HomeMy WebLinkAboutMCMAHON #2 BLK 8 LT 8 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/OR WELL INSPECTION REPORT
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
t-oT
LOCATION
DISTANCE TO:
Manufacturer
DISTANCE TO:
Manufacturer
Absorption area
No. of corn
IF HOMEMADE:
Well
Inside length Width Liquid depth
Dwelling
Well
DISTANCE TO:
No. of lines /
Top of tile to finish grade
Length
Type of crib
DISTANCE TO:
Class
line
Width
Crib diameter
Well
Depth
foundation
Material Liquid capacity in gallons
Foundation Nearest lot lineL
lOS
I Trench ~th Distance between lines
, inches
Total effectiv, eCabsorption area
)eneath tile bO inches
Depth PERMIT NO,
Crib depth Total effective~
Building foundation
line
Distance to lot line
Sewer line Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTAELER
REMARKS
APPROVED
PERMIT NO.
Absorpt on area(s)
LEGAL
PERFiI'T NO:
DFITE ISSUEf.':,:
RPF't_ T C:FINT:
FID, DF;:ESS:
CONTFICT PHONE:
HUN I C I F'FIL :[ T'-r' OF' I-3N ]:HEIDF~L"'.iFZ
E:,EF:'FIF."E:Tf'iENT ElF HEFILTH FINE:, EN'(,' I F;:ONHENTRL F'F..:OTECT I ON
~ ':"?;-, L STF::EET., FIN*'H"'F:'FIGE., Rl.:.': ':~'.~SI;:l::L
264-4720
:.:.:':-~ :'"" ;~ 5 Z'. //' LII'-'LiN:HL: b'_ .' )
~IJF.:F'H'¢
SR.FI E:O::':: ±Fj fSf[
FINE:HE~F.:FIGE., FIK
2 7"9-- ':D'9 ± 6
L. EGFIL DEL::;CRIF': SUBE.',I',,,'ISIOI'.,I: MC:I'dFIHON L.JDT: 8
SEC.:T:]:ON: 2:..=.: TOP.!NSHZP: i:;'N F..'FtI'..IGE: 3:H
LOT SiZE: 25E~EtO ,::SI]:.!. FT. OR FIE:RES::,'
L.O"I" LOCR"I"]: O1'.,I: I--II..IF'F'P1FIN ROFID
E:LOCK:,_,°
I C:EF::"F]:F'~.! TF!FIT:
::i... :[ FI!',1 F'FII','IILIFhR [,iITH THE F.:ELqL. IREMENTS FOF.: FiN-SITE SEHEF.:S FINE:, 1.4ELLS FIE; SET
FOF.:TH :, THE I'"ILINIC.~F'FILIT"r' OF FII'.,iDHC~PRISE ,::I"II.3FI) RI'.,tE:, THE STRTE OF FILRSI-:::FI.
2. Z I.,.i:[L.L. TN:E;TFILL TFIE S'-,-'STEi'I );.N FI'."'-T.F'DFINE:E !.,.I.ITP'] FILL MOFI CODES FIND F.:EGULFITInhts.,
Fii'-,i[:, ]: N E:OMF'L. T FINCE i.,].. ]: TH THE: DES; ]: GN CF.'. ]: TER 'r R OF TH ]: S F'EF.:FI ]: T.
3:. ]: H]:LL F!E:,HEF.:E TO FIL.L HOFI FINE:, STFI"I'E ~"~F RLFFI'=;KFI F..:Eg!U]:REHEi':.ITS F'F~R THE SET E:FIC:I-:::
E,]'STFIN:'ES FF.:L-iH H,K!'¢ E::-:;]:STZNG HELL, F!FI2;TE!4RTEF.: DTSF'OSFtL. _-.~_-TEi'I FiR F'UE;LTF:
SEHEF.'.FIGE '_=;'¢STEH ON TH]:S OR I'aN'-r' RD.J'FIF:ENT OR NEFIF.:E','-,,' LnT.
:i: F' FI
THEN
t,J '[ L.L
ELECTF:.~CFIL FtOF?.k: HUST E',E DONE E:'¢ FI L:[C:ENSED ELECTF.:TF:]:FtN.
S .T. EiNE[:, ~~ ~ ~ ~/// [:,RTE:
L..T.F'T STFiTIC. ii'.,I :IS .T.TNSTFiLLEE:, .T.N FIN FIREFI C:CCv'EF.:E[:, E:'.,.' HOFI E:t..IILE:,ING C:ODES.,
(:1::, FIN ELECTF.:IE:FIL F'EF.':HIT FIi'-4E:, ZNSF'ECTL(ON HUST E:E OE:TFIINED:= ,'2) FIS-BUILTL.=;
NOT E',E FtF'F'F.'EVEE, HZTHOUT FiN. E~.F-C:TF'IC:FIL II'.,!SF'EF:TION F.:EF'FIF:T.~ FINE:, (_'-:.'.) THE
Permit.~
Applicant: /~ ~.
!
Location:
Legal Description: ~o I ~/
Type of Soil Absorption System Is:
Trench: X' Drainfield:
Maximum Number of Bedrooms:
MUNICIPALITY OF ANCHORAGE
Department,,.~f Health and Environmenta?-~rotection
825 Street, Anchorage, AK. 9501
264-4720
* * * HANDWRITTEN PERMIT * * *
-~L-L~AN~/0R 0N-SITE SEWER PERMII Mailing Address:
Phone Number: ~
f~c/~/~9~/ Lot Size:
Seepage Bed: Holding Tank:
Soil Rating(sqoft/br) ~
The Required Size of the Soil Absorption System Is: '
DEPTH LENGTH GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pi~e~ and
the bottom of the excavation(in feet). ~ ~ /~-O
* * REQUIRED SEPTIC(HOLDING) TANK SIZE =~"( ~-~. GALLONS * *
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 well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection.and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion°
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may ~equire enlargement if
the residence is remodeled to include more tha~/13 bedrooms°
Signe~: Issued by:
Applicant '~-~/'~- ~
Date:
SWP/024(1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 254-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
~HONE I [~NEW
~ ~)~.~/~ [] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO: Well
~-<~- ~ Manufacturer
~I- Liq. capacty nga OhS IF HOMEMADE:
~. (~ Z~ DISTANCE TO: We
TO _Z ~ Manufacturer
Well
-~3: I DISTANCE TO:
buy
~.;1" ;~ INo,oflines I Length of each line
,~z~u I I ~ I-'iF;,
~3~- T°P °f tile t° fimsh grade
~ Length Width
'~ ~_ I~ Crib diameter
~" ~ Well
Class Depth
~: DISTANCE TO: Building foundation
Absorption area
Dwelling
Material
Width
NO. OF BEDROOMS
PERMIT NO.
No. of compartments
Inside length Liquid depth
Dwelling PERMIT NO.
inches
Material
Foundation Nearest lot line
Total length of lines ITrench width
~- ¢"~ I
Material beneath tile
Depth
inches
Liquid capacity in gallons
PERMIT NO.
Di st a n ce b et we~.~ ~/[~
Total effective absorption area
PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line
Sewer line
Septic tank
PERMIT NO.
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
I:::'EF.:H I 'T' I'.,!0.
FtP F"L.. I C l"::lhF['
!...OCAT ! ON
DEI:::'FIF.':TMENT OF' HEF:II_TH Fli'.,![':, IEi',IV]JI~Z:O?.,~HENTIR!_ PROTECTION
C-'~:.:25 '"L'" '.E:'T'F..'EET., FtNCI...K]RP, GE., I::lt{.
[ .I ,1] EP..F ~. I SES
I"'t-~ NTFII N ............. "-'
LJ:.:i~ B~'~i[ I"ICHFtI'"II:Itq SIJ!B
LJ3T 'E;ZZE :J:_'Ei/.E(~ :'SC:!IJI::II:;::E FEET
'T'.?F'E: OF '_:B.31L FIE~E;(31:~'.EFf' L' ['ll'.~ S'~'STIEM 'J: L::; ' ]"I:;..E34'XI-'
Ml:::l;q I t',11j1"t t'.,IIJMEI!ER OF EIEDF?.CuZIMS-"= 4 ':~: O ]' L RI:IT I I'.,IC:i ,:'..'El;t:.:! !::'T,.-"BR ::, =: ':'~_ ....
THE Fd::T. QI. jlF.".E[:, SIZE OF THE SOIl_ F!tF.,'SOI;.:PTIOI",I S'.?'L:;TEH IS:
E:::, EJZ: tF:" T' ~--II '== ::!L ~E~ !L_ E: !l'.a CE'i -E' tF...~, == ;;~.!? :';_':.[~ £3 E;~: IF:-~ ",,,-" EEC II .... !!3:, liE: F' '"IF It-~
TI-.IE: LENGTH [':,.'I.' MENS I AN I '.E; THE LENGTH ( I N FEET ) Of:' ]"HE TREr,ICH OR DI:;..:FI ! i'.,IF' I ELI:,.
THE DEF.'TH OF FI TRENCH OR F'IT tS THE' D ZS"I"FtNC:E BETI.,.IEEI'.~ THIE SLIF.:FI:::tC:E: OF:' THE
GROI_II'.,I[:, FIf'-,I[:, THE BOTTCd"I OF' THE EY, CFI',,,'FIT Z ON ( Z I'.,I F'EET).
THERE ].':E; NO ':51ET I.,.!!DTH FOR TF.'ENCHE~.
THE GF..:FtVEL DEPTH :['.'E; THE Mt I',!IMIJH [:,EPTH OF GF:'.F:IVEL BETI.,.IEEN THE [:iU"!"F'FIL. L. F'IF'E
I:IND "I"HE BOTTOM OF THE E',:.~',Cf:i',,,'F:!"I"ZOI'.,I (I!'.,l FEET).
F'ERH I T FIF'F'L I C:FIt'.,IT HI:tS THE I;:.:ESI::'OIqS I B .T. L I T"r' 'T'O I IqF' 3[;i'H TH I S DEEPFtRTHENT [>L.It~'. I !'-,!G THIiE
";1' .......
:1: NSTFtL. I._I:::tT I Ot'.,I I i'-ISF'ECT ]' ON'i:i; OF FII'-,I'.? I,IELL!.:.; t:::t[:,.]'!aCEt'-.!T TCI TH Z S [ F.... F EI~. I FIND THE'
· .:,EK, I=.
!',ILH"IE~E];?. )P' F.'.E:'~..T. [:'E:t",tCF~i'.~:!; THFtT THE I.'.!ELL. b.I I L..L - ..... ' '-
E!H::ICI':::F ILL. ]: iqEi (:)F' FIN"r' '- '""'""F .... " ......... E:"r'
= ~ :: ~ :-:. ~ I.,.IZTHC~I..JT I:'"'ItqF!L II',ISI::'E[::T!Cd",! FIi",![:' I'IFI- F . , HE THIS
i:::'E:F:'FtRTMENT I'.11 I_L E',E .".SL.IE~J'EL"::T TO F'R '.: '}i E 'Z .. T I Olq.
H I N ! MLIM D I STFINCE: BET!.,.tEEN F:I I.,.IEL. I_ F:flq[:, F:INh.' ON-S Z '¥'E SEI.,.IFIE~iE [.', I SF'OSF~I_ S"r'STEH I S
:LOO F[£ET F(]R ta F'I~:I',,,'FrTE NEL..I_~ O1:;:'.
!50 TO ;.:.!'.(~':iL:'~ FEET FRor,'I F:I PLIBL..'I.'C f.,.tELL DEP[CN[::,tNG I.JPON THE -!"'-r'PE OF F:'UE~LIC t.,-!EL.L.
NELL. LOGS FIRE RE~UZF.'.EE.', F:II",I[:' MU'L:.:T B[F: RETURIq. ED TO THE:. I:>EF:'FtF.:"['MENT FJI'FHZN 2i:E~ [::,l~'.r'S
OF THE t.qE'L.L COHF'LETION.
CF,rHEF:'. RE(.:]U I F.'.EMEI',IT:~; MFi"r' r':IPF'L'.r'. SPEC I FI CF!"r'~ ON'..'!; I::INE:, COI'.,IST!Td...IC:T I ESI E.', I Fi[~iF, i:FIP'I'.'5 FIRE
Ff,,,'FI T LFtE:I...E TO I Iq'.:~;LIRE PR[)PER ]: N'.E;TF:tL.I....F!T T ON.
t C:ERTIF"? THFIT
t: ! i::tr,'! F'FIMILIF:II::~'. P.IZ"I-I...I THE RELZ. K..III:~:EHENTS FOF?. ON"*'SITE SEt4EI;::'E, F:iND 14ELLS FIS SET
FC~R'!"H B'-r' THE MLIN I Ill:: I I":'F!L. I'l"k' OF F:tI",ICHORP, GE.
2: I I.,.IILL INSTF]I_L THE ::'3"r'STEM tN t::tCCORDF~I",ICIE !4:[TH THE CO[:'ES.
3: I LINDERSTFII",I[:' THF!T TFIE '.'SEI-,.IER S'fSTEM I'"i~a"/ F.'.EQIJIRE E.I'.4L.F~RL3EHEt',IT I'F THE
.I:;:!~:S I [:'IENCE I '_:'; I;.".EHCI[)Ei:t_E]) ORE 'T'HF:II'.4 4 BEI:::,ROOH'.5.
S l G 1'.4 E [:, '
T
GARY
PLAYER
CONSULTING GEOLOGIST
BOX 476~M, STAR ROUTE A " ANCHORAGE, ALASKA 99507
VENTURES
PHONE 344-7071
SOILS LOG
Performed for
Lo cat ion___~ ~ ~ ~
%5
~~;Wl'2.e~ Date 3/'~O
%
Soil Type Water Level
Remarks
0
2
4
6
~ 8
O
= 1~0
~ 12
16
18
2O
Total Depth of Excavation
Groundwat er
~Not Reached
Depth, if Reached__
Classification Method
~/Visual
( ) Sieve Analysis
()
Material at Total Depth
Bedrock
~/~Not Reached
Depth, if Reached
~ /, .-. ,
WELL OWNER
WATER W~ELL LOG
FOSS DRILLING
1336 Ingra Street
Anchorage, Alaska 99501
SIZE OP CA~ING-~ "DEPTH OF HOLE/~PT. CASED TO PT.
STATIC WATER LEVEL //~ ~ FT. YIELD ~/~ GAL.PER.MIN. WITH /~.. _
FEET OF DRAWDOWN.
REMARKS
DATE COMPLETED
PUMP TO BE SET AT
tO~
to
to
,to
? " MUNICIPALITY OF ANCHORAGE
DMSION OF .~xrvqRONMENTAL HEALTH
DEPARTMENT OF HEAL~{ AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AIYI~ORITY APPROVAL CERTIFICATE
.il~
1. Gener, al Inforn~tion Application Date ~
(a)
Legal Desc~iTption (include lot, block, subdivision, section, township, range)
Location (add,ess ox directions)
(b) Applicants Nams 'T~,
Applicants Address ~ ~/-~
(c) Applicant is (che~ or~) ~nding Institution
Buyer ~; ~her ~ (e~lain);
(d) ~nding Institution ~ Lag
(e) ~al Estate ~ a Agent
'ad.ess
Telephor~ ~k~ q _ ~5~
T_Xpe of t~sidence
Single-F~nily ~
Nu~,~eF of Bedrooms
Water Supply_
Individual K%!l ~
· e lephone
Te lelohor~
Multi-Family ~-~
O~e~ (describe)
Co~aunity ~ Public ~
Note: If cc~aunity well system~ must have w~itten confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Is the v~lt adequate for the number of b~drocras specified in this HAA (Y/N)
~osal
Onsite ~ Public ~ Cor~unity ~ Holding Tank ~
Is the wastewater disposal system adequate for tJ~e ~r of bedrocks (Y/N)
[Pa~e 1 of 2]
2-15-84
5. ~ri_!~q Firm Providin_n~n~__ctions, ~sts, Data and Information ·
I certify that I have checked, verified~ or conformed to all MOA HAA Guid~lirms in
effect on the date of this inspection.
Signed ?Z- ~::~- ,-b~L&~,%-~'~ ~'/-~ Date __
Oate
(ENGINEER SEAL)
Approved for ~/ bedrcoms
Terms of Conditional Approval
The Municipality of Anchorage Departn~nt of F~alth and Envirc~ntal Protection does
not guarantee the continued satisfactory performance of the water supply and/or the
waste,~ate~ disposal system. This approval indicates that, as of the validation date
sho~n above, based on ~31e data and inforn~tion f~rrnished by an engineer registered in
the State of Alaska, the ~ter supply and wastewater disposal system is safe and func-
tional for the number of bedrooms and type of structure indicated°
(DHEP SEAL)
7o Mail the HAA to the following address:
/ ~ ~, /' i , , . ,,'
i ,~ ~,, ~,. . _._L~ i~2.~, ..,~ . .,!' ,~-,, ?'/'4 : ,
KB2/d5/s
[Page 2 of 2]
2-15-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
Legal Description:
Well Classification ~R\VAT ~
Well Log P~esent (Y/N) RI
Total Depth Cased to
Static Water Level I~q Pump Set At
Casing Height Above Ground ~
Electrical Wiring in Conduit (Y/N) y
Separation Distances f~c~ Well:.
To Septic/Holding Tank on Lot I~ ~
To Nearest Edge of Absorption Field on Lot ]O~
To Nea=est Public Sewer Line
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAl. PROTECTIOI',J
APR 2 3 198
If A, B, c~ C, D.E.C. Approved(Y/N)
Date Completed
Depth of G~outing
Yield
Sanitary Seal on Casing (Y,/N) ~
Depression Around Wellhead (Y/N) ~
; On Adjoining Lots J
; On Adjoining Lots
To Nearest Public Se~r
C Ieancut/Manhole
Wate~ Sample Collected By --~, ~ ; Date
Water Sample Test Resg~lts ..........
Conm~nts~ ~/~/ ~m~ ~/~ /t~/~//~__ ;
To Nearest Sewer Service Line on Lot
Be
SEPTIC/HOLDING TANK DATA
Date Installed ~ O ~ C~C~) Size
No.
of'
campa~tn~nts
Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N)
Depression ove~ Tank (Y/N) ~ Date Last Pumped
Pumping/Maintenance Cont=act on File (Y/N) ; for
Holding Tank High-Water Alarm (Y/N) Teapota~z Holding Tank Permit (Y/N)
Separation Distances f~om Septic/Holding Tank:
To Water-Supply Well
To P~operty Line
To Water Main/Service Line
Course
Co,~,,ents ~ ~$~ ~
To Building Foundation ID
To Disposal Field
To Stzeam, Pond, Lake, a~ Major D~ainage
Y
[Page 1 of 2] 2~15~84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/~/~ ~
Width of Field -~ 0
Square Feet of Absorption A~ea
Depression over Field (Y/N)
Results of Last Adequacy Test
Date-of last Adequacy Test
Type of System Design
Length of Field
Depth of Field /
Gravel Bed Thickness
Standpipes P~esent (Y/N)
v
Separation Distance from Absorption Field:
To Water-Supply Well /~ ~ To P~operty Line
To Building Foundation ~ ~ To Existing or Abandoned System cn
Lot '; On Adjoining Lots
To Water Main/Service Line To Cutbank(if present)
To Stream/Pond/take/or Major D~ainage Ccu~se
To D~iveway, Parking A~ea, o~ Vehicle Storage Area
D. LIFT STATION
Date Installed
Size in Gallons
"P~np On" Level at
High Water AlarmLevel at
Tested for
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Conments
** ~eck Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or confomnmd to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed 7~
Company
KB1/d5/s
Date
MOA No.
[Page 2 of 2]
2-15-84
CONSULTING ENGINEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
Mrs. Debarha Kiland
Alaska USA
4000 Credit Union Way
Anchorage, Alaska 99503
April 23,1984
WELL INSPECTION
LEGAL:
TYPE OF WELL:
WELL LOG:
CASING ABOVE GROUND:
WIRES IN CONDUIT:
SEWER SYSTEM:
SURFACE GRADING:
LAB TEST:
DATE OF TEST:
TEST PROCEDURE:
TEST RESULT:
LOT 8, BLOCK 8 MCMAHON
PRIVATE
NOT AWAILABLE
24 INCHES
YES
ON SITE SEPTIC
LAWN MAY HAVE TO BE RESTORED
SATISFACTORY
APRIL 20,1984
Well was pumped at a steady rate of 2.5 gal
per minute for 20 minutes. The water, level
in the well went down from the static level
of 169 feet to 169-3 immediately and stayed
at that level. Pumping rate was then
increased to 5 gal. per minute. After an
additional 20 minutes the water level
stabilized at 169-7. The well was pumped
for an additional 20 minutes with no
additional drawdown observed. When the pump
was shut off the water level rose to 169
feet in less than a minute.
This well was pumped for 60 minutes with 7
inches of drawdown. It is more than
adequate for the residence it serves.
TELEPHONE (907)562-2343 ANCHORAGE INDUSTRIAk CENTER
Drinking Water Analysis Report for Total Coliform, Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
[I.D. NO.
Water S~stem Name
Mailing Address
State.
MO. Day I Year
cRoPLE TYPE: . ,
utlne
hack Sample (for routine sample
with lab ref. no.
I-I Special Purpose
(*) see h on back
Phone No.
Zip Code
r.Treated Water
Untreated Water
TO BE COMPLETED BY LABORATORY
Analysis shoWs this Water SAMPLE to be:
Satis{actory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination to
indicate reliable results, Please send new
sample via special delivery mail.
Date Received
Time .Received
Analytical Method:
[] Fermentation Tube
Membrane Filter
SAMPLE i'
No. LOCATION
i J OCT
Time Collected
Collected By
1
I
eNO, of colonies/100 mi. or NO, of Positive porlion$.
Lab Ref. No. Result* Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
0~1220 ~o)
Rev. 198~
BACTERIOLOGICAL WATER ANAEYSIS RECORD
Membrane Filten Direct Count
Verification: LTB
Final Membrane FIIt~3esult~-~/
Reported By
TNTC = Too Numerous To Count
BGB_
Date.
Time:
Collformll00ml
Collformll00ml
APPLIC ' ,tT FILLS OUT uPpER HAL :'ONLY
Prop~.~tv_Owner ,~< ~.~.4 ->~'??- 6 ~-->~ ~ Phone
Mailing ~ddre~ ~ ~ .~/~.2~ ~',~ ~ ~'~' ~ , (~: Zip Code ~-~/ ~'~ ~7
Buyer
Address Zip Code
Phone
Lending Institution
Address ~/~ Zip Code ~
Address ~D~ ~/~ '''~/ '~ ~ Zip Code ~ ~
Type of Residence
~ Single Family ~
~ Multiple Family No. of Bedroo~s
~ Other
Water Supply
~lndividual ~' LOG. A well log is required for aH wells drilled since June 1975.
A~ACH
WELL
~ 'Community ~~ For wells drifted prior to that date, give well depth (attach Icg if available).
~ Public Utility ' '
Sewer Disposal
~ndividual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
~/~ ~NVIRONM~NTAL p~OT~CTION
( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ~SAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date ~wer Installed Well To Absorption Area ( D ~ ~ ~ WeJl Log Received
December 7, 1983
Ruby Murphy
SR 1561-J
Anchorage, AK
99507
Subject: Lot ~, Block 8, Mc.~ahon ~2
Approval for the individual sewer and water facilities cannot
be granted until the ~ollowing items have been completed:
o The septic tank pumped with a receipt submitted to this
department.
An adequacy test needs to be performed on tile existin9
leaching area. This test will determine if the system is
adequate according to National Standards. A listing of
private firms performing the test is enclosed. This report
needs to be submitted to this office for our review.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
Jim Roberts
Associate Environmental Specialist
JR9/ej/E1
Enclosure
cc:
A. Palmer
Sleeper, Inc.
Century 21
8050 Old Seward Highway
Anchorage, AK 99502
A.~CHEMICAL & GEt_..,OGICAL LABORATORIES 0,- ALASKA, INC.~
TELEPHONE (907) 562-2343 ANCHORAGE56331NDUSTRIALB Street CENTER
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
I.D. NO.
Phone No.
Mailing Address
~ ·
City ~ .... =~ .... ~ ..... Sta~=' .... .;~. ~_. Zip Co, de . ~ _.
SAMPLE DATE: ~ ~ ~
Mo. Day Year
SAMPLE TYPE:
E]~Routine
[] Check Sample (for routine sample
with lab ref. no. )
[] Special Purpose
SAMPLE
NO.
I
I
I
I
LOCATION
[] Treated Water
[] Untreated Water
Time Collected
Collected By
06-1220 (b)
Rev. 1979
TO BE COMPLETED BY LABORATORY
Analysis snows this Water SAMPLE to be:
~r~Satisfactory
I~ Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
Oats RBCe~VBCi /~-~5~
Tirade Received / ~""~')
Analytical Method:
[] Fermentation Tube
I~'M embrane Filter
Lab Ref. No. Result* Analyst
I dc~7-/~- I I-~:~
/
I [--]'-I
I
I
*No o! colonies/lO0 mi. or NO. of Positive port~ons.
--~- -'--" ~' - r - ' ::.- ~'; , . . :. *~. _-
BACTERIOLOGICAL WATER ANALYSIS' RECORD
READINSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Date Collected Source
PresumPtive 10mi 10mi Z0ml 10mi 10mi %.Omi 0.1mi
24 Hours
48 Hours
24 Hours
4~ Hours
EMB Broth 24 hours:
MultiPle Tube Report:
Membrane Filter: Direct Count
Verification: I.TB
Final Membrane I~IIt~,~SUltS
Broth 48 hours:
10mi Tubes Positive/Total 10mi Portions
Colllorm/100m!
BGB
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street-Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will n~ be~esR~d. Please allow ten (10) days for processing.
1. PROPERTY OWNER
MAILING ADDRESS
PROPERTY RESIDENT (If different from above)
2, BUYER
MAILING ADDRESS
3. LENDING INSTITUTION
MAILING ADDRESS
4. REALTOR/AGENT
MAILING ADDRESS
PHONE
RECEIPT FOR CERTIFIED MAIL--30~ (plus postage)
SENT TO POSTMARK
OR DATE
STREET AND NO.
P.O., STATE AND ZIP CODE
OPTIONAL SERVICES FOR ADDITIONAL FEES
RETURN ': ~ 1. Shows to whom ond dote delivered ........... 15¢
With delivery to oddressee only ............ 65~
RECEIPTp 2. Shows to whom dote and where delivered .. 35¢
SERVICES With delivery to addressee on y ............ 85¢
DELIVER TO ADDRESSEE ONLY ...................................................... 50~
~PECIAL DELIVERY (extru fee require~) ....................................
PS Form
Apr, 1971
3800 NO INSURANCE COVERAGE PROVIDED--
NOT FOR INTERNATIONAL MAIL * OPO:ig?Z 0-4~-743
'See other side)
5. LEGAL DESCRIPTION
:TREET LOCATION
6. TYPE OF RESIDENCE
~. SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [~ Four
,Fi Two Fi Five
[] Three [] Six
Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log 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
~ INDIVIDUAL/ON'SITE*~
[] PUBLIC UTILITY
**If individual/on-site, give installation date ¢ -- F ~O/~.
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72~10(3/78) ~
THIS SIDE FOR OFFICIAL USE ONL,
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPE~'roR INSPECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYI:'F OF RESIDENCE
[] SINGLE FAMILY
MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: _;.J_;}.~-'l~ If Tank is homemade
give dimensions:
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SQILS RATING
TYPE OF 'rANK MANUFACTURER
TOTAE ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorp:tion Area to nearest Lot Line
MATERIAL
Septic/Holding Tank
[] OTHER
5. COMMENTS
Absorption Area Sewer Line
Nearest Lot Line
[t~ APPROV ED FOR c,~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
LEGAL DI:SCRIPTION
BY (Title)~
72-010 (Rev. 3/78)
Date .. :ct .
ALASKA P'-~RTMENT OF HEALTH AND SOCIAL SER~'~S
DIVISION OF PUBLIC HEALTH
Lab. No.
BACTERIOLOGICAL WATER ANALYSIS
PLEASE MAIL RESULTS TO:
NAME "~-'L ~.' ?'
ADDRESS · -
ZIP CODE
Sample collected by
Phone No,
Date Collected (
Sampling Address
Time
Specific place of collection
REASON FOR SAMPLE SUBMISSION:
[] Illness suspected
[] Health Regulated Establishment
[] Other -
WATER SAMPLE SOURCE
[] Well Type of casing
[] Improved (Enclosed, Covered) Spring
[] Surface (Reservoir, stream, lake)
[] Holding Tank
[] Other
Office
~nalysis shows this WATER SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] Questionable [] submit other sample
[] Sample too long in transit to indicate reliable results.
Sample should not be over 48 hours old at time of
examination.
....... '-, ..~.~_
Signature:
[] Bottle broken or leaked in t~ansit.
[] Other
SANITARIAN'S REMARKS
LREAD INSTRUCTIONS
BEFORE-
COLLECTING SAMPLE
06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1978
Date Collected _ /-, ~:
Date Received Time Received ',p.m. Lab. NO.
Presumptive
24 Hours
24 Hours
48 Hours
Multiple Tube~Report,-~ "~ ~
Membrane Filter.:. Direct_Count
Final Membr~ ~fl~er:~esults
Broth 24 hours:. Broth 48 hours:
' 10mi Tubes Positive/Total 10mi Portions
',, >/
.coliform/100ml
Date t' J , '