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HomeMy WebLinkAboutDEBORA BLK B LT 3050 �C► MUNICIPALITY OF ANCHORAGE \ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION II �� ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS PHONE EMIEW ❑ UPGRADE LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS O Y DISTANCE TO: Well Absorption area Dwelling PERMIT NO. W< W fa.. Manufacturer Material No. of tompartmopts o Liq, capacity in gallonsIF O'dd HOME MA DE: Inside length Width Liquid depth 6Y 10Z DISTANCE TO: Well Dwelling PERMIT NO. S Z F Manufacturer Material Liquid capacity in gallons W = DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. J LL Z Z W No. of lines Length of each line f Total length of lines Trench width cinches Distance between line /w( /// r F- O Top of lila to finish grade Material beneath lilaTotal �'f effective absorption area W Length Width Depth PERMIT NO. <f- W M1 Type of crib Crib diameter Crib depth Total effective absorption area rn DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W i DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIAL$„ //l SOIL TEST RATING 0 3 elf INSTALLER REMARKS f 1 � s I APPROV D 2 DATE LEGAL 72-013 (Rev. 3178) 4:;-) — W m N' 4' •i B m: tui Oi � 4 O Q Y V N J k +> LLJ O• J J j = a°O W 1 � W X N 60 Q W 3 v IL CLLA 0 0 m N' 4' •i B m: tui Oi iii p k +> LLJ O• QUA N a°O O ; ' r♦; LLIO O h %n IL CLLA ME 1 O I i 1% W 5 rn U ° p 0-4 co 1 %0 r -i i N W E %01 %0: p k +> G € a°O LLA r♦ : r♦; LLIO O h %n ft CLLA yrn t 7a 1 I I 1% r : 0 0 0 0 LU w w L6 O O O O w L6 LW a mi d: = i r♦ : r♦; b ; Gni: t%pd 6�i LIEtai ' al : ; : d; r•I: : «-1: to : m: b: �: b: b: ': P•I: b: cd: is ': cd: cd: co:a): tC cd. tni C17....i N(..: V(].,E 0 N: in:: xi 0 0:: 1: {.. ' vlj O O O Oi N C1 Pl O �E rli N; M: -'3i %40i C' WE O O 0' c* O F F 1f1E Oi O' O? O? NE : O E r•l i N i f -Iti vlE 1+1i %0 E n E E i E i E E i O i i i i V. O 0 O O O O O 0 O O O 0 O O O p C C C CC C C C C 5 ta. L6 ti 4. 4. w ti w ti Z mi d: iL I Tter• OF= nt4CHCkRn0E l Iut5 • DEPARTMENT L HEALTH AND ENVIRONME14TAL F :TECTION puas� 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 t4cL.FL Fir4i> �rEWEF2 F=-EFRM I T%du,e%-d &t PERMIT N0. < 810387 ) atilt 'j"10 APPLICANT EINAR A. LARSON PO BOX 227 E.R. 694-2188 LOCATION ELENORA ST. LEGAL LOT 3 ELK B DEBARA SUB LOT SIZE 10125 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 191 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 11 FLEr40-r -i= 32 13Mn l -L_ E>EF}TH= G THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT I5 THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN 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 CIN FEET). FRE IJ I RELti SEPTIC TRtJF� S} I r E= IOC GF=FLL_Ot-FS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO C 2 ] I "_S;F EGT I OFVS nFRE F;cEQlJ I FSEF? --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEE14 A I4ELL AND ANY ON-SITE SE14AGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE 4JELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO A 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, REQUIREMEFJTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERtl I T EXP I IBES E>ECEMF3EFz 311 15N01 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMEFJTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:_ APPLICANT EINAR A. LARSON ISSUED6y'��2-��c�-.� 3} ---DATE_,/_P_L�C_i�� V4. 0 Russell Oyster 694-2774 Performed for. r�' rl� .O & E ENGINEERING & DEVELOP RENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Mailing n Legal Description: Lo/ 3 ��"� ,J r 4:Z�&On4 N IS" g e Earl Ellis SOIL LOG 688-2280 � 1 Depth (feet) Soil Characteristics 1 /YIL — SttrTTp(�So�c.. W�i��'`. � OreGGN:cs �pc �-3 ' j/Y1. St�•*-y �a^�4 - adNo �=,e.O�Tra� t=,Mtr. ©eC14�itDr�4C. i 5 L&'iv Sc j6 a� �LtrO F.N� So Ma. 7- 8- 10 s 10 11 X12 13- 14_ 152 tw - e-LLrd -S>,o rjo. r�a•c-ranT ��' V IT 16 LAJI; C.Otoor-O t Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit_ Drain Field PLOT PLAN PERC.TEST ZO /"1 '1)1NCd Performed by: Date: o n6c e- fic.� a i.w.+ 04 S. LEGAL 0TRIPTID L UNICIPALITY OF ANCHORA -' MUNICIPALITY OF AN AGE DEPT. OF LEALTrI 8 \\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL PGOTECTIO \\\I\I 826 L Street - Anchorage, Alaks 88601 �y SINGLE FAMILY `\ ENVIRONMENTAL ENGINEERING DIVISION SEP 1 1 1981 Telephone 2844720 E RLSV.E D FACI REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER 7. WATER SUPPLY DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 110) days for processing. - 1. PROPERTYOWNER ' ATTACH WELL LOG. A well log is required for all wells drilled PHONE since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) MAILING ADDRESS - T V95-7 PROPERTY RESIDENT If different from above) PHONE ❑ PUBLICUTILITY hV�bic-Department. 2. BUYER PHONE E c 8 SON klorK 271 -33 - MAILING ADDRESS T U L 3. LENDING 1 TITUTION PHONE MAILING ADDRESS PC, /21- a XN AX 4. REALTOR/AGENT , tbi L v 1 8-C7S MAILING ADDRESS 3 300 - 202 Al C- i.w.+ 04 S. LEGAL 0TRIPTID L X1301enll�. STREET LOCATION FLr-NLN-AP s7- 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS �y SINGLE FAMILY ❑ One C-3Four❑ Other �` ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY - X INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM "If individual/on-site, give installation date EW >: INDIVIDUAL/ON-SITE" �v°rtwe{2�yearealAenedegvacgtestirregvired ❑ PUBLICUTILITY hV�bic-Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATEQ 72-010(3/78) 1 - �, (2`-( THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE - DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ 'THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY - ❑ PUBLIC UTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED - 3. SEWAGE DISPOSAL SYSTEM ❑IND] VIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING .. t ' ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS W API Z ✓� G �% 91--CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE III 1—e 7 t f 1 BY Title 0,2( /Z(4,r LEGAL DESCRIPTION 72-010 (Rev. 3!78) MON CHEMICAL e-`,Gi ;OGICAL LABORAT01 2S ^" ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER 1 274-3364 5633 8 Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: I.D. NO. Water System Name Phone No. Mailing Address - .l -7 - S4 City State Zip Code SAMPLE DATE: = =;,= Mo. ay veer SAMPLE TYPE: O Routine O Check Sample (for routine sample with lab ref. no. t ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE NO. !LOCATION .l 2 3 4 5 - READ INSTRUCTIONS BEFORE Time Collected Collected, By Analysis shows this Water SAMPLE to be: I ], Satisfactory Ll Unsatisfactory ❑ 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: O Fermentation Tube p.Membrane Filter Lab Ref. No. Results Analyst (,• r�� rl,� I � I, I , m l I m I m •NO of mionm✓100 ml, q NO,of .OMI" p ,i'.m 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Per. 1978 Date collected Sour" a.m. EMB Brom 24 boom Broth A hours, COLLECTING SAMPLE Multiple Tuba Report, 10mi Tub" P90 M/rotal laml Portlorla Membrane Fetes Direct Count Collrorm/106ml Verification. LTB BOB Final Membrane Filter Results r' collfoml/IOenll Reported NY •� n �s r Date Time, r a.m. P.M. n =z C R J Oa f Or � O (D O® w ®O N C ~ ♦ A ♦ A r I -` —EAGI, O N O - Jj � Z• Om ~ 4 O Z 4- r � a Y Q + W �_— C'p Z � __. \ r ♦ t C R J