HomeMy WebLinkAboutEAGLE CREST #1 TR A LT 2
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 6 PRONE
~UPGRADE
LEGAL DESCRIPTION
~GZ~ ~ ~DI~TANCE TO; ~ Dwelling PERMIT NO,
~ Well Foundation~ ~ Nearest lot hn~ / I PEHMiT NO.
k O ~ ~ Top of tile to~,fini h grade Material be~m ~de. inch~ PERMIT~O
m Well ~ ' ' ' Nearest lot line
~ DISTANCE TO:
~ DISTANCE TO: Building foundation Se~r line Septic tank Absorption area(s)
OTHER ~ 't ~
SOIL TE~T RATING
0e
I IRev. 3178)
O-&'E ENG'.~'.JEERING & DEVELO~--".,4ENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster EaH Ellis
694-2774 SOIL LOG 688-2280
Performed for:.
Legal Description:
Depth (fNt)
0__
1__
2__
3__
4__
$oll Characteristics
PLOT PLAN
PERC. TEST
14__
15__
Ground Water Encountered: Yes No ~ If yes, what depth."
.Proposed Installation: Seepage Pit Drain Field ~
Comments:.
Date: U-//' '~ ('
PERMIT NO.
["1 L[r~4 I P_,~RL I T'T' OF RI%IC~ORRGE
DEPRRTMENT' HEALTH AND ENVIRONMENTRL ROTECTION
825 '[~' STREET, ANCHORRGE, AK. 99501
264-4720
I-.-IELL PERr"! 'r T
( BIO165 )
APPLICANT
LOCATION
LEGAL
RDEPT CONST. SR-177 ERGLE RIVER
4TH &HILLCREST DR.
LKOT 2 TTACT R ERGLE CREST SUB LOT SIZE
~94-2657
17000 SQURRE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 38 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS WRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
PERM I t EXP I RES DECEMBER ~:~ ~-98~-
I CERTIFY THRT
l: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
APPLIC/~T ADEPT CONST.
V4. 0
rr ifirh rillitt L ug
DOC Co, Oba
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK. ALASKA 99567 · TELEPHONE 688-2'/59
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR /
KIND OF CASING
KIND OF FORMATION:
From ~ Ft. to
From '~ Ft. to--Ft. .~ ~ ~
From
From
From Ft. to__.Ft.
From __ Ft. to Ft.
Fr~ /(~ Ft. to
From ~ Ft. to Ft-
From /7~Ft. to ~Ft.
From Ft. to Ft
Fr~ D~ Fi. to '~ Ft.
From ~ ~Ft. to
From ~Ft. to~? Ft.
From T'o ~ Ft. to
From ~CP Ft. to ~Ft. '~
Ft. to Ft.
From
From
From
From
From--
From
From
From
From
From
From
From
From Ft. to
From Ft. to.
.Ft. to Ft.
Ft. to.__Ft.
Ft. to Ft.
Ft. to FI,
.Ft. to Ft,
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to__Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to__Ft.
Ft.
Ft.
From__.Ft. to Ft,
MISCL. INFORMATION:
DRILLER*S NAME
DAT[= RECEIVED
'- INSPECTION APPOINTMENTS
TIME TIME I'~ME
DATE DATE DATE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~O~ENTAL F;'OTE~JON825 L Str.t - Anchor., Alaska
ENVIRONMENTAL SANITATION DIVISION
Telephone ~7~ RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
I
5. LEGAL DESCRIPTION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOM$
[]~/SING LE [] One ~ Four
FAMILY
~ Two ~ Five
~ MULTIPLE FAMILY ~hree ~ Six
[] Other
7.
WATERRSUP~'SU Y
[[~'~INDIVIDUAL* ° ATTACH WELL LOG. A well log is required for all wells drilled '
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
r"] PUBLIC UTI LITY depth (attach log if available[)
[~"INDIVIDUAL/ON-SITE°' /~'~:~/ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
.~, ,. THIS SIDE FOR OFFICIAL USE ONLY
1· TYPE OF RESIDENCE NUMBER OF BEDROOM~
[~SlNGLE FAMILY r'l ONE [~"~H R E E [] FIVE [] OTHER
I--] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER ~'~ ~t~ / ~ ~,~.
" 'NOIVIOUAL ,. D .T. OFWELL 3 t
~ COMMUNITY
DATE
DRILLED
Connection Verified LOG RECEIVED
iAGE DtSP~AL SYSTEM PERMIT NUMBER ~ [ O I ~
VIDUAL/ON -SITE DATE INSTALLED
Connection Verified INSTALLER
~pticTank or ~HoldingTank
giveSiZe:~lfTankdimensions: ishomemade SOILS RATING fi ~ ~
TOTAL ABSORPTION AREA MATERIA~
4. DISTANCES ~pticJHoldmg Tank Absorption Area
5. COMMENTS
~PP"OVEDFOR ~ BED"OOMS
~ CONDITIONAL APPEOVA~ (le~ler mus~ 8ccomp~ny
~ ' DISAPPEOVED
72-010 (Rev. 6/79)
CHEMICAL & GE,.'.'OGIC,4L L,4BOR,4TORIES c.' AL.4SK,4, INC.
TELEPHONE (g07)-27g.4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
Drinking water Analysis Report for Total Coliform Bacteria
, TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
I.D. NO.
Water System Name ,-~, Phone No. ~.~
~... ~Zip~ ' ',
SAMPLE DATE:
Mo.
Day , Year
SAMPLE TYPE:
r'l Routine
[] Check S~reP~.e (for routine sample
with lab no, )
CI Special Purpose
Treated Water
Untreated Water
SAMPLE
NO.
: I
: I
, I
5 I
LOCA11OR
Time ~o~leeted
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~]~atisfactory
[] Unsatisfactory
[] Sample too long in 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-7%~1- ~/--%1 I-FI ~'~
I I-FI
I
I ~'~
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAl. WATER ANAI,YSIS RECORD
Directio.ns for Collecting Samples of Water for
Total Coliform Bacteria ExaminatiOn
This Water analysis'deals with materials present in very minute quantities. Carelessness in collecting
and handling may lead to misleading results.
Water samples will have to reach the laboratory as quickly as possible within 48 hours after collection.
After 48 hours, the significance of the bacteriological analysis is impaired and resampling will be nec-
essary. Send to Laboratory fastest Way: (i.e. special delivery mail.)
In collecting samples from TAPS or PUMPS proceed as folloWs:
a) Remove any aerators or screens attached to the outlet.
b) Thoroughly flush tap or pump by allowing water to run freely with a fully opened outlet for three
or four minutes.
ci Reduce flow so that small stream flows.
d) Remove bottle from mailing tube, Hold bottle in one hand while removing cap with the other,
"Avoid touching the neck of the bottle and the inside of the cap,
e)
Fill the bottle to its shoulder while attempting to avoid splashing. Immediately replace cap, being
sure that it is tight, but not so tight as to split th.e
Complete the-15~i6n of the lab form Which is indicated"TO BE COMPLETED BY SUPPLIERS"
Fill in all appropriate blanks carefully, including your public water system identification number
(ID No.). Contact the Alaska Department of Environmental Conservation if you do not know your
ID number. {Public water suppliers only)
g) . Pack bott e carefully in mailing tube With lab form. - -
The requirements for analysis of public water systems for total coliform bacteria are defined in the
Drinking Water regulations administered by the Depa,tment of Environmental ConserVation.