HomeMy WebLinkAboutFISCHER BLK 2 LT 1D
~ ! '~ MUNICIPALITY OF ANCHORAGE f
, 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
PHONE
[~ Manuf~turer ~e~ Materia,~. ~ No. of compartments
Liq.~ capacityo .~in gallons IF HOME.DE: Inside length,~[~I j ~ Nidth ~ i ~ Liquid depth
~O~ DISTANCE TO: Well ~ / ~ Dwelling PERMITNO.
O ~ ~ Manufacturer Material Liquid capacity in
~: DISTANCE TO: ~.~.e~~ Foundation ~0 20
~--~ Trench widlh Distance ~t~en lines
~ No. otli.~ t Lengthofeachllne~ Totallengthofli.esq~ ~,)-- ¢0 inch.
O ~ Top of tile to fini~h grade ~ ~ 0" Material beneath tile ~1 0 inches
~ Well Building f~ndation Nearest lot line
~ DISTANCE TO:
~ DISTANCE TO: Building foundation Se~r line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS / ~ ~
5OILTESTRATING ~ S " '' d ~
REMARKS / ~ ~
. '~ ~
724313 (Rev. 3/78I
MUN Z C T PRL T TY' OF Rr-.ICHORRGE
DE~RRTHENT OF HERLTH AND EWYIROr.~ME~.4TnL PROTECTION
82S 'L' STREET, ANCHORAGE, BK. 99501
2~4-4720
I-~ELL
PERMIT NO. ( 780~47 )
MT. ENTERPRISES
BIRCH
APPLICANT
LOCATION
LEGAL
Or~--S I TE SEL-IER PERM I T
LOT SIZE ~0000 SQU~RE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 '
SOIL RATING (SQ FT?BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[~EPTH = 8 LEr~GTH= 4~'~ GRFt%~EL DEPTH= 4
THE LENGTH DIMEHSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE E×CAVBTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUH DEPTH OF ORAYEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOH OF THE EXCAVATIOH (IN FEET).
REQIJ I RED SEPT I C TI~II'~I !-( _'i:; I ?__E= :1.250 Bf~LLOr~S
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURIHG THE
INSTALLATION INSPECTIONS OF ANY I.iELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TI~O ( ~ ) I ~SPECT I O~IS 8RE REQL: I RED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL RND ANY ON-SITE SEWRGE DISPOSRL SYSTEM IS
100 FEET FOR A PRIVATE HELL~ OR
i50 TO -~00 FEET FROH A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL
WELL LOGS 8RE REQUIRED AND MUST BE RETURHED TO THE DEPARTMENT WITHIN -~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVBILAOLE TO INSURE PROPER INSTALLATION.
PERM I T E×P I RES DECEMBER
I CERTIFY THAT
l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND HELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
g: I UNDERSTAND THaT THE ON-SITE S~WER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUQE-'?TO-P~E--'IHRt'/~. 4 BEDROOMS.
RPPLICANT MT. ENTERP'~?IT/
ISSgED BY__~__~_.~- ........ D A T E _ ?--_ -~-~---_ ---~_ _~_ _ _ _
V:3. 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Aneh~'~, AJ~a 99602 276-2221
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
rg
10
11
13-
14
15- ~
16,
17-
18-
19-
20-
DATEPERFORMED:'~ /~'O /"7 ~
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
TEST RUN BET~NEEN , FT AND FT
72-008 (7/76)
C
0~
~u r~f
\
WATF~ WELL LOG
POSS DRILLING
1336 I~ra Street
Anchorage, Alaska 99501
LOCATION .w. . . .
PEET OF DHA~DOWN.
BEMAHKS
DATE COMPLETED_~~___~_~PUMP TO BE SET AT~
to
to
to
to__
to
__to
__to
__to
___~o
tO
__tO__
MUNICIPALITY Of ANCHORAGE DEPT. Of HI.TH &
U DEPAR~E~ OF H~LTH & ENVIRONME~AL PROTE~NTAL
~ L~.~,A~ ~1
ENVIRONMENTAL ENGINEERING DIVISION ~0V 1 ~ 19~
/
DIREDTIONS: Co.otto dl p~ts m ~ t, In~mplm raclt.~ mil nm ~pl ......
I
PHONE
It. PROPERTY~C~NER ·
I MAILING ADDR' ESS
I PROPERTY RESIDENT
2. BUYER
MAILING ADDRESS
PHONE
,ADDRI
;~ REALTO~AGENT
ADDRESS
PHONE
PHONE
~. TYPE~SIDENCE
~--SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One ~ Four
[] Two [] Five
I--1 Three I--I Six
[] Other
7. WATER SUPPLY
.._INDIVIDUAL'
COMMUNITY
[] PUBLIC UTI LITY
sEw^ E O,EmSA SYSTEM
.~i~..~[.~..~lp UA L/O N-S I T E '
~ PUBLIC UTILITY
· A'I-rACH WELL LOG. A well tog is required for all wells drilled
since June 1975. For wells drilled p~ior~to.~at data, give well
depth (attach log if available.)
**If individual/on-site, give imtallatio, date
If system is over two (2) years old an adequacy test i~ required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72~10(3/78)
'i THIS SIDE FOR OFFICIAL use ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSP~.,~T'JR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
I--1 SINGLE FAMILY [] ONE l-'l THREE I--I FIVE [] OTHER
I--I MULTIPLE FAMILY I"-] TWO [] FOUR I-1 SIX
2. WATER SUPPLY PERMIT NUMBER
[] INDIVIDUAL DE~"I'H OF WELL
[] COMMUNITY
DATE DRILLED
[] PUELIC UTILITY
Connection Verified LOG REC61VED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON *SITE DATE INSTALLED
[:::]PUELIC UTILITY ~ ._ ~
Connection Varified
INSTALLER
[]Septic Tank or []HoldingTankf ~-~ ~"~ .,,..~,~
Size:, jP ~ If Tank is homemade SOILS RATINGe~ .
give dimensions: '
TYPE OF TANK MANUFACTURER ~/ . .-
TOTAL A~ORI~r~ON AREA MATERIAL -
4. DISTANCES Set, tic/Holding Tank Nolorptiorl Ariel ISmnmr Line I ~rmt Lot Line
WELL TO:
I
I
5. COMMENTS '
~APFROVEDFO. ~p' EED.OOMS
I-'1 CONDITIONAL APPROVAL (letter must accompany certificate)
~--'DISAPPROVED
i DATEI ,y,T C P
LEGAL DESCRIPTION
724)10 (Rev. 3/78)
P.O. BOX 4.1276 ANCHORAGE,'ALASKA 99509 4649 BUSINESS PARK BLVD.
D~nking Water.A'dab/s~s Report for Total Coliform Bacteda
TE LEI'HONE
(.07) 27~4014
TO BE COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM:
I.D.
SAMPLE TYPE:
Routine
Check Sample (for routine sample
with lab ref. no. I
Special Purpose
[3 Treated Water
[3 Untreated Water
Zip Code
SAMPLE
NO. LOCATION
5" I ';/ I ".~'
READ INSTRUCTIONS
BEFORE;
Time Collected
Collected By
I
1
i -
~'l'. ~ ' ','I,,*- ~...~ '-
TO BE COMPLETED BY LABORATORY
LABORATORY:
NAME
ADDRESS
Date Received
Time Received
CI.TY
3:~0
Analytical Method:
Fermentation Tube
~,,J~embrane Filter
Lab Ref. No. Result' Analyat
I
I I--l-1
I F'F1
COLLECTING SAMPLE
Form No. 18-310 (3.78)
Vllrlflc4llon, L.Tp~/~', BOB
5
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