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Home My WebLink AboutCOTTONWOOD HEIGHTS BLK 1 LT 4c> on woo cl i% 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 ~ / ' ~ UPGRADE LEGAL DESCRIPTION ~ DISTANCE TO: ]WelfiOO' 6 I Absorp2~rea ~ Z Manufacturer M~ ~ ~ ~OTee- [ No. of compartme~ Liv~ci.~gall°ns I IF HOMEMADE: Inside length Width Liquid depth ~--~ Manufacturer / /~ Material Liquid capacity in gallons ~ ~ DISTANCE T O: We ll/~ 7( ~ Found at ion ~ Q~ ~ Top of tile to f~ ~a~ ~e¢~l~L~e~t~il~ ~ ~¢inches Total effecti~ absorption area Length Width Depth PERMIT NO, ~ ~ T~pe of crib Crib Crib Oepth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ DISTA~Cfi TO: ~uilOin~ foundation Se~er line Septic tank Absorption area{s) PIPE MATERIALS 13 (Rev. 3/78) k~ o o o 0 o o o 0 o o o ~ PERMIT NO. ~-11_1~ ICI ~'I--]LIT'~ CIF RNCHnRRGE DEPBRTMENT HEBLTH 8ND ENVIRONMENTBL ~OTECTION 825 ~L~ STREET, 8NCHORBGE, ~K. 99501 264-4720 1,4ELL Rr-tE:. I]r-~--SITE ~SEI.4E~: E'En:b11 1- ( 8i02~5 ) RPPLICRNT LOCRTION LEGRL MICHREL J. POLVEFKO BOX 6~0 W. DIVISION STREET L 4 B 1 COTTONWOOD HEIGHTS LRKE RIDGE DRIVE 99 688-24~8 LOT SIZE 44550 SQURRE FEET TYPE OF:,U'-- IL RE,_ORFTI~.N"~ ' ' '~ ~-,'_ m_TEM'~, I~_ · T~CH ,, .,-,= MRXIMLIM NUMBER OF BE. DE. OUM_, = t THE REQLIIRED SIZE OF THE SOIL 8BSORF'T~ SYSTEM I [:,EF"TH= iE1 LE~4GTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SI.IRFRCE OF THE GROUND RND THE BOTTOM OF THE EXCBVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRL. L PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). REGILi I ~E[) SEPT I PERMIT RPPLICRNT HRS THE RESPONSIBILIT9 TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RN9 WELLS 8DJRCENT TO THIS PROPERT9 RND THE NUMBER OF RESIDENCES THRT THE WELL. WILL SERVE. TPII] (2) I r-ISPEI]TII]f4S RRE ~:EG!LIIRE£) BRCKFILLING OF RNY SVSTEM WITHOUT FINRL INSPECTION RND RPPROVRL 89 THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RN9 ON-SITE SEWRGE DISPOSRL SYSTEM IS ~00 FEET FOR R PRIVRTE WELL OR ~50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TVPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM 8 PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS 8RE REQUIRED 8ND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MR9 RPPLV. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE 8VRILRBLE TO INSURE PROPER INSTRLLRTION. F"E~."r-1 I T E:=4F' I t~:E:5 [:,EC:EI'-IBER _--<:IL.. I CERTIFY THRT i: I 8M FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIP8LITV OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN 8CCORDRNCE WITH THE CODES. }: I UNDERSTRND THRT THE ON-SITE SEWER SVSTEM M89 REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE TH8N ~ BEDROOMS. SIGNED: RPPLICRNT MICHREL J. POLYEFKO Department 825 Applicant,: Location: Legal Description: ~-~ ~/ ~, Type of Soil Absorption System Is: Trench: !/ Drainfield: M,aximum Numberof Bedrooms: ~ MUNICIPALITY Of ANCHORAGE f Health and Environmenta Protection L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON'SITE SEWER PERMIT J, ~6/~0 Mailing Address: ~-~f ~ 30 , Phone Number:, Seepage Bed: Holding Tank: ,Soil Rating (sq,.ft/br) /.~ DEPTH The Required Size of the Soil Absorption System Is: ~) LENGTH 3 ~'-,.'., . GRAVEL DEPTH ~P ' WIDTH The length dimension is'the length(in feet).of the trench or drainfield. The depth of atr. ench 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. i~he gravel depth is the 'minimum 'depth of gravel between the outfall pipe and 'the .bottom ~f the excavation(in feet). · * REQUIRED SEPTIC(HOLDING)TANK SIZE '= /~O~ 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 will serve. ' · * *TWO(2) 'INSPECTIONS ARE .REQUIRED ~ * * Backfilling of any system without .final inspection,and approval by this department wiI1 be~subject to prosecution. M~nimum distance between a well :and any on-site sewage disposal system is 100 feet for a private well or 1'50 to 200 feet from :a public well depending upon the type of public well. Minimum.distance from a private ~ell to a private .sewer line is 25 feet and to a community~sewer .line .is"'75 feet. Well logs are required and must .be r~eturned to 'this department within 30 days of the well completion. Other requirements may .apply. Specifications and construction diagrams are a~ait~ble to insure proper installation. * * * PERMIT EXPt-RES D:ECEMBER 31,, 1 9 8 1 '* '* * i certify that: (1) ii am f~amiliar with the requirements 'for 'on-site sewers and wells as set forth by the Municipality o,f knchorage. (2) I will install the system in accordance with codes. (3) I understand that tb~on-~ite sewer 'system may require enlargement if the resid~nce/~.~s~,m~~/-J~~ude more that 3 bedrooms. Date: (//,,,~../~ / SWP/024(1/81) [] SOILS LOG PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 · '~=-" 4 5 14 ~7 18 20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE ENCOUNTERED? . IF YES, AT WHAT DEPTH? [] PERCOLATION TEST SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop Robert A. She 72-008 (6/79) ~- ~- .. ' " f - / DATE I~ECEIVED "~ - INSPECTION APPOI_NTMENTS TIME .... ' ~-- T ME '~..~ 'G {~ ~) ~ TIME ' /'~/ ' MUNICIPALITY OF ANCHORAGE- ~ DEPT. ~F ~EALTH~ ~~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEc~IRONMENTAL PROT ~ION ~.; ~ 825 L 8tr,~ - Ancho.~, Alaska ~$01 s NOV 1 ? 1981 (~!~) "VI RONMENTAL SANITATION DIVISION ~ Telepho~ 2~720 RECEIVED REQUEST FOR APPROVALOF INDIVIDUAL WATERAND SEWER FACILITIES DIRECTIONS= Complete all pa~s on page 1. I ncempl~e r~u~ will not be p~d. Please allow ten (10) days for processing. 1. PROPE~TYO~NER / pROPErTY R E~I DENT (If different~rom above) ' ~ ' - PHONE - , . MAILt~G ADD~ESS, ~ / ~ 3, LEN~NG INSTITUTION ~ ~ / ] PHONE ~AICING ADDRESS MAI~/ ~: I [] 1--1 qther [~/~SINGLE FAMILY [] Two [] Five [] MU LTIPLE FAMILY . [] Three [] Six - 7. WATER s~rLy' ..... [3~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to. that date, g!ve well I [] PUBLIC UTI LITY ' depth'iattach Iogif available.) ...... ~.~ 8. SEWAGE DISPOSA'I. SYSTEM ' ' .... :'- '-' "':' ' - ~DIVIDUAL/ON-SITE** 8/ YEAR ON-SITE SYSTEM WAS INSTALLED, i [] NOTE: THE INSPECTION FEE MUSTACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM F-I INDIVI DUAL/ON -SITE r--] PUBLIC UTILITY Connection Verified []Septic Tank or l--IHolding Tank Size: /=~--5-'O If Tank is homemade give dimensions: THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS TYPE OF TANK TOTAL ABSORPTION AR EA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] ONE [] THREE [] FIVE [] OTHER [] TWO [] FOUR [] SIX PERMIT.NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER MATERIAL T..,¢ ~-~ Septic/Holding Tank IAbsorption Area JSewer Line INbarest Lot Line 5. COMMENTS Re:ED FO R~'"~~'"' BEDROOMS []~'"~CONDITIONAL APPROVAL (letter muTt')accompany certificate) [] D,SAPP OVED 72-010 ( Rev. 6/79) CHEMICAL OGICAL LABORATORIES ~ ALASKA, INC.~ TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: . ,-~ '? ~., /~'" , / / t' /.,~' .~ i W~te~ System N~me 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, LOCATION I Time Collected Colleoted By TO'~BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: .[~Satisfactory [-I Unsatisfactory [] Sample too long n 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: [] Fermentation Tube .r~ Membrane Filter II Lab Ref. No. Result* Analyst I I r-I-] i [-1-1 I *No. of colonies/100 mi. or No. of Positive portions. 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Date Collecte0 Source Date Rlcelv~l Time Recelve(I __ p.m. Lab. No. Presumptive 10mi 10mi 10mi 10mi 10mi 1.0mi 0.1mi 24 Hours 48 Hours Confirmatory 24 Hours ,48 Hours , EMB. Broth 24 hours: Broth 48 houri: Multiple Tube Report: 10mi Tubas Posltlve/'rotal 10mi Portions Membrane Filter: Direct Count Collform/100ml Verification: L.TB BGB Final Membrane Filter Results :: .~ Collform/100ml Reported By Timer ,: , ~ . ,' ~' a.m. p.m.