HomeMy WebLinkAboutHILLSIDE NORTH #1 LT 2A
~.~ MUNICIPALITY OF ANCHORAGE
DE ITMENT OF HEALTH AND HUMAN SER' --'S
Environmental Health Division 04/ O3/ ~ 7
: 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
~,~ (¢;r~'¢--/~ ~u' e ~,' ~ Tfl SEPTIC ABSORPTION
WELL
Address ~ 7 ~ f ~ ~FROM~ TANK FIELD
Phone(s) Permit No. No of Bedrooms ~ ~ ~
LEGAL DESCRIPTION LOT LINE ~ f OO ~ ~ ¢¢ ' ~ ~
LOt ~ ~ Block Subdwision
Township, Range, Section
~ I ~ ~ / ~ ~ ~/ ~ ~ driveway,~S'BUILTwaterDIAGRAMbodies, etc.)(Sh°w location of well, septic system, property hnes, foundat,on,
TANKS N
~ SEPTIC ~ HOLDING
Uaterial ~o. ol Compa~monts
TYPE OF SYSTEM O~r :,~ ~
~ TRENCH ~ BED ~ W. DRAIN Q OTHER ~
Depth to p,pe bottom from Total depth fro~ orig,na' grade / / ~/
or,ginalgrade ~ g~ H II FT~
Fill added abc .... ig,nal grade Gravel depth beneath pipe ~1 ~
Grave[ length Gravel w~dth ~/
~otal absorption area Distance between lines I ~
/
Installer J~llfl' 'Date installed /
WELLS ~/
~ PRIVATE ~ OTHER (Identifv)
~lassincatLon (A,B,C) 7ora[ DepthFT ~ Cased to FT
Installel Date Installed:
REMARKS:
: : Scale: I ~ = ~ t ENGINEER'S SEAL
: ~ Inspections Pedormed by:
I ~~' ~ ~ ce.ily that this inspe~ion was pedormed according to all
Municipal and State guidelines in eflect 0n this date: I~/~ /~7
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVl RONNIENTAL PROTECTION
825 L.. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[~' SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2 ~--e
3
4
5
6
7
8
9
10
11
12--
13
14
15
16
17
18
19
20
DATE PERFORMED: 7/~//~ 7
WAS GROUND WATER
ENCOUNTERED?
SLOPE
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND ~ FT
COMMENTS '~.¢{. t~':~ ¢~'~'~'~"" I~0'~'~ ~ro? ~ll g~, ~t~r ~ tnX~¢/~
/ ~
PERFORMED BY: ~/~ T~4~Ic*{ ~er~tt~ CERTIFIED BY: ~ ~ ~
/"~, ~, [] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERFORMED:
5
6
7
8
9
10
11
12
13
14--
15
16
17
18
19
2O
1
2 --
3
4
Nor (~
~a~,~ ~t/
~ ~ · ' WAS GROUND WATER
~ ~ ~. ENCOUNTERED?
SLOPE
SITE PLAN
S
IF YES, AT WHAT zW..~ ~'¢,o,: ~ ~o6
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN
~ FT
DATE:
Anc~orage, A!~ska 995]~
goT 8.
(&Td bc)
(~. deeWO l°e°~)
.5 I T'~ P /--A
2 H lAW5
/
5C,4l.~ .' I."= (O0 '
DOwN ~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
ON-SITE WASTEWATER DISPOSAL SYSTEM INSPECTION
ENGINEER FIELD AUDIT
TIME:
LEGAL DESCRIPTION:
ENGINEER:
EXCAVATOR:
AUDITOR:
COMMENTS:
SIGNATURE OF
McKay Well Drilling
P.O. Box 557
Wasilla, Alaska 99687
Phone 376-5058
Well Owner / ~,~ ~ ,. ,
Well Location, ~' ,
Size Casing :: , ,, Depth of Hole : ~
Static Water Level, ~ .... feet Well Test
Date
of
Completion
Date
Phone
Cased to ~,: ~ . feet
Gal per Minute for .;,?~ Hours
WELL LOG
g~:~D~.~ OF HEALTH
.... ,.,i~iv~eNT~ PROTECTION
AUTHORIZATION TO DRILL
I hereby authorize McKay Drilling to proceed with the above work. Payment shall be made in
the following manner:
Rig up Minimum feet. @
Balance due upon completion,
per foot
In the event it is necessary to insitute legal proceedings to collect any amounts due on this con-
tract, I agree to pay an additional sum of fifteen percent (15%) of the original contract price.
Plus attorney's fees, and cost for legal proceedings.
Name
Date Address
of
Anchorage
P.O, BOX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 343-4200
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 8, 1988
Robert Groeneweg
257 Fireoved Street #3
Anchorage, Alaska 99508
Subjec%: Lot 2 Hillside North Subdivision #1
Permit #870155, On-site Well Permit
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1987.
Permits are issued on a calendar year basis by authority of
Municipal Ordinance. A new permit must be obtained from this
Department for any well and/or on-site sewer syStem not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the on-site
sewer system, the original as-built inspection report (three-part
form) must be sent to this office for review and approval, and
for documentation.
Effective January 1, 1988, a new fee schedule is in effect.
When re-applying for a new permit, the new fees are; $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00 for
a combined sewer and well permit.
If there are any further questions, please call this office at
343-4744.
Sincerely,
Robert W. Robinson
Program Manager
On-site Services
RWR/ljw
enc: Copy of Permit
C#gRD
I 0~. 28' (Meas 6 Hee ~81' 333)
pg~. 40' (Meo~. 6 ~.
333) ~
~o52'20" I~5 00' 103.30' 5541' A/O~'~' dl"~
14"s2'18" 135.~0' 35~p4' I7. b2' ~30'02'~"~
45'30'04" 140.00' 111.18' 5g. 71'
1o5'14' 55" 150. P~ 275. 5G' IP~.3~'
103'29'25" 140 PO Z52.87' 177.53' S O~'P2' 19"~
Ioo4~'o~'' I~0.00' 33.~8' lb 97'
2bo38'SZ'' IlO. aP' 55.00' 2b. o9' L4~eas.~e~ ?76
58°28' ~9" I4o. O0' 190.b8' 70. f~'
?to,e o£ Alaska
~t~-eetor of Ye/erans'Af/a~?$
4
,qa~e~' Creme, Dead at Tr~x? Bene£~c ~oGy f x
~d~ k~. 4/h Pven~, d'm ZOI I
I
TTAT£ OF A~A$trA 56'
-. ~ '
~Idrf~on ,Va. I, have no abdecl/o,,~
dro/nope /rom l~e rPal-
304 O0 '
o51D
I
I
3 I
154, 9Z4 8F