Loading...
HomeMy WebLinkAboutOLSON HEIGHTS BLK 1 LT 7Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 a http://www.muni.org/onsite • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: — PID Number: 016-231-06 ❑ New ®Upgrade Name: TOM & LANELLE BACON ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ound Address: 4501 E. 135TH AVENUE, ANCHORAGE, AK, 99516 ❑ Other Phone' No. of Bedrooms: Soil Rating: Total Depth fal grade: rom ' m (907) 345-1035 3 GPD/Sq. Ft. Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade: Grodepth beneath pipe: F Ft. Subdivision: Block: Lot: FII added above original graGravel length: OLSON HEIGHTS 1 7 Ft. Township: Range: Section: Gravel width: Beds Number of lines: Distance between lines: Ft. SEPARATION DISTANCESFt. Total abs wn .... Number of trenches: Dist between trenches: TO Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines SD. n. Ft. Well *100' - - - 25'+ TANK ■ Septic ❑ S.T.E.P. ElHolding ❑Other Manufacturer. Capacity: Surface Water 100'+ — — — ANCHORAGE TANK 1250 col. Lot Line 5'+ — — — N/A Material: STEEL Number of comportments: 2 LIFT STATION Foundation 5'+ - - - Curtain Drain NONE KNOWN Manufacturer. C Y cal. "Pump on level at: "Pump off Is High water alarm at: Remarks: *BASED UPON AS—BUILT SURVEY. NOTE: THIS IS A LIMITED, SURFACE LEVEL INSPECTION OF Pump Make & Electrical Inspections performed by: AN EXISTING SEPTIC TANK THAT WAS INSTALLED IN SEPT 2001 PIPE MATERIAL WITHOUT A PERMIT OR DOCUMENTATION. House to tank CAST IRON Tank to UNKNOWN drainfield Installer Drainfield UNKNOWN CO/MT D3034 AURORA CONSTRUCTION Inspector NONE BENCH MARK (Assumed elevation) 100.00 Ft. Inspection nsp Location and Description: Dates: 1st 92001 2nd — Da 3rd — 4th — BOTTOM OF T1-11 SIDING NEAR FCO ENGINEER'S SEAL Community Development Department Approval oo� Conditional approval: Date: .................*. D ooh J. Y..:..Garn s:' .. � CE -7 QO s ceo� .311 o°o o0 Approved: Date:ape"Pr as of essio 0 ��O0000�� ELEVATIONS CALCULATED BASED ON BOTTOM OF TANK ELEVATION SHOTS ST1 TOP OF TANK AT INLET = 94.38 rST'2 RADE = 99.46-99.94 TOP OF TANK / AT OUTLET = 94.34 9 _ w w / I � � I CARPORT 4 \ ' A B ST1 39.09 24.16 ST2 EXISTING 1250 GALLON 27.93 DBL1 INVERT OF BUNG I SEPTIC TANK I INVERT OF I BUNG AT INLET = 93.71 45.26 AT OUTLET = 93.54 9 _ w w / I � � I CARPORT 4 \ ' A B ST1 39.09 24.16 ST2 46.61 27.93 DBL1 50.39 30.57 DBL2 51.16 30.98 C01 75.68 45.26 MT1 75.71 45.57 GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701 E. WWR ROAD. SURE 101 • ANCHORAGE. M 999 • PHONE (9077) 337-8179 • FM (907) 339-3246 • WECNIE m. arrnxen9ineM PREPARED FOR: PHONE NUMBER: PAGE NUMBER: TOM & LANELLE BACON (907)345-1035 2 OF 2 LEGAL DESCRIPTION: DRAWN BY: OLSON HEIGHTS BLOCK 1, LOT 7 D.J.G. TYPE OF WORK: DATE: � AS—BUILT DRAWING OF UNDOCUMENTED TANK 07/22/2014 III A. mess E Q s t vm CE— 95 ROFESSI��i��• Ik\1lLs** ?FCO F A B. DECK 4 a d..6) . 4 EXISTING .3I 3 .GRAVE I< w BEDROOM Ie DRIVEWAY ti HOUSE 4 ° \ DECK ' d: ° a 4 ° GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701 E. WWR ROAD. SURE 101 • ANCHORAGE. M 999 • PHONE (9077) 337-8179 • FM (907) 339-3246 • WECNIE m. arrnxen9ineM PREPARED FOR: PHONE NUMBER: PAGE NUMBER: TOM & LANELLE BACON (907)345-1035 2 OF 2 LEGAL DESCRIPTION: DRAWN BY: OLSON HEIGHTS BLOCK 1, LOT 7 D.J.G. TYPE OF WORK: DATE: � AS—BUILT DRAWING OF UNDOCUMENTED TANK 07/22/2014 III A. mess E Q s t vm CE— 95 ROFESSI��i��• Ik\1lLs** J a'9 54' 31" E 'Lb_ �Q4ci LJ 6?A C14a L4 (I f E� g5N4PP� I : m� 2' uv�u° ik 1l 39 53 S 11.609 TO 0 pp�EET� �JOEE OE ROA O m --TOAS-BU V=30' �i��te 4 � �l y�, w•� l occ;,�, ah 1I HEREBY CERTIFY THAT I WAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT >, BLOCK 1, OLSON HEIGHTS SUB. ANCHORAGE BECOMING DISTRICT, ALASKA, AND THAT THE VI IDLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 11TH_ DAY OF _JULY 3014. lKKi4W SUPVEY[K �RXHO CM. MRARE, DDivE MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 90M43-7997 ON-SITE SEWERNVELL PERMIT APPLICATION Parcell.D. ()1'f' Z3J_0� Property owner(s) Mailing address _ Day phone Site address Legal description (Sub'd., Block & Lot) (7 D 11,5/G A/7S 13- 1 & % Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ Septic Tank Upgrade ElDuplex (w/wo ADU) (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 24 J5— Date of Payment: Receipt Number: o)L?-ob (� Permit No. 0519)q 1311 Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: a CYC L L Y L .0 •C .0 •IV a v ani a .. E E E E O O O O 33 a " " v E ��oo cb - ,O. O. R N E In CL h� X Y0 CL - En U) co Cc d k `y 0 N u 0 d X � W V cn W d C Q O O O Y 7 3 G U N U J! O m N CU O O NC 3 7 D Q Q Q E m N 7 0 0 0 Z m y, O in - -. O UClJ = V U UU U a. D¢ U t W N M m tN6 to a N no o y o c E E N X .0J_- }'i- F- f- _11 O U as r- 0000 O w D .a+ E n � n W Y m a\o mN vu' rnaarnm ~ a -a Z .:.. F 3 0 z lV 6Y 53 L 165.00 - - - - - - EARS r _135M A l/E VUE -.------ - - - pp�A 'SHANE A. HOLT4 vOPy LS -6914 THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PUTTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR P05ITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PUT, ARE NOT SHOWN 'HEREON( UNLESS INDICATED) NOTE; FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE, AS -BUILT SURVEY V =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 7, BLOCK 1, OLSON HEIGHTS SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _11TH DAY OF _JULY , 2014. HOLT LAND SURVEYING 600 HISHVIEW DRIVE ANCHORAGE,AK 99515 345-5513 Municipality of Anchorage = - On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 018-231-08 Expiration Date: l — 1. GENERAL INFORMATION Complete legal description OLSON HEIGHTS S/D; BLOCK 1, LOT 7 Location (site address) Current Property owners) Mailing address Real Estate Agent 4501 E. 135TH AVENUE, ANCHORAGE, AK, 99516 TOM & LANELLE BACON Day phone 4501 E. 135TH AVENUE, ANCHORAGE, AK 99516 345-1035 RAMSEY TEAM W/ REMAX/DYNAMIC Day phone 261-7553 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex suamITTAL r� ❑ Multiple Dwellings (Single Family and/or Duplex) JUL 3 1 2094 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: F`IRfX§ttt TEFe SPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site U Public Water System ❑ Public Sewer ❑ waiverNanance request for i I/ u Distance: — Received by: G"':'? - Date: OOSA to be released to the engineer, unless el ise requested by the engineer. COSA Fee $ '52160�' Date of Payment r I lig e Ysi= Receipt Number odLilG COSA# Oil Iq 151p _ Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 "ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, DD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to reedlly identifiable features. The operational fife of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, CTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for -3 bedrooms. System #2 Approved for Disapproved. Conditional approval for Z bedrooms. bedrooms, with the following Phone 337-6179 Date 1,631 %4 i(i(ff(;iitr OF A&Co ON-SITE WATER AND 1tJI ,cTEWATER a= rl- j J\` Original Certificate Date: S � The 6dnici6WrA` hcn orage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 10112712) ld Nitrate Advisory Arsenic Advisory Other If more than 7 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: OLSEN HEIGHTS S/D; BLOCK 1, LOT 7 Parcel ID: 018-231-08 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 7/21/79 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 183 ft. Cased to 183.9 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 7/29/79 7/21/14 Static water level 150 ft, 128 {}, Well production 5 g.p.m. 5.74 g.p.m, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 3.90 mg./L. Collected by: GEG. Ltd. Arsenic: ND ug./L. Date of sample: 7/21/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/2001 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/23/2014 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA •BELOW EXISTING GRADE Date installed 7/16/79 Soil rating (g.p.d./WorCbdr 125 System type TRENCH Length 24 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth *16.8 ft. Eff. absorption area 384 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/21/14 Results (Pass/Fail) PASS Fluid depth in absorption field before test 54 in. Water added 490 gal. Elapsed Time: 160 min. Final fluid depth 54 in. Absorption rate >= For 3 bedrooms New deptAtL9 in. 450+ 9.p -d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date NOTE: MT ONLY EXTENDS 59 INCHES INTO 96 INCH EFFECTIVE DEPTH. TOTAL DEPTH AND LIQUID LEVELS ARE CALCULATED BASED UPON INVERT ELEVATION OF DRAINFIELD CLEANOUT. iy�e5 r/ Itr(J i���(�u�: a to e�,µu�,y �e-A- wt, 37"' zdoa h I4: D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at in. Datum Cycles tested - Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100' Absorption field on lot 100'+ Public sewer main Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots 100'+ Property line 5'+ Absorption i nn'� Water service line 10'+ Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS _006000 G. ENGINEER'S CERTIFICATION o �F ... 0 44p 0S�DOP I certify that t have determined through field inspections and * �� review of Municipal records that the above systems are in ...' .... ' ...' . ..... conformance with MOA COSA guidelines in effect on this date. O e e A. Gar ess. Engineer's Printed Name JEFFREY A. GARNESS Q� s C11- Date 53 ��DO 131/fy 4p 7 (Rev. 11105) 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/Oli WELL INSPECTION REPORT NFlME HONE EW 4-,k6 �' – O UPGRADE MAILING ADD ESS LEGAL DESCRIPTION LOCATION n (%Q _ NO. OF BEDROOMS 3_ DISTANCE T0: Well ©,� _ Absorption are t Dwelling a _ PERMIT NO. / l 'L Q Manufacturer �� Material No. of compartments ~ `��_e� n Liq. capaIt in gallons 13` ©p IF HOMEMADE: Inside length ..-- Width — Liquid depth -- DISTANCE TO: Well Dwelling PERMIT NO. 2 Z F Manufacturer Material d-eacity in gallons Liquiap O W y DISTANCE TO: Well l 0 Foundation v t Nearest lot line a- O PERMIT NO. 7 –/ �, j q J LL z H w No, of lines Length of each line /I 0 12� Total length of lines Trench width {-_ Distance be}w n lines fes. p Top of tile to finish grade _ li Material beneath tile inches Total effective abs or do area Length Width Depth PERMIT NO. iu 21-- A Type of cribrii�rneter Crib depth __—. -Total effective absorption area Well Building foundation Neart lotliaae—� STANCE T0: s Clas r Depth Driller Distance to to ine � PERMIT NO. J J � Q � DISTANCE T0: Building foundation(> Sewer line _ Septic tank r G U Absorption ar7(s� b OTHER PIPE MATERIALS (�104x)_r _— ' F aga 6 SOIL TEST RATING _ S 0 INSTALLER REMARKS _ APPgOVED DATE LEGAL �4� M d._A" ]C f,-_ I F --" Fl 1_a I -r °-s 0---1 F- n"4::� V-1 0 IES "0 i DEPARTMENT OF HEALTH AND ENVIRONMENTAL, PROTECTION 825 'L' STREET: ANCHORAGE, AK 99501 264-4720 A 0 ,� 2j , 1- d -T7 U 1 -C L_) L)L,LL S P-117- L- Il.._.. IP -j C"a @ted —a X -r F- "_ EE LL4 fib ' F' E;;? rl T. -F PERMIT NO. ( 790313) APPL.IC:AN'T Ex) HERzoo 2418 EAST 20TH AVE 2? 3166 LOCATION 135TH AVE LEGAL L? Ell. OLSEN MTS LOT SIZE 50000 SQUARE* FEET TYPE OF SOIL. ABSOREITION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL. RATING (SQ FT/BR): :12 THE REQUIRED SIZE OF THE SOIL. ABSORPTION SYSTEM IS: -IL":2.4c- THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIE LD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE.: BOTTOM OF THE; EXCAVATION CIN FEET). . THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL, DEPTH IM THE MINIMUM DEPTH OF ORAVEL. BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF' THE Er".[::AwiTION CIN FEET), F-' IF: 0'..,,a I R, FK 1--,> EES Ei'" - I C. 71a N l< °S�" ' 2! KF nL C�) 0 O L- R,... 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 NELL LdILL SERVE. �.. _ -vw0 < :a -,�o 1: P4 S.1=6 E`er- C: -IF 10 p,1 �p= "R CE F;Z F -E 0=91...1 I F--": M � ..... CACKF I L.L I NGa OF ANY SYSTEM WITHOUT FINAL. INSPECTION FIND APPROVAL CY THIS DEPARTMENT WILL. BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL. AND ANY ON -5 -ITE SEWAGE DISPOSAL. SYSTEM 1-13 100 FEET FOR A PRIVATE~ WEL..L c OR 150 TO 200 FEET FROM A PUBLIC WELL DEPEND I NQ UPON THE TYPE OF ruBL I C: WEL.1- NE LL LOOS ARE; REQUIRED RED AND MUST BE: RETURNED TO THE DEPARTMENT WITHIN '30 DAYS OF THE WELL. COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARF: AVAILABLE TO INSURE PROPER INSTALLATION. F---> I'= F� &'°'1 I -r 1 0�4 Fes' 16;R., EN ID) FE W,: IIS.' Er -1 F3 FI- :�q"I . "r w9 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND L'EEL.LS AS Sl ---T 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 REGI I I RIE, ENLARGEMENT IF THE:: RESIDENCE 15 REMODELED TO INCLUDE MORE; THAN 3 BEDROOMS. SIGNED: �.em_ ����� �.a�� AEaF'LICEi1�dT ED HE OI~_.,...��..v,�.�...^..b..a^.w.�.....H�.F, ISSUED D,'r' ._��w����v;�, fiATE.,`�/�'�� �- �- "1UNICIPALITY OF ANCHORAGE I� POUCI-, 050 a ANCHORAGE, AK 99502 0 PHONE 2l. 400 v ' FINANCE DEPARTMENT CASH RECEIPT No. 085463 REMARKS 40-007 (Rev. 8/78) DI STRI BUT DN: White — Treasury_ Yellow — Customer; Pink -- Book; Goldenrod -- Department M AN DRILLING, Inc. MUNICIPALITY Cl: ANCHORAGI; P. O. PC) -!-I:>7.'- _,I OC III wt I o I )I AI:I; I Rq:uf D T C- -. 1 ' �, u1y)"', qb) i ENVIROI n C C[ION ANCI-IOR/�GG. ALASKA "11501) PRPUNG LOG, Well O. ncr__-----_Herzog _Const:i-uction_ ----_ _ --_ _---- IJ; (, of Well ---Dora I=ocation (address of: 'Township, Range, Section, if Iinowil w d ~'.aIle(, mail: rnncL -- Lot 7 BlocK 1. Olson Heights Subd, Anchorage 6 Depth of Bole X33' feet Cased to- � '�'_� feed Size of casing— -- f _ Static water level__-- 1 -50 --ft. 0Dbm7,T,,4 (below) land T'inish of %v(,11 (check one) open end ( xx ); Screen ( ) : Perforated ( ) . De crit)screen or perforation A ----_- -- _ -- ------ -----_._---- tail ---- Well l,?I-TKyjog test at___— gallons per Q?f)#1!� ('minute) for-- _hours kvith of drawdown from static level. Date of completion_ .- 771.22 79 WFU. LOG Depth in icct from ground surface Give details of formations penetrated, sins of n,aforial, color and hardness 0 'f O 2 Casing _ stickup 3 f,0 -5 ---Cobb7,e gravel-- layey_ gravel ;_ _occas_ional- - ---5'1'O_- --70 - -- 7 0 _TO - 9_0 -- Reddish _alar-- - - --- 9.0_� O- 115 - Gray clay : -- s lightl-y-sar>dy --- --- - 115 -TO 12.0 Wet sand.—silty,—tried to _develop, _wouldn't _come in_. 12 OTO 150 Reddish clay: gravelly .-150 TO_ 1 5- -',lard -L)an- -- --1.55-TO-- 160-- ---Clay - --- - - 160 TO. ---163 -.-Hardpan i l— -- --- -- - -- -_ 163_To-_ 16.4-- ----Sand-y water grave_L:--gpm,--6 164 '1.0. 167 CI,! : gr:lvcllly 167 TO_ . _170 - - Viet gravel: sandy_, I."- _,pm, 10' S.L.- -- ----�� 170 1133 1� Sand watcIr .ravel: <;1i- htl. s 1 _y_ I - !1 ICTf NArD s 0PAGC !_ MUNICIPALITY OF ANCHORAGE€: f' /I ` DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ],1- i-i1C)N 625 L Street - Anchorage, Alaska 99501 ic, 11 NUMBER OF BEDROOMS T ❑ SINGLE FAMILY ENVIRONMENTAL ENGINEERING DIVISION Tli Telephone 264.4720 _ R E ( REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER - - PHONE MAILING ADDRESS - - - - - - since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY PROPERTY RESIDENT (If different from above) PHONE 2. BUYER - - - dJ INDIVIDUAL/ON-SITE** P TONE MAILING ADDRESS If system is over two (2) years old an ad uacy'test is required 3. LENDING. INSTITUTION PHONE MAILING ADDR SS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION LTA STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS T ❑ SINGLE FAMILY ❑ One ❑ Four ❑ Other _ ❑ two ❑ Five ❑ MULTIPLE: FAMILY „0� Three ❑ Six 7. WATER SUPP '`` -- - - - * Ffr INDIVIDUAL* ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DIS AL SYSTEM **If dJ INDIVIDUAL/ON-SITE** individual/on-site, give installation date�[U,� If system is over two (2) years old an ad uacy'test is required ❑ PUBLIC UTILITY by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED' TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size:. )O(If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area ---"[ Sewer Line 7ot Line Absorption Area to nearest Lot Line 5. COMMENTS 16. APPROVED FOR —�Z BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE q -j- lq-q C7� BY (Title) e LEGAL DESCRIPTION 72-010 (Rev. 3/78) CFI AICA. EM ®k®®L®EiIM. LMORATORM OF AL. K111i, INC. 907) 279--44014 P.O. BOX 4-1276 ANCHORAGE, ALASKA 99599 4649 BUSINESS PARK BLVD. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY -WATER SUPPLIER YS PUBLIC WATER STEM:F I EDT LD. N0. Pubtlr$WerSystem Nems 0; yJ (Melling A rase City State SAMPLE DATE: FIT FiIe--A 717 Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no._ ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION _ Collected By I I L I READ INSTRUCTIONS Bcefrinr- COLLECTING SAMPLE Form No. 18-310 (3-78) TO BE COMPLETED BY LABORATORY LABORATORY: NAME 5 ADDRESS ,4. Date Received Time Received Analytical Method: ❑ Fermentation Tube l (%Membrane Filter Lab Ref. No. Result" Analyst 1.0ml O.lml tea..-.�.-.�. 48 Hours Confirmatory L J. tF1 l ..- No. of colonies 1100 ml. or No. 61 Poslllys Portions. 0e-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source-- a.m. ource_a.m. ria Ya Rarnlvnd Tim. Rarelvnd n -m- I ih. Nn Presumptive lolnl l Oml loml 1 0m I Oml 1.0ml O.lml 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB — Broth 24 hours:_ Broth 48 hours: Multiple Tube Report: 10ml Tubes Positive/Total 10ml Portions Membrane Filter: Direct Count Coliform/l0oml Verification: LTB .y=j .___.—BGB Final Membrane Fllter fRresults Reported By —;- - _ Date Tlma _Coliform/100ml —a.m. p.m. A CIiE1�l� 8 GEOLOGIM ILMORATO OF AL"KA, INCO TELE PHONE 4 P.O. BOX 4-1276 ANCHORAGE, ALASKA 595917 4649 BUSINE;"N,S PARK BLVD. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER 9VSTEM: H7—�D I.D. NO. A SAMPLE DATE:[ Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ) C] Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE NO. LOCATION 1 1 lC� 2 3 4 5`- READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18.310 (3.78) P Time Collected Collected By TO BE COMPLETED BY LABORATORY LABORATORY: ADDRESS -%L Date Received Time Received �� " U1 V" Analytical Method: ❑ Fermentation Tube Membrane Filter Lab Ref. No. Result" Analyst L/` -=moo--- a CE 'A L I EE L- -J CL7 - L J FD - C� - No. of colonlos / 100 n11. or No. of Positive "rllonn. 00-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collectetl source, a.m. Date Received_ Time Received p.m. Lab. No. Presumptive 10ml loml I Oml l Oml l Oml 1.Oml O.lml 24 Hours 48 Hours Confirmatory 24 Hours EMB Broth 24 hours: ----Broth 48 hours:_ Multiple Tube Report: _ 10ml Tubes Posltive/Total 10ml Portions Membrane Filter: Direct Count _ Coliform/100m1 Verification: LTB BGB __ Final Membrane Fll to Cults `� __ _ Coliform/100ml tl e }�'��� / (" Reported BY Date p.m.