HomeMy WebLinkAboutTURNAGAIN BLK 4 LT 1117__2-11
(k.,/ MUNICIPALITY OF ANCHORAGE
/
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMEN'I'AL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
[] UPGRADE
MAILING ADDRESS
EGAL DESCRIPTION
3CATION
Manufacturer ~(~----~
.~ 2 I~ ~ ~ DISTANCE TO'. IWell
Dwelling
Manufacturer
DISTANCE TO: J 140
No of lines Length of e~ch line
~ IZopoftUetofinishgrade ~l
~ClassTVPeDISTANOE°f crib TO: ~ell~CribDepthdiamete~
D~elbng
IWidth
Material
Foundation ~ ! Nearest lot line ~ i
Totallength oflines T~v~dth inches
Material beneath tile
(~:~ ~-~ 7_~_inches
OTHER
PIPE MATERIALS
SOIL TEST RATING
REMARKS
Depth
Crib depth
Driller
Sew~rline
NO, OF BEDROOMS
4
No, of compartments
Liquid de~t'~
PERMIT NO.
Liquid capacity in gallons
PER
Distance between ines
Tot al e, feetive ~=~r~o n ~
PERMIT NO.
Total effective absorption area
Building foundation Nearest lot line
Distance to lot line PERMIT NO.
Septic tank Absorption area(s)
MUNICIPALITY OF ANCHORAQE
DFPT. OF H~\LTH &
APPROVED
RECEIVED
LEGAL
72-013 (Rev. 3/78)
F'EF:H!-F
L, ...... ,...b I. r',ll- .I.b.l...,.....
Ti '"' r' F'F:'Thl r',~:' "":: '" ' "~ ~ !'",~
.'~c_ , ...... ..¢::1 TR,....rI..!, I:lii: F'ZT
GF:O!J?D FIND THE EiOTT(:It"i OF' THE: j::'.:.r'.l":Ft',/'¢~"f'Ti-il'.,i
l-,,*;.- lb ~'4f'ZI SET HIE:'TH F~F' "~-"""~""~""
'i~r:' ........... GF:!:~'v'EL [:'EF'TH ¥': THE HZNIi'iUi'"! 'L:'i"h'ri4 ....... EiF' ISR:F:I',,,'EL _F'rz'T..ll.~,.'c" THE l .............. ,U ~?,~ F'IF'E:
HN[:, T .l~: ~II[)T"['(]I['i CIF "i'LIF' ~:"-"''t::"-'~:' "~'-"~'
- ,.,~. .,, ...... ~.,. ...... ........... <
H I hl I Hur,! E:, i S-I't::I?,!CE BE:TI.,tEEH R HELL. RI',!D F~i'.?¢ O?.,!-S I 'rE: SEWREiE D !
::L!S~2!! FEET FOR R F'F,:!VRTE: HELL OR ::i. SE1 TO 28Ei FEtET F,~:EIi',i R F:'UE~LiC: FiELL
LtF'OI'..i THE; 'i"'¢F'E OF' F'UE;L!C i.,.iEL!. ....
h'!iNi!',iLIH DISTFff.,!f::E F'I4'.OH R Pi.;;'.IVRTE: t4ELL "t"Ci F:I Pi-;:i',,,'BTE
TO R COHHUN[T'?' 'SE[,.!ER L!I',!E IS 75 FEET.
EITHEF: ?.E!';:!i..!iFtE:.t,!ENTS HFI'./ R,~Pi_?. 'SF'ECiFIC,~::F!"iOi'.,!:~: FiND COh.!S"t"F;:UCTiOI'.,! DiF!EiF?.Ri"iS
R',.,'RihFIBL.E TO :[i'.,ISI_.I,~'~'.E PROF'Ei~:
! E:Ei:;fTIF"-r' THFIT
J.: I RH FR.?,!!L. iFIR [,.!ITH 'THIE RE6:![..IIr..:..'EHEWFS F'OF...' OF~-Si'f'E SE!4ERS R?.~D !qEL. LS FIS S;E"i'
FORI'F! f-'{?T' ']"hie i',IUNiC~.:F'FiLIT~.? (::IF
2: ! !4!LL. II',!STRL.L T,'-4E S'.~.'S'I"EH lhi F!E:COF?.DF!i'.,!CF:: i4iTH "!'HE/ CODE'5.
3;; ! IJ?..!DEF~STRi'.,!D "f" I::IT THE ON-L:.';ITE S_~3,.iEI?. S'T'S']'Ei'! .hiR'.~.' Fi:EQi..ilF;:E E:NL. RF'.EiE:HENT iF 'THE
iq'.ES'[i)ENC[E !!:; .r,;:E IF.hi: ..IDE HOF?.E TF-ii::!N
3
4
5
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, A~aska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~/ SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION;
1
2
SLOPE
8
9
10
13.
WASGRODNDWATER ~YO ~b
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
14-
16-
17-
18-
19-
20-
PERCOLATION RATE
(minutes/inch)
TEST~ RUN BETWEEN FT AND -- FT
CERTIFIED BY:
72-008 (6/79)
GPrA. TER ANCHORAGE AREA BOROI'~H
~,~ ~,, HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
NUMBER OF
DISTANCE FROM WELL~"J,~-~ f~:~::'~///?'- MATERIAL ~/~.,.~--' COMPARTMENTS
LIQUID CAPACITY(~ ~ ~- GALLONS· INSIDE LENGTH I~SIDE WIDTH ~ /
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR WIDTH /'/~J '~ /,';~" '"
~ , LENGTH , DEPTH
· DISTANCE FROM WELT ~').-~"-~"'~' //~..-~"~ , BUILDING FOUNDATION-
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~-'~'J./~/~' SQ. ET.
TILE DRAIN FIELD:
DEPT~: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
., OF LINES
ECTIVE
IN. ABOVE TILE
~.)~ .,~r~ ~/~'..,~rm~'~: DISTANCE FROM
WELL: TYPE~ ~EPTH -~ . BUILDING FOUNDATIOn.
~ NEAREST ~ SEPTIC . SEEPAGE
LOT LINE -. SEWER LINE_ , TANK . SYSTEM
WATER
SAMPLE. --
· CESSPOOL
, NEAREST
OTHER r~
· SOURCES --
DISTANCES:
DIAGRAM OF SYSTEM
/,
DATE . APPROVED ' HEALTH AUTHORITY
GAAB-HD-2
GREATE~ ~,tNCHORAGE AREA',, 9ROUGH
HEALTH DEPARTMENT "'-/
327 Eagle St. Anchorage, Alaska 99501 279-2511
NAME OF APPLICANT
RESIDENCE ADDRESS
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
F,.ANCE. T.ROUGH
PEROOLATION TEST RESULTS
THIS IS TO SERVE AS
LOCATION OF INSTALLATION
, SEEPAGE PIT
, DRAIN FIELD
OTHER
TO BE INSTALLED BY.
ANTIOIPATEB DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
AS
. SEPTIC TANK smz~ ~ TYPE SEEPA6E AREA TYPE
OF SYSTEM
DISTANCES:
that I am familiar with the requirements of Greater Anchorpge Area B2~rog, gh Ordnance N,o. 28-68 a~nd tt~t the
I certif~escribed system is? accordance
above with said code. /,~-£.~...~
DATE APPLICANTS SIGNATURE ' /
· CASE # .
· ',REATER ANCHORA~E AREA BOROUGH
k~!/ HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
Performed For. ~,$~0~ ~o,~A ..... ~_Date Performed__l~
Legal Descriptioh: LOt Block . Subdiviszon ' c '
This Form Reports a: Soxls Log _ t/ 3' -.Percolafion Test
Depth
Feet Soil Characteristics
V
Was Ground Water Encountered?
If Yes~ At Wha~ Depth ·
Reading
Da~e
~te' £"'/
;rcolat ion ~
Gross Time Net Time
Location Sketch
Depth To H20
Proposed Insta~Se/~e Pit~ ~ , Drain Field ....
,Depth Of Inlet~~pth To Bottom Of Pit Or '~renc~
COMMENTS: i~,1 .'~ .z ...... ·
,
Test Pemfo~med B ·
Net Drop
~ ,. APPLI~ ";NT FILLS OUT UPPER HAl ~'~LY~
Property Owner C~L.i~~. ~.~ LO)~!'~)OIk~L~j~:C_ ~ ~ ......... Phone
Buyer
Address f'l Zip Code
Lending Inslitulion Phone
Realty Co. & Agent
td/~ zip Code
Type of Residence
~.lndividual __~/,~., p~l~' f3~/~{~"~ ~.¢~ ATTACH WELLLOO. Awelllogisrequiredforallwellsddlled~inceJune1975.
E] Community ~) For wells drilled prior to that date, give well depth (attach log if available).
[] Public UtiJity
Fuhlic Utility When Connected to Public U~ility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
~ ~)~,/~._ MUNICIPALITY OF ANCHORAGE
R CEIVED
(~ ) APPROVED BEDROOMS *coNDITIONS OF APPROVAL
( ) DISAPPROVED
Soils Rating Date ~wer Installed Well To ~sorption Area ] ~ 0 Well Log Received
JI ~ ~ ~ 2-- ~ ~ WelltoTank I ~ Septic T~k Size
CHEMICAL & G~LOGICAL LABORATORIES~-~ALASKA, INC.~
TELEPHONE (907}-279-4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED. BY WATER SUPPLIER
WATER SYSTEM:
Mailing Address
City
i.D. NO.
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
I
I
I
I
Time Collected
LOCATION ~ Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to De:
~'Satisfactory
r- Unsatisfactory
[] Sample too long in transit; samele should
not De over 48 hours old at examination
to indicate reliable results. Please sene
new sample.
Date Received *'
Time Recelvee " "'
Analytical Method:
[] Fermentation Tube
~Membrane Filter
Lab Ref. No. Result* Analyst
i ?~?~ ~ ';i~'I ,-j.-q
I r-'-i'-I
I I'-CI
o6-~2o (e) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1978
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Presumptive 10mi 10mi 10mi 10mi 10mi 1.0mi 0.1mi
24 Hours
EMS
Multiple Tube Report:
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM
APPROVAL TO CONSTR
Plans for the construction
~'~) Rlo~ I~ ~I Lo'ff- I I
public water system located
A J/-~ , Alaska, submitted in accordance with [8 AAC 80.100
Vo~ clev- be c(<e havebee, reviewedandare
by
~ approved.
. ~.~[3 conditionally approved {see attached conditions).
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVEDCHANGEORDERS
Change (contract order no. Approved by Date
or descriptive reference)
0_,,.,,~,~4-~,o~.~'~, oo.~/l ~=~ OL,~.<rt'c''
The "APPROVAL TO OPERATE" section must be completed before any w~ter is made available to
the public.
APPROVAL TO OPERATE
Theconstruction ofthe 7~..-",)/141 ~.l./, -~f '~..- "~/1-) ,'~/t.~j(_. ~ ~,(--- ~l public
water system was completed on (~ ~ /2_-- 7 (e (date). The system is hereby
granted interim approval to operate for 90 days following the cpmpletion date.
BY
TITLE
DATE
As-built plans submitted during the interim appr6val period, or an inspection by the Department has
confj, rmed the system was constructed according to the approved plans. The system is hereby granted
fin~[ approval to operate. ,~
'I'[T LE' DATE