HomeMy WebLinkAboutWAGNER TR 1
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
GRE 'ER ANCHORAGE AREA BO}' JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION P, EPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING ADDRESS
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE
FROM WELL
MANUFACTURER
NUMBER OF
5~ MAFERIAL. / ~ ~ ~ COMPARTMENTS
INSIDE LENGTH ~' INSIDE WIDFH ~ LIQUID DEPTH
~-~ LIQUID CAPACITY ~/mbGALLONS.
DISTANCE FROM WELL
NUMBER OF LINES__
ABSORPTION AREA __. _ '~'~ SQ. FT. LENGTH OF EACH LINE ___ '"~ ~- //Z
~ DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE -- MATERIAL BENEATH TILE ~' __ ABOVE; TILE
TOTAL LENGTH
FOUNDATION "'7/~/( NEAREST LOT LINE I 2-'! OF LINES_
DISTANCE BETWEEN LINES ~ TRENCH W DTH"~(~¢ IN. TOTAL EFFECTIVE
/
WELL:
TYPE ~ %.~ U', 4~--~, ~ _CONSTRUCTION ~_¢~1~_~ ..~(> d DEPTH __
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION __. LOT LINE SEWER LINE TANK SYSTEM_
DISTANCE FROM:
CESSPOOL
OTHER SOURCES
APPROVED. DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY: ~e I '~
SEWER LINE DEPTH:.
PIPE MATERIAL'
LOT SLOPE: ~,',~ k\
REMARKS:
Form EQ-032
DIAGRAM OF SYSTEM
DATE
(¢. ~ ' '~) , . .%~'~,~' PERMIT NO ....
~ SEWAGE DISPOSAL SYSTEM -~ APPLICATION AND PERMrr /~(_ ,
LEGAL, DESCRIPTION ---
FINANCED THROUGH - ~ -- TO I~E INSTALLED BY
SOIL TES'r RESUL'rS ~/~ ~' 4~2 ~ /~"} ~ NOTE~ THIS PERMIT IS NOT VALID WITHOUT 5OIL TE~
COMPLETION DATE ANTICIPATED ~L/~/~
FINAL INSPECTION: Z4 HOUR NOTICE REQUIRED. BACKFILLING Of ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALI'r¥ AUTHORITY WILL BE SUI3JECT TO PROSECUTION.
*~ ~ /../~/~
WATER MAIN TO SEPTIC TANK
DRAIN FIELD /~-~ )
, DI~AIN FIELD /J/~'~'~) /
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PYr
FITTED WITH AIRT]GHT REMOVABLE CAPS.
CONFORM TO BOROUGH REGULATI~/~S REGpRDING INSTAL, LATION,
This form reporCs:---'~oils log~ /
SOILS LOG -- PEROLATION TEST
GREATER ANCUORAGE AREA BORG I '
Department of Environmenbal Quality
3330 "C" Street
Anchorage, Alaska 99503
Depth
Feet
5-
6-
7-
M
Date Pe rfo r~ned~.- ¢-7~
Percolation lest
10-
11 -
12-
13-
14-
Was ground water encountered?
If yes, at what depth?
Reading Date Gross Time Net Time Depth to Water Net Drop
Percolation rabe minute.
Proposed installat~=~-:-'-~'e~!l-)~ge Pit Drain Field
'.)cp~h of Inlet Depth to bottom of pit or l. rench
COMMEIITS:
EQ 040 (6/74)
I)E:F'I::IF~'.Ti'"If=:NT I:.)F HERL. TH FIND IEN~,,'IROi"~HI:~.]N'f'RL.
2~:id..EI E. TL.I[:,Cd:~~. ~;~:1;:,.., FIi",IE:HOI:~!F~(3E., FI,t:::
F'EF!Fi I*l' NO,
LOCFI']']:£.II"4 ::t.,.*"4 r,'l]. UF' i',IF£~{:E:I!£L>Ii~3:=.; Ll*.,I
t..El:::iFIL.. 'l'~:,~: J.. [,.IFIGi'.4ER
H t I'.,I I HL.IH [) I ~;Tf:II"4CE I:=F~'.Oi'q ~41Et_.L TO I':IN'¢ '.E.;EF'T :[ E: TFINI<:,.'"F'FIC~:::FIGIE~ F'LFINT OR.' SO :[ L FIE,'~;OF~'.I::'T
:~:;"r".~i;'l'Ei:H ].~i; J..I.3r::) F:'T FOE..' F:I Pf:~'.:t.',,,'FI'I'E::b. IEI..I... RNI:) ;:.:;IEn;ill ET F;'OI:~ F'I F'I. JEIL.:[C: NLEL. L.
I.,.]ELL. t...Odi~i; f"lI.J;i~;'l b:.:lE I';'.E:TI. JR'i**,IEI) 'FO THE [::,EF'FII'~'.TMENT 1.4 ]: TH ~ I'J :ii:~:.l [.'."Fltr% OF THE
i:::O t"IF'L I~ 'f' ]: (::IN.
'.'SF'L~:C :1: F' ]: CFIT I ON:L:; FIN[::, C:ONS;TF~'.IJCT :[ O1"~ D I F:II3F,'.FIIqS F:IF. tE RVFI :[ LFIBLE TO :[ I',ISURE PROPER
:1: I",IS T RL.I..FIT Z or.,I.
FIH F;'l=li',l :[ L. ]: I::IF~: 14:1: l"H I"HE; R'E:(;:!IJ :[ I;~:Ei'"lEi'.,l'~'~_:; I::' "J~' _ iq ~. I I E. E;E,[,4EF.:E; FIN[:,
.[ fl... l P I..L :[ N RC:COF~-',E:,FIr.,IIZ:E
'Z l,h c, ' t;,. ...... ,
Well Owner.
Location
M-W DRILLING, Inc.
P.O. Box4-1224 · 1310C International Airport Road
(907) 274-461]
ANCHORAGE, ALASKA 99509
DRILLING LOG
MUNICIPALITY 0I~ ANCHOIJ3t~E
PEP'[. OF HEAL'iH
ENViRONmENTAL pROTECTION
RECEIVE '
_Use of Well
(address of: Township, Range, Section, if known; or distance main road
Size of casing (;
Static water level
Screen (
Describe screen or perforation
Well pumping test at " gallons per (K~)
of drawdown from static level.
Date of completion (; ~.',:,~ 7¢~
Depth of Hole ;{/b _feet Casedto '~()"" feet
.ft. ~.JJ'd~'~")''*'~ (below) land surface. Finish of well (check one) open end
Perforated ( ).
(minute) [or ] hours with I_(; ~;
ft.
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
· TO_ ~
) .TO ' ' '
· ~ .TO
~' C,()
· ' TO_
.TO.
.TO.
__.TC
~TC
~TC
_T¢
~TC
2 -- STATE
(907) 274-46i l
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner . '" '
Location (address of: Township, Range, Section, if known; or distance main
. Use of I
Size of casing
Static water level
8cz~en (
Describe screen or perforation" ,
Well pumping test at
of drawdown from static level·
Date of completion 6 Ma r 76
Depth of Hole ?? 5 feet Cased to 7~ . 4 feet
ft. (~t~8~[~TM (below) land surface. Finish of well (check one)
Perforated ( ).
(minute) for .i~ hours with
open end .:.
Depth in feet from
ground surface
WELL LOG
Give details of formations penetrated, size of material, color and hardness
Ca ' ' "' kui~
6O
·
TO.
TO.
.TO