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Home My WebLink AboutDIANA LT 2 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 IPHONE I ~NEW Ver~Flower I 274-3944I []UPGRADE MAILING ADDRESS P.0. Box 4-2733 LEGAL DESCRIPTION Lot 2, Diana Subd. LOCATION 8211 Nadine ~3 ~ ~ ~)t~J~ NO. ~F BEDROOMS IWell I Absorr~on area Dwelling PERMIT NO.~0~0~ ~ ~ DISTANCE TO: 162 40 Manufacturer Material NO. of compartments ~chorage Tank Steel 2 Liq. ~ap~c~ in gallons Inside length Width Liquid depth ~ . IF HOME.DE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~Z O Z ~ Manufacturer · -- ~ Material Liquid capacity in gallons ~ Q ~ DISTANCE TO: Well~0 Foundation ~0 Nearest lot I~ PERMIT NO. ~ - o same -- ~ ~ ~ ~ Z No. of lines 1 Length of ear, line Total ,~h of lines Trench6~dth inches Distance between lines NA ~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area Q ~6 f~, 90 inches Length Width Depth ~ PERMIT NO. ~ ~ ; Type of crib Crib diameter Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~ in. PVC SOl h TEST RATING 95/b~m INSTALLER Schachle ~. ~ REMARKS Pipe in place above washed rock 4'~ with plastic. ~ ~' '~ :h- ¢¢A~OVED /~ ~/~ DATE LEGAL 72-013 ~R~v PERMIT NO. MtJN I C I F ~L I TM OF RNCHL, RRGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 "L' STREET~ ANCHORAG& AK. 99501 264-4?20 WELL AND ON--S I TE SEWER PERM I T ( 780901 ) APPLICANT MEAN FLOWER LOCATION NADI~ LEGAL L 8211NRDINE ST LOT SIZE 2?4 ~44 ~000 SQUARE FEET TYI:{ OF SOIL ABSORBTION SYSTEM IS: TRENCH MflXIMUMNUMBER OF BEDROOMS = ~ ~OIL RATING (SQ FT?BR>= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 12 LENGTH= 2i GRAVEL DEPTH= 7 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD, THE: DEPTH ~ 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). REQU I RED SEPT I C TANK S I ZE= 1000 ~]ALLONS 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. TWO (2 > INSPECT IONS ARE REQU I RED BRCKF ILL I NG OF ANY SYSTEM W I THOUT F I NAL INSPECT I ON AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELb OR i150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE T~PE OF PUBLIC WELL, WELL LOGS ARE REQUIRED AND ~UST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION, OTHER REQUIREMENTS MAY APPLY, SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION, PERM I T EXP I RES DECEMBER ~:L. 1978 I CERTIFY THAT .i: I AM FAMILIAR WITH THE REQUIREMENTS 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. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS ~MODELED TO INCLUDE MORE THAN ~ BEDROOMS, , ............... APP~NT VERN FLOWER ...... MUNiC'IPAL~I~Y OF ANCHORAGE Pouch G~50, Anchorages, Alzmk;~ 99502 :-~7G-222 SOILS LOG .- PERCOLATION 'i'EST SOt t..,S ES I I-:(~AI '1 1i i(.; - f' (:() L A,T !(.~Fi I~/\I i DA'Ii: I--' ~D'~-~C--~°O MUNICIPALITY OF ANCHORAGE~3~C3 ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P/~('}'J'ECTION & ENVIRONMENTAL ENGINEERING DIVISION NOV 2 7 1978 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow.ten (10) days for processing. 1. PROP~RTY~WNER ~~~ IPHONE PROPERTY RESIDENT (l~dif(erent fr~ able) .... ~ PHONE ~- ~UYER PHONE MAILING ADDRESS Ua~L~N~ ~DDRESS ~ ~. ~. ~EALIOR/AGENT ~ J PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] ' MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled pripr to that date, give well depth (attach log if available.) '//(~ 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date_.~__.~ / ~.t'),f'~. If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-~)10(3/78) ' THIS SIDE FOR OFFICIAL USE ONLY ~ DATE RECEIVED NSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSP ECTOR I NSP ECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE [-~PUBLIC UTILITY Connection Verified E~SepticTank~or [] Holding Tank Size:. (~,~'L~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER [] OTHER DATE INSTALLED I NSTALLER~~.~, SOILS RATING MATERIAL Sewer Line Septic/Holding Tank ]Absorption Area INearest Lot Line 5. COMMENTS J~C~OVED FOR ~, BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE LEGAL DES--~-~'IPTION BY (Title) 72-010 (Rev. 3/78) CtlEMIOAL &eEOLOelCAL LABO~~ OF AI.AS~ INC. ' I I I ;~: I . P.O. BOX 4-1276 ~- ,ANCHORAGE, ALASKA 99509 484BBUSINESS PARK BLVD. Ddnking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SU~IER { i i PUBLIC WATER SYSTEM: ',' I.D. NO. ...~- Pu~iic Water Syat~-N~l~!e ...... MMIIng Addrea~ Cily Slala Zip Code Mo. Day Year ~ TELEPHONE (907) 279,4014 TO BE COMPLETED BY LABORATORY LABORATORY:. 'i r ~ ADDRESS ANCtlORAGE, AL~SF, A*" 99502 Date Received Time Received CITY SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no, [] Special Purpose [] Treated Water [] Untreated Water Analytical Method: [] Fermentation Tube ~J~ Membrane Filter SAMPLE NO, 1 2 3 ,, 4 5 LOCATION l Time Collected Lab Ref. No. Result* Analyst Collected By, ... , ~1~' · No. of colonlee 1100 mi. or No. o! Positive porllons. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) 06-].220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected source Lab. No. Presumptive 10mi 10mi 10mi 10mi 10mi Z,0ml 0.1mi 24 Hours 48 Hours confirmatory , 24 Hours 48 Hours EMB Broth 24 I~ours: Multiple Tube ReDor.~,~ Membrane Filter: Dir~t Count Verification: L. TB Final Membrane Filter Results Reportecl By~---~L"t'"':~""l'"" Broth 48 hours: 10mi Tubes Positive/Total 10mi Portions Collform/100ml BGB, Collform/lOoml Date ~l- Time: