HomeMy WebLinkAboutWOOTEN LT 1
ARclrIc Puup & WELL INc.
JimSulliv-a& CPI
PO Box 77A197
Eagle River, AK99577
(e07) 688-2510
(907)243-2282
iim@arcticpump.com
Well Decommissioning Log
Legal Address
Subdivision:Wooten
T:R
Block:
Section
Lot:1
Lot:
On-site Water & Wastewater Program certified contractor pedorming the well decommissioning:
Name: Signature:
Jim Sullivan j.in.*-
Company:
Arctic Pump & Well,Inc
WellDecommissioningDate 8-26-22 MethodofDecommissioning: AMC15.55.060ll 4n b.n c.[]
Location: Use the space below to provide a drawing of the property showingthe following items:
o North Arow
o Decommissionedwell
o Otherwaterwells ontheproperlye Two separate swing tie distances for each well shown on the drawing
Note: the swing tie distances shall be measured from either permanent structures or the propety corners.
Arctic Pump & WeIl,Inc.
Page I of I
M
GAAB HD I
~ATER ANCHORAGE AREA BORO"~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
ADDRESS
LEGAL DESCRIPTION. ~::'"'/ ,,.~b'/ ,2'~/'
PHONE
SEPTIC TANK:
DISTANCE PROM WELL__
LIQUID CAPACITY
__MATERIAL - ~' '7~'~'//
Z-Pc
NUMBER OF ~
COMPARTMENTS
~)j//~2: .~.~/- /~",~ LIQUID
INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
NEAREST LOT LINE c~.~? i
OR WIDTH
DISTANCE EROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA}
/
, LENGTH ~C)~/~/' , DEPTH
BUILDING FOUNDATION_ x~')/.
,5 EgO so...
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
· FOUNDATION_
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
, NEAREST LOT LINE
TOTAL LENGTH
, OF LINES
TRENCH WIDTH
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TIL~
~N. ABOVE TILE__
WELL: TYPE ~/~ ///O(Z-'~//D E P T H _ ~,"~' '/
LOT LINE ~" NEAREST ~ / SEPTIC
, SEWER LINE__ TANK
DISTANCE FROM ~'~-7 WATER
__., BUILDING FOUNDATION. · SAMPLE z'~') , NEAREST
p(.~' / SEEPAGE / "~/' .__. OTHER
, SYSTEM /~'~ ~_ . CESSPOOL , SOURCES__
DISTANCES:
DIAGRAM Of: SYSTEM
DATE
HEALTH AUTHORITY
GREATEI_ ANCHORAGE AREA -()ROUGH Cas. No.
HEALTH DEPAWI'MENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS ~//
LOCATION OF INSTAL..L,.~..LON
APPLICATION TO INSTALL: SEPTIC TANK'--"-'"""'-'-'""' SF~PAGE PIT t..--"_, DRAIN FIELD ,
OTHER.
-rD s,:.v,:
--///
FINANCED THROUGH ~0 BE INSTALLED BY
PERCOLATION TES'F RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS--¢~/! /.~~C.2 , PERMIT TO INSTALL A ,
· SEPTIC
DIAGRAM OF SYSTEIVI
DISTANCES:
alth Autlmrity
I t I am familiar with the requkements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
e described systenhis in accordance with said code.
94.0'
DTI002264 '*~ '