HomeMy WebLinkAboutT15N R1W SEC 18 LT 199
MUN,C PA',TY OF ANO,ORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES d/~--/ 2 ,~
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
Address
Phone(s} Permit No
LEGAL DESCRIPTION
Township, Range, Section
TANKS
~SEPTIC [] HOLDING
Capacity in gallons
No, ol Compadments
TYPE OF SYSTEM
[] TRENCH ::~"~ED [] W. DRAIN [] OTHER
original grade ~ ~,~l ~ FT !,~ FT
Gravellength
Total absorption area
Pipe material
)ate Installed
WELLS
~RIVATE
[] OTHER ¢ldentifv}
Totai Depth ~:T Cased to
Classification (A,B,C)
Date installed:
REMARKS:
DISTANCES
SEPTIC
TANK
WELL
LOT LINE ,~C:::, I,-~
FOUNDATION
ABSORPTION
FIELD WELL
, AS-BUILT DIAGRAM (Show iocstion el well, septic system, property lines, loundation,
driveway, water bodies, etc)
S & S ENGINEERING
Municipal and l
uertil
Inspections Performed by:
Da~e: '~ ~.. J ~
~ pedormed according Io all
Health Department Approval:
72-013 (3/85)
F' E F4 M :[ T
l)ay Phone
c:;apac:i'l:.yJl :1.~, ()()() ga], ].ll)rJ~. IEac:h ~,~el::M:.:~.
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:1... i1: aln t'am:i. ]. i. ar'
f'or.'Ll"~ b~/ t.l"li~k, I~L~.r~i(:;:i.l:;~a].:l. ty c~f' ~nc:hor'age (lfll:]~t) arid t.l"i~¢~ []i'Lat. f~ tit'
arid J.n ~:oml;)]:i,,lnc;~ ~:i.t.h '~:.1"i[~2 d~,~lii:i, grl c:;p~.'L*~Pi.a o[ fbi. sill D~PIIIJ, C.
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........ ................................................................. ..... ..............
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
5
6
7
8
9
10
11
12
13
14-
15-
16-
17-
18-
19-
20-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Monitoring? ~- ( .
Reading Date Gross Net Depth to Net
Time Time Water Drop
P~TION RATE __ (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN ~:T~ND __ FT
COMMENTS
~ ...... ~ _ ._~ / / CERTIFY THATTHI TESTW S PERFORMED IN
72-008 (Rev. 4/85) ~ ' ~
WATER WELL DRII,LING LOG
Use of well
if known,
Drill ln~ Co. ' ...... '
Driller .... .~ ~- v :~ y ,~ ?. ~ '~
Well ow~l er
Location (address of, To. ship, Range, & section,
or d~stance from m. ln road
Size of casin~, ~ Depth of hole 10,-'
Ststic water level ~ feet (above)
well (check one) Open end (~, Screen
Describe screen or perforations
Well pumpiu~ test at ~O ~als. Der (~) (minute)
witk feet of drawdowu from static level.
Date completed ~''~
feet. Cased to iO0 .feet.
(below) land surface. Finish of
( ), Perforated ().
for hours
Depth in feet from
~round surface
Give details of formetions penetrated,
size of materiel, colorsnd hmrdenss.
,-to
-to
to
-to ·