HomeMy WebLinkAboutDELUCIA LT 24
b.~
[DOC Co. clBa
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
ADDRESS .... ~,
LEGAL DESCRIPTION
DATE - Started
PERMIT NUMBER
Ended "~ . :
DEl'TH OF hELL / ~
ST-xTIC LEVEL OF w'ATER FT.
DRAys' DOwN FT.
GALS, PER HR
KIND OF CASING
KIND OF FORMATION:
From__ Ft. to
From Ft. to
From Ft. to
From Ft. to '
From-- Ft. to ,
From~ Ft. to
From __ Ft. to
From Ft. to__
From Ft. to
From__Ft. to
From Ft. to
From__ Ft. to.__
From__ Ft. to
From-- Ft. to
From~Ft. to__
From _Ft. to__
From__ Ft. to.__
Froln
~rom
FI , , ' 7' From
Ft. From
Ft. From
Ft. From
Ft.
Ft.
· Ft.
,Ft.
Ft. to Ft..
Ft. to ,, Ft.
Ft. to~ Ft.
__ Fl. k.~UN}C!PAL!,~' OF ANCHOPaG~
DEPT. OF HEALTH &
Ft. I~jVIRONM~Z~.~ ~p. OTSCT}ON}
Ft. to , Ft
,.to EIV E D
Ft. to__Ft.
Ft. to Ft.
Ft. to~Ft
Ft. to Ft.
Ft. to__Ft.
Ft. to __Ft
Ft. to__Ft.
Ft. to Ft.
Ft. to Ft
MISCL. INFORMATION:
DRILLER'S NAME
f - ..
~;
DTI000074
-.
,~
; .~; -
,I ,,~--("~-'~f~ 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
NAME
lPHONE KNEW
MAILING ADDRESS
lEGAL DESCRIPTION
LOCATION
Well Absorption area Dwelling PERMIT NO.
re. e c ,5
Liq. capacity in gallon~ Inside length Width Liquid depth
IC~O IF HOME.DE:
~ ~ Well
DISTANCE TO: jDwelling PERMIT NO.
Z
O ~ ~ Manufacturer --L.
~ -- ~ Material Liquid capacity in gallons
~ Well Foundation Nearest lot line PERMIT NO.
~ DISTANCE TO: I0~~ NO~ ;~ Pla . G'
~ ~ z No. of lines
--Z~ [ Length of each line~8 , Totatlengthofline~l_ Trenchwidth~._~ inches Distance between lines ~
~ ~ ~ Top of til~to finish grade ~ Material beneath tile Total effective absorptiQn are~
Length I Width Depth PERMIT NO.
< ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ DISTANCE TO: Well Building foundation Nearest lot line
~ Class Depth Driller Distance to lot Hne PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank I Absorption area(s)
PIPE MATERIALS I
Pvc
SOIL TEST RATING
REMARKS ~
APPROVED DATE LEGAL
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOl LS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
5
6
7
8
10
DATE PERFORMED:
11
12
13
14-
15-
16-
17-
18-
19-
20-
(GM)-
SLOPE !
WAS G.OUND WA- ER
E.COU.TERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
PERFORMED BY:
TEST RUN BETWEEN FT AND ~ FT
CERTIFIED BY:
72-008 (6/79)