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Home My WebLink AboutSAND LAKE #2 BLK 6 LT 7Sand Lake #2 Block 6 Lot 7 011-133-30 Not eligible for Certificate of Health Authority Approval because septic is less that 100' to the well on Lot 18A Block 5, Sand Lake #2. Development Services Department Building Safety Division ® ' On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Marksegich Anchorage, AK 99507 Mayor www.muni.ora/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Saa,lo LAKC sw5bi is g2 Home-gmec Legal Description Q Propf� Owner Name & ddress: Sit K Ct 46. t*-ir 'tZ t�C"f�dhr►so✓�-$3oq 0cr.�:e�.,sr. 3 - /_-7 -tom 6 SCAV►E-J�� C hoe 99Sb� Pump Installation Date: -Cq�, 0—/ Pump Intake Depth Below Top oof� Well Casing:'' 411 feet Pump Manufacturer's /� Name: F� " A ('� (�� Pump Model: ) I �C Pump Size 3 hp Pitless Adapter Burial Depth: lo—feet Pitless Adapter Manufacturer's Name: / Pitless Adapter Installer: l G Well Disinfected Upon Completion? ErYes ❑ No Method of Disinfection: C L 6 ef 1'7 Q Qe�S Comments: Pump Installer Name: /`' f)Ch pjeVj4 ti£Jl �vfil ��lmJ[L� Attention: The pump installer shall provide a pump installati3n log to the DSD within 30 days of pump installation. ® ; OUSE .::I WE , LOT 18A , •`, BLOCK 5 . LOT 17, BLOCK 5 (VACANT) R 100 •`"-- WELL OUSE BLOC� 5 tOT 15 BLOCK 5 40 E.QF:4Ce1g's I1 *' 49 1 .......................... .. • �.4(`:!:'i:: rs ..iii 7tf};-�„ THEOOOREF.YOORE CE -3589 �:• 4 tm Lu Ir N N 95 R 100' LOT 6 I BLOCK6 ' , , f ; u HOUSE LOT 7 M f BLOCK 6 LOT 8 BLOCK6 iff l➢ LOT 10 BLOCK6 LOT 8, BLOCK 6, SAND LAKE SID #2 SEPTIC SYSTEM WAIVER SITE PLAN FLATTOP TECHNICAL SERVICES 11INCH=50FEET 14530 ECI10 STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 APRIL, 2005 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIfv MUNICIPALITY OF ANCHORAGE DEPAR-)NiENT OF HEALTH & ENVIRONMENTAL PR&F CT10N ' ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ;.V joL',..�2 PHONE NEW ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION L ar i7 49 5f91vPzfgKF Z LOCATION vcN/ , NO. OF BEDROOMS 3 U DISTANCE TO: We &rornllN/ 7y Absorption area Dwelling / �jr PERMIT NO. �} �i �� _Y i Q LU F Manufacturer n (5 Material .s° 1" A F L No. of compartments Z rn Liq. capacity in gallons /000 IF HOMEMADE: Inside length Width Liquid depth Y Jt7Z DISTANCE TO: Well Dwelling PERMIT NO. Oz F Manufacturer Material Liquid capacity in gallons 0 w= DISTANCE TO: Well N//4 Foundation / $ Nearest lot line / 5� PERMIT NO. 8 3 6 J LL z P2 No. of lines Length of each line 5 Total length of lines Trench width, inches Distance between lines G Fes- p Top of tile to finish grade t} '%J 1'Bf,Ys e Material beneath tile �j 7W- inches Total effective absor tion area �00 W 0 Length Width Depth PERMIT NO. a w FLLU Type of crib Crib diameter Crib depth Total effective absorption area ti DISTANCE TO: Well 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 Absorpption-area(s)_ OTHER PIPE MATERIALS PPI. S7 N SOILTEST RATING �ry rr�� 0 V - INSTALLER REMARKS D O L Y 41)1 i lee APPROVED DATE LEGAL /5 /'742 63 L -0-T 17 R I S./ilND LRxr_- 2 72-013 (Rev. 3178) �-' ^ � DEPARTMENT �p^` HEALTH AND ENVIRONMENTAL �9TECTION 825 /�_/STREET, ANCHORAGE / HK. 99,--d ~ 264-4720 #.4 EEO I ��E-o 4--o V-4 I -1F E= E- . E'F_ F=EE �1--1 I -F PERMIT NO, ( 8]0125 ) U APPLICANT MARK TOUSEN SRH BOX 4035 A 99502 LOCATION LEGAL L7B6 SAND LAKE #2 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (S0 FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ��F=l"%-nE=l �EE F=" -]F " == ED THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H 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). ��U I F;' -"EE C -n =- F= F= -F 31 0- ��F-:� _`- 1: 7' F= -1 C-1 C-1 0 #::i n I I cu P-4� 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. -rwcu �� I " _�-. 1=10 E-: &=-T- I C-9 P-4 _�-- F:� R2 F= ��kJ I P�_'E= C -m � BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS i DEPARTMENT WILL BE SUBJECT TO PROSECUTION. ' MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR {}N -SITE SEWERS AND WELLS AS SET FORTH BY THE NUNICI PALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. � SIGNED APPLICANT MARK TOUSEN ISSUED BY.._v_ -----~~DHTE__��.l��.��_ V4.0 /'/ // MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 _ 264-4720 SOILS LOG — PERCOLATION TEST KSOILS LOG ❑ PERCOLATION TEST ?42 / si PERFORMED FOR: % TSS .G"7 1�>r%F Lei/C �tJ 4?77✓LDATE PERFORMED: LEGAL DESCRIPTION: SLOPE SITE PLAN DEPTH (FEET) 57 it (//Z -/L C I/L= �'Y 2 � / ;� r za-E/ M WAS GROUND WATER ! ENCOUNTERED? IF YES, AT WHAT DEPTH? s L O P E Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: .4 Pr: CERTIFIED BY: 72-008 (6/79) FT AND (minutes/inch) FT DATE:/ "I 5/—P;3 e CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of public water system located in Alaska, submitted in accordance with 18 AAC 80.100 by have been reviewed and are ❑ 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 public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. BY 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. BY - TITLE DATE APPLY NT FILLS OUT UPPER HA. ONLY w .✓ Property Owner / � j PhCo/ne 9 —. - _ Cy —� Zi Code Manic± Address p ��Q rC/ rD / ". / / ) Buyer Address `j� ! � ,S �C �/ L G+. / Zip Cade Lending Institution i - Phone Address � SC /, Zip Code D to Realty Co. R Agent // �% �� /�, f .� ,ic 1� l 7 '. Phone Inspector Address Zip Code Inspector Legal Description//Rc S r� Street Location ) v -J Ty a of Residence Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date D to Inspector Inspector Inspector Inspector Field Notes: ( "-))_ APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Da�Sewerstalled Well To Absorption Area Well Log Received �� Well to Tank Septic Tank Size 72023 (3182) CHEMICAL & GE.,LOGICAL LABORATORIES liu,/ ALASKA, INC. TELEPHONE (907)•279.4014 ANCHORAGE INDUSTRIAL CENTER o, 274.3364 - 5633 B Street �eoa.ne:ee Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: WATER SYSTEM: I.D. NO. ❑ Satisfactory ❑ Unsatisfactory Water System Name Phone No. t Mailing Address r; - City State Zip Cade SAMPLE DATE: C ` Mo. Rey Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample, ❑ Treated Water With lab ref. no. ❑ Untreated Water ❑ Special Purpose SAMPLE Time Collected NO. LOCATION Collected By t. 2 3 I I 4 5 1 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE ❑ 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 Li JMembrane Filter Lab Ref. No. Result* Analyst m ED ED I. I *No. of colonies/ 100 ml. or No. of Positive portions. 06-1220.(b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Data Collected source a.m, Date Received Time Received -p.m. Lab. No. ...._......... r„e 10m1 10m1 loml LOmI I loml 1.0ml O.lml EMB Broth 24 hours: Broth 48 hours: Multiple Tube Report: 10mi Tubes Positive/Total 10ml Portions Membrane Filter: Direct Count Collfontt/100rt11 Verification: LTB BGB Final Membrane Filter Results Coliform/IODMI _ l Reported By - Date _ Time- a.m. p.m.