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Home My WebLink AboutEKLUTNA HGTS STEWART ADDN LT 22 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 P,~ONE ,,~EW I LIUPGRADE LOCATION Width NO. OF BEDROOMS, IF HOMEMADE: Well DISTANCE TO: Manufacturer ~o. of,,n.s / J Le,~th .¢'~:,~e, Length Width Inside length Dwelling Total I~Zli ties ~Jt~iar b~r~at~)(tile 'Depth Materia) Nearesblot Ib~ Trench ~dth ,'~(.~ inches ?.- /Cinches PERMIT NO. ~iquid capacity in gallons PERMIT ,~/~ j~ D ist a n c e ~/¢vTr~J~-e s Total effec~e a~so~Jtion area PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: :lass Depth Driller Distance to tot line DISTANCE TO: foundation Sewer line Septi~c tank PERMIT NO, Absorption area(s) OTHER PIPE MATERIALS Z INSTALLER ' // ~' V ~ EMAR ~S M -W DRILLING, Inc. P.O. Box 10-378 e 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner_71. . > im -----Use of WeILL_orsltic Location (address of: Township, Range, Section, if known; or distance main road— Size of casing --li—Depth of Hole- �Z�_feet Cased to -2, Static water level__12- , _ift. (above) (below) land surface. Finish of well (check one) open end Screen ( ) ; Perforated (X' Describe zareen or - Well pumping test atm C1__gallons per ftun) ----- -- r (minute) for -hours of drawdown from static level. Date of WELL LOG Depth in -feet from ground surface Give details of formations penetrated, size of jnaterial, color and hardness _TO_ ____ , T 0 -TO- 2_6 cobl) ',oval wet INWIVA Certified Contractor 3 — CONTRACTOR MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmental ~rotection 825 ~ Street, Anchorage, AK. ~9501 264-4720 ~>~/~_ * * * HANDWRITTEN PERMIT * * * Permit 4 ~ ,yELL.AND/OR ON-SITE SEWER PERMIT ~/i ~.. f'-'~ :. .. - , '/~ '~ '~) Location: Phone Number: ~' d;'~,/_. ~ ~"2 Legal Description: ~ 2 Z ~,~t~i £ LOt Size: Type of Soil,~sorption System Is: Trench: ~_ Drainfie!d: Seepage Bed: : Holding TankL ~ .._~_~./,~/,,// Maximum Number of Bedrooms: ~__~ Soil Rating(sq.ft/br) ~D~ ' The Required Size of the Soil Absorption System Is: DEPTH LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of 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). · * REQUIRED SEPTIC(HOLDING) TANK SIZE = . ." ~ GALLONS 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 wil. 1 serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by ~ Municipality of Anchorage. (2) I w~ instal~/./the system in accordance with codes. (3) I ~nd~tand/~hat the on-site sewer system may requ~e enlargement if %~e ~/~de~ is remodeled to include more that 3 ~e~rooms. i/:,:/ Date: ' ~u SWP/024(1/81) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 COMMENTS PERFORMED BY: ~,,:( >/"' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl., PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST .//!/ SOILS t_OG PERCOLATION TEST SLOPE SI FE PLAN Gross Net Reading Date Time Th'ne 5 '~ '5 ':'"* t:~ ....... i"; ? ', /, /'; /.., .5 " L ,1,,/~ Depth to Water l;; Not Drop PERCOLATION RATE -~" (minutes/inch) TEST RUN BETWEEN ' FT AND FT ? 72-008 (6/79) .;2]' ~/;~i?~. ,,, [.. ~//P~ MUNICIPALITY OF ANCHORAGE ,;~_~.-~.~%~, ! ~(;v DE~ARTIVlENT OF HEALTH AND ENVIRONMIENTAL PROTECTION ~/ SOILS LOG -- PERCOLATION TEST PERFORMED FOR: / · LEGAL DESCRIPTION: SOILS LOG PERCOLATION TEST 10 11 12 13 14 15- 16- 17- 18- 19 2O COMMENTS 72~008 (6/79) WAS GROUND WATER /~2 ," ENCOUNTERED? ~"~ IF YES, AT WHAT DEPTH? Reading Date PERCOLATION RATE __ Gross Net Depth to Time Time Water , TEST RUN BETWEEN A)/ FT AND CERTIFIED '" ' ( L.:f_/' (minutes/inch) ~.~2 . F'I- Net Drop APPLI \NT FILLS OUT UPPER : ONLY ....... ' Property Owner Buyer /,; ..,/:: Address Zip Code :,/~' :":/ 0 _ Zip Code Phone Lending Institut on _~-J..,-?'~'¢'~:-.--~:.; ......... -~';~?.~:'-,~:"~:"~.~;~:~."z'---C~z','~'G~'// ' Phone ,-~,.t/ .' Address ¢; -:,... 4 ¢4" , ' Realty Co. & Agent /.)%q,///~:,..?. (;; .( ,,:~ /:~:,:. ,, ~ . ///:.(~ , Phone Address/, / · ~ ,- . y. ,, :~~ ,,../,. . Type of Residence ~].¢Single Family [2~ Multiple Family No. of Bedrooms E3 Other Water Supply ~ 1975 ~¢' dividual ~ ATTACH WELL LOG. A well log is required for all wells drilled sin6e Jnne . E] Community ~ For wells drilled prior to that date, give well depth (attach log if available). ~ Publ c Ut y ..... / Sewer Disposal ~'ff~dividual Year Individual Installed: [ J Public (Jtility When Connected to Public Ulility: t l Homd~nk ............................................... NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUES1 BEFORE FeqOCESSING CAN BE INITIATED. Time Time Time Time ................................. ~'~:, Date Date Date Date ~ I .',' Insp~tor Insp~tor Insp~tor Insp~to~ F, ield Notes: ('~..APPROVED BEDROOMS "CONI)ITIONS OF AI>PROVAI ( ) DISAPPROVED ( ) CONDITIONAl. Ai?ROVAL* CHEMICAL & G ~LOGICAL LABORATORIES F ALASKA, INC. TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Water System Name Phone No. Mailing Address City State Zip Code MO. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. , I I 4 I I LOCATION Time Collected Collectect By TO BE COMPLETED BY LABORATORY Analys~s snows tn~s Water SAMPLE to oe: [] Satisfactory [] Unsatisfactory [] SamDleToo ongmtransit: sample should not be over 48 hours om at examma[~on to nd~cate reliable results Please send new sample. Date Received Time Received Analytical Method: [] Fermentation Tube [] ~Membrane Filter Lab Ref. No. Result* Analyst J J I-[-] READ INSTRUCTIONS BEFORE COLLECTING SAM PLE 06-1220 (b} Rev. 1978 BACTERIOLOGICAL WATER ANAI'YSIS RECORD Date C ollecteci Source a.mo Time ReCelvecl Lab. NO. Presumptive 10mi 1Omi 10mi 1Omi 10mt 1.0mi 0.1mi 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB Broth 24 hours: Multiple Tube Report: Membrane Filter: Direct Count verification: LTB Final Membrane Filter Results Reoor t~cl By Broth 48 hours: 1Omi Tubes Positive/Total 10mi Po~tlo~l Collform/100ml BGB Date Collform/100ml Time- &,m. p.m.