HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 7 LT 1
; ~,UNICIPALITY OF ANCHORAGE~
~ ~- Hea n and Environmental Prote~
· Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
I/'q 51 DE LEFIGTH
INSIDE WIDTH
LIQUID DEPTH
NUMBER OF
COMPARTMENTS _ ~
LIQUID CAPACITYJ_~"~ GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WE LL~4~f"/T"'"L"~_"~_t_ FOU NDAT ION .... c¢'~0/ NEAREST LOT LINE /*~'~ r:~ oFTOTALI~INELENGTH_ ~ ~ 11.
t! of Lines ........ J DISTANCE BETWEEN t If'"ES --~.~-.-/A----TRENCI4viIDTH~LIN. TOTAL EFFECTIVE
Ai,SOHPT'OS4 AREA---2~ SQ. FT. LENGTH OF EACI' LINE Z/R '
j DEPTlt OF FILTER /
DEPII,: lOP OF IILE TO f !hIISt, GRADE ._~ MA1ERIAL BENEATH TILE._~ '__~ ABOVE TILE ~ .IN.
SEEPAGE PIT:
Log Crib Rings
13UiL_DIP,~G FOL;NDATIO['~I___
DIAMETER __OR WIDTH LENGTH_ , DEPTH
Crib Size: DIAMETER .... DEPTtt_ DISTANCE FROM: WELL
1OTAL EFFECTIVE
NEAREST LOF LINE__ ABSORPTION AREA (WALL AREA)
SQ. F'F.
~11
Lass :~3, Depth:
~11 Distance To: Lot LSne
~dg: Sewe~-~ Line :.~
ipe Materials:
of Bedrooms:
~staller:
7marks:
- Depa -'~ent of Health a;ld.Enwronmellta3
~ *" ' Anchorage 'Alaska
- fo ed for ': ~05~ /'~: ~ · '
Lega~ ue.,crlpc'lon: : &/ ~-7 '~- ~-'
This for,I report..' ~ '-~'~So~ls ...................... 1~9.. -- ................
-
Feet ' ' ,
Was ground wa~;er encounterad?:
'Reading'
~~- . pate ' Gross Tim · Net Time : _ _~ptj~z~p W~t? Neb 'droptt? ,;']'"-¢ ..
lercola[~on tale I",~'/~" inure ':
Pro)osed insta,11at)on: g~epage Iht .... lrai
'
COI.lt'ENTS: ................. - ...... ~ .... ....
Dri
Dri
WELL CONSTRUCTION LOG
Wel owner .~a~ ~P~ ~ 5~ Nearest community
Well location: (address & legal des~tion)~0~/ /~/~.~ Location ,k, tch or r,marks
Oepth of well /2~ ft. Casing'. depth ~'q ft. diem.. ~
Static water level ft. (above. below) lend surface. Date
Finish of well: (open-end, screen, perforated, ~other)
Describe intervals and size:
Well yield tested by (pumping, bailing, air) at
for hours with
.gal/miff.
ft. of drawdown from static level.
DRILLER'S MATERIAL LOG
Depth below land
surface in feet
Give description of strata penetrated
(size of material, color, hardness of drilling, and water content)
f~'MUNICIPALITY OF ANCHORAG~
DEPARTMt '~ OF HEALTH AND ENVIRONMEN~ PROTECTION
825 L Street, Anchoraa~. AlasKa 99501
264-4720
Date Received: February 28, 1978
#1: Time 9:30 a.m.
~2: Time #3: Time
Date 3-2-78 Thursday Date Date
Insp Pratt ~Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Alaska
Mailing Address:
Phone:
2. Property Owner: Mose PENDERGRASS Phone: 349-4207
Mailing Address: Star Route a Box 1585-B 99507
3. Legal Description: Lot 1 Block 7 Mountain Park Estates ~2
4: Single Family Residence: (x) Number of Bedrooms: Four
Multiple Family Residence: ( ) Number of Bedrooms:
Well System:
Permit #
Construction
Individual well (x) Community/Public System ( )
Depth of Well ~ ~ ~ Well Log on File
Bacterial Analysis
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System (x) Public Utility
Installed 1977 Installer
Manufacturer
Soils Rate Material
( )
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot.line Absorption Area
to Nearest Lot Line
Page -~wo
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 1 Block 7 Mountain Park Estates ~2 Subdivision
Comments:
Affadavit Attached:~ )
Approved: ~_~ ~r~~/~~
Disapproved:
Letter Attached
Date:
Date:
Department Worksheet:
(ep!s ~aWo oaS) --03OlAOUd ~9V83A03 33NVBflSfll 0N 008£ m~o~ Se
~V~lSOd
~g8 ............Aluo easseJppe o1 ~Ja^!lap ql!M ·
~g~ "paJaA!Iap a~aqa pue elep 'moq~ o1 s~oq$ ': ld1~038
~g9 ............~luo eassaJppe oT X]aA!lap ql!M '~
~g! ........... pa~a^!lap aiep pue moqa oi
--$33J 1VN01LIOQV UO~ S]OIRU]S 1VNOII~d0
]ooo dlZ o~3~¥is "oma
'oN aNY 133B15
Oi IN35
(e~SeTsod snld) ~0£--91Vl61 O31.-II.LB30 BOJ J. dl303B
· ~" ! MUNICIPALITY OF ANCHORAGL
, , Protection
~ i Department of Health and Environmental
/[~~/ 825 L Street, Anchorage, Alaska 99501
264-4720 ~
~ ~quest for Approval of Individual Sewer and Wa~er Facilities~
1. Property Owner: ~ g~ ,~ ~ ~7~/~?~/~
Mailing Address: ~/~, .~ /~m-~ Phone:
2o
Name of Buyer: /~ ~
Mailing Address: ~
Phone:
Se
Lending Institution:
Mailing Address:
Realtor/Agent: ~6JDq ~Q~C//~
Mailing Address:
Legal Description: r/~/tT~
Street Location:
Phone:
Phone:
Single Family Residence:
Multiple Family Residence:
Number of Bedrooms:
Number of Bedrooms:
o
Water Supply:_ *Individual Well
If Individual Welt, well depth
If Community System, name of system
Public/Community System
( )
Sewage Disposal System: *~n-site System
If On-site System, date of installation:
Public System ( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
.test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
06-1220(a) Rev. 1973
DATE
AL~
BACTERIOLOGICAL
DEPARTMENT OF HEALTEAND SOCIAL ~ 'CES
DIVISION OF PUBLIC. HEALTH
INDIVIDUAL AND SEMI-PUBLIC
WATER ANALYSIS
Lab No.
OFFICE
INDIVIDUAL []
SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
CITY
ADDRESS
OF SOURCE _ ; - -_ .
ZIP CODE
COMPLETE THIS SECTION
ONLY IF WA. TER IS .:AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED TIME COLLECTED
Sample Collected From ~'[] Kitchen Tap [] Bathroorr Tap [] Basement Tap
[] Other (List)
Well -- [] Dug E Driven ~ Drilled
SOURCE: [] Spring [] CTstern [] Other
Dug Well or Cistern Conslructlon:
Walls--[] Wood [] Concrete [] Metal
Top -- [] Wood E Concrete [] Metal
LOCATION:
[] Jn Basement [] Basement Offsel
[]In Yard [] Other
Building 5ewer
DISTANCE TO: or Other Drainage Pipe
Tile Seepage Cess-
Field Feet. Pit __ Feet. Pool
Other Possible
Sources of Contamination
MATERIAL: Building Sewer- [] Cast Iron [] Wood [] Tile
[] Plastic Joint Material - Type
GENERAL: Does Water Become Muddy or Discolored?
When?
[] Tile Brick or
[] Open Top[] Concrete
[] Under House
Septic
Feet. Tank Feet,
Privy Feet.
[] Fibre [] Asbestos
E Yes [] No
Diameter of Well
Well Casing
Material Diameter
Length of
Drop Pipe
Offset in
PUMP LOCATION: [] In Well [] Basement
On Top
[] Of Well [] Other
PURPOSE OF EXAMINATION: Illness Suspected?
New Source of Supply? [] Yes
Depth Feet.
Depth
Water Depth
From Bottom Feet.
In Utility
[] n Basement [] Room
Analysis shows this Water SAMPLE to be:
[] .Satisfactory
[] Unsatisfactory
[] Questionable
[] Sample too long in transit; sample should not be over 48
hours old at examination to indicate reliable results. Please
send new sample.
[] Bottle broken in transit, please send new sample.
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
SANITARIAN'S REMARKS
~] Yes [] No -
[] No Repairs to System? [] Yes [] No Signature
o6-12~o (bi BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973 . ,
' ') (' L/ am'
Date Received , : - ? ='~Time Received 7 pm Lab. No.
Lactose Broth 10cc 10cc 10cc 10cc 10cc 1.0cc T.0cc
24 Hours
48 Hours - · - ~ ..... .-
Brilliant Green
24 Hours ( '
48 Hours
EMB AGAR
Lactose Broth, 24 hrs. 48 hrs.' Gram's stain
Coliform Dens~ty . (Most probable No. per 100cc)
MF Results
Reported by
ThTs analysts indicates Coliform Organisms to be: ,Absent"
Present
a.m.
