HomeMy WebLinkAboutGOLDEN HILLS BLK 1 LT 1j~Lh'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 T01ephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAILING ADDRESS
[] UPGRADE
LEGAL DESCRIPTION
LOCATION
I DISTANCE TO:
~vI
I- ~ [ Manufacturer
in ILiq capac tyin ~a~'lons
/ ~., ,~'O IF HOMEMADE:
~ ~ ~ Manufacturer I
~ ~ Well
~ ~ ~ No. of lines Length of each kine
~ ~ Top of tile to finish gra~e
~ ~ I Type of crib
~m ~ Well
~ ~ ~ TO: 8u~ dm~ foundabon
Absorption area
fDwelling
Width
Inside length
NO, OF BEDROOMS
PERMIT NO.
Liquid depth
Dwelling PERMIT NO.
Liquid capacity in gallons
Foundation
I Materiat
Nearest lot line r
Total length of lines / Trench wCd~-I~"
//t' _./ 3_(~ i.che~
Material beneath tile ~
Depth
PERMIT NO, ~¢~ /~. ¢.~
Total effective absorption area
PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line PERMIT NO.
Sewer line Septic tank Absorption area(si
OTHER
PIPE MATERIALS
SOILTESTRATING ~ ,).:p
INSTALLER
REMARKS
DA'rE LEGAL
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[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 ~'76-2221'
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
7
8
DATE PERFORMED: Al_Or', ~--7 ~ ~-~I /6~ }~
(-J i L b.L)
SLOPE
SITE PLAN
10
12
13
14
15
16
17
18
19
20
COMMENTS
WAS GROUND WATER
ENCOUNTERED? /k) O L
P
E
IF YES, AT WHAT . ,
DEPTH?
Gross Net Depth to Net
Reading Data
Time Time Water Drop
PERCOLATION RATE "~ '7 (minutes/inch)
TEST RUN BETWEEN d~, S-- FT AND ~-, O FT
PERFORMED BY: ~0~ ~ ~'~ ~'t ~ I" 3 ,, ~t, lC
72-008 (7/76)
I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'rl0N
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1.~OPERTYOWNE~ _ ' PHONE
MAILING A D~ R ESS
PROPERTY RESIDENT (If different from above} PHONE
~, BUYER PHONE
MAILING ADDR E~)~
4, REALTOR/AGENT ¢_. __ PHONE
MAILIN8 A~B~
STREET LOCATION
6, TY~.~ RESIDENCE
~. SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDR~O~MS
[] One ~l~] Four
'-] Two 'la.] Five
[] Three ~] Six
Other
WAT?_2UPPL¥
~ INDIVIDUAL~
U COMMUN TY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilleo prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~ IN DIVI DUAL/ON-SI'I'E**
[] PUBLIC UTILITY
*'If individual/on-site give installation date J (~tJ~ ~.
If system is over two (2) years old an adequacy test is required
by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72.010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED .
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR I NSP ECTOR INSPECTOR
DIRECTIONS:
I, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[~] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING'
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES Septic/Ho]ding Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[~[~' APPROV ED FOR ~r- BEDROOMS
E~ CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title)
LEGAL DESCRIPTION
72-010 (Rev, 3/78)
Fre~ Cro~er
,~v~ar }loute A Box 36-C
Anchorage, Alaska 99507
Sub'ect~,. , .] LOt 1 .~lock 1 Golden Hills Subdivision_
~.hJ .... department did riot qive a final ap;)roval on tl'l¢~ sow¢~r
installation for the subject prop(~rty.
Y~efore approval will be grante(], you will ne. ed to do the
f .
(t) A well log s%%b~'.,itted to ~hl,, ~epartn~ent.
(2)
?lie depression or pit arom~d the well c~sJ.ng needs to
b~ fillea with impervious t. ype soil so that it slopes
away from the well casing.
The water analysis report be (lelivered to this office
from Chem Lab, ~633 B Stree9, for our revl(w.
~-~ake arran~$ements to get a final inspeotion on the
se,~er system~ ~4rs. I,indquist was the inspector who
disapprove~l you s~cond inspection. You will n~ed
to c~nta~t her so that she c. an inform you on what will
be require('i.
Please notify this department fer a re-inspection when the
descrepancJ..es have been correcte~lo If there are ~ny further
questions, pleas~ contact this office at 264-.4720.
Sincerely,
Robert C. Pratt,
Associate Spe¢:ialist
RGP/ljw
cc: First National Bank of Anchorage
Post Office Box 4-.2090 995~.0
81 ~EOLOGIC. AL LABORATORIES OF ALASK~ INC.
P.O. BOX 4-1276 4649 BUSINESS PARK BLVD.
ANCHORAGE, ALASKA 99~09
Drinking Water Analf/Sis Report for Total Coliform Bacteria
TELEPHONE
(907) 279-4014
TO BE COMPLETED BY WATER SUPPLIER
PUSL,C WATER SYSTEM= k l I I I I I
I.D. NO.
Public Water System Name
Mailing Address ~
City State
Mo. Day Year
Zip Code
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
E] Untreated Water
SAMPLE
NO. LOCATION
~ I/-/ ¢?/r I I
~I I
4I I
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
LABORATORY:
NAME
ADDRESS
Date Received
Time Received
Analytical Method:
CITY
/ ~1~--~
Fermentation Tube
t~'Membrane Filter
Lab Ref. No.
Result* An~yst ,
READINSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Form No. 18-310(3-78)
'~?~912 2 0 (b)
Rev~ 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected
Date Received
Presumptive
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hour
Multiple Tube Report:
Membrane Filter: Olrect Count
1Omi Tubes Positive/Total 1Omi Portlorls