HomeMy WebLinkAboutTIMBERLANE PARK #1 BLK 4 LT 3AJanuary 10, 1986
P.O. ~OX 3650
ANCHO~RAGE, ALASKA 99502-0650
(907) 264-411 t
TO,~Y KNO:/¢LES,
A!A YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
TO: Permit Applicant
Subject: Permit # 850087 ~
Lot 3 Block 4 Ti~berlane Park Subdivision #1
A permit issued by this Department for an individual well and/or on-site
sewer system ha~ expirad as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date°
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private en§inee~ inspected the installation of the on-site sewer system
the original as-built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264~4720.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
r::.Fi::~,f-.I T T N [ii x
DATE] .......... iL) ~
,D!:::l-~.n"~,!ll.:.lx!! .')F !h.-.~- ~I fiND IENVII::Z3NIqEIgTAL t.-:,- ...... I...l
AFtZ'I_ICL,/"~'q''. I_,/.:$1CE l'I. I"I):L.I._.!!::'~'
,A)i)T)I':;~ES8~ :I. 2:];;}C; I-i!/L..TEIF:' DFi'..
ANtJHE)RAGE, ,/.:',K 995 15
t:L)f'J. TAC]' I:-:'I-.I[),~IE~ 344'- I :l..'~:l-Ei
I...IZGAL DEZSCI~ I F:' = :9:iLIBD IV i S ]: (:IN :: '1" I t"'IBEi::':.'!. ~lxllE LOT 2 ::; BL. CiCK:
SECT I ON: 24 'T'OWNSH I F:': 121"4 F;:ANGIL ~ 61/~
I...0]' S! ZE: 2:S0()0 fS9. I:::'T. OR ACRIES)
MAX BEDROOMS: 3.
.......~,, .. &r'i comp ]. ;i.~;i~i(::E:~ v~ith the ds;,tsiCll~.., Er' itEcf' 'i4~ r_] ~', t.h ;i.-~;i i;)~:¢r'm ]." '(.' ,,
3. i ~.~.d ....... 't 1 ac!l'x-;;me t.c) all,~'~ '¢~,(.)r, ~:,,,~,~ S't'..a'L6: oi' A!as!.::a PeqL~:i.t'~'~_r.,...li[f'~"" ..... := 'ICH*' 't' ....... i'~¢-= ?~(ce'c ........ ,.,.~., ~".
tF A, L....,-' ,i'-w .¢cm-~'vl"Trlx~, ,_,..,.._.,~ "~].,:. IN:STAI_L..ED !N F.~ixl- AREA Ci]VtZI:RE'~ ............ BY MOA E',UIL. i}!NG ........ "'~'~ re'
,.I ,X¢I,~.,..,.-.,,.. F:'ERMIT Al'qO ............ t ...........hJ .... BE ,_E T..., ..........~ ....... <,., .c,d.l.l_.l,¢
h 'r ~ ~ [:,j::: ¢~ :: r' ) -, W ]: ]]'"lOUT AN :::1 F:F:Tr4' I ["]¢.~l -r ~ ::~:u::'r',- '-r r ~ oc:' ::,r' c,"r ,,
~ .......... NOT ..~1 ........ 1¢..) ! ..... I J,,.,, AND (3)
............... F..J.t~,... ..... (.~,~ ........ I -,L ...)Eh,,l:~ *:~ .., ,...J.C[::,,~c).::-/ c.L.l::.,., ~ ~ ....... ~ .41,.=
% ......................... ......... ....................
F)F'F'~..I(:;;AN','~ ,L.AIx,,3,.~ I1. P, II....,...[:,:,'.
ALASKA :)IROIlllqeI1TAL COI1TROL
~qJ.¢~rinq ~, {~,ironmcM~l $t~cli~s
February 15, 1985'
12300 Hilltop Drive
Anchorage, Ak. 99}0t
Dear Mr. Miller:
After talking with you and Lee Karbelnikoff, I would recommend
the following on-site sewer system be used for Lot 3, Block 4,~
Timberlane Park Subdivision.
A bed system is recommended. It should be built by excavating
to the top of the silty sand (SM) at a depth of 5 feet. The
bed should be backfilled with a clean poorly graded sand (SP)
to a depth of 2 feet from ground surface. The gravel and
pipe should be placed on the sand. The ground could be
mounded at 2+ feet above the gravel or a combination of 2
inches of insulation and 2 feet of dirt would then bring it to
the original ground surface. See attached sketch.
A note should be placed on the plat that states to the effect
that an engineered system is required for this lot.
If you have any questions, please let me know.
Sincerely,
1200 Lg~st 33r8 ~u~nu~, Suii~ [~,Anch0roq¢. J~J0ska 99503,(907) 561-5040
CONTROL SERVICL
; INCa
12OO We~t 33rd Avenue Suite B
ANCHORAGE, ALASKA 99503
Phone 561-5040
SHEET NO.
CALCULATED DY
CHECKEO BY
SCALE.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3 C~
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
PER.,FORMEDBY:
DATE PERFORMED: ~h/
SLOPE SITE PLAN
WAS GROUND WATER S
ENCOUNTERED? Cio L
O
P
IF YES, AT WHAT
OEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
"ll3 2 ~-s- -
') .~ o5' lc) , ~ ~-
T ~/~ /o .2o
3 ~'- .Y~
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN ~/'~Z. FT AND ~- FT
"' ' I
~O~ ~'C~~ 0~ CERTIFIED BY: ~
72-008 (6/79)
MUNICIPALITY OF ANCHORAG,- '
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 2644720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGAL DEscRIPTION:
PERCOLATION
TEST
1
2
.3
4-
5-
6
?
8
9
11
13
14
15
16-
17-
18-
19-
20
~togTL-g5
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
PERFORMED
SLOPE
S~TE PLAN
Time
'l/lO
Time
./0
Depth to ! Net
Water Drop
.o/
MUNICIPALITY OF ANCHORAGu
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[~t~/~ppE R CO LATION
TEST
PERFORMED FOR:_
LEGAL DESCRIPTION:
· 3
4
5
6
7
8
10-
11
13-
14-
15-
16
17
18
20-
COMMENTS
SLOPE SITE PLAN
ENCOUNTERED? __
Gross Net Depth to Net
Reading Date Time Time Water Drop
~3~ 4,0 . I/
~7 .IO ~o . IO
PER~LA~I~ )N RATE
TEST RUN EEN ~ '
CERTIFIED
ALASKA t nUIROnmE nTAL CONTROL SE!RUICI S,
~nclincerin,t 6 ~nuironrnenl~l
InC.
LANCE MILLER
12300 HILLTOP DRIVE
ANCHORAGE ALASKA
99515
SELLER-SAME
APRIL 2 1985
WILL PICK UP FROM OUR OFFICE
50076
LEGAL:TIMBERLANE PARK #1SUBD/BLOCK 4/LOT 3
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE-MARCH 25 1985
~{E TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 406 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 370 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 414 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A
HOME OF 5 BEDROOMS.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 GALLONS IS INADEQUATE BY
250 GALLONS FOR THIS HOUSE OF 5 BEDROOMS.
THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON MARCH 18 1985
1200 West 33r(~ Aucnu¢, $,it¢ B .. Ancher,qe. Al~sk. 99503 · (907) 276-1361
MUNICIPALITY OF ANCHORAGE
', DEPA.TMENT oP .EA.TH ~ ENV,.ONMENTA' ~ROT~CT,ON
( ENV,RON~NTA' ENG..EER,NG ~,V,S,O.
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE
~ UPGRADE
Well , Dwelling
~ Manufacturer ~~ Ma~
Liq. cap~ns iF HOME.DE: Inside length .__ Width ~ Liquid ~th
, ~ Well PERMIT NO.
~OZ DISTANCE TO: ~ ~ ~ Dwelling
~ -- Z , ~ inches
Total Jen~o~
Length of e~ ~e D istan~Z~en lines
~D Top of tile to flnish grade ~, Material beneath tile ? -mc,..~ Totar e f fective ab~ ~area
Length Width Depth PERMIT NO.
''~ Type of cri~ ~ ~rib diameter~ Crib d~ ~ Totel~~~~effectiv 'on area
~ DI~OE TO: ~ ~ing foundatio
. ~ ~ Depth Driger Distance to lot Jine PE~MIT~ ~
~a DISTANCE TO: Building ~ found~tig~ Sewer line ~ Septic tank/~
OTHER
SOl L TEST RATING
INSTALLER ~ ~
REMARKS
72-013 (R~ ~/78) /~
Well Owner_
( ' M.-W DRILLING, Inc.
P. o. Box 4..1224 · ] 310c In[e~ndtional Ail poi[ [?oad
(907) 274-46t]
ANCHORAGE, ALASKA 99509
Lance M. Miller
DRILLING LOG
RECEIVED
Use of YVel] Domestic
Location (address of: Township, Range, Section, if known; or distance main road
Lot 3 Block 4 ~-~ Park ~/1
Size of casing_
Static water level
Screen (
Describe screen or perforation N/A
Well pumping test arC'gallons per ~l~y3
of drawdown from static level.
Hole 62 __ feet
Depth of ___ feet Cased to 62
1-9 ft. (~pA~i~ (below) land surface. Finish of well (check one)
); Perforated ( ).
(minute) for 1 hours ~vith 100%
open end ( xx);
Date of completion 10/19/79
WI~LL LOG
Depth m feet from
ground surface G~ve details of formations penetrated, size of material, color and hardness
.... ~ TO___
.... 2 TO
3 TO
35 TO
53 TO
55 TO
_ 59.6 o
_TO
TO
TO
TO
_TO
TO.
_TO.
2 Casing stickuR
3 Clay
35 Clay and cobbles: large
53 Clayey cobbles
55 Sandy claz
59.6 Sandy gravel
62 Water sand
1- CUSTOMER
F'ERH:[ T I'.,I C
DEPRRTMENT OF HERLTH I:::IND EIqVZRONHENTFIL PROTECTZON
825 "L" STREET., FINCHORRGE., RK. 9)951~kt
264-4728
790497 )
FEd. :[ ~.HN I LlqlqCE i'"t. t'l:El~.L~E:i,;'.
LOCF[TION HZLLTOP DR
[..[}TGFIL. L_i.': B4 F].rlE:EI,..L.,Cfl[. F'i.::: c,,.,r: 4:~:1.
...... J .... IEI.,.IELL LI< RE:,
LOT SIZE 4.7Z2~3 SL::!IJFIRE FEET
'T?F:'E ElF :,~IL I'E,__,_R[_,IZ_~'4 _,L, Eil I:..,: FF:EN_H
I.,1RH]X','ILIH NLIHE:ER OF E:EI:,ROE$'I:.~.; = 3
'.':;llJ]:L Ri::tT.'[HIii ¢%:.) F'T,'E,R::,~-- '1'2.2
THE I,;~:EI;!I..I]:I:~:E[:, :,].,~[: OF THE Si IL HE,::,UI.,.I' F:(ON ..,T_,I~Ei'I ~[_,.
THE LENG'f'H I.3, IHENSZCff'~ IS THE LENGTH <IN FEET) OF THE 'I'RE:NC:FI OR DRRINFtE:L.D.
THE [)E:PTI,~I OF' R TRENCI4 OR.PIT 15 THE DIS;TRNCE 8ETI.qEEN THE SURF'RCE OF' THE
GROUND RND TFIE BOTTOH OF THE E:HCR',/FITION (IN F'EET).
THERE ZS NO SET 14~DTH FOR TRENCHES.
THE GRRVEL DEPTH :[% THE FIZNZHUH DEPTFI OF' GRRVEL BETHEEN THE' OUTFRLL PZPE
RI',ID FHE BOTTOH OF THE EHCFI',/RTZON (ZN FEET).
PERHll" RPF'LIE:FiN-I- F.IFr:5 THE: RESF'ONE;IB!'L. ir.T'¢ TO :[NFORP1 TH):5 DEPRRTP'IENT DL.IR:[NG THE
ZNS:;TFILLFITZON IN'SF'ECTION% OF:' FIN'¢ 14EL. LS R[:,J'RCENT 'TO TI-]ZS F'ROPERT'¢ RND THE
NLli',IBER OF R[~9;IE:,ENE:E'..S TI-IF:IT TIqE NELL 1.4ILL
[3FIC:I<I,:':[I_.LZNf_'i Cfi: FIN"?:,T:,~-'"-"TTM-:H HITI-ICflJT F:[I",IRL ]:blSF'ECT:[ON Riq[:, I- .... I'[[;_,' -dL [.,:" "rH:[S
[:,EF'IqRTVIENT 14 Z [.L E:E :SI_IE;(YfELi:T TO F'R i 'Z[:21 ~ T l i N.
f,1]:NN,'IUH [:,I.'FJTFtNCE BEif'HEEN R I,IELL. FIND RN'¢ ON-...S]:]'E SEHRGE D]:SF::'OE;laL. S'~.'S'TEFI
d. Cl';3 FEET F'OR i:.:I PR:E'¢FITE 1.4ELL.~ OR
:1..5[~1 TO 2(~10 FEET FROf'I FI F'U[E~L.[C HELL DEPENE.',]:NG UPON THE TYF'I,_::
HELL LOGS FIRE RE6!LIN~:ED RI'.,I[;, t',IUST BE RETURNED TO THE DEPRR'I-HENT
OF THE HELL E:Oi'dPL. E:T]:ON.
OTI,-IER RE{;R..I.'ERE'i'dENT~; VIFI'.¢ FIF'F'L'¢. SPEC:[FICRTIOf.~S RND C:Oiq::..:;TRLICTZON Di'RGRFIMS FIRE
R',,,'I::I l LFIBI..[i[ TO I NSLli,?.I'E F'ROI::'E[4: I NSTFILLFIT ]:
]: CERT:(F'T' THR]'
i: Z RI"1 FRi"IILIFff;: I,.I]:TH TH£ RE(;!UIR. EHEN-i'2; FOR ON--'SZTE SEHERS; RND H~]_.LS F[S SET
FORTH B'¢ TI4E HUN:[E:]:PFILN"¢ OF' FtNE:HORFIGE.
2: Z I.,IZLL iNSTRLL THE S"r'STEH ~f'4 RCCORDRNCE NZTH THE CODE:R
3: ~ I..INDER%TFIND THflT THE Of',I-'-SZTE SE:HER S'¢%-FEP1 f"lFlh-' F'.E6¢..IZRE ENL. FIRGEHEN'F ]:F' THE
RESIDENCE
RF'F'LICRNT LFINCE H. FI~LLER
llE[:, B '~-~ ' ._..._[.'hi [E~ . ~ - ..... ~,"'~ ":'
FRO~ '
Redi~prme 4S 471
Poly Pak (50 sets) 4P471
SIGNED
SIGNED /
SEND PA RI'S I AND 3 WITH CARBOF~ INTACT - PART 3 WILL BE RETURNED WI?H REPLY
ARCTIC SUBARCTIC
· Geotechnical Engineering · Petroleum Geology · Engineering Geology ® Drilling Management
MICHAEL B. BERGMANN G£OCONSULTANT
BOX 191, STAR ROUTE A, ANCHORAGE, ALASKA99502
{907) 344 9150
Ms. Joan Notti
Century 21 Krenik Inc. Realtors
9109 Jewel Lake Road
Anchorage, Alaska 99502
May 24, 1979
Subject: Soils investigation for sanitary sewer system on Lot 3, Block 4, Timberlane
Subdivision, Anchorage, Alaska.
Dear Ms. Notti:
At your request of April 18, 1979, I conducted a soils investigation at the proposed
location of a sanitary sewer system on the subject lot. This investigation, which was
accomplished on April 20, 1979, encountered water at ashallow depth, but it was con-
sidered to be a result of surface runof~ming from breakup that was in progress. Therefore
it was decided to drill a second test hole at a later date, as well as moving the test
hole location further up the hill.
The second soils investigation, which was accomplished on May 23, 1979, consisted of the
inspection of soils removed during drilling using 6 inch diameter solid flight augers,
powered by a Nodwell mounted CME 45 drill rig. Auger refusal was encountered at the 15
foot depth and the hole was terminated at that point.
After completion of drilling, Test Hole No. 2 was filled with water and a percolation
test performed. The results of this test are tabulated on an accompanying sheet.
The soils encountered are graphically shown on the accompanying test hole boring log.
The soils consisted of a thin layer of Organics (0.5 feet thick) on top of a Silt with
some Clay (2.0 feet thick), overlying a Sandy Gravel with a trace to some Silt to a
total depth of 15.0 feet. A sand seam was noted at 8.5 to 9.0 feet.
No water table was encountered.
Test Hole No. 1 is now dry to at least the 7.0 foot depth. This was determined by probing
the test hole with a metal rod. The rod c~~'pu~ed further than the 7.0 foot
depth. Upon removal of the rod it was noted that the soil adhering to the rod was only
slightly moist.
The topography of the lot consists of a moderate to gentle slope in a southerly direction.
Vegetation present on the subject lot consists of moderately dense spruce with an
occasional birch 30 to 40 feet tall, with some alders and willows to 8 feet tall, and a
low ground cover of grasses and some mosses.
An accompanying drawing shows the subject lot with the approximate locatios of the test
holes in relation to the property lines.
ARCTIC - SUBARCTIC
· Geotechnical Engineering · Petroleum Geology · Engi*~eering Geology · Drilling Management
MICHAEL B. BERGMANN GEOCONSULTANT
BOX 191, STAR ROUTE A, ANCHORAGE, ALASKA 99502
(907) 344 9150
I appreciate the opportunity to be of service to you. Please contact me if you have any
questions regarding this soils investigation.
Very truly yours,
Attachments: Drawing of test hole boring log with location sketch, and tabulation of
percolation test results.
xc: Department of Health and Environmental Protection
ARCTIC - SUBARCTIC
· Geotechnical Engineering · Petroleum Geology e Engineering Geology · Drilling Management
MICHAEL B. BERG ANN GEOCONSULTANT
BOX 191, STAR ROUTE A, ANCHORAGE, ALASKA 99502
(g07) 344-9150
May 24, 1979
Lot 3, Block 4,
Timberlane Subdivision,
Anchorage, Alaska
Percolation test performed on May 24, 1979, using Test Hole No. 2, by filling the 6 inch
diameter, 151~0 foot deep (hole caved at 7.0 feet) test hole with water, and measuring
the water level drop periodically for one hour.
TABULATION OF PERCOLATION TEST RESULTS
TIME LEVEL(inches) DROP(inches) ET(min)
1116 8.5" start start start
1126 28.75" 20.75" 10 0.5
1136 36.25" 7.5" 10 1.3
1146 41.75" 5.5" 10 1.8
1156 44.75" 3.0" 10 3.3
1206 47.75" 3.0" 10 3.3
1216 50.0" 2.25" 10 4.4
RATE(min per inch)
Average percolation rate for entire hour = 1.4 minutes per inch
Average percolation rate for last one half hour = 3.6 minutes per inch
Michael B. Bergmann
Consulting Geologist
Hilltop Drive
30'
N 86~58'30" W
93'
140'
155.21"
75'
~TH~2
TH#i
(Report 4-22-79)
N
30'
Lot 3, Block 4,
Timberlane, Subdivision,
Anchorage, Alaska.
50'
WEST 155.00'
50'
Thomasson Drive
Distances are approximate and have not
been measured by surveying methods as
to locations of test holes.
Not to scale
T.H. No. 2
5-23-79
0.0'
moist, loose,
roots etc., green to
~b ~2~ nJ- .... 0.5'
Silt: w/some Clay, trc
Gravel, moist, soft, brn.
~ (Mm-CE)
mandy Gravel: w/t~c Silt,
sl moist, dense, occ
cobbles, graybrn.
(GW-GM)
8.5~
streak 9.0'
Sandy Gravel: w/trc to some
Silt, occ cobbles & boulders,
moist, dense, graybrn.
(GW-GM)
Auger reached refusal on
boulder at 15.0'
No water table encountered
15.0'TD
Test Hole Boring Log represents soils
encountered on Lot 3, Block 4,
Timberlane Subdivision,
Anchorage, Alaska.
Michael B. Bergmann
Consulting Geologist
Box 191, Star Route A
Anchorage, Alaska 99502
(907)344-9150
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR - INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF t',2ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTEI~RoNMENTAL
825 L Street - Anchorage, Alaska 99501
i ENVIRONMENTAL SANITATION DIVISION JAN p, 8 1980
Telephone 264-4720
r3 E ['El\/C: r~
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER I PHONE
MAI LIN G ADDR ESS
PROPERTY RESIDENT (If different from above} PRONE
PHONE
MAI LING AD DR ESS
5. LEGAL DESCRIPTION
kT3 15 k
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four [] Other__
~-- SING LE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
7. WATER SUPPLY
~d'~INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~'~INDIVIDUAL/ON-SITE** l~?~ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTI LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(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 UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDI VI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ! O '~-~ 7
Connection Verified INSTALLER ·
[]Septic Tank or [] Holding Tank~,.~ ~..~.~,~_.
Size: t~,~ If Tank is homemade SOILS RATING
give dimensions: J I '~..~
TYPE OF TANK MANUFACTURER/N~'~/~ ...~.~
TOTAL ABSORPTION AREA MATERIAL
Septic/Holding Tank Absorption Area ~ ~' ~'¢"--' Nearest Lot Line
WELL TO: Sewer L ne
4.
DISTANCES
Absorption Area to nearest Lot Line
5. COMMENTS
~'A~OVED FOR -~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~
DATE BY
72-O10 (Rev, 6/79)
P O BOX 4 1276 .... KA ~ ~9 BUSINE~ PARK BLVD,- · ,
· ~ ANCHORAGE, ALAS ~ ~ ~
D~nking Water Analysis Repod for Total Col~orm Ba~efia
TO BE COMPLETED BY WATER SUPPLIER
Public Water System Name
Mailing Addres~.l~
City
Mo. Day
?
SAMPLE TYPE:
[] Routine
[] Check Sample (for rout ne samp~le~i
with lab ref. no. : ' ~=
[] Special Purpose
State Zip Code
Year
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
3 I
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
LABORAT~)RY: ·
NAME
~ AD~)REss
Date Received
Time Re~*eived
Analytical Method:
CiTY
[] Fermentation Tube
'~ Membrane Filter
Lab Ref. No. ~Result* Analyst
~6-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BE~=ORE
COLLECTING SAMPLE
Form No. 18-310 (3-78)
Date Collected Source
Reported By
Broth 48 hours*
10mi Tut)es positive/Total 10rnl PortioNs