HomeMy WebLinkAboutT15N R1W SEC 8 LT 8816i\J pato
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825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl.. INSPECTION REPORT
MAILIN ADDRESS
Well
DISTANCE
Manufacturer ~
Licl. capa~g~l~' y ' galtm sJ I F HOMEMADE'
~O -~ ~.~ IVlamO~ Manu facture~ -- '
I DISTANCE TO:
Lengt~ Width
Type or cri~ Cdb~Uamet~:
I}IST~NC E~O~ Wel~-
Class Depth
ANCE TO: Bu~khng foundation
Inside length J Widt~
/
Dwelling
Crib depth
Building foundation
Driller
Sewer line
OTHER
PIPE MAT E FIl,~ *",
SO,L*EBT R^T,NO
NO.O~BEDROOMS
No. ofc~c~par tree nts
Liquid depth
l Nselarest lot line
Distance to lot line
~k
PERMIT NO.
Liquid capacity in gallons
D~/~.~ n ! i n es
Total effe' ivAgbsorp~on
PERMIT NO.
Tota~ effective absorption area
PERMIT NO.
Absorption area(s)
DATE LEGAL
i>EI:::'Fff¥thlF:;NT ,'"~:' HEF:II...'rH FIi'-.!E:, !EI'.,I'v';£F~'.Cd'.d',ltENTF!L. '"'~;' 'T'E "'T'r'31'.! ~.,~ .~,,~
,:,,:~ ..... 'STF'F'FT. :: '. C .. i)~; F,3E;., F::ff::;. 9 ::~i:J.
I:::ff:'F'L ;[ CRWI' I','ILI:E;CF~:FIT F r L!>EI:~% P. CL E, .., ~ :;2!4 ~::;'~,::I--.':%-: ~:~
~ I [_.N !.....LE..I..h 'ET
E"3~:~l L r'rr ':":" ' ............ r"l ~1'1 "'.'
'T't?F'E~ 0F' ...,..]L.. ~ E, ,.F.f- Ii...N :. ~!...11 I:5: D!,:.H!NF'iELD ~ '~ '
h'lRt:':', I I"ll...IFI ~.,lt..ll','llS:[~r~: OF: E:EE:,F[:C ~ H5 .... 5: SO JJ7 L F[ff:l'l" I big ( 5~5Q FT,..' 131:;;: :: .....
E::" EE E::;" "T' ~ ~"~~='= ,"::~- - ~:~:Z ~'- ~ CE~ 'T- k....~ ........ .7:~: EE; E2a ~;~: F~ %,," ~EE ~ ....... ~Z~ ~ E::::" '~1t"~ ~....~ ..... ('?,
I.ENG'TH E:, I HE['.4~; I ON I :E; THE LIENECI"H ,:: I J'..I FEET > E F' THE/ 'i"N~ENC:H OR [::,[~:FI Z NFi ~.~,~
THE E E:.~ I J-J OF F:I TI:;]:ENCH "f~' PI]' ]:.E; 'THE [:,]?r'}:~[,.]l::~: E, IET!..[tEEN 'THF' ,::;! I~'I:::I::IF"F I"IF' THE .....
I[~i]:~:OIJN[> FIN[> THE 1:3 3'r TOH OF:' 'THE: E::.:: :: I:[%,'I::[T [' '~ ~.1 ( ! ~.4 FEET ).
THE 13FP. N',,,'[]~I.. DEF'TH ~; T}..t[~ HlhJlFJI. JIvi E:,EF"rI.-[ Cfi:' GI:~ff:I'v'EL BETT'I.41EE['.,I THE: OI..I']'F:'FiI. ~..Z."' i"-~.
FINE:, THE E:OTT" ['"l OF' THE E?~:C:FI',,,'FfT :[ (3N ,:~ I N F'E~ET ).
~ [: F. I I I::II:::'I:::'L. :[ C:!::~N-F HI::I'.:~:; THE [ .E.._,~ ,. I',L 1 ~:, 1 !,. 1 I r T
.[I'LI l....!_.! FI_ , " ::
IH..I E...t I...hL::, FFr RN'¢ I,tELI..~; FIE:, 'I::I'-EJ'I'..'I" "1¥3 THIL'
hILIFIE:EF4: OF' F,.E..::,!.I...E.N._.E.=, 'T'HF:IT THE HELL I,.iIL.,L.
f:,EI::'t:::II:,~tTMEI'-4T I)I..IR :£
i::'F.%)PEI:;FFb' Fib. ii> 'I'T.!Ei;
igF:ICI:::F'II.J...!r.,Ii3 OF FIN'¢
HILLr',~,E.'" _':l IE:,,
1"I I I'.,] Z h'lL.Ih'l f:, I '.ST[:fI'rE:[~[ E:E:THE!]:F,I I::1 HELL FIND F:II'.,IY O!",I-'.:!!; I -I"E: E;EI.,.IFI(!iEE D
tE*Ei FLEET FOr;it t::f F'F.:I',,,'Fi~r'E: I,.IEL. L. OF'. ::LU.;Ei 'FO 2e~e~ I.:'E:E:T F'F;!OI','I 1::1 F'l.J[~:[_If2 !,IEL.L L>EF'Eh,!t3, IhlG
UPON 'T'HE 'T'¢F:'I.:E OF' PUBLIC HI:ELL
I"11'I'..!]:FIUH E)]2.T;TFtt'.,!CE [:'l-;~:l:::lt',1 FI F:'F:I',,,'FIT_E:: kiEL. t_ ]"0 F:I F'I::~:I'v'I':IT[E :5E;I,.![:~ff;~: LINE '1':i~; ;2!![~ F'EE:I' FIND
"fO t::1 COHPII..II'.,E[T'-r' S.EI.,.ED:,:.: LINE I:E; 7~1 FEET.
t.,.!EL[.. LOG:~; I:lr.~lE FiiEI~:¢..II?.ED F:I['.,ID P11..19";T f3[E [?.E:TL.li.?.I'.,IEL':, 'f'O "l"Hl:f
ElF THE PfffL.L..
OTHE!F: F'.E:QLIIF'.E:H[.-::NT'_:~; f"lf:l"r' F:IF'F'L'¢. :!!;F'ECIF:[CFITICIP,I:F:; FIND E:OI",ff:-:;TFi:UCT];Edq DII::IEiFff::If'IE;
Fi"/F:IIL. FIE:L.E: TO It",!$LI[~'.E F'F%E:IEF;: INS:,TFIL..LFIT:[OPrL
I C:EI:;[:'T'IF'-? THF!T
.'.1.: I Fir,? FFIHIL:[I::IR I,.Ii'['H
I::OFirT!.I E?T' THE HLIF,
2: :1: HILL. ]:l'.,t'!
73: :[ UI'.iI[>EFC.E;"
I:;~:E:Ei ]: 13ENCE
"['HE tEiE~;!UII:REHE:NT':E; FOR ON--.::/ITE 15EI.,.I[i:Fi:E; FIND I,IE:I,..I...:~':; I::r5
FICCC~F?.E:'FII",E:E I']ITH THE: C:CIPET~;.
E;¥?I*E:H HI:::I? Fi:EI:;:!UI,~:Iii; [~}'.I!._F:It~:(:JEME:NT ]:F::' '!HE
O & E ENC'..NEERING & DEVELO, ,vlENT CO.
,)t.. Eagle RAver, Alaska 99577
Box 90. Davis c,
694-2774 or 688-2280
Russell Oyster
694-2774
Performed for: Name:
Legal Description:
SOIL LOG
Earl Ellis
688-2280
Tel. No,
Depth (feet)
$oll Characteristics
0
PLOT PI.AN
Ground Water Fncountered:
Proposed Installation:
Comments:
Performed by:
PERC. TEST
Yes. /_
Seepage Pit
No. _ If yes, what depth
__ Drain Field
E A Z. E ~ ,,/_~_L_L.= ~.c o ~.
Dr ll I t n~ Company Nan~ ~.]V~9.~J~].l~O~l_]~)]2illi~l~ ............. Or I I1 i nD Petrol t No.
Mr. V/alt Kurka
Muskrat ]Builders
Eagle River~ Ak.
green
roR~T
ro~TC
green rocK'
200 ~t, - ......
USE:
CASING: [] Tbreadad ~3~le I dad
ft. after
II, WELL HEAD COliPI,ETION:
Type: ~Submer$1ble
lbs/ft.
...... Fitt~ngs:
~] In A~proYed Pit
~]Reciprocating
E]o~he,':
Perforations from 45-60
Bail tested at 15 G.P,II,
Oct,
1981
MUNICIPALITY OF ANCHORAGE
[~] PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
Pouch 6-650, Anchorage,.~la~ka 99B02 276-222'~
LREDTFOR~, 4S 472 SEND PARTS 1 AND 3 WlTtl CARBON INTACT -
PERCOLATION RATE minutes/inch)
FT AND
TEST RUN BETWEEN
''.4: 1/ · ,' :': '-'- ~ ,,',~'~,;'~.:,; ,-' !' ' :~'-',! . · '~'~ f,,','~ ~ ," ~:";J · .". , " " : :~
t ...... ' ~ '~'~' .1 ~ ',, ' ': . '....~. ' . :-.,~:.~e.,~...~' ....... .. ,. , ~: .... ~ I ' ~ '.~SOLSLOG * ,;"t .:'.
[:,~.~. ;,~ ~',~::;::, ' :' ' MUNICIPALITY OF ANCHORAGE .- · ' .
[(~/;~";' '[~, ?, '~;" DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
: ~;~'? ' . ' : ': TEST '. ' ; ' ~ "'
':' ~j .: ' · Pouch ~650. An~ora..~l~k. 995~ 27~222f . __(~ ~ .
L;,'. :'. '.. : .?' -- 801LS LO~---- PERCOLATION TEST ~/~
WAS GROUND WATER
ENCOUNTERED?
IIE YES, AT WHAT
DEPTH?
Rcb~.,t A. She
· ~' PERCOLATION RATE
SLOPE SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
FT AND
TEST RUN BETWEEN
[ ': COMMENTS
·· "-",--"'" ' ,,:01/
. .
~ .... . PERFORMED BY: ERTl El) El
~ ...... ;, '7~:-..' ....... [=_:... . -~-~- · ....
_minutes_inch) .
· ;',.:....~
-- FT .'-'"
· o
,,' ,. '.
PERFORMED FOR:._
DESCRIPTION:-
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALT~ AND ENVIRONMENTAL PROTECTION
Pouch 6-650, AnchGrage,~Alaska 99502 276-222I
SOILS LOG - PERCOLATIO~T
[] F'ERCO LATION
TESt
7
11
13-
WAS CROUND WATE.
/....(.,;ENCOUNTERED?
I~ YES, AT WHAT
DEPTH?
14-
15-
16-
18- A,
No, 1457-~
19-
2O
COMMENTS
SLOPE
SITE PLAt
Dross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BE~NEEN ...... Fl' AND
; ,/..)//,,lhf ,
C RT,F,EDS ,
(minutes/inch) ': r
FT · , :,
Time Time ~-
', Date Date Date
Inspectur Inspector Inspector
Comments
Condltlo~ Approval
Date Sewer Inst611ed Permit No. Septic T~nk 81ze
~ ~ --~ Huldlng Tank Size
8oils Rating Well To Absorption Are~ Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner ~¢r~///¢ ~ ~//~,¢'/z s Phone
Address
-Lending Institution ~*}¢¢.~///¢ /~/./~ Phone
Address
Street Location
Type.gl Residence ~ /
~ Single Family
~ Multiple Family No. of Bedrooms
~ Other
~ater Supply
~ Individual A~ACH WELL LOG. A well Icg is required for all wells drilled since June
~ Community 1975. For wells drilled prior to that date, give well depth (attach leg
~ Public Utlllt~ available~
~ew~e Disposal
B Public Utility When Connected to Public Utility:
B Holdln~ Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EAOH REQUEST BEFORE PROCESSING CAN BE INITIATED.
P.O. I'k>x 1798
Approval for tho individual sewer and water ~ ' '
).ae3.] 3.'ties canno.L
be grantod until the ::oll. o,';lng l'Lenls have been comp~(~to~{:
o ~.=Ar'~:/el] loq submikted to this of.J~e for our E' =,-
° ~q~e top of the well ci~.sing seal~d with a saqitary seal
that q ' ' '
o ~/)he wmLer analv,~j,~ report needs to 13o submiLkod to [:hi.q
office 5roll the Chem I,i~b, 5633 D .q'Lr(~et, :,_"'or our reviev;.
Plea:3e { , .
noted di~cre'panJies hl]ve b(!ol'] correcte~]. If 'there are any
furthor questions, please ea].l thzs o:;[n, eo ;l't 264-4720.
SJ. ncer~y,
Robert C. Pratt
A. ssoci,.qt~ ]':nvironmontal S})~cJ. alist
RP60/p/I?.U
· CHEMICAL & G )LOGICAL LABORATORIES .~F ALASKA, INC.
A -- TELEPHONE (e07)-279.4014 ANCHORAGE INDUSTRIAL CENTER =~
......... "'~, Drinldng Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
I.D, NO.
?! ,~,,:>-~;,~,~, >i t:.~ ~
Phone No,
Meiling Address
City State Zip Code
SAMPLE DATE'.
Mo, Day Year
SAMPLE TYPE:
[] Routine
El Check Sample (for routine sample
with lab ref, no,
r-] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO, LOCATION
Time Collected
Collected By
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. Plesse send
new sample.
Date Received
Time Received
An-'tlytlcal Method:
[] Fermentation Tube
I~i' Membrane Filter
Lab Ref, No, Result* Analyst
~'No el color, les/100 mi or NO o[ Positive portions
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-Z220 {b)
Rev, 1978
BACTERIOLOGICAL WATER ANALYSIS RECORr)
Date Collected Source
. Broth 24 haur$=_