HomeMy WebLinkAboutSUMMIT ESTATES BLK 2 LT 12015
~i~j 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
PHONE
[] UPGRADE
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
I D,STANCETO: IWe''
~ Liq. capacity.~in gallons I IF HOMEMADE'
I /~o I '
~ z ]~ DISTANCE TO: IWell
~ Manufacturer
~ ~ ~I No. of lines I Length of each line
7'
~m~~ Class DISTANCE DISTANCE TO:To; WelIBulldmg De~d~ foundation'
I Abs°rpti~n~ea
Inside length
Dwelling
Dwelling
Material
Width
Material
Foundation~.r~ /~N,~ Nearest
Total length of lines Trench wLdth
Materi~ beneath tile
Building foundation
Driller
Sewer line
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
REMARKS
NO. OF B~/~ROOMS
PERMIT NO.
~oo/o q
No. of oo~pa._~.. ~
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERM'T ~'¢..0 Io
Distance between lines
Total effective ab~ea
Deptl~ PERMIT NO.
Crib depth Total effective absorption area
Nearest lot line
Septic tank Absorption area(s)
Distance to lot line PERMIT NO,
APPROVED
72-013 (Rev. 3/78)
DATE LEGAL
and G ~sical Surveys (DGGS)
WATER WELL RECORD
Drllllng Company Name VernI s Drilling & Ente __
A.D.L, No.
~ Summit
lc. Distance and Direction from Road Intersections 3, OWNER OF WELL:Gene Green
~. WELL LOG Surface 90 Completion
,ateria, Type TOp I Bottom ft. 4/2/82
sandy brown till, rocky 0 17 s. []Cable tM, [Rot.fy [Dr~v~. []Dug
~rown silty till 17 65 []A.0.r [detEed []~red []Other:
little gravel~silty,seepage 67 75 ~o~.t,~ ~pub,~ s.pCy
hard brown silt 75 80 ~.
cemented silty gravel 80 87 [--1,rr~oat~o. I--1Rech.~De
seepage ~Te,~ w.,,
sand and gravel H20 87 90 7. C^S,NG: ~Th~.de~
6 in. to 90 ft. Depth Weight
Type: open end Diameter:
9. STATIC WATER L£VEL: 45' ft.
E~Above ~De)ow land surface
T. DfC.
MUN)CIPAI FY OF ANC tORAGE ~0 ,,. ft, after ~ hrs. pumping 30 , g.p.m,
ENVI~ ;: il iI,:A,, i :O Fi_ 1
12. GROUTING: Well Grouted: [~Yes
~l~b! ~ [ ~ Material: F'~Neat Cement E~0ther:
13. PUMP: (if available) HP
Type: ~-~$ubmersible E~Necipracating
F~ Jet []Other:
Water Temperature:
Vern's Drilling & Enterprises AA 3327
^dd ..... S~A BOX t560 Anchorage, AK 99507
Signed: Da~e: A~'rd 1 ~5r lg~2
FE~.1 I NF
F!F'F'L I CRNT'
LOCRTZ ON
9E:TN ,M.,,L.- L, IR....H
L.:1..2':'":' c; ¢,' .....
6,= ..... Ii'ti'1.1. I E::T
LOT ':; f
HFIXI["IUH NUi"IE:EF.: OF E:EDRC.Df"IS .... *.~
':'-
._,,...Iii_ RRTING
THE LENGTH [:, I MENS I ON I:E; THE LENGTH '.'.'IN FEE'['> OF THE TREI",IC:H OR [)RRINFIEL[:,.
THE DEPTFI OF' F! TRENCH OF:: PIT tLZ-; THE DI:ETTF!iqCE: BETHEEN THE SURFACE OF TH.E
CJRO£.,'ND RND 'T'HE E~OT'!'OM OF THE EXC:Ff,,,'RTION (:IN F'EE:~T').
THERE I:.:.'; i",tO S-;E'T' I,.I!!],TH FOF-: TRENCHES.
THE £~RFI',/EL [:,EF'T!t IS THE f'I:[N:[M£.IH DEPTH OF GF:RVEL BE't"I.dE:EN TNF:-' O(.Yl'FRLL. F'IF:'E
FINE) TF!E BOTTOH OF THE E',:'::CFIVFITtON (IN FEET).
F'EF:.:M!T RF'F'LIC:F!NT HRS THE RE:SF:'CIN:'5IE~IL. ITY TO ,.hF, .i-, THI'_'5 DEF'FIF:"FNENT DLiR:t:h,i(:~ 'THE
ZN"---'__"-'-, ~ r-il ~ h I Z LiN .[I,L-FEL. TiL, N...:,' '- ' --' " :: OF FINY ................ P.!E:I_I_:E, Ft[)..:FFIC.ENT "FO TNI':; PF:'-PFFq"TY FIND TFIE
. -F'D'~ ~ -.
.NUHE~ER OF REStDENE:E'L:; TFIFIT TF:tE I.,IELL HILL
E~RC[::;Fi'LL]:NG OF RNY SYSTEM WITHOUT FINRL. iNSPECTION FIND RF'PROVRL BY TH!%
DEPRRTMENT W:[L.L. BE SUBJECT 'TO PROSECLITZON.
MINZPIUH DZSTRNC:E: BETWEEN R WELL RND RNY ON-SITE SE[,.!RGE DZSPOSF!L E;YSTEH Z:5
%¢N2~ FEET FOR R PRZVRTE HELL OR :1.50 TO 280 FEET FROH R PUBLZC HELL DEPENDZNG
UPON ,['HE TYPE OF PUDLIC WEL. L
HZNZNLIM DZSTFINCE FROH R PF:'.ZVWT'E WEL. L. TO F! F'RI',,,'RTE SEWER LZNE Z% 25 FEET RND
TO R E:OMMUNZTY SEWER LINE ZS 75 FEET.
I.,.IEL. L LOGS FIRE REQUIRED RND MUST DE RETURNED TO 'FF!E DEF'RRTMENT P.!iTH:[I',I 2::8 DRYS
OF TFIE WELL COHPLETZON.
OTHER REQUIREMENTS f'IRY RF'PL.Y. 5PE:CZF]:E:RTZONS FiND CONSTRUCTZON [)ZRGRF'if"I% RF::E
R'¢FIZL. RE',LE TO ZNSUF:'.E F'ROF:'ER ZNs"rRLLRT ZON.
I CERTIFY THFI"F'
l: ! RH FFtMiL!RR WITH TI-IE REQUIREMENTS F:'OR ON.-SI"f'E SEWERS RF,!D WELLS RS SET
FORTN BY THE NUNZCIF:'RLZTY OF RNE:HORRGE.
2: ! WIL. L INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
3:: I UN[:,ERSTRN[:, 'THR'T' THE ON-SITE SEWER S'¢STEH NRY REQUIRE ENLFIRGEHENT IF THE
RES]:DENCE IS REHODEL.ED TO iNE:LUDE HORE 'T'HRN 4. BEDROOMS. -, ~ ~ ~
~*~F' /~'---- ~ C* - -* .~t' / / z~, l/ ~// ' ~
"'R';' IFF' P"' - x_ ,; p ~-~pt. .a.~ E'FITF o/~J ~ * ~ ~ ~ ',,,'4. F:
...................................... ~, ............................. ¢...: .................................. = ........ , ..................
PERFORMEO FOR:
LEGAL DESCRIPTION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LO~3 -- pER,CgEATION TEST
[] SOILS LOG
[] PERCOLATIQN
TEST
~t
5
6
7
8
9
10
12
13
14
18
20
COMMENTS
PERFORMED BY:
SLOPE SITE PLAN
'WAS GROUND WATER ~)O S
ENCOUNTERED? L
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
72-008 (6/79)
· APPLI¢ , T FILLS OUT UPPER HAl, ,ONLY
--~- ' · Phone
Buyer
Address Zip Code
Phone
Lending Institution
Address ' Zip Code
Phone
Address Zip Code
Street Locat,~ ~¢
Type of Resi~nce
(
~ Olher
~lndividual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (Attach log if available).
~ Public Utility
~ Public Utility When Connec ed to Pubhc 0bi ty
~ Holding Tank
NOTE: THE iNSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time ~ Time Time Time
Inspector Inspirer Insp~tor Inspirer
{ ~ROVfiD BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAP~OVED
Soils Rating Date ~wer Installed Well To Absorption Area ~ ~ Well Log Received
~--8~ Well ,o Tank %~' Septic T~k Size
72-023 (3182)