HomeMy WebLinkAboutUS SURVEY 3202 LT 14 S2 T10N R1W SEC 10Onsite File
US Survey 3202
Lot 14 S2
#090-022-16
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
LOCATION
DISTANCE TO' Well ~ ,~
~anufact~rer. A ~.) ~
I k'q' ~a~ gall°nsI IF HOMEMADE:
Manufacturer
DISTANCE TO: I /~ ~
~o. ol lines~ ~ Len~th~f e ' e
Top of the to finish ~rad* ~
ken,th ~idth~
Absorption area
Inside length
Dwelling
Total le~J i~es
Material beneath tile
Depth
Crib depth
Building foundation
Driller
Sewer line
OTHER
P'Ep Z? O d
REMARKS~ ~ ¢~"~
PHONE ~NEW
[] UPGRADE
Material
Nearest~l~i~
Tren~w~h
NO. O F~:) R O OMS
PERMIT NO..
No. of c~rtments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
O is ta~7~v~ n lines
inchesinchesTota~l~y~bsorption area
PERM1T NO,
Total effective absorption area
Nearest lot line
Septic tank
Distance to lot llne
~sRor~'it~o~iea (s)
72-013 (Rev. 3~78)
P]~rmit WELL AND/~ ON-SITE SEWER PERMIT
~ l~]~~ck~ ~/~c~ C~ae Nullfoer:
MUNICIPALITY OF ANCHORAGE
Department./~f Health and Environmenta?~rotection
825 ,' Street, Anchorage, AK. ~ _9501
264'4720
* * * HANDWRITTEN PERMIT * * *
L cation: - 7 /4
'~$-~/0
Legal Description: L_/~ ~(~ ~ ~'~0~'~---- Lot Size: -~
Type of Soil Absorption System Is:
Trench: ~ Drainfield: Seepage Bed: Holding Tank:
~aximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /~
The Required Size of the Soil Absorption System Is:
DEPTH /C) LENGTH ~ GRAVEL DEPTH ~ ._ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel ~between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(~) TANK SIZE = /CF~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this dep~rtmen~
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of' public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet Well logs are required
and must be returned to this department within 30 d~Y~ of the well completion.
Other requirements may apply. Specifications and construction diagrams are
a~ailable to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes. .
I understand ~that the on-site sewer system may require enlargement if
~.. (3) p~side~nce~emodeled to include more that 3 bedrooms. ~
J~-W DRILLING, Inc.
~ , r, p.O:Box 10-378 o 10300 O~d Seward Highway
(907) 349-8535
' ~ ,, ~ ANCHORAGE, ALASKA 99511
Well Ownen Jeff S.
Location (address of: Township, Range, Section, if known; or distance main road
'Dot 14 US.~_) 3202 .
Size of casing- 6" ._Depth of Hole 54. feet Casedto_53'.6 feet
Static water level 20 ft~ (~-'~'-'~'(below) land surface. Finish of well (check one)
Screen ( ); Perforated (~ ).
Describe screen or perforation i~ --
Well pumping test at .5 gallons per ~0~) (minute) for_ 1. 'hours with 1007~
of drawdown from static level.
Date of completion :.Tt~e l: ,1083
WELL LOG
~)epth in feet from [ '
ground surface Gi~e der.ails of formations penetrated, size of material, color and hardness
0 TO. 2 (~o.sin~ stickt~
. Z _TO- 23.
Use of WellD°mst{c
open end ( xxx );
23 TO__ 25
__, ~ TO_ ~g
TO.
.TO.
__ _TO
__ TO_
TO
TO_
TO.
TO-
- .TO
_TO
3--CONTRACTOR
PERFORMED FOR:
LEGAL DESCRIPTION:
4-
5-
6-
7-
8
9
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST ~
,:5202 I..Jo
~ SLOPE SITE PLAN
~, SOILS LOG
[] PERCOLATION
TEST
10-
11-
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
72-008 (6/79)
APPLiO -xiT FILLS OUT UPPER HAL'r- ONLY
-- -- Phone
Buyer'~ :,~_ ~'1~.
Address Zip Code
Phone
Lending Institution I ~ ~ :_~ :,:
Address Zip Code
Phone
Re~lty Co. & A~nt
Address Zip Code
Type of Resi~nce
.~[ngle Family
~ Multiple Family No. of Bedroo~ "~
~ Other
Waty~Su~ply
~ Individual A~ACH WELL LOG. A wall log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach ~og ii available).
~ Public Utility
Sewer Disposal
~dividual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date
Inspector Inspector Inspector Inspector
F ' e I O N et e s: ~.,~y,~./,~
~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL
(
( ) DISAPPROVED
OATE /~ /~ ~ ~ ~
/ ~D c ¢'~ WelltoTa,k /~ ' .~ Septic T~k Size