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Home My WebLink AboutOUR MOUNTAIN BLK 2 LT 9fi 0' 1 [[I MUNICIPALITY OF ANCFIORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTF_CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPFCTION REPORT NAME ~AILING ADDRESS LEGAL DESCRIPTION LOCATION _ :xh' I-~ Manufacturer " ~ ~,¢. r~ lLiq. capacity in gallons J ............ Inside length ~ ~ Manufacturer . ~ ~ DISTANCE TO: ~ell /~ ~ /~ Foundation /¢ ~ ~ j No. ofhnes ~ ILength of each lin~ ~t- Total lengthof,li~es ~ ~- ~rade ~ ~_ ~aterial beneath tile ~ Top of tde to flmsh --~ / Length Width -- Depth /mypeofcrib lCribdiameter ~/~ Cribdepth ~ DISTANCE TO: Well ¢ Building foundation ~ ~ ~ss Deptb Driller ~. ~ / DISTANCE TO: Building foundation Sewer line PHONE L'~ NEW [] UPGRADE I Dwelling Material Width Material Nearest lot line // Cf. Trench~v~id~.~ inches Z./~,~ inches NO, OF BEDROOMS PERMIT NO.c¢:?~. //// No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT Total effeo{i4e absorpti~ area PERMIT NO, Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Septic tank Absorption area(s) INSTALLER OTHER PIPE MATERIALS ~MMM~/~_~. SOIL TEST RATING REMARKS E:,EF'RRTMEN'F OF klEFfLTH RN[:, EN'v'IRONMENTRL PROTIEE:TIEdq 825 "1..." STREET., RNCFIORRL-~E., RK. 995~Z~:1_ 264-4720 F~ N 82iiii ::, F'EF.'.H I'T' NO. RPPLIL-:FINT FF..E:,TLN =, FEI-FEB. F'O E qX ±064 E.R. :~:'~57'7 LEGRL ~OLIR MOLINTRZN ~6M ~c> % LOT SIZE T"r'F'E OF SOIL HE,:,URFT~LN S"r'~TEM I'IRXZHUM NUHBER OF BEDROOMS = 2: SOZI_ RRTZNG '::~5Q FT,."'BR)= 147 THE REQUZRED SIZE OF THE i) E F' '1- H == ;;' L E ["~ ":i T ~'t = 5 6 ~3 ~ Ft ',.,' E: L [::" E: F' T' F'I ~: 4. THE LENGTH [:'ZHENSZON [S THE L. ENGTH (ZN FEET) OF THE TRENCH OR DRFIZNFZEL[:'. THE DEPTH OF R TRENCH OR F'ZT Z~ THE D[~TRNCE BETNEEN THE SURFFICE OF THE GROLIND F~ND THE E',OTTOH OF' THE: EXCR',/RTZON (IN FEET), THERE ZS NO SET NZDTH FOR TRENCHES. THE GRR',,,'EL E:'EPTFI ]:S THE MZNZHUM DEPTH OF' GRFIVEL BETNEEN THE OUTFRLL PIF:'E RN[:' THE BOTTOH OF THE EXCR',/RTZON ([N FEET). 694-,9681 999999 SQUFIRE FEET PERMIT RPPL. II]'FtNT FIRS THIS RESF'ONSIBILI'F"r' TO INFORM THIS DEPFIRTHEN'r E:,UF..:II'.4G THE INSTRL. LRTION INSPECTIONS F~F RN"r' P.IELLS RE:,JRCENT TO 'THIS PROPERT"r' FIND THE NUMBER OF I;.'.E:SIDENE:ES THRT ]'HE WELL 1.4II_L SERVE. P, FICKFZLLING OF" RN'¢ S"r'STEM WITHOUT FINRL INSPECTION RND FIF'PRO"/FIL D'T' THIS E-"EPRRTMENT NZLL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNf.::E BETI,.IEEN R WELL RN[:' RF,I'¢ ON-SITE SEI4RGE DISI:'OSRL S'¢STEM IS :.1.00 FEET FOF.: FI PRI'v'RTE NELl_ OR '150 TO 200 FEET FROM R PUBLIC NELL DEPENDIHG UF'ON THE T'¢PE OF PUBLIC NELL. MINIMUM DISTRNCE FROM R PRIVRTE NELL TO R PRI',/RTE SEWEF.: L_INE IS 25 FEET RNI} TO R COMMUNIT'¢ SENER LINE IS 75 FEET. WELL LOGS RF.'.E REQUIRED FIN[:, MUST BE RETIJRNEI} TO THE DEPFIRTMENT NITHIN 30 OF THE NELL COMPLETION. OTHER RE6!UIREHENT':; MR"r' RPF'L"r'. SF"ECIFICRTION':; RN[:' CONSTRUCTION [:'IRGRRI'"IS FIRE FI',/RILRBLE TO INSURE F'F.'.OPER IN:=;]"FILLRTION. I CERTIFY 'FI4R'F :'L: I RI"1 FRt"IILIFIR NITH THE REr..:!IJIREMENTS FOR ON-.SITE SEP.IERS RND NEL. LS RS SET FORTH B'¢ THE HUNICIPRLI'F"r' OF RNCHORRGE. ~i:: I NIL.L INSTRLL THE S',/'."STIEM IN RCCORDRNCE I.'.IITH THE COl}ES. 3: I UNDERSTRND THRT THE ON-SITE SENER S"r'STEM MFt"r' RE6!UIRE ENLFIRGEMENT IF TI'fiE RESIDENCE IS.'; REMC)E:'ELE[:, TO INCLUDE blORE THRN 2: BEDROOMS. S I GNEE:,: ..... {_r _z~__~_'_:~_.~.___.~=~~ ......................... FIF'PL. ICFINT F'F.:ESTON S F'EF'PEF'. I S:51_IED E,' ,r .... ~..z~" .................... ¢' ' ;..~.*' ....... ' ....... .. ......... E. kITE.z' ...... :' Z__.;_' " ..... / -__..~.~; '~ ",,'4. El MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: &':"CO 1 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN 4 ? (minutes/inch) ,7 FT Property Owner Mailing Address APPLIr LNT FILLS OUT UPPER HA 'ONLY Preston Peppers Phone P oO, BOX 1064, Eagle Rive~r, Ak. zip Code 99577 694--968]. Beyer Willi~n C. and Cbarle~e Davis Address 4110 De~3rr Rd. Space 2-D , ~c~rage, Ak, z~p Code 99504 Lending Institution ~aska Mut~,l ~ Phone Address ]~le R~ Brach zi~ Cod~ 99577 694--9571 Realty Co. & A~nt ~ R~lty, ]~C. / F~nda ~s Phone Address P,O, ~x 911, ~91e ~ver, ~. · Zip Code 99577 694~9494 Legal Descriplion :~t 9F ~l~k 2¢ ~ ~1~ ~[~. s[reet Loc*ati~ ~'~ ]~ards Ci~le, Pe~s Cr~k, ~A. Type of Residence ~ Single Family [] Multiple Family No. of Bedrooms 3 C] Other Water Supply ~ Individual A~'ACH WELL LOG. A well log is required for ell wells drilled since June 1975. [] Community For wells drilled prior lo that date, give well depth (attach log if available). [] Public Utility Sewer Disposal ~ Individual [] Public Utility [] Holding Tank When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RF_QUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Date ~- ~ /' /'~ .~,., Date Date Date Inspirer ~ // ' Insp~tor Insp~tor Insp~tor ~ ~ ~ MUNICIPALIW OF ANCHORAGE ' ~ ENVIRONM2NI'AL ( ~PPROVED BEDROOMS~ 'CONDITIONS OF APPROVAL ( ) DISAPPROVED Soils Rating Date ~wer Installed Well To Absorption Area Well t_og Received /~'7 Well to Tank Septic T~k Size /C) 0 C~ __ 72.023 (3/82) by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND : /,,) ~ :'.t /; L ~ STATIC LEVEL OF WATER FT. , ', ',' DRAW DOWN FT. ~ ' Ended /',~ i '~ ' GALS. PER HR i, ') KIND OF CASING ADDRESS '~ LEGAL DESCRIPTION DATE-Started ' ?' ~' ' ;' PERMIT NUMBER KIND OF FORMATION: From .' Ft. to ,.) Ft. ~3 '' ' ':~ ~'J ~/:~-''''.'' - ' From .... Front Ft. to :~: ? Ft ,~} /i ~, ~: / ,:~ ,v,." , .' .... From From____Ft. to _Ft,,'[,/ ,,Z ..,;c~}' ~: ,~r>(Jr; ~'c ,::-' From_~ / Front :,: : Ft. to ; :' ~ Ft Front, '? ~' Ft. to / r 5' Ft. From / "; Ft. to .~h Ft.. Front Ft. to Ft. From Ft. to Ft From Ft. to__Ft From__Ft. to__Ft. From____Ft. to Ft Front Ft. to__Ft From Ft. to__Ft From Ft. to__Ft, From__Ft. to Ft. From Ft. to___Ft. From Ft. to Ft. Ft. to __Ft. Ft. to_____Ft Ft. to____Ft From Ft. to Ft. · From ~ FI. to Ft. From Ft. to Ft From Ft. to Ft From~Ft. to~Ft From Ft. to FI. 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 MISCL. INFORMATION: DRILLER'S NAME ? f CHEMICAL &'Gl LOGICAL LABORATORIES ,~£ ALASKA, INC~ ~ -- TE[~EPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street Drinking Water Analysis Report for Total Colifo~'m Bacteria ~~ TO BE COMPLETED BY WATER SUPPLIER I.D, NO. Water SYstem Name Phone No, Mailing Address City Zip Code SAMPLE DATE: MO, State Day Year SAMPLE TYPE: E] Routine [] Check Sample (for routine sample with lab ref, no, £] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. 3 L 4 I . I LOCATION Time Collected Collected ,By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample, Date Received Tirne Received Analytical Method: U}- Fermentation Tube , [] Membrane Filter Lab Ref. No, Result* *No o[ colonies/I00 mi or No of Positive portions Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALY!HS RECORD Oats Collected Source . Date Received Time Recelve(J p,m, Lab. No, Presumptive ZOml ].Omi ].Omi 1Omi ].Omi 1,0mi 0,7. mi 24 Hour~ 48 Houri Confirmatory 24 Hours 48 Houri EMB Broth 24 houri: .Broth 48 houri= /0mi Tubes Positive/Total ].0mi Pc~tlon$ __ Collform/3.0Oml Collform/100ml Multiple Tube Report= Membrane Filter: Direct Count Verification= [.TB Final Membrane Filter ResUltl Reported By CHEMICAL & Gl LOGICAL LABORATORIES ,~,; ALASKA, INC. ~~ Drinking Water Analysis Report for Total Coliform Bacteria ~~ TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: [--II I I I I 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, ri Special Purpose U] Treated Water E~-'Untreated Water SAMPLE NO. 1 Time Collected LOCATION Collected TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: E} Satisfactory [] Unsatisfactory [] Sample too long in 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 [] Membrane Filter Lab Ref. No. Result* Analyst *No ofcolonres/IO0 mi or No of Pos;two portions READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date C ollecteci Source Date Received Time Received p,m, Lab, NO, 3resumptlve 1Omi 1Omi 1Omi 1Omi 1Omi 1.0mi O,],ml 24 Hours 48 Hours ;onflrmatory 24 Houri 48 Hours EMB Broth 24 hours: Multiple Tube Report: Membrane FIIterl Direct Count_ Verification= LTB Final Membrane Filter Relults__ Reported By _Broth 48 ho~lrs: _],Omi Tubol Polltlve/Total 1Omi Portions Collform/~,OOml Date Collform/] 00mi