HomeMy WebLinkAboutVANS BLK 3 LT 7BLO
MUNICIPALITY OF ANCHORAGE
Department ~ Health and Environmenta]~rotection
825 _ Street, Anchorage, AK. .9501
264-4720
* * * HANDWRITTEN PERMIT ~ ~ *
Permit ~ ~~ WELL AN~-/-~--(~N~STI'~--S'E~PER PERMIT
Location: ~ Phone Number:
Legal Description: ~7~ ~ )/~q~ Lot
Type of Soil Absorption System Is:
Mailing Address:
Size:
Trench: ~ainfie~d~ ~e~l~a~-: Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
UEPTH ,LENGTH GRAVEL DEPTH ' WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
d~epth 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 department
wiI1 be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
f~m- 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 2 * * *
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
third__remodeled
/024 (1/81)
to
include more
Issued by:
Date:
that 3 .bedrooms.
APPLIt "NT FILLS OUT UPPER HAV%ONLY
Mailin~A~dress ~ ~ ~/-- /1,~ ? ZiP Code ~Z/ ~ ~F~~-~
Buyer
Address Zip Code
Lending Institution ./ Phone
Address Zip Code
Phone
Type of Resi~nce
~ngle Family ~
~ Multiple Family NO. of Bedroo~s
~ Other
Water Supply
~dividuaJ A~ACH WELL LOG. A wd~ Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give web depth (attach Io~ if avaiJ~)~
Sewer Disposal
~ Individual Year Indiv~ual Installed:
~ Pub~i~ ~ility When Connected to Public Utility: ~ -~ ~J~, ~
~ Holding Tank Q~ C~ ~ ~A.~-~ {
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSrNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
SEP 9 I982
RECEIVED
( ~PPROVED BEDROOMS ~ 'CONDITIONS OF APPROVAL
( ) DmSAPPROVED
( ) CONDITIONAL APPROVAL'
Well to Tank Septic T~ Size
72-023
WATER WELL R E C 0 RO
STATE OF ALASKA
0EPRRTMENT OF NATURAL RESOURCES
A.D,L. No,
lc, Distance and Oirection from Road Intersections 3, OWNER OF WEt~jeA
8116 Br±arwood " .......
,2. WELL LOG Surface 1 12' '°"
brovrn silty till rock at 1 ~' 0 15 s. F]cab~et~l []Rotary []Drive, ~]DuR
gray smZty gravel 15 108 ~g,~
gravel wztn s~d bits of
gray clay ~o 10~ 112 ~. us~: ~o~i,
~lrrlgatlon ~Recharge ~Co~rcial
~Test ~ell ~0ther:
...... ~m~i~ OF ANcHO~ AGE
~ ~ ~ lg~ Set batten ft, and ft.
~ I .~ ~l 9. STAT)C WATER LEVEL: 38 ft.
~A~ve ~8e)ow land surface
ft. after hrs. pumping 30 g.p.m.
) 1~. PUMP:
Length of Drop Pipe ~:~ ft. ca,city ~ g.P.~
Type: ~Sub~rs[ble ~Recijrocat]ng
~j~t ~0~h~:
Water Temperature:
Vern's Drilling & Ent ~
Address:
Signed:
12241 Avion St,~ SRA Box 1560 Anchorage; Ak
Authorized Represent
Coo¥ Distribution: WHITE - 5ta:e DGGS~ PiNK - Driller,
99507
CANARY - Customer
CHEMICAL & Gff'~LOGICAL LABORATORIES ~'~ ALASKA, INC.
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
fi ,~ I.D. NO..
Phone
/: :'~ ,> .....
Mailing Address I.~/
~ ~---~ .Fj' ~>.~ ~ i"x,~ ~:~-, ....
C[~ State
MO. Day Year
. Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref, no.
[] Special Purpose
[3 Treated Water
[] Untreated Water
SAMPLE
NO.
1
2
3
4
5
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows mis Water SAMPLE to be:
I~:1 .~S,~tisfactorv
[] Unsatisfactory
[] Samr)le too long m transit: samole should
not De over 48 hours om a~ exa ruination
to indicate reliable ~esuIts. :lease send
new samore.
Date Received
Time
Received
Analytical Method:
[] Fermentation Tube
~:Membrane Filter
Lab Ref. No. Result* Analyst
Ix.-z z a-~-'lr-~
i
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (t~)
Rev. :t978
BACTERIOLOGICAL WATER ANALYSIS RECORD
D~te Collect ecl Source
PreSumptive ).Omi 1Omi ;.Omi ).Omi ).Omi 1.0mi 0.1mi
24 Hours