECIFICFITIONS FIND
RVFIILFIBLE TO INSURE PROPER INSTRLLFFFIO. N.
4ELL DEPENDING
IS 25 FEET RND
WITHIN ~0 DFIYS
CONSTRUCTION DIFIGRRblS RRE
F'E[4.'t'.I 1-_ T E::::<;F" J.F.:E. . [- E _-E.~E. EF:. 3:t..
t CERTtF'¢ THFIT
±: I Fll"l FRMILIFIR HITH 'THE REQUIREMENTS FOR ON-SITE SEI.4ERS
FORTH BY THE HUNICiPFILiTY OF'FINCHORFtGE.
2: ~ HILL. iNSTFILL THE SYSTEId tN FICCORE:'RNCE HITH THE CODES.
3:: I UNDERSTBND THFIT THE ON-.SITE SEHER SYSTEH MR¥ REQUIRE
7ESIE:,EN,~f~MODELED~~ ~~NCLI-IDE ME, RE TFIRN ]: BEDROOI'I~.
RND WELLS FIS SET
ENLFIRGEblENT IF THE
V4.0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
[~PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
6-
7-
8-
9-
10-
11
13-
14-
15-
16-
17-
18-
SLOPE SITE PLAN
20-
COMMENTS
PERFORMED BY:
WAS GROUND WATER ~*~ 0 SL
ENCOUNTERED? pO
E
IF YES, AT WHAT
DEPTH?
Gross Net
Reading Date Time Time ~[~.,t, ~.~) Depth to ~ Net
Water ' ~ Drop
PERCOLATION RATE ~ ,~ (minutes/inch)
TEST RUN BETWEEN I~ FT AND I~.,~ FT.
CERTIFIED BY:
72-008 (6/79)
ALASKA eR?,~orlmgllTAL CONTROL ~r)v~'~
~'.,n',,,,.. ~%
INC.
PERCOLATION TEST DATA SHEET
CLIENT ~P-~O
ADDRESS ~.
ZIP CODE
LEaL LOCATION
TOTAL DEPTH OF HOLE
ZONE TESTED
TH # \
c~. ~ ft.
ft TO -'2~, %~' ft
TEST HOLE DIAMETER (m/'
READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in)
OATUM
FINAL PERCOLATION RATE I~,~ ,,., (min/in)
SQUARE FOOT/BEDROOM
PERFORMED BY
MOA 5T83-024
.~/~-W DRILHNG, Inc.
/~. P.O. Box 10-378 · 10300 Old Seward Highwa',/''-~
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner BRAD MC~RE Use of Wel! Don~stic
Location (address of: Township, Range, Section, if known; or distance main road Lot 1 USS ~3201 Secrlon 9 T]0N R]W S.N.
Size of casing 6" Depth of Hole
Static water level !] 5 ft. (~
Seree~ ( ); Perforated (
&2 feet Cased to ]4] feet
(below) land surface. Finish of well (check one) open end (xxx );
).
Describe screen or perforation _M_.r3o. e
Well pumping test at 4 gallons per ~ (minute) for
of drawdown from static level
Date of completioD Au~pl~qt 18:1983
WELL LOG
1 hours with 100%
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 ~0 2 Casing stickup
2 TO 3
3 TO_ 82
82 TO_ 112
112 TO 140
14Q_TO 142
TO
TO
_ TO_
TO_
TO_
TO
_ TO
___~TO
Overburden
Brown s~d ~ ~a~! (wet)
~ clay_
Water~
Certified
Ce~tzf%c~ ~ Co.~_ .
'~ ~vo's, 814
'~ 973
1--CUSTOMER
, APPLIC '\NT FILLS OUT UPPER ONLY
' i Phone
Realty Co. & A~nt
Address Zip Code
Street Locati~
Type of Residence
~ Single Family
Water Supply
~ Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
g Public Utility
Sewer Disposal
~ Individual Year Individual Installed: J ~ ~ ~ - ·
g Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Inspector Inspector Insp~tor Insp~tor
Field Notes: ~ Z S ~
( ~PROVED BEDROOMS *OONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Ratin9 D~ r al Well To ~sorplio. Area ~O O~ Well Log Received
~:e~t ~ WelltoTank ~ = , SeptioT~kSize /¢~O'
CHEMICAL & G["~LOGICAL LABORATORIES Y~ALASKA, INC.
~'~"~ Drinkifi0 W~iter Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
I.D. NO.
Phone No.
Mailing Adaress
City State
MO. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
t ILl
I
~ I
I
LOCATION
P f~
I
I
I
I
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
~aws s.snows this Water SAMPLE to be:
~ Satisfactory
[] U~satisfactorv
Sampm too long n transit: sample should
no[ De over 48 hours old a[ examination
[o ndicate reliable results. Please send
new samDle
Dat~· Received ";~' - / (~/- 0~ ~
Time Received / ~-O 4)
Analytical Method:
[] Fermentation Tube
/~ Membrane Filter
Lab Ref. No. Result* Analyst
I
I m
*NO of cOlonies/lO0 mi or No of Positive ooruon$
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANAL~'SIS RECORD
P~esumpt lye 10mi 1Cml 10mi /0mi Z0ml 1.0mi 0.1mi
24 Hours
46 Hours ~
Confirmatory
Time* ,/~-~'~") a.m.