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Home My WebLink AboutSAND LAKE #2 BLK 5 LT 4t„ 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 NAME �' & �, O Edt / NEW ❑ UPGRADE MAILING DDR L / LEGQDESCRIPTION ,7-13-6� (S Al klyOLA LOCATION NO.OFaDROOMS Uy DISTANCE TO:®(J Well fP Absorpti area Dwelling Gl/( PER O. ��-} (� i Q W FQS� Manufacturer (.-.�,.� ( �j Materi� 1, No. f compartments rn Liq.70peoalloj IF HOMEMADE: Inside length Width Liquid depth O y J C)z DISTANCE TO: Well Dwelling PERMIT NO. O Z F Manufacturer Material Liquid capacity in gallons O W = DISTANCE TO: Well Foundation/� Nearest lost -Ne 0 PERMIT , d / (� -W.I LL z P z W No. of line Length of a ine Total length gylines - Trench wi inches Dista nc a e lines _ HTop O of tile to finish grade Material beneath tile __Mteh Total of tde orption area W Length Wid Depth PERM NO. a Q h- Lu Type of crib Crib diameter Crib depth Total effective absorption area WWell N DISTANCE TO: Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER 71FEWERIAL �r SOIL TEST AT I NSMA LLER REMARKS 10 7-G lam' R- APP VED DATE LEGAL r 72-01bIRev. 3/78) ' / U _ z TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: r-1 U r4 I I::-- 1� 'F -i I I -F N -e Cl F-- F4 r-4 I::- V 'I FR F4 fi:3 F= - :1 -13 DEPARTMENT HEALTH AND ENVIRONMENTAL "-r!OTECTICIN 825 'L' STREET., ANCHORAGE, AK. 954501 264-4720 L3 r-4 I -IF F= I -IF tSf- PERMIT NO. 82:1066 ID I q 19 APPLICANT DOUGLAS N JENSEN 2111 CHANDALAR DR kv 118. LOCATION LEGAL L4B5 SAND LAKE #2 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 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). F -'E: 9�® U I FRIE EN '-SE= F=:* -r I fl:: - -F F1 N K "H. I =FE_ -1 C-1 C-Ew I D- OD F:W I 1 1-3 lrA 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. -r W s_® <;2 > I I r_® "FROFE OE:L U I F-E:C-- - — — FR -Da e BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT 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 15 75 FEET. OTHER REQUIREMENTS MAY APPLT t, SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=2 1=1T M I -F #=" 1=0 I f=-'1= _° LD, E-= C_; FE M E.* I=- FZ :IL a -1 "-=A EU 22 I CERTIFY THAT 1: 1 AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES - 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: --- ---- -------------------- APPLICANT;.; PPLI C-ANTAFj0 N NSEN ISSUED B4--_'_ -- -DATE___l 1_2 -L-'-- V4. 0 76 , , ;/�Zll, :1 -13 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). F -'E: 9�® U I FRIE EN '-SE= F=:* -r I fl:: - -F F1 N K "H. I =FE_ -1 C-1 C-Ew I D- OD F:W I 1 1-3 lrA 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. -r W s_® <;2 > I I r_® "FROFE OE:L U I F-E:C-- - — — FR -Da e BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT 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 15 75 FEET. OTHER REQUIREMENTS MAY APPLT t, SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=2 1=1T M I -F #=" 1=0 I f=-'1= _° LD, E-= C_; FE M E.* I=- FZ :IL a -1 "-=A EU 22 I CERTIFY THAT 1: 1 AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES - 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: --- ---- -------------------- APPLICANT;.; PPLI C-ANTAFj0 N NSEN ISSUED B4--_'_ -- -DATE___l 1_2 -L-'-- V4. 0 76 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Q O -Q C 5 C 1) S 16- Y\.1 DATE PERFORMED: 0 (\ LEGAL DESCRIPTION: DEPTH SLOPE SITE PLAN -7— 1 (FEET) 1 1 1 1 1 1 1 1 COMMENTS WAS GROUND WATER S ENCOUNTERED? L 0 Fw Em-% IF YES, AT WHAT E DEPTH? PERCOLATION TEST Reading Date Gross Time Net Time Depth to Water 2 3 AL 13 !Ida. 6 7 9 10 11 J, 12 - 0.4 13 - 14 15- 16 - 0 17 - 18- v '91 20 COMMENTS WAS GROUND WATER S ENCOUNTERED? L 0 Fw Em-% IF YES, AT WHAT E DEPTH? PERCOLATION TEST Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE K. a. W-'44nuteshrich) TEST RUN BETWEEN 'IX PERFORMED BY:iC(-Cv—% CERTIFIED BY -DATE: A -r rVf. d' 72-008 (6/79) o Stizj.S CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT ❑ approved. ❑ conditionally approved (see attached conditions). _. BY _ - TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the f ' public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the completion date. TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. TITLE DATE CHEMICAL & GE, -. yOGICAL LABORATORIES ALASKA, INC. OE NDEPENOFNT TELEPHONE (907)-2794014 ANCHORAGE INDUSTRIAL CENTER o` ®� '$ 0 274-3364 5633 B Street o Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: Analysis shows this Water SAMPLE to be: I.D. NO. Q Satisfactory ❑ Unsatisfactory Water System Name Phone No. READ INSTRUCTIONS ❑ Sample too long in transit: sample should not be over 48- hours old at examination to indicate reliable results. Please send new sample. } Date Received Time Received Analytical Method: ❑ Fermentation Tube '0 Membrane Filter Lab Ref. No. Result' Analyst " I m I. I m ED I I FF1 *No_ of colonies/ 100 n]. or No. of Positive "portions. 0e -122o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Data Collected Source Received Time a.m. p.m. Lab. No. o........ n.mn. I 10ml I loml I loml I Joint I loml I 1.0ml I O.lml Hours BEFORE 48 Hours Confirmatory 24 Hours 48 Hours EMB - Broth 24 hours: Broth 48 hours. COLLECTING SAMPLE Multiple Tube Report: 10ml Tubes Positive/Total 10ml Portions Membrane Filter: Direct Count Collform/100ml Verification: LTB BGB Final Membrane Filter Results ` Collform/100ml Reported BY ,._ _ -Date _ ,F _Time• ` a.m. P.M. Meiling Address City _ ., State > :`Zip Code .. m EEI I 1 J SAMPLE DATE: Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample) with lab ref. ❑Treated Water ❑ Special Purposee ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By,, 1 2 3 a 5 READ INSTRUCTIONS ❑ Sample too long in transit: sample should not be over 48- hours old at examination to indicate reliable results. Please send new sample. } Date Received Time Received Analytical Method: ❑ Fermentation Tube '0 Membrane Filter Lab Ref. No. Result' Analyst " I m I. I m ED I I FF1 *No_ of colonies/ 100 n]. or No. of Positive "portions. 0e -122o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Data Collected Source Received Time a.m. p.m. Lab. No. o........ n.mn. I 10ml I loml I loml I Joint I loml I 1.0ml I O.lml Hours BEFORE 48 Hours Confirmatory 24 Hours 48 Hours EMB - Broth 24 hours: Broth 48 hours. COLLECTING SAMPLE Multiple Tube Report: 10ml Tubes Positive/Total 10ml Portions Membrane Filter: Direct Count Collform/100ml Verification: LTB BGB Final Membrane Filter Results ` Collform/100ml Reported BY ,._ _ -Date _ ,F _Time• ` a.m. P.M. •�� moi. /In n M1n:iC1/�� - Time APPLI( NT FILLS OUT UPPER HAI ONLY Prop,. _ -- `� ✓, ,::.; � . � � j i� �-� \151_t�� S�'� — Phone ( rte( C M Z- 0_" IL.. Mailing Address r' ::;:- % ;J Zip Code Buyer Date Address rte? s�_->''�'" i' -C- �- Zip Code Lending Institution Inspector Phone Address "_ )C> �. Ws 1;�E'«-`_,�_�,--., '� Zip Code Realty Co. & Agent `, 1„ Phone Field Notes: ENVIRu,d;..=,',.;>.-. 'LTION Address .u. Zip Code -..�f�`• Legal Description1-c.�%-'"�, fCIE Street Location - , >e' (Ii`,; -_ Type of Residence ❑ Single Family *a Multiple Family No. of Bedrooms ( DISAPPROVED ❑ Other (K) CONDITIONALAPPPROVAL' Water Supply El Individual _ ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ♦ l Community «' <= `- For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Well To Absorption Area Sewer Disposal :J Individual Septic Tank Size (' 11 Year Individual Installed: ' 0 �' ❑ Public Utility Well to Tank When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. •�� moi. /In n M1n:iC1/�� - Time Time Time � n Time - 0\0_"Z 0\ ( rte( C M Z- 0_" IL.. Date Date Date Date Inspector Inspector Inspector Inspector MUNICIPALITY OF NCHORAGE Field Notes: ENVIRu,d;..=,',.;>.-. 'LTION .u. c � " fCIE Coal APPROVED BEDROOMS _ _. -'CONDITIONS OF APPROVAL - - ( DISAPPROVED --------- (K) CONDITIONALAPPPROVAL' DATE ' r ! ~ 83 Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size (' 11 / �� Well to Tank 72023 (3182)