HomeMy WebLinkAboutLAKEWOOD HILLS #4 BLK 1 LT 4
! 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 REPQRI'
NAME PI-lONE 3/<~<~ ~'I~W
LOCATION N~OF BEDROOMS
Well ~ Absorption area Dwelling PERMIT NO.
~ ~ Manufacturer Materi~ No. of compartments
~ ~ Liq. capacit~ in ~nllons Inside length Width Liquid depth
/~ )--~ ~F HOMEMADE:
, ~ Well Dwellin9 PE~MIT NO,
~ ~ ~ DISTANCE TO:
O ~ ~ Manufacture~ Material Liquid capacit~ in 9allons
~ Well ' Foundation Nearest lot line PERMIT NO,
DISTANCE TO: ~-~ ~ O ~ / O
~ No. oflines / Lengthofeach,ine~ ~-- Total~thoflines_ Trenchwidth~ inches Distancebetweeniines
~ Top of tile to finish grade ~ / Material beneath tile Total effective absorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
lO0
INSTALLER
,
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APPROVED ' d2:~ ~a?,~' ,,, ',~ t~ ~ ' d ~'~}~~;' DATE LEGAL
72-013 (Rev. 3/78)
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~' SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-222~
SOILS LOG- PERCOLATION TEST
[] PERCOLATION
TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
/
Y
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND FT
DATE::JVi ~, ~ ~'
72 008 (7/76)
(907) 2Zl, 3-7893
KEN JOFINSON
PUMP SALES & SERVICE
3163 LINDEN DRIVE
ANCHORAGE, ALASKA 99502
Keith ~right
F,OB. ~teel Inc.
Lot /~ Blk /~
Lakewood Hills Sub°
O' to
65' .t:o 83
83' co 85
t35' i;o 91
~ATER ¢/]~LL LOG
Brown silt
Brown silt and Med. grave].
Same but Looser
Brown sS. lt wiCh ,','ied. ~zrave] .... 3rills open l~, to 5'
Pine ::;and
]iard?a.nl..oourso gravelwJ, th ':C~'~iysil't 'bin~.le~' (
Same but looser
Hardpan (tight)
91' I ~ O
105' l,'ied, sand and !~rave]. with brown silt blinder
dr:ills open 2' to 3'
105' 'to i.tS' Hardoan ( ~Lvh't )
11~' to 125' same but looser
125' bo ]3L~' bed rock ( fractumed granite ) ~tai~er bearing at
134'
Static water level 109' ( 25' )
dater very clean and clear
casiag cut
DATE RECEIVED
iNSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
tNSPEC~C)R . INSPECTOR INSPECTOR
f)
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION
DEPARTMENT OF HEALTH ~ ENVIRONMENTAL PROTECTION
825 L Street - Anchorage. Alaska 99501 ~0V ~ ~ ~g79
ENVI RON~ENTAL SANITATION DIVISION
Telephone 264-4720.RECEIVED
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.
PROPERTY RESIDENT (If different from above) J
2. BUYER PHONE
MAILING ADDRESS
~AI LING ~DRES~
5. LEGAL DESCRIPTION
STREET LOCATION /
~ One ~ Four ~ Other~
~ g Two D Five
SINGLE
FAMILY
~ MULTIPLE FAMILY ~ Three ~ Six
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
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-O10 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
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 NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[~Septic Tank or [] Holding Tank t
Size: I~,.~) If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5, COM[VlENTS
~___~- APPROVED FOR ~ BEDROOMS
E~ CONDITIONAL APPROVAL (letter must accompany certificate)
DATE [] DISAPPROVED BY
72-010 (Rev, 6/79)
/A ?I~IIC,N. & eEOLOtilCAL LABORATORIF.8 OF ALASKA~ INC.
Z,/u~xA~0~s-.-,~P.O. BOX 4-1276 4649 BUSINESS PARK BLVD.
ANCHORAGE, ALASKA 99509
Drinking Water Analysis Report for Total Coliform Bacteria
TELEPHONE
Ig07) 279.4014
TO BE COMPLETED BY WATER SUPPLIER
city state
SAMPLE OATE: D-I¢ I
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no,
[] Special Purpose
[] Treated Water
E3 Untreated Water
SAMPLE
NO.
4
5 ,
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
LABORATORY:
NAME
ADDRESS
CITY
Date Received //~ /~/'
Time Received / ~/o o
Analytical Method:
[] Fermentation Tube
~.J~M embrane Filter
Lab Ref. No. Result* Analyst
I I
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Form No. 18-310 (3-78)
06-1220 (b)
Rev. 2978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
Date Received .Time Received p.m. Lab. No.
Presumptive 10mi 20ml 10mi 10mi 10mi ~..0 mi 0.1mi
24 Hours
48 Hours
Confirmatory
24 Hours ;..
48 Hours
EMB Broth 24 hours:.
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: LTB .~
Final Membrane FIIter~c~//~ts ,~-
Reported By ~'/-~/'~,. t-~: --
Broth 48 hours:
10mi Tubes Positive/Total 1Omi Portions