HomeMy WebLinkAboutTERI #3 TR 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN Sr"RVICES
Environmental Heallh Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
LEGAL DESO~IPTION
TANKS
SEPTIC
DISTANCES
:ROM
WELL
SEPTIC
TANK
ABSORPTION
FIELD___
WELL
I I ?
HOLDING
TYPE OF SYSTEM
~,~&rRENCH ~) BED [~] W, DRAIN [] OTHER
FT
WELL.C;
~ PRIVATE
REMARKS:
FT
I~uflicipal and Stale Duidelinos in elleol on lids date:
Heallh Depadment Approvah ~
cedily Illal Ibis inopecdon was porfornlod accordio(J Io all
72 013 (3/85)
t I(~LJtI:::, '" "
!',;ill,.t~,,l F:'IiI::?. I:::JIL~!:hILh:R'S
Iil:Lh~ F:'[ .I '~I'"! ]: F !./q ....... .l.I :~ ' '~' /?C)(hl'qD V¢hl,:!:O I:(:iJ::i ('~ :! ; :t: t",ll )t I:ii: I:(iIi:1:I_'~ I lid"Il:i,
[ ::'~i: ',:Ii'" I t, I ,J ¢-tt I ! 'ltlli:: :il;l:i::blF::F/ S"¢fi;l 1:::,I~1 '1 [) (4 /I
b~::!(::. L :i (:)ii ~.,.,.,':~ ':~, 'l'o,,,)rv:il'~ :i p i: :L.'!II',I I:~:,'-'~r'~ge 'ri, :IE
I.ta::: ):~(~: d 1~ c,(::)m~ r', J' h :i. ~'~ F'(a r. m :i 'L :: 5; 'l ~:,)I'. a I.,a~)a,~ - ]' '" ~,," ..,'
· Lank (~) .:::
O
hereby certify that I have surveye~ ~' ,'Dha~k
Subdivision, Anchorage Recording Precinct, Alaska,
and have replaced all lost corners with 5/8" x 30" rebar. It is the
responsibility of the owner, prior to construction, to verify proposed
building location on lot, grade~ and utility connections, also to
determine the existence of any covenants or restrictions which do ~ot
appear on the recorded plat. Dated at Anchorage, Alaska this
day of,
CONSTRUCTING ENGINEERS, INC.
9601 Buddy Werner
Anchorage, Alaska
346.2000 694.9098
PLOT PLAN
SCALE 1" = ioo,
:4URiCiDality of Anchoraqe
DEPARTMENT OF HEALTH & HU~vlAN SERVICES
325 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
EEGAL DESCRIPTION: ~. :'%ci ,%"/ .... ; /d ,,. ¢% -. Township, Ranqe,. Section: .J /;q :'.~ '7-', ~ ~ .~'! ,'(Ir' ~
(FEET)
114
f3 -
i4-*
!54
COMMEN~S
SLOPE
SITE PLAN
:-
i i
....) I >lAS GROUND WATER
ENCOUNTERED? ~L] ~
IF YES, AT WHAT
DEP'FH~ ;' ]/'~
PERCOLATION RATE
Net
Drop
Immutesnnchl PERC HOLE DIAMETER __
:ES1 RUN BETWEEN __ FTAND ET
PERFORMED BY: -,';~ ,: t?-,JcYm <; : n.,2,¢ .~,~, .... I i~'D~¢:'~ :v'cJ¢~' CERTIFY THAT THtS TESTWAS PERFORMED IN
ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE
DOC CO, dba
SULLIVAN WATER WELLS
OWNER OF LAND ~?~/IA ,/ : (' ! .:
ADDRESS , ' (',~ ;~ () [ 6/
DATE - Started Ended
PERMIT NUMBER
P.O. BOX 670272, CHUGIAK, ALASKA 69567 · TELEPHONE 688.2759
DEl'TH OF WELt. / / 9
ST&TIC LEVEL OF WATER FI' [ ' ~ >
DRAW DOWN IrT.
GALS. PER HR __//~ .9, )
KIND OF ('ASING
KIND OF FORMATION:
From__~ Ft. to Ft,
From ;' Ft, to '/'__Ft.
From :f Ft. to ;.~ Ft.
From Ft. to____ Ft
Fromm, :' Ft. to~-~,:' Ft.
From Ft. to __Ft.
From t .... Ft. to ~ :~ Ft.
From Ft. to___
From ;:t, , Ft. to
From_ Ft. to
From__/:' Ft. to r',
, /
From~/¢ Ft. to Ft
From Ft. to Ft.
From [/ J Ft. to ] ~,(~Ft.
From/~',L(, Ft. to ,/ ;iii' Ft.
From/;; (~' Ft. to
From Ft. to __Pt
,)
Ft, to .... Ft.
Ft. to Ft
Ft. to_ Ft.
Ft. to _Ft.~
., ,,, .
Fl. to~Fl.
From Ft, to-
From Ft. to_._
Frolo ..... Ft.
From Ft. to
Pt.
Ft.
Ft.
Ft.
Ft.
_Ft.
MISCL. INFORMATION:
DRILLER'S NAME / ' ': .d ,