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Home My WebLink AboutPROSPECT HEIGHTS BLK 1 LT 8B MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE [~UPGRADE MAI LING ADDR ES~ LEGAL DESCRIPTION DISTANCE TO: Manufacturer Liq. DISTANCE TO: Man ufacturer LOCATION 1 I^bs°rpt'°n"' e I nside length IF HOMEMADE: Dwelling JWidth ~. NO. OF BEDROOMS ,_~, PERM,TNO.? No. of comp~_,~ts Liquid d e pt h,_.~ Dwelling Material PERMIT NO. We, No.~'o~,~.~,;cET°: i Length of eaeh ,n.3 le to finish grade Foundation Total length of Iines.~ Material beneath tile Nearest Jot line Trench width Length Type of crib Width Depth PERMITNO-.~ O(Z~ Dis,anee bet 7 Total effective ~f~;~orption area PERMIT NO. D.~g~CE TO: Well Depth DISTANCE TO: Building foun.~ati~nO OTHER ng foundation Driller Sewer line PIPEMAT~.~ ~_ ~ ' I NSTAL~(_,~~ REMARKS LEGAL Total effective absorption area Distance to lot Septic tank ~ too ]PERMIT NO~ ~ Absorption area(s) , PERMIT NO. FtF"PL. I C:RNT LOCFIT I ON I_EGFIL I<ENIqET[4 ]'l' 'EFY,,,'rlL.~ PROS;F"EC:T DR LSD BfL PF.'.OSPECT HTS [:,EF'F!R]ff'IENT OF' HEF:ILTH FIN[:, ENV!RONMENTFfL [::'ROTECT'[Cf-4 .... 825 '"L"' STREET.. FtNCH']RFIGE., FIK. 9951Ed.. ,:: ';::'90066 ) BOX :t.O-ZD4: SO. STF1T.rOf',t ]:44 77!7 LOT SIZE 4.6200 S6!I..IFtR. E FE[ii:T TVF'E OF SOIL RBSOF..:EF['ION SYSTEM IS: 'T'REi'.4E:H MRXIMLIM NUMI3ER OF BEf}ROOMS, = 3 SOIL RR"f'ING (5;Q Fr'T/BI;4)= 85 THE REQUIRED SIZE OF: ]"HE SOIL I:IE:SORPTION S'¢STEH IS: THE" LENG'f'H DIME]qSION IS THE !...ENGTH (IN FEET) OF THE TRENCH OR [:,F..:FIIi'.4F!EL.[). THE [:,EPTFI OF F:I ]'RENCH OR PIT ):S THE [:,ISTFtI'qCE BE'f'I.,.IEEN ']"FIE: SUF.:FRCE 0F THE GROLIN[) RND THE E',OTTOH OF' THE EY:CRVRTtON ,.':IN FEET). THERE IS NO SE:T 1.4.r[:,TH FOR ]"RENCHES. THE GRRVEL. [:,EF'TH 'rS THE MINIMUH [:,EF'TH Of:' GF..tRVEL BETP.IEEN THE OLITF'FIL. L PIPE RN[." TFIE BOTTOM OF' THE E',dC:RVRTION (IN FEET). PE:RMIT FIPPLtCFINT HRS THE RESPOIqSISII_IT"r' TO INFORi'd THIS DEPRRTHENT [:'U[RIi",!G THE INSTFILI..RTION INSPECTIONS OF' t::IN'¢ HELL'::; RD,:rRCENT TO THIS PF..'OPERT'¢ FIND, THE NUMBER OF I:~:E:'..'.];IDEi'4C[ES THFIT ]"HE WEt..L !,.IILL SERVE. E~FICKF~LL.rNG OF RNV ':S'¢'::5TEM HITHOLIT FINFII.... .rNSPECTICIN RNE:, RPPRO',,,'FIL. B"r' TI'4'rS [:'EPk]F.'.TMENT HILL. BE.'". SUE"]JECT TO PROSE:CLITION. MINIMUM DI':..]TFII'.,ICE 8ETHEEN R WELL FIN[::, FIN'.r' ON-SITE SEI.qFIGE D.rSPOSFI[.. S'¢STEM IS :L00 FEET FOR FI PRI',,iFITE NEt..L.~ OR :l. SF~ '['0 20C.~ FEET FROH FI PUBLIC !.,.IELL DEPENE:,ING UPON THE 'TYPE CIF F'USLIC I.,.!ELI. .... HEL..L LOGS FIR[.--. REQUIRED F:IN[:, MLIST 13E RE:TURNE[:, 'FO THE DEF:'F~RTMENT HITHII'.,I Z.':O [:,FI'?'S OF THE HELL C:OI"IF'LET]:Cd'.4. OTHER RE[.:PJ'rREMENTS l'dF!'.r' FIPPL'.?. SPECIF'rCFITIONS FIND CONSTRUC]"ION !}ZFIGRFII"IS FIRE RVRILRBLE TO IN:~UF.'.E PROF'ER 'rN~:-.,TFILLFITION. I CERTIFY T[4RT !: I Ffl',l FFIMILIFIR HITH THE REQUIREMENTS FOR ON-S, ITE E;EI.,.IERE; RND HELLS R.S SET FORTH B'¢ THE MUN.rCIPFILIT¥ OF FINC:HORFiGE. 2: I HILL INSTRL. L THE S¥S]"EM IN RCCORDRNCE HITH THE E:O[:,ES. .3:: I UN[:,E'RSTF:IND THRT THE ON.-SITE SEHER S'¢STI!Ef'I HRY REL-]UIRE EI'.,IL.F1RGEMENT IF' 'T'F!E RES.rDENCE Ii.E; REMODEL. ED TO INCLU[:.',E MORE: THF:fN 3: BEDF,'.OOHS. ......... :_ ...................... /. ....... ...... :,.....,..,..,,._..__.. . PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6.650, Anchorage, Alaska 99502 276-222~' SOILS LOG -- PERCOLATION TEST DATE PERFORMED: [~' SOl LS LOG [] PERCOLATION TEST 1 2 3 4 5 6 8 9 10 11 13 14 16 17 20- ;LOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS TEST RUN BETWEEN FT AND ' -' ~ FT PE.FORMED BY: CO ia'~'1~' CERTIFIEDBY: ~ ~~ WELL,OWNER LOCATION A WATER WELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 9950! MUNJ .ILITY OF ANCHORAGE DEPT. O~: i!~.~LT;-t & ~NVIRONMF_NTAL i ~:.OrL~CTION SIZE OF CA~ING L "DEPTH OF HOLEJ~T. CASED TO ~-~/') FT. STATIC WATER LEVEL ~ ~ FTo YIELD~-~' GALoPER.MIN. WITH~ DATE COMPLETe, ~-~-- 7'¢ PU~ TO BE $~ AT Oto/N ALV/v/ ~)~. ~"~,-,n. /.~t o ~) ALVN ~to to ~o to~ to , to to~ ~0 to _~0m , ~tO ~ DATER ECEIVED INSPECTION APPOI ~ITMENTS (~-(_X.2-~(~/jj~.~' ~__~,~ TI~JE TIME TIME DATE DATE DATE INSPEC~R · INSPECTOR INSPECTOR MUNic~PALi~ OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF ItEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEOTIo~NVIRONMENTAL PROTE~ION 825 L Street - Anchorage, Alaska 99501 NOV 1 6 1979 ENVl RON~ENTAL SANITATION DIVISION REQUEST FOR APPROVAL DIRECTIONS: Complete all parts on page 1. I,oomplete requests will not be proae~e~. Please allow ten (10) days for processing. 1. PROPE~TYO~NE~ ~ . PHONE jz/z/_ 7 7/7 MAILING ADDRESS/ - PROPERTY RESIDENT (If different from above) z PHONE 2, BUYER PHONE MAIU~G 4. REALTOR/AGENT ~ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOOATIbN ~ 6. TYPE OF RESIDENCE [~ SINGLE FAMILY ~ MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF~BEDROO~/ ~ / ~ One ~ Four ~ Other~ ~ Two ~ Five ~'~ Three ~ Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) B. SEWAGE o,sPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [~ PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) ] i & eEOLOelCAL LABORATORIES OF ALASKA, iNC. P.O. BOX 4-1276 4649 BUSINESS PARK BLVD. ANCHORAGE, ALASKA 99509 Drinking Water Analysis RePort for Total Coliform Bacteria-. TELEPHONE (907) 279-4014 TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM: I.D. NO. ,,~ MilII~ City Slate Mo. Day Year Zip Code SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose r- Treated Water E Untreated Water SAMPLE NO. LOCATION Time Collected Collected By ] TO BE COMPLETED BY LABORATORY LABORATORY: NAME ADDREss Date Received Time Received Analytical Method: CITY /? [] Fermentation Tube 5. Membrane Filter Lab Ref. No. Result* Analyst * No. o! colonial ! tOO mi. or NO. ol Pollllve perllon$. 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) Date Collected_ Source ~3ate Received Time Received p.m. Lab, NO, 24 Hours 48 Hours 3onflrmatory 48 Hours EMB_ Broth 24 bouts: Broth 48 hours: Multi ~)le Tube Report: 10mi Tubes Positive/Total 1Omi PortJorl$ Membrane Filter: Direct Count Collform/10Oml Verification: LTB BGB Fina Membrane Filter R~s~lts ~..~,~,-.-'/ orm/lO0rnl Reported By __~, Date THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [~ OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL sySTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~:~ Connection Verified. INSTALLER []Septic Tank or [~ Holding Tank Size: /,~.~) If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank ]Absorption Area Sewer Line I Nearest Lot"'Line WELLTO: I 5, COMMENTS ~ APPROVED FOR ._~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY