HomeMy WebLinkAboutROEHL #1 LT 12
10/09/2012 22:34 9072430742 AWPS, INC. PAGE 02102
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Mayor
Pum Installation Log
Well Drilling Permit Number: SW,�
;parcel Identification Number:_
Legal Description
Roe -4/ ,�/
Pump Installation Date: ✓d �'%�
Pump Intake Depth Below Top of Well
Pump Manufacturer's Name: 14YI41L
Pump vlodei: f,JI92�O✓7 �
Pump Size yz„ hp
Pitless Adapter Burial. Depth: /fi feet
Pitless Adapter Manufacturer's Name:
pitizas Ad,iv2e lu'lAller! NIA
%V -ll Disinfected Upon it3stata"sc':inaz? y�.>'xy
NieshD" ADls3a'lectmn:
Comments:
0
feet
Bate of Issue:
Property Owner Namo & Address:'.
Pump Zus[n3ler Name:.y G
Attention: The pump installer shall provide a Pip installation log to the DSD withita 30 days of pnnp installation.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
Address
Ph'onels) '
Permit NOV No. ot Bedrooms
LEGAL DESCRIPTION
Township, Range, Section
TA~NK~ '~
~'EPTIC [] HOLDING
Capacity in gallons
Manufacturer
Material
No. of Compartments
TYPE OF SYSTEM
[] BED [] W. DRAIN [] OTHER
Depth to pipe bottom from Total depth from original grade
originat grade ~ FT ~ 0
Fill added above original grade Gravel depth beneath pipe
~, FT '~ F1
Gravel width
Total absorption area
'~ ~::~ FT
Number of lines
Soil rating
"~....~'"~ SI~ FT
Distance between lines ~,~
Pipe material
Date ~nstalled
WELLS
~IVATE [] OTHER (Identilv)
Classification (A,B,C) Total Depth ~ Cased to
Date Installed: FT[ FT
REMARKS:
WELL
DISTANCES
SEPTIC
TANK
LOT LINE
FOUNDATION
ABSORPTION WELL
FIELD
AS-BUILT DIAGRAM (Show location of well, septic system, property lines, foundation,
driveway, water bodies, etc.)
inspections Performed by:
I
~GINEERIN~
River L~ R~d Ne_ 9~ ~ily that ~is Jnspeaian was peHorme~ acoording to all
Health Depa.ment Approve..~Z~~~~ Date ~~
ENGINEER'S SEAL
M U lq .1: C I F' A L.. I T Y O F A N C H O R A (¢' E
Depaptn'len'L o{' Health & Human Sepv:i. ces
~h;;.,..~ L. Str'eet~ Aqcl"lc:)r'age~ Alaska 99',%)1 ';' ";' ~'7;'~''~
0 N "' .1: S P
::, "1" E S E W E R '*
...... ,. IE P "1" I C T A N K E R M ]: T
Number' ,", 8901..700
Day Phc~ne.:
.... ~.,.. f
l:::'ai" c:e ]. .11 d:02~'.0'""092'""S7
L. ot L. egai.1:', Subdiv:i.s:i.c~n: ROEHL.. NO,, I L.~t:~ 12 BlLo~:k~ 0
sec t:. J. (::~r'~: 00:3 "l"o~,~n sh :i. p: I :t. N Ran g e: 3W
Lot S:i.:.~e 4:L;?.3:3 (sq,,~'t,, of
Max Bedr'ooms~ This Per'mit.: 3 'T'ot. al Capac:i.t:y~ 3
............... ~ .......... ~...pt...~.L tank (s) < 4~ ')
£ee,'t r'equi~"(~:s :i. nsula'Lic)r"~ c)¥er' 'Lank (s).
TFIE TWO E XtST]:NG WEL..L..S L.O[;A'f'IED ON L. OT :f.:5 MUST BE F'ROPERI...Y
ABANDONIED,, !NS'T'ALL IN AC;CCiRDANCE WITH I::I',IGINE]ER'S F'I...ANS AND
SF:'EC :1: F' :1: CAT I [:INS ,, ND'T' t F'Y DHHS F'R ]: OR TO AL..L. COIqSTRUC','T ]1 ON
.1: N S P E C T I 0 N S
:1: CIER'T'.1:FY THAT:
:J,,, i[ ,:¢dfi t.'am:i.l:i, ar' ~,~:i.'L.h the r'(:~:,quJ, r'ements~ eof on,-!ili:i, te sewer's and Ne].ls as set,
{'c:"t:.h by the Mun:i.c:i. pal:i.'Ly or Anchcmage (IdOA) and t. he State or Ala.ska,,
2,, .1: w:i. ll :i.n~itall 'Lhe sy~it, em in acci2ndanc:e wJ.'Lh ali. MC)A codes and pe(,::lulat:[cu'~s,
and :i.n (::ompIiar~ce t,~i't,.h the design cr'i'Ler':i.a or 'Lhis per're:it,,
3,, :t: ~,¢:i.].l adhepe t.o alJ. MOA and St.a'Le of AlaE4ka r, equ:tr'eme:~nts ~(:)r' the sec back
d :i.s!:.anc:es ~ r' om ar'~y e>( :i, s'L ing we:l, ]. ~ t,.,~ast, e~,~a'Ler' d :i. spcCsa.1, sys'l:,em (;:)P pub ]. i
se(.~ePagE.) sys't'.(~)r[~ (::)i"~ 'Lh:i.s or' any ad.j.¢~(:::sr'YL c)p i']eE~Pby .1. c)'t',.,
4,, ]: Lu'"~der'stand 'Lh.~?cL th:i,s per'mit :i,s valid {'c)r' a ma.x:i, mLutt (::){' 3 I:)edr'Q(:)ms,,
als(:) under'~ivLand that the capac:i, ty c~¢ 'Lhe tota.1, system :i.~[i :];; b(.:,~dl"(:)c~fitfii~ and
any ~.,:,r'~.1. ar'~y~:,m,~)r'rt,wi.1:l, r'~;.:~qu:i,r'e an add:i,t, ional pe~"m:i.t,,
"'"~ .... DA, b.:
............ ~.,.. d F~y ~ '" ' ''~ ......
.r ~ SCALE
~ ~-~'"~ 7__
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~
LEGAL DESCRIPTION: L..-' ~'"'~
5
6
7
8
9
I0
11
12
13
14
15-
16-
17-
18-
19-
20-
DATE PERFORMED:
Township, Range, Section:.--[" [ I t,~ ~ ~..'~L.~ ~-~_._ ~--z.~
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S.
L'
IF YES, AT WHAT O
DEPTH?
E
Deplh to Waler A!JP,[,..-/_.tF
Monitoring:' ~'~- 7 Date: .~'~'~
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN '7 FT AND ~ FT
COMMENTS
/.~---~ j_j~' /
PERFORMED By:17034 Eagle RI~.. ..... L~ Road No. 2~ I~FY THAT THIS~TEST W~ PERFORMED IN
Eagle River, AlasKa
~.,~,.~, ~ ER'S SEAL)
Municipality of Anchorage ~,~ ~" _~
DEPARTMENT OF HEALTH & HUMAN SERVICES ~r ~ -- ~
825 "L" Street, Anchorage, Alaska 99502-0650 ~
so, s -
~SCRIPTION' ; / ~ ¢0 ~ t4 * ¢/ T°wnship Range Secti°n' ~/M ~~ SICE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SLOPE
/¢>N WAS GROUND WATER
COUNTERED?
.1~//' ,&;~,?AT
Depth to Water Alter
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE --
(minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN .-- FT AND -- FT
I v Alaska 99~77 ....
PERFORMED IN
Municipality o! Anchorage
BEPARTMENT ~)F HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska ~J9552-$65~
SOILS LOG B PERCOLATION TEST
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
J(L,~c'
Township, Range, Section:
SLOPE
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth to Water Alter
Monitoring? Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __
~ / /~ ,~? TEST RUI~B.E-'~WEEN *. FT AND FT
PERFORMED B~' ' EN~IN~R'N~ J. ~2_~RTIFY THAT THIS, TEST W~S PERFORMED
ACCORDANCE~~~IPAL GuIDeLINE EFE T ON THIS DATE. D : // ~ ¢~ /