HomeMy WebLinkAboutMCMAHON #1 BLK 3 LT 21
GRE/~,ER ANCHORAGE AREA BOR. ]GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE
FROM WE,, i~0' MANUFACTURER
I
INSIDE LENGTH ? INSIDE WIDTH
MATERiAL~¢~, ~¢ NUMBER OF ~,
COMPARTMENTS
LIQUID DEPTH ~_ LIQUID CAPACITY('~(2GALLON5o
TILE DRAIN FIELD:
D,STANCE FROM WE'' /O~' FOUNDATION
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPT,ON AREA ,~ 75-- SQ. FT.
/
DEPTH: TOP OF TILE TO FINISH GRADE
NEAREST LOT LINE /a ! ~- TOTALOF LINEsLENGTH"~'~
N~~ TRENCH WlDTH-~ IN. TOTAL EFFECTIVE
DEPTH OF FILTER
MATERIAL BENEATH TILE b~SI ~'/ABOVE TILE y IN,
WELL:
TYPE _~
CONSTRUCTION
BUILDING ~ NEAREST . NEAREST
FOUNDATION~J¢/'~-, LOT LINE~/0 ~, SEWER LINE
SEPTIC
TANK
DEPTH ~'(~ DISTANCE FROM:
SEEPAGE
SYSTEM [~0 I
CESSPOOL , OTHER SOURCES
APPROVED J DISAPPROVED
REMARKS
DISTANCES: __
INSTALLED BY: ~')'~
SEWER LINE DEPTH:
PIPE MATERIAL: ~
LOT SLOPE,
REMARKS:
Form EQ-032
DATE ¢/,¢~/'7¢~2 App ROV ED ~'~ ~~B~ .
DEF'RRTMENT HEflL'TH HN[. ENv Ifi. CNHENTflL dJTEL. TIL~N
, , '~ ' 2,?a]-222t
F'E~M I T NEt
,,~H,I[. E H_. ~ILLI,RR~ . :, R H BIJ,.., 4'~. x~ a44~.L~.,Y
L[:[r: szze ' ' '
HI,JHBEE, OF BEDROOMS
THE R~QLtZRED SZZE OF ]HE SOIL ~BSORF'TZON SYSTEM IS:DEPTH= 9. 5 LENBTH= '~'
THE MINIMUM DEPTH OF DRIVEL. BETWEEN ]HE OUTF~L.L PIPE fiND, THE E~'¢OflVR]'ION BOTTOH
ZS ~.~ F"T'
THERE IS NO SET WIDTH FOR TRENCHES. FOR DRRINFIELDS., 'THE WIDTH IS ~FT.
THE DEPTH OF TRENCH OR PIT IS THE DISTRNCE BETWEEN ]'HE] GROUND SURFRCE RND ]'HE
BOTTOM OF THE E',=~',CRVR"FION.
THE LENG'TH DIMENSION IS ]'HE LENGTH OF ERCH SIDE FOR R SEEPFIGE PII' OR THE
LENG]'H OF' THE TRENCH., OR DRRINF'IELD.
THE RE~T!UIRED SEPTIC TRNK SIZE I'-q ±00~3 GRLLONS
BRCKFIL. LING OF' RH'T' SVSTEM WITHOUT FINRL. INSPECTION BM THIS DEPRR'['MENT WILL
BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE FROM HELL TO RNV SEPTIC 'T'RNK/PRCKRGE PLRN]' OR SOIL RBSORPTION
SV-C;TEM IS J. OE.I F'T FOR R PRIVRTEWELL RND 2EIC~ FT FOR R PUBLIC WELL
WELL [_OGLE; MUST BE RETURNED TO THE DEPRRTMENT WITHIN :~:C~ DRVS OF THE HELL
COMPLET I ON.
SPEC:[F'ICRTIONS RND CONS]'RUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER
INSTRLLRTION. ' '
I CERTIFV THRT I RM FRMILIRR WITH THE REf;~.UIREMENTS FOR ON-SITE SEWERS RND WELLS
RS SETFORTH BV THE P1L.INICIPRLI]"T' OF RNCHORRGIE RND WILL. INSTRLL IN RCCORDRNCE
WITH THE CODE.
Location (address o~: To~s~ip, R~ge, ~ Section (if kno~); dist~ce ~rom road:
Size of Casing ..~. Depth of Hole~eet. Cased to .~ .~ ~ ' feet.
Static water level ~ ~ feet ~ (below) l~d surface. Finish of ~ell
{check one)` ~en end ~: Screen ( ): Perforated ( ).
Describe screen or perforations: .
Well p~ng test at--gallons p~ '~ (~in') for ~ hours '~ith
_ . ~eet of drawdo~ ~rom static level.
Remarks
}~ELL LOG
Depth in feet from Give details Of format'ions ~'e~e~rated~ ~ize' 'of' material,
ground surface color, and hardness.
to x.x..' '
...... ~
to
to
to
to
to
to
I ~ ,, _
* % INSPECTION APPOINTMENTS
"¥1ME /'~'~-L _ TIME TIME
I NSPECTO~ INSPECTOR INSPECTOR
MUNICIPALI~ OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RoNMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVlRONMENTALSANITATION DIVISION SEP ,6 1980
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE I I
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
PROPERTY RESIDENT (If different from above) PHONE
MAILING ADDRESS
3, LENDING I~STITUTIO~ PHONE
MAILING ADDRESS
PHONE
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four
~ [] Two [] Five
SINGLE
FAMILY
[] MULTIPLE FAMILY ~J~ Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. Awell )og is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
- depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUALJON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 ( Rev. 6/79) b,~p
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
--I~] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO F~I FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
~ [] COMMUNITY INDIVIDUAL DEPTH OF WELLc-~ (~
DATE DRILLED
Connection Verified LOG RECEIVED
PERMIT NUMBER
3. SEWAGE DISPOSAL SYSTEM
'[~ INDIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified. iNSTALLER
~]Septic Tank or []Holding Tank
Size: \,~(~ If Tank is homemade SOiLS RATiNG~-'3~
give dimensions: [ ~)~c~
TYPE 0. F TANK
M A N U F A~.~ER
4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
[];]~/APPROVED FOR -3 BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)
ISAACS PUMPING SERVICE
(Norm Tibbetts, Owner)
6218 Quinhagak Street
ANCHORAGE, ALASKA 99507
Phone 344-0114
uu~ruMeR'S ORDER NO. I P.~ONE . ~.DATE (~'_.~/,~
CASH C,O.O. ~ CHARGE ON ACCT. MDSE.RET'D. PAID OUT
TAX
All claims and returned goods MUST be
2233..... panled by this bill.
~ank~ou
SERIES 609
CHEMICAL & GEOLOGICAL LABORATORIES o,F ALASKA, INC.
TELEPHONE 1907)-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:
I.D. NO.
I.., -: ' I~ ~',~/ '
Mailing Address
"~-,:- ~ .(-' ,i~ ,.;t ~' ~,,.',. t. ~'
City State
MO, Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
D Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO,
I
3 I
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] Sample too ong 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
I
I ICI
*No o! colonies/100 mi. or No of Positive portions.
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
48 ;-k~urs
Conflrn~atory
24 Hours
48 Hours
EMB Broth 24 hours: Broth 49 hours.'
Multiple Tube Report: lOml Tubes Positive/Total 10rnl Poctlona
Membrane Filter: Direct Count Collform/100ml
Verification: LTB BGB
Collform/100gnl
Reporte~t By ;: ~ i : ~ '; " Date ' '
