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HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK A LT 10 REM  ~_~ MUNICIPALITY OF ANCHORAGE , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME /? IP"°NE ~NE~ LEGAL DESCRIPTION LOCATION L~~allons IF HOMEMADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well~//~ Dwelling PERMITNO. O ~ ~ Manufacturer Material Liquid capacity in gallons Q W~I Foundation Nearest lot line PERMIT NO. ~ ~ No, of lines h line Total length of Pines Trench width Distance between lines ~ inches ~ - Top of tile to finish grade ~ Material beneath tile Total effective absorption area Q inches ~ Length~ . l Width ~O ' Dep~ ./ ~ [X~ W~ PERMIT N~ ~ ~ Type of crib ~ Crib diame~ . Crib depth Total elective a.rption area '~/~ Well /~ Buildi~foF~on Nearest ,;t ,i~ DISTANCE TO: /~ -- j C~ Depth Driller Distance to Jot line PERMIT NO. 1 ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s} OTHER PIPE MATERIALS SOl L TEST R REMARKS %4~%:-. x . .,.-,: ..:,<d~ ~ , i- ~OV~///~ //~ DATE [ LEGAL ~ ~ ~ e'.'~GiNE~Rii~ 3/78) 264-4720  * * * HANDWRITTEN PERMIT * * * Permit ~ WELL AND/OR ON-SITE SEWER PERMIT Applicant: ~ Mailing Address: Department ~f Health and Environmenta~ Protection 825 ~._~ Street, Anchorage, AK. 'L~9501'~ 7/1 ' A3 Location: Phone Number: Legal Description: L0~/~ ~/~ /~~~ ~ot 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 Absorptio~ System Is: ' DEPTH ~'"'-~'-- / ; ~ LENGTH ~/ GRAVEL DEPTH d~9~'C?,',~. 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(++OC-D'[m~'G~ TANK SIZE = /~d:) 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 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 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 ~ .bed~ ~1 i~an t Date: ~c~/~/~4./=~- ~ ~/~ ~,~' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ,~ SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 12 13 14 15 16 17 18 19 20 ~ o ¢- 1o /'¢1,¢ ,4 PERFORMED BY: /,.~]-~ ~, 2~ SLOPE DATE PERFORMED: ~-~ '~. /~;"~2 SITE PLAN WAS GROUND WATER ¢;~'t),, ~'~')o) S ENCOUNTERED? ~-~.~C L O P E DEPTH?IFYES'ATWHAT ~ Gross Net Depth to Net Reading Date Time Time Water Drop PER CO bATION RATE /.1¢~( VI ~ ~'¢// (m in utes/inch) TEST RUN BETWEEN FT AND ~ FT DATE: 72-008 (6/79) CERTIFIED BY: Permit # Applicant: Location: Departmenti' ~-~$~i~H-~ ~vlrG{~[[: Protection /~ 825 ~ Street, Anchorage, AK. k~'~501 . . HANDWRITTEN PERMIT * * * WELL ~/-~ CCC-~..~.L~-'~m~ PERMIT ~~~ ~~ Mailing Address: Phone Number: Legal Description: A f~ ~l~ ~/~¢~3f~ ~/~ ~ Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) DEPTH The Required Size of the Soil Absorption System Is:' ~/~-- LENGTH ~ GRAVEL DEPTH 'I//M- 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 Dipe and the bottom of the excavation(in feet). ~ * REQUIRED SEPTIC(HOLDING) TANK SIZE = '17/,4- 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 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. Date: SWP/024(1/81) CHEMICAL & GI~.£OGICAL LABORATORIES ~ ~' ALASKA, INC. ~ TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 ;;6:33 R Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETEDBY WATER SUPPLIER WATER SYSTEM: Water System Name I.D. NO. Phone No. Mailing Address City State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine ID Check Sample (for routine samp!e with lab ref. no. I [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. , 4 LOCATION '/ Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE To be: [] Satisfactory [] Unsatisfactory [] Sample too long m 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 ~ Membrane Filter Lab Ref. No. Result* Analyst I I I FTq I m *No. of colonies/lO0 mi. or NO of Positive oorhons. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source Time Received __ p.m. Lab. NO. I~'esumptlve 1Omi /Omi /Omi 1Omi 1Omi 1,0mi 0.1mi 24 Hours 46 Hours Confirmatory 24 Hours 48 Hours EMB Broth 24 hours= Broth 48 hoists; Multiple TuPe Report= 10mi Tubes Positive/Total 10mi Po~tlonl Membrane Filter: Direct Count Collform/100ml Verification: LTB BGB Final Membrane Filter Rilsults - Collform/3,00ml Repor tm:l By Date APPLI¢ ~IT FILLS OUT UPPER HAl." 'ONLY ~ Phone Add~ess Zip Code Lending ns~ ~u~on~~ ~:~ ~/C~ ~~ ~o~ Phone Addre~s Zip Address t ~ . Lega/ Description /6l~l /~ /~0~ ~ ~6~(/~' --~ ~/~ Street Locati~ Type of Resi~nce ~ngle Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~ndividual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~, ~ Public Utility Sewer Disposal /~ ~' ~dividual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Ti.me Time Time Ds,e Date Data Date Inspector Inspector Inspector Inspector Field Notes: ~ ~ ~'~0~=~- ~ OJ'~ . ~ I t~ ~ ' ( ~OVEDBEDROOMS ~a-~.~ ~ "CONDITIONS OF APPROVAL ~ ~coN~mo.~ ~...ow~' Soils Rating Date ~wer Installed Well To Absorption Area ~ © Well Log Received ~ ~ ~ ~ -~ ~ WelltoTank ~ ~ I Septic T~k Size 721023 (3182)