HomeMy WebLinkAboutLA FORET LT 7
¢"' , ,,c, \%%% Municipality of Anchorage Page ?__~__of
%%9 ~o ,~,~) DEPARTMENT OF HEALTH AND HUMAN SERVICES ·
~ ~~ ENVIRONMENTAL SERVICES DIVISION
~ '~.O. Box 196650 · Anchorage, Alaska 99519-6650 * Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~ ~ ~ ~ 75- PIDNumber: ~ I 7~o ~
Name:
~o~ f~oem~ Wastewater System: c~ New ~ Upgrade
Address:
13Z~I ~m~ole Cmcfe ABSORPTION FIELD
No. of Bedrooms:
Phone: ~ ~ ~ . ~ ~ ~ ~ ~ Deep Trench ~ Shallow Trench B Bed ~ Mound ~ Other
L E GAL D ES C RI PTI O N sci, Rating: Total Depth from original grade:
J, ~ GPa/Sq. Ft. J ~, ~'
Lot: Block: Subdiv~ion: Depth to pipe boltom from original grade: Gravel depth beneath pipe
Township: ~ Range: Section: Fiji added above original grade: Gravel length:
I
Gravel width:
Number of lines:
Oislance between lines:
WELL: ~f D New Q Upgrade
~' &~ Ftc,, J -- Ft.
ClasSification (Private, A,B,C): To~7'~epth: Cased To: Total absorption area: Pipe material: ~- ~1 ~
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Yield: Pump Set at: Casing Heighl Above Ground: TAN~ v
GPM Ft. Ft.
SEPARATION DISTANCES e Septic B Holding U S.T.E,P.
To Septic' Absorption Lift Holding Public/Private Manufacturer: Capacily i~
From Tank Field Station Tank Sewer Lines ~ ~ O~ ~ /
Material: Number of Compadments:
Surface
Water ~OO' ~ too' -- -- -- LIFT STATION ~. &
kot Sizo in 0allons. Manufacturor:
Line 3 I -- --
Foundation ~ ~ o~ "Pump on" level at: "Pump off" level at: High water alarm
Cudain Pump Make & Model Electrical Inspections performed by:
Drain ..... , ....
Bemarks,:,xy¢ ~m /~ [~ /¢¢ ~ppr¢~4 BENCH MARK ............
Location and Description:
J
Assumed Elevation:
BN~INEER'S
Inspections performed by: ~'la P~p ~ ~c, Dates: 1st. ¢1/q1¢ ~ *'""';'~',"'"r;~ ~.' ,~ .'~'
2nd
Department of Fleal~ an~ Human Services approval ~0, _ ::~'~°*°~' ~'""°°~_ :,. .
a--r-ve~ppu u My'-':: M_ ~:-qs ~ '?, ',. ,,' ::.,'~,
Reviewed
and
72-013 (Rev. 9191) MOA 25 ~ '. ·
PERMIT NO: SW 960235
PAGE 2 OF 2
PID NO: 01734207
49' LONG SOIL
ABSORPTION
W. 8.5' SEWER GRAVEL
DIV. VALVE
PLAN VIEW
SCALE: 1" = 30'
SWING TIES
FROM: COR. "A" COR."B"
TO:
S.T.C.O. "C" 29' 30'
S.T, C,O, "D" 35,5' 37'
VALVE "E" 37' 38,5'
DBL. C,O, "F" 34' 40'
TR. M.T. "G" 38.5' 63'
TR. C.O, "H: 52.5' 80'
II
]~IEW 1250 GAL.
SEPTIC TANK
95.0
MINIMUM 2' SOIL COVER
BOTTOM It
T.H. #2 MT.
DRY 7/19/96
PROFILE VIEW
NOT TO SCALE
LOT 7, LA FORET S/D
SEPTIC SYSTEM UPGRADE
AS-BUILT INSPECTION REPORT
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, ALASKA 99516
SCALE: AS NOTED
DRAWN BY TFM
SEPTEMBER, 1996
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
\C~ , CiL
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960235
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:SHOEMAKE THOMAS KARL &
OWNER ADDRESS:13251 GINPOLE CIR
ANCHORAGE, ALASKA 99516
PARCEL ID:01734207
DATE ISSUED: 8/07/96
EXPIRATION DATE: 8/07/97
LEGAL DESCRIPTION:
LA FORET LT 7
LOT SIZE: 50238 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE:
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
August 7, 1996
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject:
Waiver Request for Lot 7 La Foret Subdivision
Waiver Reqoest # WR960038, PID #01%342-07, SW960235
Dear Mr. Moore:
Your request for a waiver of the required 10 foot separation between an on-site
wastewater disposal system and a lot line has been approved. The waived distance is 1
foot from file absorption area to the south property line.
This approval applies to the existing septic system lot line separation only. Any future
upgrade to the on-site wastewater disposal system will require all separations be met or
another approval from this department
If there are any further questions or concerns regarding this waiver, please call our office
at 343-4744.
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljm: Shoemake
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR ~[.j, .sp ~ ~.~[~ 0~ PID% 017-342-07 HAY
Date Received: August [, ].996
Legal Description: Lot 7 LaForet
Engineer: Ted Moore, P.E., Flattop Technical Services
Permit
14530 Echo Street, Anchorage, Alaska 99516
Applicann: Tom Shoemake
Waiver Requested: Lot line waiver of 1 foot of south property line
Criteria: 1. Geology: Points:
A. Wa~er Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
3. Other:
Waiver zs Granted: ~ Waiver zs NOT Granted:
List Conditions or Reasons for above: ff~ f~/*~F~'f ~~p
Date:
Rec ~: 02087/1325
By:
A~nount: $ 115.00
Name of Reviewer
Date Paid: August 1, 1996
CIVIl. & ENVIRONMENTAL ENGINEERING ', ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 July 31, 1996 ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dem' Sirs:
The purpose of this letter is to provide the required design narrative in suppmt of our application for a
permit to upgrade the wastewater disposal facilities on Lot 7 of La Foret S/D, located at 13251 Ginpole
Circle. The present soil absorption n'ench is no longer able to accept the wastewater load generated by the
residence. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for
your review. A lot line waiver is also requested allowing the proposed trench to be co~structed with£n 1
~bot of the south property line.
The proposed system will be constructed in the vicinity of test hole # 2. As can be seen from the soil
log, the native material between 7 feet and 19.75 feet below ground level is a poorly graded fine sand with
a measured peru rate of 4 minutes per inch. Using the soil application rate of 1.2 gpd/sq, ft. specified in
the wastewater ordinance, a 4 bedroom residence requires a total absm~tion area of (4 x 150)/1.2 = 500
squm'e feet. The proposed 50 foot long trench design with 6 feet of sewer gravel below the horizontal
distribution pipe has a total absorption area of 600 square feet. Although the proposed upgrade is sized
for 4 b~di'ooms, the existing residence has ouly 3 bedrooms, and a 3 bedi'oom pmTnit is requested. This is
because T.H. #1 which was dug in a planned reserve area did not turn out to contain soils which perc
faster than 60 minutes per inch. The horneowner is aware that before the system could be approved for a 4
bedroom residence additional reserve area would have to be found on the lot for a 4 bedroom system.
The topography of the lot in the area of the proposed construction is generally level. There is a 5 foot
high cut bank located 25 feet west of the west end of the proposed wench where the property line intersects
Ginpole Ckcle; however no waiver should be requh'ed of the normal 50 foot setback from a cutbank,
because the top of the sewer gravel will be lower than the bottom of the cutbank.
The location of the existing well is such that a lot line waiver is needed in order to allow a soil
absorption trench to be constructed in the vicinity of test hole #2 without encroaching on the well's 100
foot protective radius. The alignment of the proposed trench was chosen to follow a pre-existing clearing
along the lot line so as to minimize tree cutting. Because of the large mnount of available m'ea on Lot 6,
construction of the proposed trench in this location will have a lninimal impact on the ability to consU'uct
replacement wastewater disposal facilities to serve Lot 6. A letter of non-objection froln the owner of Lot
6 is included.
The proposed project will have no significant impact on present or future water supply and wastewater
disposal systems serving adjacent propetlies, nor will it have any significant impact on reserved space-
surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on
this submittal.
Siucerely,
Ted Moore, P.E.
SEPTIC o
SYSTEM
LOT 8
NSTALL NI--W
1250 GALLON HOUSE
SEPTIC TANK
100'+ FROM P/L
'#2
LOT 7
LA FORET S/D
CONSTRUCT 50' LONG
L ABSORPTION TRENCH
W. 6' GRAVEL BELOW PIPE
LOT 6
PROPERLY ABANDON
EXISTING 1000 GALLON
.FIBERGLASS SEPTIC TANK
~--~.~.e EXISTING TRENCH
INSTALL
BULL RUN"
DIVERTER VALVE
LOT 5
LOT 7, LA FORET S/D
SEPTIC SYSTEM UPGRADE
SITE PLAN
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, ALASKA 99516
1 INCH = 50 FEET
DRAWN BY TFM
JULY, 1996
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
INSTALL C.C. /
CONSTRUCT 50' LONG SOIL ARS.
%. TRENCH W. 6.0' GVL. BELOW PIPE ~
% .... INSTALL NEW /
~ ~ A 1250 GALLON _~
. - u~l~MT , ,NSTALLDOUBLEC.O. ¢ ~.,,,rl
4" D~^. ASTM F-al0 / I
TO ORIG.
TRENCH
INSTALL
"BULL RUN"
DIV. VALVE
PLAN VIEW
SCALE: 1" = 10' - 0"
MONITOR TUBE
CLEANOUT
MOUND COVER MATERIAL 12"
GROUND
FABRIC
4" DIA. F-810 PERF. PIPE
SECTION "A- A"
SCALE: 1"= 5'- 0"
I/2"-2 1/2" SEWER GRAVEL
BOTTOM OF
EXCAVATION
LOT ?, LA FORET S/D
SEPTIC SYSTEM UPGRADE
PLAN AND CROSS-SECTION
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, AK, 99516
SCALE: AS SHOWN
DRAWN BY: TFM
JULY, 1996
Flattop Technical Services
14530 Echo Street, Anchorage, AK99516
Phone (907) 345-1355
Lot 7, La Foret S/D
13251 Ginpole Circle
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of abandonment of an existing 1000 gallon fiberglass septic tank
and installation of a new 1250 gallon septic tank followed by 50 feet of soil absorption U'ench containing a
total of 6.5 feet of sewer gravel.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or requh'ed by the engineer conducting the inspections.
All construction procedures and material specifications shall confo~n with Municipal and State
requirements. All separation distances shall be in confmTnance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessat~y utility locates, and to work around any
buffed utilities. An existit~g natural gas service line does run through the proposed trench area.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there m'e no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after
the soil is compacted, as well as placement of topsoil and reseeding all areas distm'bed by the construction.
2.0 Septic Tank:
2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top
and backfilling with soil.
2.2 The new 1250 gallon, 2 compartment septic tank shall be Municipally approved and shall be set
level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4"
cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type,
rigid insulation.
2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste
line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A
cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed
within 5 feet downstream of the septic tank.
2.4 A "Bull Run" diversion valve shall be installed downstream of the septic tank allowing effluent to
be diverted back into the original soil absol/ation trench in the future, if desh'ed.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by excavating a 50 foot long trench to a depth of
13.75 feet below original ground level in the vicinity of T.H. #2.
3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to
allow proper infiltration.
3.3 A total of 6.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with
the perforated distribution pipes laid level such that the pipe inverts are no less than 6.0 feet above the
bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened g~'avel, with less than 3% passing
the #200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the design drawings. The potlion of the monitor tube extending through the sewer gravel shall be
perforated.
3.5 Approved filter fabric shall be placed over the enth'e top surface of the sewer gravel. A minimum
of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet,
two inches of rigid, burial type insulation is to be placed over the enth'e top surface of the gravel, in
addition to the filter fabric.
3.6 The top surface of the cover material shall be raised a minimum of 12 inches higher than the
sun'ounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for m~'anging to have the
site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed
to promote rapid revegetation of all m'eas disturbed by the consu'uction.
4.0 Inspections:
4.1 A minimum of 4 engh~eering inspections will be required during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative sm'face to ensure that it is level and at the right elevation, and confmrns with the soil test
information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected
up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backf'fll and
grading is complete. The septic tank requh'es one inspection after it is set level and the piping connected,
but prior to backfill. This inspection may be incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently fro' in
advm~ce to ensure the availability of the engineer.
TEST HOLE
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: lot 7, La Foret S/D
DATE PERFORMED:
PERFORMED FOR:
July 12, 1996
Thomas and Deonne Shoenmke
DEPTH
(feet) Pt
SM Reddish sandy loam
ML Gray somewhat saudy silt
Similar to T.H. #1
SP Cie,an, fine/medium saed
No gravel or cobbles
SLOPE
Depth to Groundwater Date
No Orouudwater 7/12/96
Monitor tube dry 7/19/96
SITE PLAN
LOT 7
LA FORET S/Di
#2 #1
~9.75
Clock Net Time Percometer Net Drop
Date Reading Time (rninutes) Reading (inches)
7/12 12" Presoak 27 3/8
Add water and start 3:25:40 23 7-/16
#1 3:30:40 5 22 1 7/16 _
Arid water 3:31 _ 23 3/8
#2 3:36 5 22 ! 3/8
Add water 3:36:30 23 5/8
:/t3 3:4l:30 5 22 1/4 1 3/8
COMMENTS:
PERCOLATION RATE 4 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 9.5 FTAND 10.0 FT
Tile sand which was removed from the pore test hole appeat-ed to be somewhat fieer/siltier than typical of stratum.
PERFORMED BY FLATTOP TECHNICAL SERVICES. I %..~ff' ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/.,7t / 9 ~"
TEST HOLE
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 7, La Foret S/D
Jul~ 12, 1996
Thomas and Deonee Shoemake
DEPTH
(feet) __
Pt
SM Reddish sandy loam
ML Gray, somewhat sandy silt
Dense, dry
Sidewalls do not smear
A few cobbles and boulders
SLOPE
SITE PLAN
LOT 7
FORET S/D
#2 # 1
SM Silty floe sand
Depth to Groundwater Date
1'4o Groundwater ?/1--2/96
MoNitor tube dry ?/19/96
SM/MI, Fine silty sand
Dry
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
7/12 Bottom ~erc bole 2:27 P.M. 17 1/4
12" presoak 2:27 __ 5 1/4
2:39 12 5 5/8 3/8
3:23 44 6 1/4 5/8
3:54 ~ 6 1/2 1/4
COMMENTS:
PERCOLATION RATE >60 (minutes/inch)
TEST RUN BETWEEN 6.5 FTAND 7.0
Measured perc rate is too slow for convectional soil absorption system.
PERC HOLE DIAMETER
FT
PERFORMED BY FLATTOP TECHNICAL SERVICES. I ~¢'~'~..¢~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
July 25, 1996
C~om:
To:
George and Judy Jett
133010inpole Circle
Lot 6, LaForet Subdivision
345-7689
Ted Moore, FlatTop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Re: Proposed sewer system for Tom and Deonne Shoemake
Ted, as per our telephone conversation this afternoon, I
have no objection to the proposed drain field being located near
my north property line. It is understood the drain llne will be
I2 inches +/- from the south boundry in the ~outhwe~t corner of
lot 7.
George Jett
Judy Jett
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 LStreet- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTION
LOCATION /,,
DISTANCE TO: Well
~v Manufacturer
Liq. capac[t,,~ in gallons
IF klOM~~gt~_~_~idt,{/
STANCE TO: Well [ Dv~elling
NO, OF BEDROOMS
PERMIT NO ~,,~) ~
No, of compartn~,,~s
Liquid depth
PERMIT NO,
DISTANCE TO: Well fO (~ Foundation .1~,~ Nearest lot line c-~l~) '
N°' °f~eh¢2~ Length °' each ~e~'2 T°ta' length °' 'i~(D Trench wide] ~_z2~ inches
Top of tile to finish grade .~, Material beneath tile
PERMIT NO,
Distance between /~/~,.-.~./
/
Total effective absorpti
Length Width Depth
PERMIT NO.
Type of crib
DISTAN(
Crib diameter
Total effectiv area
~uilding foundation Nearest lot line
Depth Driller Distance to lot line
Building foundation Sewer line Septic tank
DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TI=ST RATING .-/ ~7~
REMARKS
Absorption area(s) ~L ,/~),
LEGAL
DATE
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0 0.5
(ii. 5 2. 0
2 0 o Q
~ti{{.,
c'i ] ~
daY, i;,
}'IFC{: '~ ,'!t.,_]7 ~,(,v.,l ;
:!.0'
}!C':]O l;})qC']7',':"(~
2'
3 ] 0. 0
4 ] 5.0
] 3. ? (;P.A}i
] 4 . 2 Glb\¢
C-' OLID
T,-"{ F HI,
test,
I]: .ing t~.(' abovo t. :,~ ti:o (;!:s(,Yvc:d -' - ' ' :~('.rc(~aILl(}:~ ~ att(~
was 5. 5 mi.n/i:~c~ ~.,~ t('~'l-.~ hole l, a",d .... i ~ min. ', ....,.,_,,'4' ,..,F.~-,- tent:
:,~:~su]t:'~ o[ [l:o final :)c. rco]aLio~t test:s t:o
,~{;c:( '..s i :: ', ; {','id,~'(~ t:(: L~O s:~ Lc, ~)ac}:aqo
ton ioof.
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED AT THE RATE OF _ $18.00 PER FOOT.
PROPERTY OWNER //~o' Yo~ Sh.oe..~t~ 344-7810
LOCATION OF WELL SITF
DRILLER
WELL LOG:
az. 373 ¢.e.e*. d. id. 5aho~ ~ ~t~e.6~ o.L SgJJgll gd'~o 7h~ t~e.U. /w~ 750 ~e.Z' o~. ~w~,. ~gmxd. O~
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILL. ING WORKS FOR TIdE SUM OF $¢774.00
THANK YOU VERY MUCH.
DATE
BERNIE CLeF RAMPART DRILLING WORKS
SERVICE CHARGEOF 1~-% PER MONTH WILL BE ASSESSED ON PAST DUEACGOUNTS.
~ /'~////~/'~:~ -/7 MUNICIPALITY OF ANCHORAGE IENV~RONMF-NT"~- ~ ' .~CT~O~
~ ' ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~
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.
I PROPERTY OWNER , ~ PHONE
MAILI GAD R~ · -~ ~ ~- ,
PROPERTY RESIDENT (If different from aboveb ~ ---- /~/ PHONE
~, BUYER ~ ~/ P~NE
3, LENDINOlN~TIT~ " /) · . [ PHONE
MAILING ADDRESS
'4. REALTO~/AGEN~ -- I PHONE
I
MAILING ADORESS
~.l LEb~L DESCRIPTION
~"rR EET LOCATION
~," TYPE OF RESIDENCE
NUMBER OF BEDROOMS
[] One [] Four
NGLE FAMII_Y [] Two [] Five
[] MULTIPLE FAMILY r~h. ree E~ Six
[] Other
?. WATEI~ SUPPLY
~----~NDIVIDUA L*
' [] COMMUNITY
[] PUBLIC UTILITY
8, SEWAGE DISPOSAL SYSTEM
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975, For wells drilled prior to that date, give well
depth (attach Icg if available,)
~;~-_~N_ DIVIDUAL/ON-SITE** **If individual/on-site, give installation date 'YO4:F
If system is over two (2) years old an adequacy test is required
E PUBLIC UTILITY by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR I NSP ECTOR INSPECTOR
DIRECTIONS:
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SiX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NU'MBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified. INSTALLER
F-]Septi~.T~r~ or [] Holding Tank
Size' ~{~Of'-~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURERg~ , ,.~l_
4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area S~wer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
" *PPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
C~___I~t. ICAL & ~IEOLO~IICAL LABORATORI¢.~ OF ALASKA,
P.O. 8OX 4-1270 4~0 BUSINESS PARK I~LYD.
ANCHORAGE, ALASKA gg~09
Drinkin§ Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETEr) BY WATER SUPPLIER
Public Water Syetem Name
:.
City State
Mo. Day Year
ZIp Code
SAMPLE TYPE:
[] Ftoutine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
E~ Untreated Water
SAMPLE
NO.
1
4
5
LOCATION
I
Time Collected
Collected By
TELEPHONE
(907) 279-4014
TO BE COMPLETED BY LABORATORY
LABORATORY:
NAME
ADDRESS
CITY
Analytical Method:
[] Fermentation Tube
~,~, Membrane Filter
No. of colonlel I 1 C~ mi. ar No, of Pollllve portions.
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Form No. 18-310 (3-78)
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
a.m.
Date Received __Time Received p.m. Lab, NO
Presumptive 1Omi 1Omi 1Omi 1Omi 1Omi 1.0mi 0.1mi
24 Hours
Confirmatory
24 Hours
48 Hours
EMB__ Broth 24 hours:.
Multiple Tube Report:
Membrane Filter: Direct Count
Roport~ By /~