HomeMy WebLinkAboutMCMAHON #2 BLK 7 LT 12MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
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GREA.,:R ANCHORAGE AREA BOR .. GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAT,ON LEGAL DESC, ,PT,ON
SEPTIC TANK:
DISTANCE
FROM WE~
INSIDE LENGTH
MANUFACTURER(~
INSIDE WIDTH
MATERIAL
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY___
GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPTION AREA
DEPTH:
NEAREST LOT LINE
TRENCH WI DTH ~/~IN.
~("//O SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
TOTAL EFFECTIVE
IN, ABOVE TILE
IN.
WELL:
TYPE
BUILDING
FOUNDATION__
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
, OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE_
DEPTH
SEPTIC SEEPAGE
, TANK__ SYSTEM
REMARKS
DISTANCE FROM:
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY: ~'
SEWER LINE DEPTH:~
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
D AT E [O/~,'~(¢/,~(.0 A p p R O V E D
6.A.A.B.
Form EQ-032
PERHIT NO.
( 7682i )
WILBUR [:,ITTBREN[:,ER
'I'RIGFI DRIVE
Li2 B? HC MFIHON SUB
FIF'P L I CRiq]"
LOCFtT I ON
LEGFIL
SRR BOX 4]764
LO]" SIZE 296t. 7 SQUFIRE FEET
TYPE OF' SOIL. RBSORBTION S'¢STEM IS: TRENCH
MRXIMUM N_MBER OF BE[:,F.:OCd-'IS
TNE REQUIRED SIZE OF THE SOIl_ FIBSORPTION S'¢STEM I:.S:
~r£::. E: F" "F P~ .....::IL ~
'I"HE LEI'.,IGTH [:, I MENS I ON IS TNE LENG T) OF THE "I"RENI]:H OR [:,RFIINFIEL[:,.
'T'HE DEPTH OF R TRENCH OR PIT IS THE [:,ISTFINCE BETWEEN THE SURFFICE OF' THE
GROUI'.4D RN[:, ]"HE BOTTOM OF THE EXCFI'v'FITION (IN FEEl").
THERE tS NO qET WIDTH FOR TRENCHES.
THE GRFIVEL DEPTH IS THE MINIMUM [:,EPTH OF GRR',,.'EL E',ETWEEN THE (]UTFFiL. L PIPE
FIND THE BOTTOM OF THE ENCFI',,,'RTION (IN FEET.':,.
EI]"HER FI CLFISS I OR II NSF RF'PROVED PLFINT MR'¢ BE: INS'T'FK.J._E[:,.
FI C:ONTINUOUS MRINTENRNCE FIGREEHENT IS REQUIRED. IF' FI MRINTENRNCE
FtGREEi"IENT IS NOT KEPT CURRENT YOU HFI'-r' BE REE!IJIRED TO ENLFIRGE THE SOIL
FIBSORF'TION S'¢STEM FIND,-."OR '¢OU I"IFI'T' BE SUBJECT TO PROSECUTION.
IF R CI_RSS I SWSTEM IS USED THE LENGTH IS 45. E~ FEET.
Il:' FI CLFISS II S'-r'S]TEM IS USE[:, THE LENGTH IS 58. 0 FEE.F.
BRCKFILLING OF RN'¢ SYSTEM WITHOUT FINRL INSPEC:I"ION RN[:, RPPROVFIL BY THIS
DEPRRTMENT NIL. L BE SUBJECT TO PROSECUTION.
HINIMUM ['.,ISTFIIqCE BETWEEN FI WELL FIND FINY lIN-SITE SEWFIGE I}ISPOSRL S'¢S.;TEH IS:;
:1. E:~0 FEET FOR Ft PR. IVFI]'E WELL OR 20E~ FEET FOR R PUBLIC t.4ELL..
PJEL.L LOGS F~RE REQUIRED RND i'"IIJST BE RETURNED TO THE DEF'FIR]"HENT WITHIN 20 DRYS
OF' THE WELL COIdPL.ETION.
SPECIFICRI"IONS RND CONSTRUCTION [:,IRGRFIHS RRE R',,,'FIILRBLE TO INSURE PROF'ER
I iqS ]"FILLRT t ON.
I CERTIFY THI~T
~!.: i AVl FFIMiLIFIR WITH THE REQ. UIREMENT'=; FOR ON-SITE SEWEF.':S FIND WELLS RS SET
FORi"H B'¢ ]'HE MUNICIPALIT'¢ OF RNCHORFIGE.
2: I WILL INSTRLL THE S'¢STEH IN RCCORDANCE WITH THE COB, ES.
2: I UNDERSI'FIND 'I'HFIT THE ON-SITE SEWER. S'¢STEH i'4R'¢ REG!UIRE ENL. FII;.:GEMEt'.~T II-- I'HE
RESI[:,ENCE IS REHODELED TO INCLUDE I',IORE THAN 4 BEDROOMS.
.... .................................
FIPPL ~ CFINT W ~ LE;UR DITTBRENDER
I SSUE[:,~ E' [,H rE ' ~ 6~
, . ............ _~ _~.. . .._ ...... ~s_ ..... ':-' . ......... _-~ ...... L-._ ......... .:
-- STATEMENT --
Consultant , Inc.
P.O. BOX 6087
ANCHORAGE, ALASKA 99503
May 25, 1976
Falcon P~sonry
P.O. Box 4-1513
Anchorage, Alaska
Invoice No. 1-656236 SAtANC~ FORWARD
For Services Rendered May 1976
Soil Log and Report
Lot 40 Block 3, Lot 12
Block 7
McMahon Subdivision
Total Due
$ 475.00
1% per month (Z2% yearly) service charge will be charged after 30 days
TH i
ORGANICS
SILTY SAND
GP~E LLY SB~D
SO~"~ SILT
(SP-S'>i) 200 sq- ft
0.0~
3.0'
TH 1
TAZGA STREET
NO Scale
S~.ND, TRACE GRAVEL
TRACE sILT
S~-NDY GRAVEL
GRADING TO GP~%VELLY
S~D [SW-SP)
140 sq- fi/bedroom
13.5'
No water
Log Represents
Location of Test Hole
Lot 12 Block 7
McMahon Subdivision
OWN: VRZ
_CK0: WED
DATE: 5-2.5,76
[ SC'~L~-: 1"--3'
GRID: .
/ -01'
Log of Test Hole
FalcOn Masonry
An~horaqe, kla~ka
PERCOLATION TEST
FALCON MAS ONP~
R & M NO. 656236
6:30
6:31
6:32
6:33
6:34
6:35
6:40
6:45
6:50
6:55
7:00
7:05
7:10
7:15
7:20
7:25
7:30
ELASPED
TI~E
0
1
1'
-1
1
1
5
5
5
5
5
5-
5
5
5
5
5
60 Minutes
DROP
INCHES
.75
.25
.25
.25
.'25
.50
1.0
. ~75
.75
.50
· 50
.25
125
.25
.25
.25
Total
Drol~
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Date Received November 12,~1976 ~-',
Time of Inspection ~
Date of Inspection /}- 17A7(~
FirSt National Bank of Anchorage -% Marie Iiams
1. Approval requested by:
Mailing Address: Post Office Box 720 99510 Phone: 279-6400 x 483
2. Property Owner: Wilbur H. Dittbrender
Phone: 349-2235
Mailing Address:
NHN Taiga Street
3. Legal Description: Lot 12 Block 7 Mc Mahon Subdivision
4. Location:
5. Type of facility to be inspected Single Family No. of bedrooms 2
6. Well Data:
o
A. Type
C. Construction
Sewage Disposal System:
A. Installed
Individual
On-site system
B. Depth
D. Bacterial Analysis
1. Size
C. Septic Tank:
D. Seepage Pit: l. Absorption Area ~A/~3D,'
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
B. Installer
2. Manufacturer
2. Material
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines ,
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
P:ge 2 of two pages ' Re¢'~-~'~t for Approval of Individual .~'~r & Water Facilities
Legal 'Description Lot 12 Block 7 Mc Mahon Subdivision
Comments
Approved ~/<Y ~A <:> ~
Disapproved
Date
Approval Valid for one year from date signed
Greater Anchorage Ar~a Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
1. Type of Inspection:
2. Property Owner:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
MUNICIPALITy OF ANc
r~.,..-DEPT. OF 1.4r~z,... HORAGE
RECEIVED
CMRO VA
WiLbur H. Dittbrender
FHA CONV X
Mailing Address:
3. Name of Buyer:
NHN Taiqa Street
Paul & Johanna Shawler
Day Phone 349-2235
Mailing Address:
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
B Plaza Hotel 831 B Street Day Phone 277-6622 _~ 207
First National Bank of Anchoraqe
P.O. Box 720 99510 Phone 276-6300 ext. 483
Evelyn Givens @Marston
2804 W. Northern Liqhts Phone 277-3511
6. Legal Description:
Location:
Lot 12 r Block 7r Md~ahon S./D
Anchorag~r A]a.~ka 99507
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply:
No. Bdrms. 2
Public Utility
Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site)
EQ-037 (1/74)
Marie Iiams 11/10/76
06-1220~) Rev.'1973
DATE
AL~='~ DEPARTMENT OF HEALTH AND SOCIAL Sr ~'CES
DIVISION OF PUBLIC HEALTH ~
INDIVIDUAL AND SEMI*PUBLIC
BACTERIOLOGICAL WATER ANALYSIS
Lab No.
OFFICE
INDIVIDUAL ~] SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
ADDRESS · ' -': -~-
CiTY " ' ~ ZIP CODE
ADDRESS
OF SOURCE
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY '- ~
DATE COLLECTED TIME COLLECTED
Sample Collected From [] Kitchen Tap [] Bathroom Tap
r-I- Other (List)
Well- [] Dug [] Driven E Drilled
SOURCE: [] Spring [] Cistern [] Othe-
Dug Well or Cistern Construclion:
Walls--[] Wood [] Concrete [] Metal
Top -- [] Wood [] Concrete [] MelaJ
LOCATION:
[] In Basement [] Basement Offsel
[]in Yard [] Other
BuJldJng Sewer
DISTANCE TO: or Other Drainage Pipe
Tile Seepage Cess-
Field Feet. Pit __ Feet. Pool
Other Possible
Sources of Contamination
MATERIAL: Building Sewer- [] Cast Iron [] Wood [] Tile
[] Plastic Joint Material - Type
GENERAL: Does Water Become Muddy or Discolored?
When?
Diameter of Well
Well Casing
Material Diameter
Length of'
~ Drop Pipe
Offset in
PUMP LOCATION: [] In Weg [] Basement
On Top
[] Of Well [] Other
PURPOSE OF EXAMINATION: Illness Suspected?
New Source of Supply? [] Yes [] No
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
r~ Basement Tap
Bored
[] Tile Brick or
[] Open Top [] Concrete
[] Under House
Septic
Tank Feet.
Feet. Privy __Feet.
[] Fibre [] Asbestos
Cemenl
[] Yes [] No
Depth Feet.
Depth
Water Depth
From Bottom Feet.
In Utility
[] In Basement [] Room
~nalysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] Questionable
[] Sample too long in transit; sample should not be over 48
hours old at examlnatbn to indicate reliable results. Please
'~ send new sample.
[] Battle broken in transit, please send new sample.
SANITARIAN'S REMARKS
[] Yes [] No
Repairs to System? [] Yes [] No Signature
06-1220 (b) BACTERIOLOGICA"L WATER ANALYSIS RECORD
Rev. 1973
Date Received / -~J -~ / -- ' / ~' Time Recelved / - I~n~ L~b. No. 'i ~ :
La,lose Broth ~ 10cc 10cc '. 10cc ]0cc 10cc 1.0cc 1.0cc
* 24 Hours
48 Hours
Brilliant Green
24 Hours
48 Flours
EMB AGAR
Lactose Broth, 24 hrs. 48 hrs. Gram's stain
Coliform Density (Most probable No. per 100cc).
MF Results
,~sent
Present
This analysis indicates Coliform Organisms