HomeMy WebLinkAboutUS SURVEY 3043 LT 70A0cl \ - \q
~ MUNICIPALITY OF ANCHORAGE~
~' Department~ ~ Health and Environmenta ?rotection
825 ~ Street, Anchorage, AK. 99501
~'' 264~4720
* * * HANDWRITTEN PERMIT * * *
Permit #
WELL A~E~ PERMIT
Applicant: _ ~C ~C~>'r~P<-A~'<~>~'~'~ Mailing Address..IC>
Location: Phone Number:
.~ ( J~ Lot Size:
Type of Soil Absorption System Is:
Trench: -- Drainfield: ~ 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 minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = '------" 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 departmen~
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 1 9 8 3 * ~ *
I certify that:
(!) 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
the residence is remodeled to include more that 3 bedrooms.
Signe~: Issued by:
Applicant . ~
Date'
swp/024
-~ M N~C~PALI Y OF ANCHORA~ .
~ D~pa~tm~ of H~alth and EnVironment~ ~roteo~txo~
~2~ ~ gkree%, ~chora~e, AK. 99~01
~4~720
~e~m~ .~ ' ~LL ' ~ . P~RMiT
~¢~ion: ~ ~ Phone Nu~: ~: ~?-
Maxim~ N~b~r of Bedrooms: ~ Soi~ ~at~g(aq.ft/br) .......
WIDTH
LENGTH GRAVEL DEPTH
~the boC~om of ehe e~cava~ion(~n eeoc). ~re i~ n0 ~t w~d~h for
<The grave~ depth is ~he min~ depth o~ g~av-! b~ween the out~a~l
~Bhe ~tom of the excavation(in
' ~ fl~QUIR~D SEPTIC HO~IN TANK ${ZE ~ GALLONS e
of residences that the well will ~erva. - '' ' '
for a prmva~e w~li or l~0 to ~00 feet ~rom a publi~ w~%l depending upon
~: ~ p~b~'~c we~.- :'M~n~ ~a~an~a from a.pr~vate well to a przva~e
~ certify th~
(~) ~ ~ f~illar with the retirements for on-si~ sewers and
set forth by th~ M~pal~y of .~cho~age.
~~[~ ~em°d~l~ to ~nclude ~re ~hat 3 ~rOO~S..
Well Owner D_A2q~5
rvI-W DRILLING, Inc.
P.O. Box 10-978 · 10500 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Use of Well
lt~nmstic
Location (address of: Township, Range, Section, if known; or distance mmn road
Lot 7OA USS ~h't043
Size of easing 6" Depth of Hole 82 feet Cased to 80,7 feet
Static wate~ level 46 ft. (l~lfoV~)" (below) lane surface. Finish of well (check one)
Semen ( ); Perforated ( ).
open end ( XX );
Describe screen or perforation ?,lone-
Well pumping test at 5. gallons per
of drawdown from static level.
(minute) for 1 hours with
Date of completion
Depth in feet from
ground surface
0 TO 2
2 TO_ 4
4 .TO_ 15
15 TO 20
Give details of formations penetrated, size of material, colo s
Org~e
20 .TO 75
Gray silty
75 TO 83
.TO.
.TO_
¸TO_
TO_
TO_
TO
__TO
TO
NWW,~ Gertifl~i ~{~
"ertificate No','. 814 ~ F~
3--CONTRACTOR
HAL.
: APPEIC-~NT 'FILLS OUT UPPER ~ONLY
':~ :,'t. ~. * ~ :~ '-~ .~: .~..I ~-;~ .{-~/'~ ~!\1~'[ ]?'~ Phone
Buyer ~ -
Address , ~ ,:, , :,, L~.~ L,':, ~; ~: ~Lk/b ~ (~ ~ )~' / /-~ ~0~-~.~ -~ pCode
Address ' /~J ~ ' · Zip Code ·
Type of ~esi~nce
~ Other
Time Time Time Time
Date Date Date Oate ~//-~L~C~ ~~ \'
Inspector Insp6ctor Insp6ctor Inspector ~ ~
FieldNotes: ~//~ ~ ~ ~=~ ..... OF
._ ~ ENVIRONMENTAL PROTECTION
JUL 5 1983
( ~PROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CON DITIO NA ~ML'
Soils Rating Date ~wer Installed WePTo ~sorption Area Well Log Received
Well to Tank Septic T~k Size
· CHEMICAL & Gl LOGICAL LABORATORIES tJF, ALASKA, INC.
TELEPHONE (907) 552-2343 ANCHORAGE INDUSTRIAL OENTER
· 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Mo. Day Year
SAMPLE TYPE:
[] Routine
~ Check Sample (fol' routine sample
with lab ref. no.
[] Special Purpose
r- Treated Water
[] Untreated Water
SAMPLE
NO.
I
I
I
I
LOCATION
I
Time Collected
Colleoted
TO RE COMPLETED BY LABORATORY
.~,~alys~s shows this Water SAMPLE to be:
~"~t isf act o r ¥
[] ~nsatisfactor¥
[] Sam 31e Too ~ong in transit; samole should
~bt ee over 48 hours o1(~ at examination
to nomate reliable results Please send
new sample.
Date Received '~- 7-7 3
Time Received t~,~ ~
Analytical Method:
[] Fermentation Tube
~ /[~embrane Filter
Result* Analyst
J
Lab Ref. No. -.
~?~7-/~ I
I
J
READ INSTRUCTIONS '
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Lab. NO.
Presumptive 10mi 10mi :[0ml 10mi 10mi 1.0mi 0.]mi ,
48 Hours
Confirmatory
Time* 7.F~'~. ~,~ (~') a.m.