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Home My WebLink AboutT15N R1W SEC 30 LT 84Lo " 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 [] UPGRADE LEGAL DESCRIPTION NO. OF BEDROOMS -- ~ 9 ~ Abs°rpti°n area ' Dwe,ling ' z Manufacturer 6~ Material No. of compartmentsx ~ DISTANCE TO: /7~ ~ Trench ~h /5~ No. of lines Len th f ach li~ Total ]en th of lines Distance between lines Top of tile to finish grade ~ ~ /¢ Material beneath tile ~ ~ inches Length Width Depth PERMIT NO, ~ DISTANCE TO: OTHER PERHIT NO~ APPLICBNT LOCATION LEGAL MYERES CONST TiSNRiWS20 L84 PO BM 25i CHUGIAK LOT SIZE 54000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= 2~8 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:.EF"T H= 7. 5 LE[4"-STH= --'-': ± :=: ,3R R %-'EL [:,EPTH= 2~ 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 PIPE AND THE BOTTOM OF THE E~CBVRTION (IN FEET). RE[:" SEF'T I C: TRNK S I ZE= 22513~ ~_SRLLElf4S PERMIT APPLICANT HRS THE RESPONSIBILITV TO INFORM INSTRLLATION INSPECTIONS OF ANY WELLS RDJRCENT TO HUMBER OF RESIDENCES THAT THE WELL WILL SERVE. THIS DEPARTMENT DURING THE THIS PROPERTY RND THE 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 ±00 FEET FOR A PRIVATE WELL OR ±50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE T~PE 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. OTHER REQUIREMENTS MAY RPPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVBILABLE TO INSURE PROPER INSTALLATION. F"EF-:i-"'I :[ T' E::'=:F' 'ii' F~'ES [:.E¢-:E ~-'IBE F." -----=:t.. t.~qE:--TM I CERTIFY THAT ±: I AM FAMILIAR WITH 'THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS AS SET FORTH BV THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTFILL THE SYSTEM IN AC:COR[:,AHCE/4~4ITH ~H~ COD~S. 2: I UNDERSTRN[:, THRT THE GN-SITE/SEWER S'~T~i'I h'lR~ REQUIRE ENLRRGEMENT iF THE RESICENCE IS REMODELEB TU IHZ:LLC~ MERE T~RNI~: BEDRF-M'~ ~ . _~ - ~ ....... ~ If * APPLICANT~ t"lk~ CONSF/ ¢ V -- "Y I~l~I ¢ - .~ [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERCOLATION TEST 3 ,gCc go 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS SLOPE SITE PLAN WAS GROUND WATER y ~_~ ~ ENCOUNTERED? ~ IF YES, AT WHAT i/~_/ E Gross Net Depth to Net Reading Date Time Time Water Drop : :., 2o /o.,:: 6 % PERCOLATION RATE TEST RUN BETWEEN % PERFORMED BY: 72-008 (6/79) DEPARTMENT OF NATURAL RESOURES Division of Gsologicol & Geophysicol Surveys gTol,,A.C.' A.o D"ECT'O" ''OM "OA0 I"TEN,ECTlO,, ,.OW,E, OFWELL= ~ ~. Sfree+ Ad~e~l and Aria of Will Locaflo~ 2. WELL LOG Feet Oelow 4. WELL__DEPTH:r(final) 5, DATE OF COMPLETION_ ........... M oterlol Type Top 80tram ~ft. _ _ -'P~ ......... *~ .~ o ...,..., - F~~~' , ,~ -~,~' ,.c.~, ~T~,..,.~ ~ /7 ,l,,. *...o ~ ,,. o,p,h w.~,~, -. ,./,,, ' ~/ ~// diem. In, to fl, Depth lfllkul , fl, -.- lO, STATIC WATE~ LEVEL: ft. .................. fi, after .bra. pumping 00.bm, ~ Jet ~ Centrifloal 0 Other ~ 0~ · 5~5 ' APPLI¢ -NT FILLS OUTUPPER HA[- ONLY Property Owner .~,~? YL~ ~ ~ 0/~/3/~L~[/~ ~ Phone Mailing Addre~ /~? F ~-~ ~ ~ / Zip Code ~-~ ~y- ~/~ Buyer Zip Code Address ~ Lending Institution /:/IC~ ~"~) ~:~ ~ ~.. Phone Address ~/( ~ (/2 ,~//~/~ . ZiP C°de ~ ~ Realty Co. & A~nl Phone Address Zip Code Street Locati~ Type of Resi~nce ~ Single Family ~le Family No. of Bedrbo~ ~ y~ ~L ~ Water S pply Individual A~ACH WELL LOG. A w~l log is required for ag wells drilled since June 1975. ~mun[ty For wells drilled prior to that date, give well depth (attach log if available). ~ Pubgc Utility Sewer Disposal n~]vidual Year ~ndividua~ Installed: /~ blic Utility When Connected to Public Uti~ty~ ~ ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE tNITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: .~ ~n__~. .... Mu,icJpali~,,Dep.. ....... '*'CONdlT NS oF APPROVAL fi (~)( ) APPROVEDDisAPmOvEDBEDROOMS ~ ~. ~~ ~ Protection" ( ) CONDITIONAL APPROVAL' lled Well To ~sorption Area Well Log Received SOHs Rating Date ~ Well to Tank Septic T~k Size 72.023 (3/82) I I /- HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL GENTLER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WAT~B SYSTEM: I o m State Zip Code c~ Mo. Day ~ Year ~ Routine D Check Sample (for routine sample/ ~.Treated Water with lab ref. no. ) ~Untreated Water ~eclal Pu~ose SAMPLE .o. , ~C^T,~. / I I Time Collected TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~'~Sati'sfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indidate reliable results. Please send new sample via special delivery mail. ..,....,v. / ~,ma.sc*l--. / ~0 0 Analytical Method: [3 Fermentation Tube ~ Membrane Filter Lab Ref. No. I I I I : I Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE ~6-12~o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Finn1 M~bre~ F#ter R Its ~, d'-~'~' -