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Permit
Applicant: ~7~
Location:
MUNICIPALITY OF ANCHORAGE
~ Health and Environmenta3
~ Street, Anchorage, AK.
Department
825
264-4720
HANDWRITTEN PERMIT * * *
WELL At~.~l~_~ii~ PERMIT
~'~-~F~,~3 Mailing Address:
Legal Description: ~'~ /~ ~
Type of Soil Absorption System Is:
Trench: ~ Drainfield: ~
'rotection
~9501
Phone NurSer: ~3--g/--/~
''Lot Size:
Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: __~ _ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH ~ LENGTH . .C..~ . GRAVEL DEPTH <.~'r'r'Pr 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 ~ravel 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
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 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-sJ, te
the residence[~s remodeled to
Signe~: ApplJ~cant II
as
sewer system may/~quire enlargement if
include more that ~ bedrooms.
Date: C~/~ ~
SWP/024(1/81)
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hlINIPILIN [:'IS]"FINr':E L,E'T.[,.IEEN FI I.,.IEELL FIN£:, F¢.,1'¢ OI",I-LS, ITE L:.:,EI,.IFIISE DI~F'OSI:::IL :'" ........ ,' ',"'
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· -. F ....... · ..... ,: dt~ FEET FROM F'I F:' EL
I Pii'.,I -r'HE TrFE: FF F .IE, LZL NELL.
HINIMLIH E:'I'.:.;TFIh,IC:E FROH FI F'I:4:I:',,,'FITE I-,IELL. TO F/ F'F" ..... _,E.LIEr< LINE FEE-I' FIP.,t[:,
'- ..... ]:rE: - ,.1 ,~- ]E =- '" I:'5 ;--'::5
'TO R COHHUNZT'.r' .:,EI.,.IE.,~. LINE 7'5
I.,JELL I "3': :';
]F..E F".".E6!UII~:Ei:D FII",I[:, i"il...IEST B~Z ;"
- " F.EII..IF:.I,~E.[ "FO THE [:,EF'FIF::'T'J',IIENT I,.IITH~i'.J
OF THE NELl. C:OHF'I_EFION. '" ' "-
O"I-FIER [;;~E(;!I..I}~REHEN]'$ HFI'T' FIPPL¥. SPEC I F I CRT I ANE'; FIN[:, CONL:,TRUC]'
I~1 FIILb[:LE TO ' -I ; ~
i PJ=, _11' .E F'FtCIPE[.:t I NZ.:,'rF t. _F T I ON
E ~2_ ~. :. ~f. ~ % -'F ~1:=..:-=,, I~.--. % IF:_ E: _~; E?, lei: C: IE:E E."J E. iE= IE ~: Z~i: dL ...... :IL.._..,~ ...... :.fl._
I CER"I" ]: F'? 'THI:::IT
::t: I Fd',l F:FIHIL. IFtR HI'TH THE RE6!UIREHENTL:; Fr'R ES,I-SITE _EHEF.::, F;~I',I[:, IIEL.I__-:.,
F'OF::TH ,?~ THE i"1LIh,IIC:IPF:ILI]'? OF' RNCHORFiCiE - H_, '.'~:;E'T
'":': I f.,.llI._t .... N;:,IML_ THE '-'"' ....... ,'
~:, .:,1 Ell ~1",1 FIC:COF::DFINCE H~]"H THE CO[:,EE;.
January 4, 1982
Daniel Morgan
SRA Box 1197M
Anchorage, AK
99507
Permit ~ 810400
Subject: L16 B4 ZODIAK
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Sewer and Water Program
Enclosure: Copy of Permit
STATE OF ALASKA ' ' '
OEPARTMENT OF NATURAL RESOURES
Division of Geologicol 6~ Geophysical Surveys
LOCATION OF WELL {Pleame ce~plefe eliher Io~ lb o¢ lc.)
Address: ..\/,~y . C~ ~
(' :..,~
7. USE: ~ome~Iic ~ Public Supply
~ Irri~otmon ~ ~echarge ~ CommerlOal
~ Teel Well ~ OStler:
Prop iy Owner
Mailing Address
APPLI
Ronald E. Rivard/ Quest Enterprises Inc.
4325 Laurel St., Suite 2600 Anchoraqe,Ak~
FILLS OUT UPPER HAL 3NLY
zip Code 99504
Phone
561-1638
Buy~arilee & Barbara Deloney
Address Zip Code
Lepding Insti!ution Phone
Address Zip Code
Realty Co. & Agent BUJ. 1der/Agent. Phone
Address 4325 Laurel St.,Suite 240 Ancho~ge.Alaska 561-I638
Legal Description
Lot 16,Blk 4, Zodlak Manor S/D
S~reet Locatio~ 8412 Jupiter DrLvt~
Type of Residence
~xSingle Family
["J Multiple Family NO. et Bedrooms~4.___
~ Other
zip Code 99504
Water Supply
~XIndividual Al'TACH WELL LOG, A well log is required for all wells driiled since dune 1975.
Community For wells drilled prior to that date, 9ire well depth (attach log if available).
[] Public Utility
Sewer Disposal
[] Individual Year Individual Installed: _. )~Lx
X~ Public Ulility When Connected to Public Ulility: ~-~8~
Holdin9 Tank --
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE P~OCESSING CAN BF- INITIATED.
Time Time Tim~ Time
Date Date Date Date/
Field No~es:
APPROVED BEDROOMS
DISAPPROVED
CONDITIONAL APPROV/~L~/
"CONDITIONS OF APPROVAL
Soils Raling
Dale Sewer Installed
Well TO Absorption Area
Well Io Tank
Well Log Received
Seplic Tank Size
_CHEMICAL & GE~ OGICAL LABORATORIES ( ALASKA, INC.
TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRfAL CENTER !~
5633 B Street I~
z.,",*. ....... ..-,~ Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
I.D. NO.
Phono No.
Mailing Address
City State
S*M.LE DATE F)T-$1
Mo. DayYear
Zip Code
SAMPLE TYPE:
;~Routlne
[] Check Sample (for routine sample
with lab ref. no. )
[] Special Purpose
[] Treated Water
- Untreated Water
SAMPLE
NO.
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[~ Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be Over 48 hours old at examination
to indicate reliable results. Please send
~_evy sam,~le. ~ +
Dete Received ..... ,... ',-L ..;0. ;
TlmeRecelved _/ ,r4~,~ -
Analytical Method:
B Fermentation Tube
~ Membrane Filler
Lab Ref. No, Result* Analyet
I [SE]
J F-Fq
06-13~0 {b)
Rev, 1978
BACTERIOLOGICAl. WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
