HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 2 LT 7
NAME
MAILING ADDRESS
___pO
LEGAL DESCRIPTION
MUNICIPALITY OF ANCFIORAGE
DEPARTMENT OE HEAI_-FH & ENVIRONMENTAl. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl_ SYS'rEM AND/OR WEI_I. INSPECTION REPORT
~'~'N E
DISTANCE 1'O:
DISTANCE ] O:
IF HOMEMADE: / Inside leng~h~
Well - ] ~w~w e~--
Well Foundation
~op of tile to finish grade
Length
Width Depth
tile
Material
Trench width_..~ 6~~ inches
PERMIT NO.
__
PERMIT NO,
Typo of crib Crib diameter Crib depth Total effective absorption are8
DISTANCE ] O:
OTHER
PIPE MATERIALS
INSTALLER
REMARKS
APPROVED TX
72-013 (Rev. 3/78)
"'I.! ( :l: i',! I::'EiJET Z:, OF THE; 'I'i:~:E:NCI. i Of;?. E:,I:;i:i::! :i NF l: E::L D
THE I_'i;, ~ I:~; "f" l:':l B! C I!!:
{E '.~':i(::: F:l'v~i::! T I ! :) i".i
1~ i:;;i ,~:?',I C H E: i!{;.
DEl:::' T !~1 OF'
l.i:'.:.0:];i::;!',?'i::{T']:(]ti.,i (lin F=EET).
' ' ' ~. ,,, [BiG Fl-Il.'-'
:i: i'.t~; T!::ll_.l..i::!'! [ 01'.,I :t: i.,i'i];F'!i:!Z:T :I: Cff.l'.:i; r i~:' I:::it'.?./ l,!t=i;l. L.S I~:I[~ 'tq" t.::.;H ~' TO !' H ]i ;::i; ~:'~ ' :' '' ' ,
i'.~!Ul',!E!'.[iil:: FtI:: , :',:= T ',l=i'..l!':!':;c:i TI-ii=Ii. ll.l!:iil HEll_I_. ,! '[ i - ~
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF: NATURAL RESOURES
DivisioR of Geological & GeophySiCDi Surveys
LOCATION OF WELL (Please complete either la, lb or tc.)
Borou§h SubIHvision LOt Block I V4 qfr$
DISTANCE ANO DIRECTION PROM ROAD
Street Address o~d Area of Well Location
B WELL LOG
Material Typo
Top
Section No.
Feet Below
Surf(ice
4. WEL~L OE~°TN: (final) I 5 DATE OF COMPLETION
6. .~Cable fool E]Rot°m'Y []Oriven []Dug
[~] Auger E],o,t.d [~ Bored 00fher'
7.USE: [~]"Domestlc [] Public Supply [] Industry
8. CASING: [] Threaded ~ WeLded
ff.
lO. S'FATiC WATER LEVEL: ')
[]Above or J~]eelaw land surface
~ 12.GROUTING Well Grouied: []Yes ~ NO
~, Material: [~Neat Cement [] Other:
[] Subm. [] Jet ~ Centrificol [] Other
14.REMARKS:
16, WATER WELL CONTRACTOR'S CERTIFICATION:
water Temperature -- [] F [] C
Farm OS-WWR (Il/SI) Copy Distribution; WNITE*Stele DGGS, PINY-Driller~ CANARY-Customer
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTM[:NT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchora§e, Alaska 99501 264-4720
SOILS I.OG - PERCOLATION TEST
PERCOLATION
TEST
SLOPE
8-
_~ / ENCOUNTERED?
13
C; iv, /
16
18
19
20
DATE PERFORMED:
COMMENTS
E
SITE PLAN
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
'7. .3 . 0 ~/ i0 I. 7 ~ -
~.E~ ..... 7 ~ ~;- /~/A _~ 7.. o ?_. ~_ /~ ....
PERCOLATION RATE
dy. ,~- FT AND
(minutes/inch)
CERTIFIED BY:__ ;/~,, /~-~*/
72-008 (6/79)
APPLI( NT FILLS OUT UPPER HAl ONLY
Buyer
Address Zip Code
Realty Co. & Agent
Address
Street Locdtfon
Zip Code
Type o ,,Residence
[] Multiple Family No. of Bedroorns
(~-dlld]~ual /~L~ ~-,L~. ATTACH WELl_ LOG. A wall Icg Is required for all wells drilled since June 1975.
I~ Community (~ ~-~ I ~ For wells drilled prior to that data, give well depth (attach Icg if available).
[] Public Utility
E] Public Utility x~/~/~,~ When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY F-ACH REQUEST BEEORE I>ROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspirer Inspirer Inspirer Inspirer
( ~APPROVED BEDROOMS ¢ 'CONOITIONS OF APPROVAL
( ) DISAPPROVED
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
~/~ ~ 'L_ w., ~o T~.~ S.,B~ T~ S~.
CHEMICAL & GI,J_£OGICAL LABORATORIES t,,; ALASKA, INC.
TELEPHONE {907)-270,4014 ANCHORAGE INDUSTRIAL CENTER .-~
274-3364 5633 S Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIFR
WATER SYSTEM: F I I I I--~-I
· I.O, NO.
Mailing Address
State Zip Code
Day Year
City
SAMPLE DATE: ~
MO.
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref, no,
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
I
I
I
I
LOCATION
Time Collected
Collected ay
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE'to be:
~ Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample·
Date Received
Time Flecelved
Analytical Method:
[] Fermentation Tube
[]~Membrane Filter
Lab Ref, No. Result*
I
L I ~3
I F'r-I
Analyst
READ INSTFtUCTIONS
BEFORE
COLLECTING SAMPLE
06,1220 {b)
Rev, 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
24 Hours
.~.4,e HOurs ..........
.~48 Hours
October '~ 1982
P. O. Box 971
~.or the individunl sc~%;c.r and k/ato, r l]acilities cannot
be ~jrantod until thc following itoms havo boen co,lpletedl
A ueil log submigt~i to this
office Cot our ~,~1~..~ and
analysis k'eport need to l)c ~ubmitted to this
Chem l,ab, 5633 }'~ [;treot, for our rcvio~;.
notod (IJ.,~;crei),'u'~cichq n~ vo [)eon cor'r~:ctod, if there are any
further que~;'tions, ])loaso call this ~ :' ' 264-4720.
Since~'ely,
llObOl?t (.,. ] l. dut
A.~so~:J. ate l]nvir'onmonl%l S[)ecial:[s~t
RP. 2