HomeMy WebLinkAboutBRUIN PARK BLK 5 LT 9
i 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 IPHONE [] NEW
MAILING ADDRESS - --
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
l Well I Absorption area Dwelling PERMIT NO.
v DISTANCE TO:
I
2~ Manufacturer ~/1~, . . Material No. of compartments
Liq. capacity in gallons Inside length Width Liquid depth
~ ~, ~ IF HOMEMADE:
I~, ~ Z~ DISTANCE TO: Well Dwelling PERMIT NO.
~ -- ~ Manufacturer Material Liquid capacity in gallons
: Well Foundation Nearest lot line PERMIT NO.
DISTANCE
TO:
'J Z ~ No. of lines Length of each line Total length of lines Trench width Distance between lines
I- ~: ~ inches
r¢ I- Top of tile to finish grade Material beneath tile Total effective absorption area
~ inches
Length Width Depth PERMIT NO.
L~
<~ I- 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.
.J
~J
~ DISTANCE TO: Building foundation~ Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
REMARKS
APPROVED /3 DATE LEGAL
72-013 (Rev. 3~78)
PERMIT NO.
· =":~:' ..... ,.. 5"r'r,'EET., FtNCHORFIGE., RI-::;. '=7., S, .j :3 :1
;2 E; 4 - 472 C~ .... 1[,.-- 7 ,"-~-¢u~.C.¢._.~./
C, P-.il ........ ,"SE; % T' EE 5.'E.:: E: II,,qt It!E:: I[,%:;: ~,.._11 F" ,:3 IF.:;." !F='] !E> E.:,] Il==" E: E;;;;: IP'lt
,:: 8:2 E~i:.-':E 5 >
F:I F' P L. I C: Fl N T
L O C f:t T I O ht
LEGRL
t'"tFI[:,EL I NE S!',! I
F' 0 L.I:::!R [> R I ',,,'E
L 9. B 5 BRUIN PFIRK
S.RFI E~OX ±764-H :.:.~95E~2
L, OT S ! ;-'_"'E
"F'-¢F'E OF SOIL FIBSC~RF'TION S'¢STEM IS: [:,RFIINFtELD
2E;E)E~E~ SC.:!UFIF:':E FE:ET
MFI';',:IMUM NI...tMBER OF BE[:,ROCIMS =
SO I L RF!T ! N6 ,:: S(;! F"F/E;R > = SX~XX
THE REtT!LIlRED SIZE OF THE: SO!L f::IBSORF'TION Sh'%TEM IS:
E> EEC F" 'T 1[-il == ::[;4FcX iL.._ ET lb4t C3i '-IF' 1[.-I! == ::~L~:~_ X C2~ _r4.?_ I1~ "..,- ." E".. Il ..... Il::::.:, E:" F" '-If" iF--~ ....... ~;k:X
'!"HE LENGTH D, IMENSION IS 'T'HE LENGTH ,:: I1"4 FEET > OF TFIE TRENC:H OR [>RFII!'.,tF!E:L.E:,.
"FHE: DEF"I"H OF R TRENCH OF.: PIT :[:5 THE [:,ISTRNCE BETh.tEEN THE SURF'FIC:E OF THE
GROUI'-,ID RI'.4D THE: BOTTOM OF T!'aE E',:'::CR;,,'RTIOI'.,t <I1'.,! FEET).
'T' IH EE -il- ~'~: E~. f¢-4t C: IF~ !I.,..tl IIE:,, -ir" H1 ][ S; c-~. C-, ~.iE.~p C'~ IF:::" EE E~. -T" ..
THE GRFIVEL E:,EF'TH IS THE MINIMUM [:,EF'TH OF' GF.:FIVEL BET!.4EEN THE OUTFRLL PIPE
F:IND THE BOTTOM Of:' THE EXC:W,,,'FITION ,.':IN F'EET>.
~OL \"'~ \"("~L.~.
PERMIT RF'PL. iC:FINT HFI:'S THE RESF'ONSIBILIT'?' 'TO INFORM THIS DEF:'RRTMENT DURING THE
ZN:STRLLRTZON INSF'EC.'TIONS OF FIN'[ PJ. ELL. S FIDJFICENT TO THIS F'ROPERT'¢ I::II',IE.', THE
NLIME;ER OF F.:EStDENCE'.:!!; "FFiRT THE I...!ELL I.,.IILL SERVE.
.................... T' b,,~ C:) < ;2:_:: :.'::, I II".,,tl :ES; F' E: C: '1"' I plp !P.,,II :S~.; I::=I1F~: E 1[:;:~: E: C;:! ItJ ::[ f;: E:: [>
BFICKF'IL.L. ING OF Ft.I'.,I'?' SY'=;TEM I.,.IITHOUT FINRL INSPEE:TIOt'.,I RN[> FIPF'F.':OVRL P"r' THIS
DEPFIRTMENT !,.IILL BE SUBJECT TO F:'ROSECUTION.
MINIMUM DISTFINC:E BETI.'.IEEN R I,.!E:LL FIN[> FINh.' ON-..SITE SEI.,.tFIGE [>ISPOSF:IL S"r'S'I"EM IS
::L. 00 FEET FOR FI PF.'.I'v'FITE 14ELL. OR :t. 50 TO 2E~0 FEET FROM F:I PUBLIC b.tEL. L. DEPEN[:,ING
UPON THE T"?PE OF PUBL. IC I.,.IELL..
MINIMUM [:,ISTFII"~C'E FROM FI F'RIVFITE WELL TO Ft F'R!VFtTE SE1.4ER LINE IS ;25 FEET FIND
TO FI C)OMHUNIT"r' SEt4ER LINE IS '75 FEET.
OTHER RE6!L.II REI'"IENTS HFI"~' FIPPL.'¢. SPEC I F I CFIT l ONS FIND COI",ISTRtJC:T t ON B't FiGRRMS' FIRE
Fik.'FI ! L!=IE~L.E TO I NSUF..'E F'F.'.OF'ER I NSTFILLRT I ON.
i C:E R T t Fh" T HFIT
:1.: ! FII'"i F:I::t!'dlL!RR WI'TH THE REQUIREMENTS FOR ON-SITE SEHERS FIN[:, WELLS I::IS SE"F
F'O.[;U'FH B'.,.' THE MUN I C I F'FIL I T'¢ OF RI'..ICHORFIGE.
2: I I.,.ItL. L. it'-,tSTFILL. THE: S'¢S"t"EM :[t"4 FICC'ORE:,FIt'.,IC:E t.4ITH THE CODES.
3:: ! UNDERSTFIND "t"HFtT THE ON-SITE SEI.4ER S'T'STEM MRh.' RE:C!UIRE: ENLFIRGEMENT i1=' 'T'HE
RIESIE:,ENCE tiE; F.'.EMODELED TO INC.:LLIDE !'"lORE "FHFiN :ii: BE:DROOMS.
Note: If there is an existing
:SI(3t',IE.[:,' ....................................................................................................................... tank, it may be used as long
FIPPI_.ICFINT MFIE:,ELII",IE SNiF".:3 as you get a total of 2,000
~ _ gallons.
Permit
MUNICIPALITY OF ANCHORAGE
f Health and Environmenta'
_ Street, Anchorage, AK.
Department
825
264-4720
* * * HANDWRITTEN PERMIT * * *
~,, A,,~,/,,~ ON-SITE SEWER PERMIT
9rotection
~9501
Location: .. ~'V,~4~.-.,. Phone Number: ~)(~)~(~bCA- (,,',,3i~ [ ..
Legal Description: [~ ~ --~ ~-~ ~c~/?~( ~ot Size: ! ~ ~ --
Type of Soil Absorption System Is:
Trench: Drainfietd: Seepage Bed: Holding Tank: ~
Maximum Number of Bedrooms: Soil Rating (sq. ft/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 minLmum depth of gravel between the outfall Pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = ~3o 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 31j 1 9 8 2 * * *
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 require enlargement if
that 3 be o s.
the residence is remode. Zed to inClude more nat 3 bed~om
Signe~: '---/~'-/~~~ ~~_ ~ Issued by:
Date:
SWP/024 (1/81)
T, r
Date Date Date
InSpector ' Inspector Inspector
Date Sewer Installed Permit No. {,.I,J~.~~J,.k,~,_ Septic Tank Size
TC-'=''wa'j~:~o ^bsor)t~on-Area- ' --L~ (. -~-e ~- ,o~d~ng Tank S,ze
Sol'Is Ratlr~g Well Well Log Received
Well to Tank .
APPLICAN~_....T .FILL$O~T L.O, .W, .ER,.H.?LF O~L;~
Buyer
Address
Address '
Type,L~Resldence
.~3-Slngle Family
[] Multiple Family No. of Bedrooms
[] Other
Wat~pply
,~-~ndlvldual ATTACH WELL LOG. A well Icg Is required for all wells drilled since June
[] Community. 1975. For wells drilled prior to that date, give well depth (attach Icg If
A~ Individua~ " ¥oar Individual Installed:
' [] Public Utility When Connected to Public Utility:
[] Holding Tank ·
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
CHEMICAL & G, Z, OGICAL LABORATORIES ' ALASKA, INC.~
" TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER
~ Drinking water Analysis Report for Total ColifOrm Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name :' Phone No.
Mailing Address
State Zip Code
City
Mo. Day
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
Year
[] Treated Water
[] Untreated Water
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~ rSatisfactory
[] Unsatisfactory
[] Sample too long 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
SAMPLE
NO. LOCATION
$
Time Collected
Collected By
Lab Ref. No. Result* Analyst
I ~
*No. of colonies/lO0 m~ or NO. of Positive oOrUOnS.
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Date Collected Source ,
Date Received Time Received p.m. Lab. No,
Presumptive 10mi 10mi 10mi 10mi 10mi 1.0mi 0.1mi
24 Hours
4e Hours
Conflrmetory
24 Hours
48 Hours
EMB Broth 24 hours: Broth 48 hours: ,
Multiple Tube Report= 10mi Tubes Positive/Total 10mi Portlonl
Membrane Filter: Direct Count Collform/t00ml
Verification: LTB BGB
Final Membrane Filter Results Collform/lOOml
Reported By .- , -, Date
Time: - .,. I.m.
of
nchora
PO ~CH 6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
T~)NY KNOWI. ES,
A4A YOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
June 21, 1982
To whom it may concern:
Because of neighboring wells and the well on the subject property,
it was necessary to install a holding tank on the property.
The installation was inspected and approved on June l, 1982.
If you have any further questions, please call 264.-4721.
Robert C. Pratt, R.S.
Associate Specialist
RCP/mag