HomeMy WebLinkAboutMAJESTIC VALLEY ESTATES BLK 3 LT 4Majestic Valley
Estates
Block 3
Lot 4
#050-731-20
Municipality of Anchorage 111111rawlills" Is
On -Site Water and Wastewater Program • (907) 343-7904 0 Page 1 of
ON-SITE WASTEWATER INSPECTION REPORT my si
Permit Number: SOP131089 PID Number: 050-731-20
Dwelling: K Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New X Upgrade
Name:
Dean Davidson
ABSORPTION FIELD
[:]Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
25960 White Spruce Dr., Eagle River, AK
❑ other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
694-2545
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original gradeGravel
Ft.
depth beneath pipe
Ft.
Subdivision Block Lot
Majestic Valley Estates 3 4
Fill added above original grade
Ft.
Gavel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
100+'
100+'
NA
NA
25+'
TANK W Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1000 Gal.
Surface water
100+'
100+'
NA
NA
Material
Number of compartments
Lot Line
10+'
10+'
NA
NA
Steel
2
NA
Foundation
5+'
10+'
NA
NA
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
None
None
None
Gal.
Remarks Upgrade was to tank only. See notes on
Pump on level at
Pump off level at
High water alarm at
P.3 of 3. House to tank pipe material & tank to
in.
in.
in.
leach field is ASTM w/label D3034
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank Tank to
drainfield
Dean Construction
Drainfield comer
Inspector F. Kenley
BENCHMARK (Assumed elevation) 100.00 ft
Ins dates: 1� 5/21/13 5/21 /13
Location and description
2-
3f°
Concrete slab next to garage.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
�s��1
Conditional Approval: Date
tp go..9 .
• T �'?
f J 8t
Approved zl, Date
� � I�ZI .� n r
I .� '
1�.Uv�(�
/ /20' UTILITY EASEMENT '
/ q'A
O
/ TFO
S
I
3 C
3 Bed Room
Lot rJ Residence
\ (aa
� M
7 7' 9 0'
\ x /
\ GREENHOUSE
12.2'X16.2' SHED -
SEPTIC CLEANOUT AND MONITOR
TUBE TYPICAL, SEE ORIGINAL
AS—BUILT-
Lot 4
UTILITY EASEMENT
\ BSS0.
Lot 8 \ `
I DRIVEWAY
New 1000 gal. septic \
tank. \
8.0'X16.2' LEAN—TO
Lot 3
DOUGLAS T. KENLEY, P.E. Civil Engineer ASBUILT
cuort. Dean Davidson
"Majestic Valley Estates S D, Block 3, Lot 4
'D0 25960 White Spruce Aven., Eagle River, AK %0 N11BE°'050-731-20 OSP131089
11/13/13 °H"'DTK °fl"""' FK '� 1" = 50' J0B X11' �"`"°°a"13108 1 SHEET 2 of 3
Existing 1000 gal.
septic tank was
replaced as per code.
yP�E OF q`,q`s`',1
*:'49 T .*
DIaas T. Kenley
''��l%,o ROFESSONP�������
�
O
\
Q
so
New 1000 gal. septic \
tank. \
8.0'X16.2' LEAN—TO
Lot 3
DOUGLAS T. KENLEY, P.E. Civil Engineer ASBUILT
cuort. Dean Davidson
"Majestic Valley Estates S D, Block 3, Lot 4
'D0 25960 White Spruce Aven., Eagle River, AK %0 N11BE°'050-731-20 OSP131089
11/13/13 °H"'DTK °fl"""' FK '� 1" = 50' J0B X11' �"`"°°a"13108 1 SHEET 2 of 3
Existing 1000 gal.
septic tank was
replaced as per code.
yP�E OF q`,q`s`',1
*:'49 T .*
DIaas T. Kenley
''��l%,o ROFESSONP�������
93.3'
1000 GALLON ANCHORAGE TANK
TANK SECTION (PROFILE)
NTS
NOTE: NEW TANK PLACED @ SAME DEPTH AS
EXISTING THAT WAS DECOMMISSIONED AS PER
CODE ON SITE. ELEVATIONS & SWINGTIES SHOWN.
THE DBL. WYE AFTER TANK CLEAN—OUT WAS
NOT INSTALLED AS PER OWNER'S INSTRUCTIONS.
HE SAID HE WOULD TAKE CARE OF IT WHEN &
IF HE EVER SELLS HIS HOUSE.
Distance between A & B =26.1' C & D = 28.3'
SWINGTIES
A
B
C
D
O
TCO -1
68.9'
55.1'
2OE
-2
77.3'
63.6'
L
12.2'
24.2'
DOUGLAS T. KENLEY, P.E. Civil Engineer I ASBUILT I
MOEE. NatlsVGrtN. Ptlmr.PIWU WME p0i1]K10)8
tl n' -Dean Davidson
c Volley Estates S/D, Block 3, Lot 4
White Spruce Aven., Eagle River, AK
5 'O' DTK ' FK ",.," NTS
1 —20 """" """°"` OSP 131089
13108 SHEET 3 OF 3
VSUL.
TO EXISTING SYSTEM
OFA
*: 49 TH
......................
yz
Dou»s . Kenley
I ,q CE -8176 i
?�
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
OSP131089
Tax Code Number:
05073120000
Work Type:
Septic
Permit Effective Dates: May 16, 2013 to May 16, 2014
Design Engineer:
DOUGLAS T KENLEY
Subdivision:
MAJESTIC VALLEY ESTATES
Site Legal Address: MAJESTIC VALLEY ESTATES BLK 3 LT 4 G:0363
Owner/Address: DAVIDSON REVOCABLE TRUST
DAVIDSON DEAN F & DONNA K 25960 WHITE SPRUCE DRIVE EAGLE RIVER AK 995779668
Site Mailing Address: 25960 WHITE SPRUCE DR, Eagle River
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy
Lot Size in Sq Ft: 54526
Total Bedrooms: 3
N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
By: Date:
Dater
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. a5n - 73/- 16
Property owner(s) De,.a.o Day phone 6 9y
Mailing address ;&`f6 o AK 99577
Site address d"fir/6 z./!„le x' f'
Legal description (Sub'd., Block & Lot) L2Uje'5 A"c Ute//ems E3 tAirs s/d
Legal description (Township, Range & Section)
Lot Size ✓''/SSC Sq. Ft.
THIS APPLICATION IS FOR:
(® all that apply)
Absorption Field ❑
Septic Tank
❑
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms -Y
THIS APPLICATION IS AN:
Initial
❑
Upgrade
Renewal
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
property goner or
Permit/Rush Fees: 010D 7011y,k Oh 61
Date of Payment: 5 ✓ 13%( 3 c4
Receipt Number: OS
Permit No. 05 P 120 O'M
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
G.'SuildingOn Sft\Foi \Client FonnsTermlt App 0[ 041 l.doc (Rev. 1/11)
SEPTIC TANK SPECIFICATIONS:
1. ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH M.O.A.
WASTEWATER CODE CHAPTER 15.65.050.
2. EXISTING TANK TO BE REMOVED & DISCARDED ON THE LOT ACCORDING TO CODE
REGULATIONS.
3. EXISTING 3—WAY HAND CORE DIVERSION VALVE, DBL.WYE—CO's & TWO SEPARATE
LEACH FIELD TO BE LEFT IN PLACE.
4. PROVIDE 10' MINIMUM SEPARATION BETWEEN EDGE OF TRENCH AND FOUNDATION.
5. PROVIDE 10' MINIMUM SEPARATION BETWEEN SEPTIC SYSTEM AND PROPERTY
LINE.
6. PROVIDE 100' MINIMUM SEPARATION BETWEEN SEPTIC SYSTEM, WELLS &
SURFACE WATER.
• ASSUMES DOMESTIC WATER USAGE FOR RESIDENTIAL HOME CONSUMPTION.
• CALCULATION METHOD OBTAINED FROM MUNICIPALITY OF ANCHORAGE "WASTEWATER
DISPOSAL CODE REGULATION" FEBRUARY 14, 2003; AMC 15.65.050.
NOTE: FOR APPLICABLE EXCAVATION, TRENCHING, AND SHORING SAFETY
STANDARDS, CONTACT THE STATE OF ALASKA, DEPARTMENT OF LABOR, OCCUPA—
TIONAL SAFETY AND HEALTH COMPLIANCE CONSULTATION, AND TRAINING DIVISION OF
LABOR STANDARDS AND SAFETY AT 269-4955.
DOUGLAS T. KENLEY, P.E. civi, Engineer ur—awry
PoME.HOMSYr CYOM PeY,v,NeW8AE15 •,WnTKlun CALCULATIONS
:.EST: Dean Davidson
Majestic Valley Estates S/D, Block 3, Lot 4
"e.25960 White Spruce Aven., Eagle River, AK'M0"050-731-20 'oe'n-u—
"" 5/9/13 enl«ne DTK I OB` FK I "`E N/A '108 xue8 13108 1 SHEET 1 OF 4
OF A kk
*:49TH*
. *I
' Do as T. Kenley '
�9�
VALLEY VIEW
Lot 10
ATES #1 S/D
BLOCK 2
Let 9
SPRUCE LANE
0
—
X20' Mutt rAS mwF
S 1
1
I / I
1 1 r
1 1 l
\ 1 /
\ I /
I
\ ♦ 1 / / 2okad curt x
I Let $ g5k1g5 LEp
Lot 6
Lot 4
sa.aso ar.
2d MLIIY FASE.EnT
Let ] Bs�
Lot 8
/ a \
/ o \
1 u 1
1 I
1
I I ,
1
DOUGLAS T. KENLEY, P.E. Civil Engineer
MME9aNMrCirt4 • WiugRWef9M5 • IMn7WM9
d.. Dean Davidson
1f4 Majestic Valley Estates S/D, Block 3, Lot 4
"25960 White Spruce Aven., Eagle River, AK ".o N1NBn
°"'e 4/25/13 1 M"` DTK 1 e"""" FK
Lot 3
Lot 9
DESIGN
/
13108 SHEET 2 OF 4
/
Lot 6
Lot I
Block 2
y�P�E OF ga<,gs.1�-0�1
*: 49 TH ill
Douglas .Kenley. /
(+�GfFq
JC.E16�`iiS510���
5
\
\
\mk/
\
axi
A.r
1
alp
\\
m�
LEw-
Lot 4
sa.aso ar.
2d MLIIY FASE.EnT
Let ] Bs�
Lot 8
/ a \
/ o \
1 u 1
1 I
1
I I ,
1
DOUGLAS T. KENLEY, P.E. Civil Engineer
MME9aNMrCirt4 • WiugRWef9M5 • IMn7WM9
d.. Dean Davidson
1f4 Majestic Valley Estates S/D, Block 3, Lot 4
"25960 White Spruce Aven., Eagle River, AK ".o N1NBn
°"'e 4/25/13 1 M"` DTK 1 e"""" FK
Lot 3
Lot 9
DESIGN
/
13108 SHEET 2 OF 4
/
Lot 6
Lot I
Block 2
y�P�E OF ga<,gs.1�-0�1
*: 49 TH ill
Douglas .Kenley. /
(+�GfFq
JC.E16�`iiS510���
/ /20' UTILITY EASEMENT
/l
/ I °o.
4�
I °�O
� I TZF
I � M
N
I � WELL
I / 2.0'X9.0' CANT
't Lot 5 9.5'X19.5' DECK—
/
\ ^7
\ 7.7' x 9.0'
GREENHOUSE
6.1'X77.3' A6iIC ENTRY
/\
CANT
t
I �Or
COVERED DECK
\ / a
i
12.2X16.2' SHED—
1 DRIVEWAY
'o \Q
Existing 1000 gal. / \
septic tank to be
replaced. See note, / \
r6.0'X16.2' LEAN—TO
100' Well Radius
---------------------
SEPTIC CLEANOUT AND MONITOR
TUBE TYPICAL, SEE ORIGINAL ,Lr I
AS—BUILT
Lot 4 \
54,460 s.f. \
Lot 3 `
UTILITY EASEMENT \ \
` \ 8SS0,
\
\
Lot 8
DOUGLAS T. KENLEY, P.E. CIA Engineer DESIGN
M e."mu GM • evw,urvays • peArnava
C"n Dean Davidson
30 White Spruce Aven., Eagle River, AK1e"0050-737-20 'j'_
3 c"""E°DTK °F"`" FK" 1" = 50' '14B« 73708 SHEET 3 of 4
Owl OF A�gs��'1
*: 49 TH *+�/
.6.Kenley
.......
Dts�glas
FROM
FCO
uv i wm
TANK SECTION (PROFILE)
NTS
2" RIGID INSUL. IF REQ.
0 EXISTING SYSTEM
NOTE: NEW TANK TO BE PLACED ® SAME DEPTH AS
EXISTING THAT IS TO BE DECOMMISSIONED AS PER
CODE ON SITE. ELEVATIONS & SWINGTIES WILL ACCO-
MPANY AS -BUILT DRAWINGS.
DOUGLAS T. KENLEY, P.E. CIWI Engineer I DESIGN I
PoMEMwM 0b - PMwr'N 8 . (Mn 1161Pri
"Dean Davidson
— Majestic Valley Estates S/D, Block 3, Lot 4
"25960 White Spruce Aven., Eagle River, AKII
°""4/25/13 1 `"" DTK °RPN"' FK I — NTS
Me "U.. 13108 1 SHEET 4 OF 4
Lot 8 \ \��
PLOT PLAN _ AS BUILT X SCALE 1" = 50' GRID SW 363 Project No. 13-033
Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Registered Land Surveyors (907) 522-4625 Fax
kenOlongsurvey.com / jonathanOlangsurvey.00m A' QF q
�� ........., qS
I hereby carfify that I have surveyed the following described property:
Lot 4, Block 3, MAJESTIC VALLEY ESTATES SUBD. (Plat No. 77-27)
Anchorage Recording District, Alaska, and that the improvements situated thereon aro49� y*
within the property Iinss and do not encroach onto the property adjacent thereto, that •.. .. .. """" ..
no improvements on the property lying adjacent thereto encroach on the surveyed
promises and that there aro no roadways, transmission lines or other visible ................... .....
easements on said property except as indicated hereon. KENNETH G. LAN a
�1 a
Dated this the Day of Mev , 'Lnt'15 , at Anchorage, Alaska Q �LS 5202,.•'
Oi •.......foo
M Is the rosponatbilTfy of the owner to determine the existence of any easements, IONN-
covenants. or restrictions which do not appear on the recorded subdivision plat.
Municipality of Anchorage Page of _;2-
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SV1J94P0B1 l PID Number: _050 - 73/'70
�
Name: t7ea n � Donna a vt So
Wastewater System: ❑ New X Upgrade
Address:
75 940 LAA c 5 rude Dr. t5w K.
ABSORPTION FIELD
Phone:
No. of Bedrooms:
Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating: —
O. 6
Total Depth from original grade: r
5'5
GPD/Sq. Ft.
Lot: Block: Subdiv' ion:
41
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
iG E y i5s T.
0. ;:� Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
length: ole4c✓/ 0/ -
2 Ft.
.Gravel
O7
Arq dx �J�i v %D%t7/ I Ft.
WELL: ❑ New 1:1 Upgrade
Gravel width:
Number of lines:
Dislancebetweeenlines:
Ft,
Ft.
Classification (Private, A,B,C):
Total Depth:
ral6sed To:
Total absorption area: p
Pipe material: �'7 /
Ft.
792 SO. Ft.
10 V -7O -d' 7
Driller:
Date Dril
Static Water Level:
Installer:/�
Af A%%l I�' AJ r
Date installed: p
9 Z % lP
Ft.
1. 7n,5
!
_
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
❑ Septic ❑ HIng T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capa5 in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
Well-
/
/00 f
r
/OD 4-
—
_
!
Z5 1
Material:
Number of Gompa ents:
Surfac
Water
100'4
!oD ��
-
/06 /f
LIF STATION
Lot
/r
/0 +
/D1*
--
'
/D
Size in gallons:
Manuf hirer:
Line
FOUndation
14
/
/o f
"Pump on" leve t:
"Pump off" le at:
High wale larm at:
Curtain'
Z5
ZJ
_
Pump e & Model
Electrical pactions performed
Drain
Remarks:
BENCH MARK
Location and Description:
I
sin L
nevale S nc
/ /c%i
AC �O SfC/Y/ W G//�G/� O La 6a ee,
�.
x ca l/a lei/ Psf /ank t11-10 i 151a�le�r! S� �i'"
_
Assumed Elevation:
/
/� /
le Court le,-el a A,,,9 0Z NYyef2a' ENGINEER'S SEAL
LQ C
®dee pe je��0
n L��Hi
Inspections by: 41V49e 2j hee� Dates: 1s 9z
performed
2nd 9 z e�Q°a�9�eo e•upo ee B
9 _4 �G Kenneth N.. I.'efl"VS f�
Department of Health fid Huma , rvices ap ol ®® 6, o°® C@ 71 IG
' / %�"'" C•' �OF96pp ��'b�"G°e°'y�
` " / �t►���5����
Reviewed and approved b : Date:
Pp y
72-013 (Rev. 9/91) MOA 25
A—C=65.2
B—C=78.9
A—D=64.6
B—D=86,15
A—E-63,7
B—E=88.35
A—F=111.0
B—F=130.8
A—G=113.35
B—G=135.3
AS -BUILT SYSTEM DETAILS/SITE PLAN
LOT 4, BLOCK 3, MAJESTIC VALLEY ESTATES S/D
5 5 5w5FG
W o o p o 0
N w w jjIa
p u u u uouuw
EXIST.
1000 GAL
m SEPTIC
E
0
�
SCALE NTS
OF ALS �0
�* 49TH
KENNETH AL ,PUS
CE -7118 - W4
ir
\ a PftPRSS100" w
Driveway Y^
JVra,F"
�/ c.::mo Fo-m
F
IL
alm. maer1111
WELL a
z• INSUI
FILTER FABRIC\
SEWER ROCK
TRENCH #1
4 7' —
D FINAL GRADE
FILTER FABRIC\
SEWER ROCK
TRENCH #2
52' —
NOTES:
1. Inspected exisltng tank & verified Integrity
2. Existing field tied in w/diverter.
r
SCALE; 1" = 100'
w
w�
5
00
u
0
ITVARIES
1
4•I
?�OJ
W 80,50 BOH
w
VARIES
L_
Al
T
80,50 sou
REPARED FOR: KND ENGINEERING
DEAN & DONNA DAVIDSON 20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
25960 WHITE SPRUCE DRIVE (907)696-6111/FAX(907)696-8111
EAGLE RIVER, AK 99577 DATE- 10/15796 DRAWING It
SCALES AS NOTED 96078 -SI
/W PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE -2
DEPARTMENT OF HEALTH AND HUMAN SERVICES !�
P.O. BOX 196650, 825 "L" STREET, ROOM 502 �Z. CSO A,, ST=
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960311 DATE ISSUED: 9/24/96
DESIGN ENGINEER:KND ENGINEERING EXPIRATION DATE: 9/24/97
OWNER NAME:DAVIDSON DEAN F & DONNA K I
OWNER ADDRESS: r\ch -
1��OG
PARCEL ID:05073120 cL_
LEGAL DESCRIPTION:
MAJESTIC VALLEY ESTATES BLK 3 LT 4
LOT SIZE: 54526 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
A FLOW DIVIDER, ZABEL 2200 OR EQUIVILANT, MUST BE
INSTALLED TO EQUALLY DISTRIBUTE THE SEPTIC TANK EFFLUENT
INTO BOTH TRENCHES.
I ti i i
RECEIVED BY:
ISSUED BY:��ll �l.Li.c lL�.�✓J
DATE:
DATE: C �"
14D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11/FAX (907)696-8111
September 13, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Lot 4, Block 3, Majestic Valley Estates S/D
Gentlemen:
At the request of the owner, on August 29, 1996 we excavated two testholes for the
subject property for the proposed upgrade of the existing system. The proposed
system is for a three bedroom single family residence. The results of the soils tests
and water monitoring are attached.
The property has several slopes and benches running from northeast to southwest.
At the southwest end of the property the slope begins to level off as indicated on the
site plan.
We propose to install a 4 foot deep trench 2' wide. The tank will be inspected and
replaced with a new 1250 tank. The larger tank size was requested by the owner for
possible future expansion. A diverter will be installed post -tank so that the existing
system can be maintained for future use. If required, additional fill will be placed
over the system to provide a minimum of 3' of cover when complete.
There are no public or private wells within 200' of our proposed system location
except as identified on our site plan. There is neither surface water within 100' nor
any known curtain drains within 50'. We do not expect that there will be any
adverse effect on adjacent lots by the development of this system.
If you have any questions regarding this application, please contact me at 696-
6111/FAX 696-8111.
MUNICIPALITY OF ANCHORAGE
Respectfully submitted, CNVIRONMENIAL SCRVICES DIVISION
H,Uvv'1D Engineering SEP 16 1996
Kenneth M. DufeP.E. RECEIVEU
attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WASTEWATER ABSORPTION SYSTEM DETAILS & SITE PLAN
LOT 4, BLOCK 3, MAJESTIC VALLEY ESTATES S/D
Appro)
41) OFAL4 'k,,
.49
IKE� OF
CE -7118 - a
IN��no %//3`�j_V`AO'
p�'OFESSIONP4 S
DESIGN CRITERIA
SYSTEM.
EXCEPT AS SHOWN.
1. 3 BEDROOMS X 150 GAL./DAY/BEDROOM = 450 GPD
2. SUILS RATING 16 MIN✓INCH = APPL RATE 0.6 GPD/SF
3. 450 GPD/0.6 GPD/SF = 750 SF
4. 750 SF /(4x2)= 94'L
5. MIN. DESIGN SIZE = 2 TRENCHES - 47' LONG x 2' WIDE x 4' DEEP
6. DEPTH OF GRAVEL IS 4'.
7. TOTAL DEPTH OF SYSTEM IS 4.5 FROM ORIGINAL. GRADE,
8. 2' HD INSULATION REQUIRED OVER FIELD <3' OF COVER
9. 2' HD INSULATION REQUIRED OVER TANK <4' OF COVER
10, CONTRACTOR TO VERIFY AND INSURE MAX 27. GRADE FROM HOUSE.
NOTES:
1. Inspect exisitng tank & install new 1000 gallon steel tank if required.
2. Insulate all lines with less than 3' of cover.
Insulate field if it has less than 4 feet of cover.
3. Contractor to insure 2Z grade from house.
4. If exisitng tank inadequate it will he abandoned inplace.
5. Field to be tied togeter with diver -ter valve post tank.
PREPARED FOR: KND ENGINEERING
DEAN &DONNA DAVIDSON 20441 PTARMIGAN BLVDEAGLE RIVER, AK, 99577
25960 WHITE SPRUCE DRIVE 907-696-6111
EAGLE RIVER, AK 99577 DATE, 9/8/96 DRAWING a
SCALE- 1' - 100' 96078 -SI
WASTEWATER ABS❑RPTI❑N SYSTEM DETAILS & SITE PLAN
LOT 4, BLOCK 3, MAJESTIC VALLEY ESTATES S/D
Appro)
���OFA �t
0 * 9TH��
KENNETH Ai. DU*
CN -7116 /
p�F'GSS]D�Py Air
�
DESIGN CRITERIA
SYSTEM.
EXCEPT AS SHOWN.
1. 3 BEDROOMS X 150 GAL,/DAY/BEDROOM = 450 GPD
2, SOILS RATING: 16 MIN./INCH = APPL, RATE 0.6 GPD/SF
3. 450 GPD/0.6 GPD/SF = 750 SF
4. 750 SF /(4x2)= 94'L
5. MIN. DESIGN SIZE = 2 TRENCHES - 47' LONG x 2' WIDE x 4' DEEP
6. DEPTH OF GRAVEL IS 4'.
7. TOTAL DEPTH ❑F SYSTEM IS 5.0 FROM ORIGINAL GRADE.
8. 2' HD INSULATION REQUIRED OVER FIELD <3' OF COVER
9. 2' HD INSULATION REQUIRED OVER TANK <4' OF COVER
10, CONTRACTOR TO VERIFY AND INSURE MAX 2X GRADE FROM HOUSE.
NOTES:
1. Inspect exisitng tank & install new 1000 gallon steel tank if required.
P. Insulate all lines with less than 3' of cover.
Insulate field if it has less than 4 feet of cover.
3. Contractor to insure 2% grade from house.
4. If exisitng tank inadequate it will be abandoned inplace.
5. Field to be tied togeter with diverter valve post tank.
PREPARED FOR: KND ENGINEERING
DEAN & DONNA DAVIDSON 20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
25960 WHITE SPRUCE DRIVE 907-696-6111
EAGLE RIVER, AI< 99577 DATE, 9/8/96 DRAWING B
SCALE, V = 100' 96078-S1
�Z(W��(q�gl¢
490009 esee •-(� �/�
O. 000 - meea�� ��
Municipality of Anchorage 9 1
DEPARTMENT OF HEALTH & HUMAN SERVICLSR1
+a ae o° 0
9e 0999 9e aee• ee94•m
825 "L" Street, Anchorage,Alaska 99502-0650
e .9se4e ae• •ale 09
SOILS LOG — PERCOLATION TEST Wig, Kenneth M. D t r�
�.5 'e_ CE 7116
%A -Te 'C'60o daeNQ. V
t /
�e 4TI
PERFORMED FOR / /7 /� i(OK) _ _ _ DATE PERFORM E D:`_-� /?OFESSO'-�O
f� , 5ti��1 f�OfTownship. Range, Section.
LEGAL DESCRIPTION
DEPTH J� SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
1
20
COMMENTS
or?
BoH
CIal/
GROUND WATER
/?'/WAS
/Y!I/10% �'%a U[ ENCOUNTERED? O
S
IF YES, AT WHAT L
DEPTH? A/A. O
P
E
Depth to Water Aller
Monitoring? 4 Dale: �
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
9--- �
/7: J-
—
—
/7 ;5
z12
„
s
5�
a
.DU
3
�
z �
is
v6
Oe2
z
PERCOLATION RATE I (l Immulesnnchl PERC HOLE DIAMETER--/ly
TESI RUN BETWEEN 2— FT AND 3—F1
PERFORMED BYAl✓1_1J::)L°�.✓_.//N/�-Z��LL% _ CERT IFYOTH Taj T/F{I/S,TEST WAS PERFORMED IN
ACCORDANCE WI1H ALL S 1 A
IVAN[) MUNIC-11A GUIDE TINTS IN EFFECT ON THIS DA1E DAiE _JI ILL-(1�----------- ---------------
,:' 008 (He' 4(3'n
Municipality of Anchorage
DEF'ARTMENi OF f IEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
I
�J 'ORR(
PERFORMED FOR: DATE PERFORMED:
l FOWRShip, Range, Section: DESCRIPTION:,/p ✓Lb
-/)�//
1
2
3
4
5
6
8
9
10
11
12
13
14
15
16
17
18
19
20
GM/SN% u/lSarnw1/CaSe15
/�!C/casil7 �rr/si/-y
la lel ✓
80P
116�� 1'4 OZ
SLOPE
Grown >ZrRr1� Glad.
l�"/wAS GROUND WATER
�///nlrlOr �✓A1)b ENCOUNTERED? _ Na
S
IF YES, AT WHAT L
DEPTH? All 0
P
E
Deplh to Water Aher
Monitoring? Dry Date: "11
SITE PLAN
.0
Reading
Date
Gross Net
Time Time
Depth to
Water
Net
Drop
-
v 0
z
�; 2
3
r�
PERCOLATION RATE immutesnnchf PERC HOLE DIAMEIEll
TEST RUNN BET/WEEN �r, nmll.`� r'
COMMENTS
PERFORMEDBY �!✓1_Qt1L�tY.J-CGrL h
I CERTIFY,/I H, SIJ IF I/S-TEST WAS PERFORMED IN
ACCORDANCE WIT FI ALL STA I /ANO MU AE GUIDELINES IN EFFECT ON THIS DATE DATE -_.f1 -fGL �!!� -
Municipality of Anchorage T" '
tom, p y 9 s eoa oo mroe Mit'
0"..'.
`oev
cf t DEPARTMENT OF HEALTH & HUMAN SERVICES
e .°oeos a avvv+. �
825 "L" Street, Anchorage, Alaska 99502-0650 �' s Kenneth N.. rte„ .. `r
SOILS LOG — PERCOLATION TEST f4. CE �11G °a`�
PERFORMED FOR: 12 L fpayld. o-) DATE PERFORMED:
LEGAL DESCRIPT]ON:�Q:'�;STI/ YCIA��I/G$ �3 /,9T TOWnShip, Range, Section: 1Nt:,-;o(w�ST
DEPTH SLOPE SITE PLAN
O,er,
i - SCI �.►
2
3
a
5
6
7
8
9
10
11
12
6/)'9151w %4s2
In/�s7 arc
T�ti/- hrown c/ay
WAS GROUND WATER �a
alCh51 ENCOUNTERED?
S
IF YES, AT WHAT L
v1
DEPTH? /r 0P
E
13 { 13 �AIZOP1fl11
14
15
16
17
18
19
20
COMMENTS
Depth to Water After
Moniloring? a# pale:
®Depth
to
I Water
Net
Drop
//_ /t�; U Z z
PERCOLATION RATE tmmutesnnchl PERC HOLE DIAMETER /~ /�
TEST RUN BETWEEN A—/ FT AND FT
PERFORMED BY .LV � I -4f'-h Dee CERTIFY 1HATHIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE —�7L—
Municipality of Anchorage a.•�e' • pfus
DEPAR [MENT OF HEALTH & HUMAN SERVICES
•825 " L" Street, Anchorage, Alaska 99502-0650 s'� - Kenneth M. w
SOILS LOG — PERCOLATION TEST ®d s'•• CE 7116
UFESSVJ .,oma
PERFORMED FOR: O&Z fpayldSO✓) DATE PERFORMED:
��7 1 Vd/ /� p L/�/Townshi Range, Section:�T-
LEGAL DESCRIPTION:/y//J 5 U Lv/,/Y✓S, FJ� /-077 p� 9
DEPTH SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
GM15M Tar)
0
efts � f �/ZG
hrow'I c a
I
ca�CnSi�� "ENCOUNTERED?
WAS GROUND WATER
Net
Drop
A142/nG✓r.Q.srd
S
IF YES, AT WHATA//Y, L
O
DEPTH? /V # P
6;3
E
Depth to Water Alter
Moniloring? _ 112ru Dale:
ReadingDate
Gross
Time
Net Depth to
Time Water
Net
Drop
6;3
s
PERCOLATION RATE / (D Immulesnnchl PERC HOLE DIAMETER
TEST RUN BETWEEN FT AN F1
PERFORMED BY 4LL(l_ 4-o e� -2 I zren /iGlF�.i S CERTIFY I�A THIS TEST WAS PERFORME=D IN
ACCORDANCE WIT H ALI`_;TA I E ANO MUNICIPAL GUIDELINES IN EFFECT ON THIS DAT F DNF_-..------
GRE,. , ER ANCHORAGE AREA BOL .. IJGH
4,Ia Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM p
NAME_ _N�N_70 MAILING ADDRESS __ ^ , )PHONE�
LOCATIONS h- _ LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE I+
FROM WELL t Co
INSIDE LENGTH
.T#t-EEDRAIN FIELD:
r � � qQ NUMBER OF
MANUFACTURER l9 MATERIAL `-�'�I -___-COMPARTMENTS --
INSIDE WIDTH_"' LIQUID DEPTH LIQUID CAPACITY10L GALLONS.
- I I TOTAL LENGTH
DISTANCE FROM WELL 108+ _FOUNDATION r�� '-�_NEp'AREST LOT LINE_J D_ � _OF LINES LIC)
OF LINES_-- DISTANCE BETWEEN LINES _-PI TRENCH WIDTH�6 IN. TOTAL EFFECTIVE
ABSORPTION AREA (0 4- --) SQ. FT. LENGTH OF EACH LINE
I
DEPTH OF FILTER /
DEPTH: TOP OF TILE TO FINISH GRADE __MATERIAL BENEATH TILE l� IN. ABOVE TILE IN.
WELL:_
TYPE T110 � CONSTRUCTION ���_� CSS 'C� DEPTH_- �� DISTANCE FROM:
BUILDING NEAREST NEAREST
FOUNDATION LOT LINE__ SEWER LINE
CESSPOOL
OTHER SOURCES
APPROVED_ DISAPPROVED-_ REMARKS
DISTANCES:
INSTALLED BY:
141.
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS: �`� is IV)
Form EQ -032
0
SEPTIC
TANK_
SEEPAGE
SYSTEM_
DIAGRAM OF SYSTEM
S 01 15 1'-t U o
..f
� �4
DATE *1
APPROVED
G.A.A.B.
T Yf",E OF SOIL Af.-,SORBTION SYSTEM IS: TRENCH
MHXIMUM NUMBER OF BEDROOM SOIL RRTING (S8 FT/BR)� 190
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
�����1_1 ���PIA V 1 -1� �577. �����I_,
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD
THE DEPTH 8F H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND HND THE BOTTOM OF THE EXCHYHTIQN (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
`
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE (3UTFHLL PIPE
ANLI THE B8TTOM OF THE EXCAVATION (lN FEET).
��GA-) IE ���r-UIK- J. F -E. ��P:,;D �L_ L". C-)��
�1.4 10 -:2 P" E7 C, -V 1: ��IE--_ If W.r. F--, V_;.]
BACKFILLING OF ANY SYSTEM WITHOUT FINAL FIND HPPRQVHL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION
M11,41MUN DISTANCE BETWEEP4 A ��) ANY ON-SITE SEA.-IRGE SYSTEM IS
100 FEET FOR A PRIYHTE WELL OR 200 FEET FOR 8 PUBLIC WELL
WELL LOGS FIRE REQUIRED HND MUST BE RETUR61E0 TO THE DEPHRTMENT WITHIN ]0 DHYS
OF THE WELL COMPLETION.
SPECIFICHTIONS
AND CONSTRUCTION DIHGRHMS ARE HVHILHBLE TO INSURE PROPER
�THLLHTION
IN .
�� ���� ��� ���� ����� ������
I CERTIFY THAT
1: I HM FHMILIAR WITH THE REQUIREMENTS FOR 8N -SITE SEWERS HND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2� I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES
]� I UNDERSTAND THAT THE 8N -SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT IF THE
HPPLIGHN9
ISSUED BY
l-//'-)1
Ju
�����/J
� �
DEPARTMENT
HEALTH HND
ENVIRONMENTHL
O"FEC TION
m
825 'L'
STREET, ANCHORHGE/
HK. 99501
����_ ���
��������
������ �/
PE�MIT
NO. ( 77�01 )
'
\/`� [(�
HPPLICANT
RQX
]2] E.
\
R. ` 68G�2]90
LOCATION
5PRUCE'LIT-Q7~
LD
L4 B2...' IIAJESTIC ',MLI
EY Si1B[)
U)T SI�E 54460 S��H�E
FEET
T Yf",E OF SOIL Af.-,SORBTION SYSTEM IS: TRENCH
MHXIMUM NUMBER OF BEDROOM SOIL RRTING (S8 FT/BR)� 190
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
�����1_1 ���PIA V 1 -1� �577. �����I_,
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD
THE DEPTH 8F H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND HND THE BOTTOM OF THE EXCHYHTIQN (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
`
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE (3UTFHLL PIPE
ANLI THE B8TTOM OF THE EXCAVATION (lN FEET).
��GA-) IE ���r-UIK- J. F -E. ��P:,;D �L_ L". C-)��
�1.4 10 -:2 P" E7 C, -V 1: ��IE--_ If W.r. F--, V_;.]
BACKFILLING OF ANY SYSTEM WITHOUT FINAL FIND HPPRQVHL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION
M11,41MUN DISTANCE BETWEEP4 A ��) ANY ON-SITE SEA.-IRGE SYSTEM IS
100 FEET FOR A PRIYHTE WELL OR 200 FEET FOR 8 PUBLIC WELL
WELL LOGS FIRE REQUIRED HND MUST BE RETUR61E0 TO THE DEPHRTMENT WITHIN ]0 DHYS
OF THE WELL COMPLETION.
SPECIFICHTIONS
AND CONSTRUCTION DIHGRHMS ARE HVHILHBLE TO INSURE PROPER
�THLLHTION
IN .
�� ���� ��� ���� ����� ������
I CERTIFY THAT
1: I HM FHMILIAR WITH THE REQUIREMENTS FOR 8N -SITE SEWERS HND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2� I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES
]� I UNDERSTAND THAT THE 8N -SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT IF THE
HPPLIGHN9
ISSUED BY
® Et E GEOT-.. HNI CAL Et, DEVELC, MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 689-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 689-2280
Soils Et Foundations Land Development
Performed for: Name: � � _� Tel. No.
Mailing Address:�_��_ -
Legal Description:�� 3' _
Depth feet So ha cterist e
0
1
2
3��
4
(around Nater Encountered: Yee No— If yes what depths___
(proposed Installation: SOOP890 Pit Drain Field
(.OmmentS:W�,,,,._.,n
Perfomi ed by: Date:
.a:rt'%V%NjA®
,{
OF � 4 08
7
p e
7 1Ao����/
E-'v� ° TLl F' e,
°°�V��fi Cwt• �'bi
• ff
e oo a0o00.00e000ev0eoeee0,e•i •r, '
s1.o 0:••oeOL°•0 ar.�e N�e•,�• H �
Earl P. Ellis W %
NO. 1745-E ,.0
pp • o •�AV
,•.000,0
C,rdifirb Drilling Kxg
by
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694.2588
OWNER OF LAND ('N,,�Q«S r P��.7., DEPTH OF WELL 3 60
t
ADDRESS LSTTATIC LEVEL OF WATER FT. �2
LEGAL DESCRIPTION Loi 4 CC/C /Ylfi(r Sii� q� pItAW DOWN FT.
DATE . Started :t%/! 6 -7 Ended `F / GALS. PER HR 4 '0
PERMIT NUMBER 77/01 KIND OF CASING 4
KIND OF FORMATION:
Fromn_Ft. to 3 Ft. oucQ LJ•d lOEi�/
From
Ft. to
Ft.
From 3 Ft. to1�Ft. CIL .4f't
From
Ft. to
Ft.
FromFt. to/'9 3 Ft. ti'a'Frrrom
Ft. to
Ft.
From �Ft. to a /O Ft. dikLe0CK hlARd 6A t=E"rrom
Ft. to
Ft
From J t o Ft. to Ft. L1 EO 40c K /�Q1cTu 7��
From
Ft. to
Ft
From ;3a Ft.to 307Ft. -�_X'dQ0CK ioc1A
From
Ft. to
Ft.
From?o f_Ft. to ? // Ft. /'Qa�Tv?EO !�� lJu L
From
Ft. to
Ft.
From ?// Ft. to=Ft. A60 d .c K .0 a e / O
From
Ft. to
Ft.
From 34(_ to 3 2 -Ft FAA<rv'7G o �� r�/Qi t<
i
4.
FrromC6q
Ft. to
Ft.
p ,..'
From��Ft. to 3" Ft. Arrol f o c K So< "o
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft
t
NIISCL.INFORMATION:
r44
r
DRILLER'S NAME
MUNICIPALITY Of" ANCHORAGE
DEPARTME' OF HEALTH AND ENVIRONMEN- PROTECTION
825 L Street, Anchorage, Alasxa 99501
279-2511, ext, 22.4 or 225
-J Date Received: June 28, 1977
If 1: Time _si�s��)_ ll _ #2: Time ----------- #3: Time — ------ -
Date -�' 11s7��15. Date ------ Date
Insp �_�_�_ Insp T Insp - ----
REQUEST FOR APPROVAL OF INDIVIDUAL ;SEWER AND `;DATER FACILITIES
1. Lending Institution Request:
Mailing Address: Phone:
2.. Proper Ly Owncr: Charles/Pogany Phone: 688-2390
Mail-ing Address: Box 323 99577
3. Legal Description: Lot 4 Block 3 Majestic Valley Subdivision
4: Single Family Residence: (x) Number of Bedrooms: three
Multiple Family Residence: ( ) Number_ of Bedrooms:
5. Well. System: Individual. Well (Y Community/Public System
Permit
# 77101
Depth of Well ( '��`_ Well. Log on File
Construction^
_1(J c
O(
Bacterial Analysis 7 7
6. Sewage
Di-sposal
System: On-site
System ( x) Public Utility c(�
Permit
# 77101
Installed
% / " ✓ Installer`
Septic
y _ Y
Tank Size`
Manufactureri�egrl1�-__
Absorption Area
�a a Soils
Rate e�- `- Material. �ICZc�-r
7. Distances: Well to Septic Tank lev � to Absorption Area
to Sewer Line _7- Nearest Lot line `(� _ Absorption Area
to Nearest Lot Line T
�a
Page Two
Department of Health and Environmental. Protection
Request for Approval of Individual Sewer_ and Water Facilities
Legal Description: Lot 4 Block 3 Majesctic Valley Subdivision
A Ef aday.i 1. Attached: ( ) Let -Ler Attached:
Approvcci
Disapproved: Date:
Dc�pa)--tment Worksheet:
MUNICIPALITY OF ANCHORAGE MUINflcu>AldI'( o;
Department of Health and Environmental Prpt�f�t•i�ni'' .!.i :<
0 Jequest
825 L Street, Anchorage, Alaska 9"J5Oe1'"�'`IF'•c a"jo�l
279-2511, ext. 229, 225 ,J 7
for Approval of Individ al. Sewer and Water Facilities
1. Property Owner: (c'S
Mailing Address :)r -e.0 Phone: 'V�N-z D:' c)
2. Name of Buyer:
Mailing Address:
:3. Lending Institution:
Mailing Address:
4. Realtor/Agent:
Mailing Address:
0c)U
Phone:
Phone:
Phone:
r_(
.�. Legal Description: ;
Street Location: \ a' �:
6. Single Family Residence: ( Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply: *Individual Well ( Public/Community System ( )
If Individual Well, well depth
If Community System, name of system
8. Sewage Disposal. System: On-site System Public System ( )
If On-site System, date of installation:
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
06-1220(a) Rev. 1973 ALR DEPARTMENT OF HEALTH AND SOCIAL S ICES
DIVISION OF PUBLIC HEALTH Lab No. —
INDIVIDUAL AND SEMIPUBLIC
DATE BACTERIOLOGICAL. WATER ANALYSIS OFFICE
INDIVIDUAL ❑ SEMI-PUBLIC — /satisfactory shows tills Water SAMPLE to be:
❑ CHLORINE RESIDUAL PPM SSatisfactory
REPORT RESULTS TO ❑ Unsatisfactory
NAME - - - ❑ Questionable -
-❑ Sample too long in transit; sample should not be over 48
ADDRESS hours old of examination to indicate reliable results. Please
send new sample.
CITY - ZIP CODE _ - _ ❑ Bottle broken in transit, please send new sample.
ADDRESS - _ -
OF SOURCE
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY - ---
DATE COLLECTED TIME COLLECTED- _ -
Sample Collected From [I- Kitchen Tap E]Bathroom Tap ❑ Basement Tap _-
❑ Other (List)
Well — ❑ Dug ❑ Driven ❑ Drilled
SOURCE: [-]Spring E] Cistern
❑Bored ---__
❑ Other__ -___ —
Dug Well or Cistern Construction:
walls —E] Wood ❑ Concrete ❑ Metal❑ Tile Brick or
Top — - E:) Wood ❑ Concrete [D Metal
LOCATION: [J Open Top ❑Concrete
-
❑ In Basement ❑ Basement Offset-
❑ln Yard 11 Other
❑_Under House
Building Sewer Septic _
DISTANCE TO: or Other Drainage Pipe__ Feet. Tank —Feet,
Tile Seepage - Cess -
Field -- Feet. Pit _ Feet, Pool — Feet. Privy ---Feet. -- - - —
Other Possible
Sources of Contamination—
MATERIAL: Building Sewer - ❑ Cast Iron ❑ Wood ❑ Tile ❑ Fibre ❑ Asbestos _ -
❑ Plastic Joint Material - Type _ Cement .
GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No -
When? - --
Diameter of Well - Depth Fee
Well Casing - —
Material _ Diameter _
Length of Depth
Drop Pipe Water Depth --— _
— From Bottom Feet.
PUMP LOCATION: Offset in In Utility
❑ In Well ❑ Basement ❑-In Basement ❑ Room
On Top —
❑ Of Well ❑ Other -
PURPOSE OF EXAMINATION: Illness Suspected? '❑ Yes ❑ No
New Source of Supply? ❑ Yes ❑ No Repairs to System? ❑ Yes ❑ No Signature
06-1220 3
Rev. 20 ( BACTERIOLOGICAL WATER ANALYSIS RECORD
R
READ INSTRUCTIONS Date Receivedam
Time Received .__—___pm Lab. No.
ON
REVERSE SIDE
Lactose Broth IOcc lOcc
IOcc Iocc IOcc I.Occ
1.0ce
24 Hours
48 Hours
Brilliant Green
-
24 Hours
--
48 Hours
—
BEFORE Lactose Broth, 24 firs
-- Coliform Density _
MF Results
COLLECTING SAMPLE
Reported by
This analysis indicates Coliform Organisms to be:
--- AGAR —
18 hrs.---
Date
Absent
Present _
Gram's stain
(Most probable No. per 100cc)
a.m.