HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 2 LT 1212-
;AME
ADDRESS
MUNICIPALITY OF ANCHORAGE
DEPARI'MENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND~J~ WELL INSPECTION REPORT
- PI-lONE NEW
L~AL DESCRIFTION
NO. OF BEDROOMS~
Absorption a~ea PERMIT NO
DISTANCE TO: I ~ 2~"
Manufactu,er Materia~.-~.~ No. of compart ,nts
DISTANCE TO:
IF HOMEMADE:
Dwelling PERMIT NO.
Top of tile to finish 9rade
Length
tile
Type of crib Crib diameter :rib depth
Well Building fou ndati~;~'
DISTANCE TO:
Total effec ire absorption a .~a
PERMIT NO. //
Nearest lot line
Class Depth Dri[h!r Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
REMARKS
DATE
LEGAL
72-013 (Rev.
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MUNICIPALITY OF ANCHORAGE
Department Health and Environmental rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
Applicant: \/~/~ J~-' Mai=lng Address:
Location: q~.~.~_~> ]}~ . ___ Phone Nu~er: _
Legal Descrlpt~n:'-- $' ~/ ~ ~ ~~ ~o~Size: _
Type of Soil ~sorption System Is:
Trench: ,~ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: _,~_ Soil Rating(sq.ft/br) /~
The Required Size of the Soil ;~sorption System Is:
DEPTH // LENGTH iT/'/ 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 tile minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /OOO 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
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 censtruction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 Q 1 * * *
I certify that:
(1) I am fsmiliar 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.
Applicant ~ ~/
Date: h?
SWP/024(1/81)
MUN I C H]AL,[ ~'~ OF
..... ~b ~, ,~c~.~.~, ~h~ag~, ~g, 9950].
264-4720
W~LL AND/OR ON~i~[r~
Trench~ _~_ ora~:ka~d~ ....... 8aapage ~a,l~ floldinq Tank~
g~
[:ha bat ~om
the ~ttom of
~ ~ R~t~UI[{~I) $~P'fiC(HOI~ING) TANK SIZ~ ....... ~0_ uALtONo
avaLLable to i,n~u~m p~op~ i. nstaklation,
PERFORMED FOR:_~
LEGAL DESCRIPTION:
1
2
3
4
5
6
7-
8
9
10
11
12
13-
14
15
16-
17
18
DEPARTME~''~ OF HEALTH AND ENVIRONMEN~rAL Pill ~ =~, ,u,~
TEST
.. Street, A~chorai~e, Alaska {)9r~1 2~4-4720
SOILS LOG -- PERCOLATION TEST
DATE
SLOPE '~t~E PLAN
W^SG.OU.DWAT"R
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Gepth to Net
Roading Data Time 'rima Water Drop
7'/7 ¢~ - ¢ '
?'17 ,,s-.~ ~'
19
20 :8 ~ERCOLATION RATE
z TEST RUN BE~E~ ~/ -- FT AND ....
72-O08 (6/79)
M-W DRILLING, Inc.
P.O. Box4-1224 · 1310C International Airport Road
(907) 274-461]
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner .TA,( '" .~
Use of Well
Location (address of: Township, Range, Section, if !mown; or distance main road
Size of casing_ 'f Depth of Hole J--'~: feet Cased to [D ~.. 6 feet
Static water level .ft. (above) (below) land surface. Finish of well (check one) open end ( X );
Screen ( ); Perforated ( ).
Describe screen or perforation.
Well pumping test at gallons per (h~u/r) ~(minute) for hours with
of drawdown from static level.
Date of completion ::k)veml)cw 9, ].,)bi, /~' c_c_~ ~,?////:/~>
! WELL LOG
Depth in feet from
ground surface
0 _TO 2
2 _TO ~ J
Lh _TO J)
80 _TO. i42
GiVedetaiis of formations penetrated, size of material, color and hardness
Caai~g stickup
_ .T, al~ silty y,raw~t
_ %an sll~y ~.ravel
MUNJCIPAI. ITy OF ANCFJORAGE
19.82
Watary zrave].
ft.
.TO.
TO
~0
~0
.TO.
.TO.
~VWA (,erhf ed Confrac~m~
.TO.
3--CONTRAC'FOR
Property Owner
Mailing Addre~
Buyer
APPLI(....NT FILLS OUT UPPER HAt
Address
ONLY
Zip Code
Phone
Lending Institution
Address
Realty Co, & Agent
Address
Legal Description ~,
Type of Resi~nce
~ Single Family
~ Multiple Family No. of Bedrooms
~ Other
Water Supply
.,~ Individual
F~ Community
E~ Public Utility
Sewer Disposal
.~k Individual
I~ Public Utility
[] Holding Tank
Zip Code
Phone
Zip Code
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
Year Individual Installed:
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE Pf~OCESSING CAN SE INITIATED,
Time Time Time Time
Date
Inspector Inspector Inspector Inspector
--(~'~) APPROVED BEDROOM'~...q~ 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( )CONDIT[ONAL APPROVAL'
Soils Sating Date Sewer Installed Weft To Absorption Area Well Log Received
'~'~ __ _,~_,~_,~_,~_,~_,~[ ..~ ~_ Well to Tank Septic Tank Size
CHEMICAL & GE~.~OGICAL LABORATORIES ~ ALASKA, INC.
274.3364
Drinking Water Analysis Report for Total Coliform Bacteri~t
TO BE COMPLETED BY WATER SUPPLIER
V^TERSVSTEM: E..I I I' l"-l--q
I.D, NO.
Water System Name Phone No,
Mailing Address
City State:~ Zip Code
Mo. Cay Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref, no.. )
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
2 k
LOCATION
Time Collected
Collected By
TO'BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[~] Satisfactory
?
[] Unsatisfactory
[] Sample too Iong *n transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
[]qMembrane Filter
Lab Ref. No. Result* Analyst
CFI
J r-Fq
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-[220 (b)
Rev, 1978
BACTERIOLOGICAL WATER ANALYSIS RI[CORD