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Home My WebLink AboutTURNAGAIN BLK 1 LT 5 ' ~ ~. 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 /' PHONE EW MA, L,NG^DO.ESS . ' ~o. ~ DISTANCE TO: i~Jb( J~U labs re,~ Dwelling /~ / P Liq. ca acity in gallons Inside length Width Liquid depth ' ~ Well w~ 9~z g~STANCE TO: g/ 3~ PERU~T CO. O Z ~ Manufacturer f ~ / ~ - ~ / ~ Mat~ial Liquid capacity in gallons ~ DISTANCE TO: W~,~ ,< I /~ Foundation ~:"+ Ne~t~t',~ PERMI~NO.~ ~ ~ ~ Top of,,,~ to fi(dn~ra~e ~ ~ri~X~)~ ~ ~ inches Total elfect~e absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter ~rib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line . , ,Class Dep?b~(~ ~ / ~ ?riller .istance to ,o. line PERBIT NO. ~ DISTANCE TO: Budding foundation Sewer line Septic tank Absorption area(s) SOl L TEST RATING/~5~ //~ ~ ~ REMARKS ) ff~ ,~I ~.~t;'~ .~L... ~ ../ APPROV~x/// ~/ ,/ //' DATE , LEGAL 72-013 .3/78} PERMIT NO. ( RPPLICRNT I,.IR","NE BRITTIRN SR BO}':[ -~0~:0 -*9.9567 LOCRTION KLRTT RORD LEGRL LOT 5 BLOCK t TURNRGRIN SZD; LOT SIZE 20088 SQURRE FEET ,- - =- , ~,,- ,=. , ~~ T'¢PE OF =,OIL ME,-,uRFTIO[~ -,:=,TEM I_,.~ MRXIMUM NUMBER OF BEDROOMS = 4 SOIL RRTING (SQ FT/BR)= t25 THE REQUIRED SIZE OF THE SOIL RB~ORPTION S'~'STEM IS: E)EPTH= 12 LE~-,I,3TI4= ~ ~3RR~¢'EL CcEF"T~4= :Z] THE LENGTH D[HEN3[ON IS THE LENGTH ([N FEET) OF ERCH SIDE FOR R SEEPRGE PIT. THE DEPTH OF R TRENCH OR PIT [S THE b[STRNCE BETWEEN THE $URFRCE OF THE GROLIND RND THE E:OTTOM OF THE E;:':;CA',,,'RT[ON (IN FEET). THE GRRVEL DEPTH [S THE MZN[MUM DEPTH OF GRR'v'EL BETWEEN THE OUTFRLL PZPE RND THE BOTTOM OF THE EXCR'dRTZON ([N FEET:.". F'ERMIT FIPF'LICRNT HMS THE RE_,FuN_,IBILITT TO INFORM THIS DEPRRTMENT DURING THE IN_,Ti3LLHrlOIq If~_,FEL. TIoN=, OF RNY WELLS RDJRCENT TO THIS PROPERT'¢ RND THE NUMBER OF F,'E_,IDENcE=, THRT THE WELL WILL _,ER/E. E, ME.k. FILLINB OF RNY _3r_,TEtl WITHOUT FINRL INSPECTION RND RPPF..O/ML BY TI-ITS DEPRRTMENT WILL BE _,LIE, JECT TO PRO-,EL. UTION. MINIMUM DISTBNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVBTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC: WELL. MINIMUM DISTRNCE FROM R PRIYRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. F"EF:~"'I I T E ~-::,P ][ RE'-] B, EL--:-EY'IE:EFR -----=:1., I CERTIF~ THRT t: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTRND TNRT THE ON-SITE SEWER SYSTEM MR~ REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. _,IUHE[ .......................................... RF'PL ICRNT WRYNE E, RITTI RN I_,_,UED E,'r .............................. [*RTE ........ '¢4. 0 PERPII T NO. APF'LICANT ~0¢-~11~C ~'~r,'t~-I~ I~ LOC:~TION K~ ~D LEGAL LOT ~ B~I ~u~ ~m~mm ~[D TYPE OF '~O~L AE._OEPFIJ~ SYSTEffl MBXIblUM NIJMBER OF E:EDROOldS = ~ SOIL RATING THE REQUIRED S~ZE OF THE SOIL NE, z, OKFT[ON SYSTEM I~: I'-llJl'-I 1' ,3 I PAL I T'-r' . CIF DEPARTI'IEi',¢'-~,~F, HEALTH ANO' ENYI RONf'IENTE',~"~PROTECT I ON 825 .L STREET.. ANCHORAGE, AK. ( 264-4720 CH%I--S ]2 TE :~;EI-.-IER PERId I T < ?030 LOT SIZE ,,,.~/~l~OOO 9DUARE FEET ,"SQ FT/BR>= 1¢-¢ · · ! E:,EF'TH= I ~.~1 LEI--.i,]TH==,=21X;,q.I [:'EPTH= ¢ THE LENGTH DID1EN-SION IS THE LENG.TH (IN FEET) OF THE TRENCH OR C, RRINFIELD. THE OEPTi4 OF FI TRENCH OR PIT IS THE ~TRNCE BETL4EEN THE SURFRCE OF THE GROUHO AND THE BOTTOM OF THE EXC:RVA'FION (IN FEET). THERE IS NO SET NIDTH FOR TRENCHES. THE GRAYEL DERTH IS THE MINIMUM DEPTH OF GRAVEL BET&4EEN THE OUTFRLL PIPE RNO THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY'TO INFORM THIS DEPARTMENT DURING THE IHSTHLLATION INSPECTIONS OF ANY ~ELLS AD.TACENT TO THIS PROF'ERTY AND THE NUMBER OF RESIDENCES THAT THE DELL HILL SERVE. TI..IO ( ~ > I ~4SPECT I ON~] ARE REQU I RED BACKFILLI~O OF AHY SYSTEI'I HITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SLEJECT TO PROSECUTION. MINI~VM DISTANCE BETHEEN A HELL AND ANY ON-SITE SEI4AOE DISPOSAL SYSTEM IS 1~0 FEET FOR A F'RIYATE HELL OR 15~ TO 20g FEET FRODI A PUE:LIC HELL DEPENDING UPO~I THE TYPE OF PUBLIC HELL PIlNIMUI'I DISTANCE FROM A PRIVATE fELL TO A PRIVATE SEHER LINE IS 25 FEET AND TO A COD~UNITY SEHER LD-IE IS ~5 FEET. 14ELL LOGS ARE RE~LilRED AND I~UST ~E RETURNED TO THE DEPARTHEHT HITHIN ~0 [)~YS OF THE HELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIOHS AND CONSTRUCTION DIAGRAHS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEF-.: f'l I T E><P I F-:ES DEC:EI"IE:ER _--:-.--it.. ::L98i-_~ I C:ERTIFY THFIT 1: I Rf'l FAMILIAR 14ITH THE REQUIREMENTS FOR ON-SITE SEI4ERS AND HELLS RS SET F)RTH BY THE 1,1UNICIF'ALITY OF flNCHORRGE ~: I WILL INSTALL' THE _.~_TEM IN ACCORDANCE 14ITH THE COPES. c"¢ REQUIRE FNLRRGEDE~'T IF THE g:I UNC, ERSTAND THAT THE ON-SITE SEHER _,~:,TEM HAY FcESIDENCE IS REMODELED TO IN~LLIOE MORE THAN 3 BEDROOMS. '- I ]HEC RF'pL I CANT 1 2 3- 4- 5- 6- .-----2' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION SOILS LOG-- PERCOLATION TEST ,~. SOILS LOG [] PERCOLATION TEST DATE PERFORMED: S{TE PLAN 14 15 16 17 18 19 2O IDFEPYTEI~'TATWHAT ~_._._~_[_ LZI..__I_ J_ J _L_.J Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch} · ~, TEST RUN 13E/T~,~EEN ~ F~T AND> - STATE OF ALASKA lc. glsta~¢e and Direction From Road In[ersectJons 3. O~NER OF ~/ELL: ~.~z~Z~.~ .s..2~ 'f;ll a I~ ,. ~Cable t~J gRotary ~ Driven ~Oug ~FI~J -)'~'/~ ~/ /~ ~ 6. USEs ~Do~stic ~Publlc Supply ~Industry ~ / ~A~vp ~eelow land surface /~ ft. after ~ hrs. pu~ping ~/. g.P.~- 12. GROUTING: We1) Grouted: ~Yes MUNtCw~L~TF ~ ,t~i~ ;HO~AG~ Length of O,op Pipe /~ ~ m / s~..~: ~.~: /~-12-~ ACHEMICAL & GJ~ JLOGICAL LABORATORIES ~.,F ALASKA, INC. TELEPHONE (907)-276-4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATERSYSTEM: Water System ~arne I.D. NO. City Mo. Day SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref, no. [] Special Purpose State Zip Code Year [] Treated Water [] Untreated Water SAMPLE NO. I 3 I I LOCATION Time Collected Coltected By TO BE COMPLETED BY LABORATORY Analvsm snows this Water SAMPLE to De: ~ Satisfactory [] Unsatisfactory [] Sample too ~ong in transit: sampm should ROI De over 48 hours old at exam nabon to indmate reliable results. Please send new sample. Date Received / Time Received Analytical Method: [].,Fermentation Tube [] Membrane Filter Lab Ref, No. Result* Analyst r ~ i MT-] I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (0) Rev. 197e BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collecte<t Source 24 Hours 4e Hours :onflrrnatory 24 Hours 4B Hours Time- ' ";' ! !l' / DA, E RECEIVED " INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP ECTOR INSPECTOR I NSP ECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. DJ: HEALTH & 825 L Street - Anchorage, ENVIRONMENTAL PRO'FECTION Alaska 99501 ENVIRONMENTAL SANITATION DIVISION IviAY $ 1981 Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow t~n (10) days for pr~e~slng. 1. PROPERTY OWNER ~,~) MAILING ADDRESS," PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAILING ADDRESS LENDI INSTITUTION I PHONE MAI LING ADDRESS 4. REALTOR/AGENT I PHONE MARLING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION NUMBER OF~BEDROO.OMS TYPE OF RESIDENCE [] One [~ Four [] Other__ [] SINGLE FAMILY [] Two [] Five ~] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY E~ 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 Io§ if available.) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE~* //~ ~ /~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX I 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 L Connection Verified INSTALLER []Septic Tank or []HoldlngTank Size: /'~Of, D If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER ~.. TOTAL ABSORPTION AREA MATERIAL . 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~ APPROVED FOR Z~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev, 6/79)