HomeMy WebLinkAboutTAIGA LT 4ALo'T-
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?;;<HV 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.
011 421 02
TAIGA 4A
MAHAFFEY JAMES R & DIANNE LIVING TRUST
9601 MIDDEN WAY
ANCHORAGE, AK 99507-1231
05 05 2023
160
GOULDS
75C311-8S16
.75
13
MARTINSON
PELLETS
ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
ANCHORAGE AK 99518
, ~ -~-.~.,VlUNICIPALITY OF ANCHORAGE ,~....,
t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
QN-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
~ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
~ '~ ' NO. OF B~. ROOMS
~. DISTANCE TO: ~ Well. /~ J Absemd°n area;~ O Dwelling~
~ < ~ ~. Materiar No, of co~rtments
~ ~ Liq. capacity in gallons Inside length Width
/ ~ IF HOME.DE: Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z ~ Manufacturer
· -- ~ Material Liquid capacity in gallons
r I Well Foundation Nearest lot line PERMIT NO
. ~ No, of fines ~ Length~of ~e¢¢h line ! Total ~. of lines Trench~idt~ ~ inches Distance~between fines
~ Top of tile to finish grade / Material beneath tile Total effective absorption area
Length Widt~ Depth
m PERMIT NO.
~--~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
e DISTANCE TO: Well Building foundation Nearest lot llne
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO; Building foundation Sewer line Septic tank Absorption area(s)
OTHER ~'~/ ~J~, ~
PIPE MATERIALS
T'¢F'E OF SOIL HE,..,.~[..E,I ]...f',l ""
'1-- .....
::, .:, I Eld .... 1 . TRENE::H
3:49 17'5:t
1OOO~J0 SL::!I...IF:IF~;'.E F:EIET
flH,',IMJH HIJHE:ER'. OF E:E[::'RO01"T:-:; = 3: .:,L"- IL I'd-IFIN :~:; ............ '::SL::! I"'],. E,I ...... - ':':'
THE REQUIRED :,I,:.E (."iF 1-HE SGIL
THE: LENGTEI DIh'IENS;ION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRR:[HFIELD.
'THE [:,EF'TH OF R TRENCH OR PIT IS ]'HE DISTFINCE BETWEEN THE SURFRCE OF TFIE
GROUND RND THE BOTTOH OF THE EXE:R',,,'RI'ION ':.'IN FEET>.
I"HERE IS NO SE"r I.,.IIDTN FOR TRENCHES.
THE GRRVEL DEPTH IS THE: HINII',ILIH DEPTH OF GRR',,,'EL BETklEEN I'HE GLITFFiLL. PIPE
RND THE BCFTTOH OF 1"HE E::.-','CR',,,'RTION <IN FEET>.
' ' "- ' 1H I_ DEF:'FIRTHENT [:,L.IF.: !' NG THE
F'ERf,I!T RFFL] _.-NF HFIS THE RESF'ON2.;_TBZL]:T'¢ 1"O iNFORH .... '--
].N_ [hLLtiTZu, IN...FE_.T.[_h:, OP FINer' HELL_x, FIDJRCENT T'L3 THIS FF. LFER.~ ~ RND THE;
FtUHBER OF F..E...,T. DENL. E::, THFIT TI~IE HELL I.,.IILL
_ER, E.
E4-tC.F..F-(LLIN~= OF RN"r' _,r_"',FEM 14ITHOUT FIHFIL IHS;F'E'CT'r:]N_ - RND [IFFY- ';'"',l-IL .... BY"' 1H" ""~::,
DEPRRThlEf.,IT HILL BE .:,UE,.TEL. T TO I I..U_,EL. UTI_.N.
MINIMUM DZSTRNCE BE'THEEN R NELL RND RN"r' ON-S:[TE SEI4FIGE DISF'OSFIL S'¢S"FEM IS
±00 FEET FOR R PRI'¢RTE I.'.IELL..; OR
t50 TO 200 FEET F'ROF1 R PUBLIC WELL DEPEHDING UPON THE T'¢F'E OF PUBL..ZC HEL. L1.
tqELL LOGS RRE REQUIRED RND HLIST BE RETURNED TO THE DEPFIRTHENT WITFIIN 20 Dl~tr'S
OF TFIE [4ELL COHF'LETION.
OTHER REQUIREHENT2'; HR'¢ RPPL."r'. SPECIFICRTIONS RND CONSTRLICTIOf.,! [:'IRGRRH:5 FIRE
R'¢R:[LRBLE TO INSURE PROPER IHSTRL. LFCFtON.
I CERTIF'¢ THRT
t: t Rf'l FRMILIRR
FOR-FH 8"r' THE F'ILINICIPRL. IT"r' OF RNCHORRGE.
2: I 14It_L. INSTRLL THE 2';b'STEH IN RCCORDRf-4CE WITH TIdE CODES.
]:: I UNDERSTRND THRT THE ON-SITE SEHER S?STEH HF:W REQU):RE
RESI[:,Ef4bE IS REH~][:,EL.ED TO ZNCJ_U[:,E HiRE "iFIRN 2: ~:E[)ROOr,Is.
FIF'PLICRNT .A[f,'I HFIHFIFFE'¢
I~;SUED E:~.__~"' ...... : ..... = ....................... [',FTE._._~.~__.~ .....
HITH THE REQUIREHENTS FOR -' ':: ' ' -" "T
Llll ..IRE 2;ENERE; RND HEL. LS FIS :,E.
EI"tLFIRGEHENT IF THE
z:- O
rfbn,~d f~r -~-.~ Date pe ed
gal' Description:
.~is form reports: Soils log' - Percolation test'
,pth
,,s'ground water encountered?
Reading
Date
GroSs Time
If yes, at what depth? ......
Net 'rime
Depth to H20
Ne~ Drop
~r~olation rte
minute,
~roposed installation: Seepage Pit' Drain Field
)epth of Inle~ . Depth to bottom of pit or trench ..
"ONE TEST JG WOJiTH A THOUSAND OPINIONS"
2204 CLEVELAND AVENUE e ANCHORAGE, ALASKA 99503 e 277-O231
April 4, 1978
Jim Mahaffey
5111 Shaun Circle
Anchorage, Alaska
RE: Percolation Test for Lot 4~ Taiga Subdivision
Dear Jim,
Per our phone conversation this date, a percolation test
was performed on the referenced lot on November 7, 1975.
A copy of that percolation test showing 85 square feet per
bedroom is enclosed.
If you have any questions, please call.
Very truly yours,
C~UCTIONC~ TEST LAB
Seal tlausam~ P.E. ~ L.S.
NH/ja