HomeMy WebLinkAboutFAIRMOUNT LT 18
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Pump Installation Log
Well Drilling Permit Numbet-:
SIV-- Date of Issue:
Parcel Identifficativn Yumber:
Leg21 Description
Property Owner Name Addmis:
Fo--(, r m Octet,
Pump Installation Date: CI '
,,18, /,Z6
Pufrip futake Depth Below Tot) of'kArelf Camng: Cejo feet
Painp Manufacrarer's Name: 10-12e.
- I
Pump Model: 64N S�V(
Pump Size hp
ftless Adapter SuriA Depth; feet
Phle-:S Adapter Installer-
WC11 Disinfected Upon Cout,pletiozi? "d �Yes i ! Nu
Method ol'Disinfution
Comments -
Pump Installer Name: Vvejj & Pump Service, L......
31 10 East 76th Avenue
Anchcrage, AK 99518
Phone: 907-21113.0740
F -,v! 907-243-0742.
ktteution: The pump installer sna!! picvidc a primp installadon log lo -,hL DSD wi�.-'tin. -30 :.,avS ofpu-m., instai'atio-n.
GAAB-HO- I
/,,- 2.
~,P""tER ANCHORAGE AREA BORG"
HEALTH DEPARTMENT ; Y -///
327 ~A~'LE ST. ANCHORAGE, ALASKA 99501 27~2511
NAME
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY_
GALLONS.
MAIERIAL (~"~ ~J'~"'/~''' NUMBER OF
COMPARTMENTS
INSIDE LENGTH ! INSIDE WIDTH '~' /
LIQUID
DEPTH ~"~'
SEEPAGE SYSTEM: SEEPAGE Pit:
NUMBER OF FITS ..... / OUTSIDE DIAMETER.
LINING MATERIAL__
NEAREST LOT LINE
o, W,DT, /5'"'"
DISTANCE FROM WELL /.~'~ O '/
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
,LENGTH // ,
, DEPTH
, BUILDING FOUNDATION
so. ET.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER OF LINES
ABSORPTION AREA
FOUNDATION.
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
TYPE DEPTH
NEAREST SEPTIC
LOT LINE , SEWER LINE , TANK
, NEAREST LOT LINE
'fRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WATER
SAMPLE
DISTANCE FROM
, BUILDING FOUNDATION
SEEPAGE
, SYSTEM , CESSPOOL
DIAGRAM OF SYSTEM
, NEAREST
OTHER
, SOURCES
DATE
APPROVED
HEALTH AUTHORITY
GAAB-HD-2
GREATEI
327 Eagle St.
,_NCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
ROUGH
27%2511
Case N o.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
~ MAILING ADD R ESS~,
NAME OF APPLICANT ~ · /
RESIDENCE ADDRESS--7/'~,'9 Z-~) /;'2' ';~:.~' LOCATION OF INSTALLATION
~ / LEGAL DESCRIPTION ~7~::./,~
~ , SEEPAGE PIT ~/ ,DRAIN FIELD
TO BE INSTALLED BY~
ANTICIPATED DATE OF COITION
PHONE NO.
,OTHER
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
AS DESCRIBED BELOW.
. SEPTIC TANK SIZE.
DISTANCES:
, PERMIT TO INSTALL A
SIZE OF UNIT TO BE SERVED
TYPE SEEPAGE AREA
DIAGRAM OF SYSTEM
TYPE
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE APPLICANTS SIGNATU RE
DAT~ RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE ~ / DATE
,NSPECTO ,NSPECTO ,NSPECT .
!
MUNICIPALITY OF ANCHORAGE ~UNIClPALI~ OF ANCHORAGE
825 L Street - Anchorage, Alaska 99501 "
ENVIRONMENTALSANITATION DIVISION JUN 1 9 1980
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be p~oce.ed, Please allow ten {10) days for processing.
1. PROPERTY OWNER I PHONE
MAILING A~DRESS
PROPERTY RESIDENT (If different from above) ~ PHONE
2. BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION ~ PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT PHONE
MAI LING A~DR ESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
~i~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
~ Three [] Six
[] Other
7, WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] I N DIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: / ~)(~)(~) If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
Absorption Area to nearest Lot Line
5, COMMENTS
[~//APPROV ED FOR -~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)
To/ ben Spurkland P.F..
8155 Cranberrv St.
Anchorage, Alaska 99502
Phone (907) 243-5302
Mrs Ginger Cassle
Busi Bee Realty
1401W 34th Ave
Anchorage, Akaska 99503
ADEQUACY
TEST
July 19,1980
MUNICiPALiTY OF ANCHORAGE
DEPT. OF I.F,\I.'?II &
ENVIRONMEN] AL D',LO I ECl'ION
,JUL g 8 1980
RECEIVED
Legal:
Residence:
Water:
Sewer:
Lot 18, Fairmount
3 Bedrooms, 2 Storey, Unfinished
On Site Well
From Municipal Records:
Constructed in 1969
Tank: Concrete, one compartment, 1OOO gal. capacity
Seepage Pit Concrete Rings
Absorption Area: 468 Sq.~%.
Date of Test: July 18, 1980
.~..' .
~e?;' ~ ..~..'~. taken:
~ · 0
Jl~;'.. ...;~';~ Absorption Rate
~2.45
ol.0o
4.45
Absorpt ion Rate:
Test Procedure: Tank Pumped on July 14, 1980
System inspected July 17.
Bottom of pit 7'-3" below ground
20 inches of water in crib
20 inches of water in tank.
Line between tank and crib 24 inches below ground. Cleanouts at
midp&int.
Crib was filled with water &n July 18 and the following readings
Depth In Crib Depth In Tank
24 24 "
50 24
70 24
¥
7O
54
41
29
24