HomeMy WebLinkAboutJAYNE'S PLACE LT 2ae's P(aOE
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~'~J 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 ANBCI~WELL iNSPECTION REPORT
NAME
MAILING ADDRESS
S¢.n &,x
LEGAL DESCRIPTION
L~.,- O.. d~-. ' .
IO0^T,ON . _ ~s ~c.~
DISTANCE TO:
Manufacturer
Well Absorption area
city
IF HOMEMADE: Inside length
tfacturer
Well
DISTANCE TO: I ~--
N°' °f lines/ I Length ~h?F
Top of tile to finish grade
Dwelling/~'~ ~.¢
Materia]~. ,
Width
NO. OF BEDROOMS
PERMIT NO. O(~10 ~,(_]?
No. of compartments
Liquid depth
Length
Type of crib
Well
CE TO: /
Foundation ,~ ~.~ .~ I Nearest lot line
Total le~gIh~f ~s Trenc~ w dth
Material beneath tile
Depth
Crib diameter
Buildin~ foundation
Class
DISTANCE TO:
Depth Driller
Building foundation Sewer line
OTHER
PERMIT NO./
tyin gallons
PERMIT NO. ¢~,/~}~¢,~) ¢
Distance between lines
Total effective absorption are~
o~/0 ss~ :/-2-
PIPE MATERIALS
Pvc~ 'g3o3 ~
SOIL TEST RATING
INSTALLER
L;'..
REMARKS
PERMIT NO.
Total effective absorption~area~,,~"~
Nearest lot line/
IDistance to lot line
Septic tank
PERM,TNO. ~/O~O 7
Absorption area(s
APPROVED
72-013 (Rev. 3/78}
DATE
LEGAL
":' ~ ~)'"' U-.DEF'BRTMEF,IT Ii...~HE~[..TH BND EN',,,'IRONMENTBL ,~.,OTECTION
RF'F'L!CBNT MERLE E:EETER SRB E:':.' f54~-E
L: '3RT I :: N BNC H .......... '"'
LEGBL. E 1/2 LOT ~E~ SEC 33 T12NR3:N ........... IF T S!ZEE 49E~921 ~:n F~'FE-' FEET
TYF'E OF SOIL ~BSORF'TION S T~:'TEM ~.S: TRENCH p/~ ~ f
HRXIMLIH NUHBER OP BEDROOHS = 4 SOIL.. R~T[NG (Se FT,--"BR>= J..25
'THE REE~UIRED SIZE OF THE SOIL BBSORF'TION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TF.:ENCH OR PIT IS THE DISTBNCE BETNEEN THE SURFFICE OF THE
GROUND BND THE BOTTOM OF THE EHCA',,,'F4TION (iN FEET).
'THERE IS NO SE]' !.,.I.iDTH FOR TRENCHES.
THE GRBVEL. DEF'TH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OU]"FRLL PIPE
RND THE BOTTOM OF ]'HE E>=',C'FI',,,'FITION (iN FEET).
PERMIT FIPPLICFIN. T HFIS THE RESPONSIBILITY 7'0 INFORM THiS DEP8RTMEN]" DURING ]"HE
INSTBLLFITtON I.NSPEE:TIE~NS OF FINY !.,.IELL.'iz: BDJBCENT TO THIS PROPERTY BND THE
NLIMBER OF RESIDENCES THBT THE NELL NILL SERVE.
8BCKFtLL. ING OF' f~NY SYSTEM NITHOUT F!NBL INSPECTION BN[:, BF'PROVBL BY THIS
[:,EPBRTMENT !.,.!ILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTFINCE BETNEEN B NELL. BND FINY ON-SITE SENBGE DISPOSBf_ SYSTEM IS
±,'--]E~ FEET F'OR B PRI',,,'BTE 14ELL OR J. SF_.~ TO 2~..']e~ FEE]' FROM B PUBLIC NELL DEPENDING
UPON ]'.HE TYPE OF PUBLIC NELL
MINIMUM DISTBNCE FROM B PRIVBTE NELL TO B PRZVBTE SENER LINE IS 25 FEET .~.ND
TO B COMMUNITY SEI.,J. ER LINE: IS ?'5 FEET.
NELL LOGS BRE REC!UIRED FiND MUST BE RETURNED TO THE DEF'F~RTMENT HITHIN :.~:F~ [:,FLYS
OF THE !.,.IELL COMPLETION.
OTHER F.'.EC!LIIF.'.EHENTS MF!Y BPPLY. SPECIFICBT_TONS AN[:, CONSTRUCTION [:'IBGR.~MS FIRE
£-'IYBILBBLE TO INSURE PROPER INSTI:~LLBTION.
F' E.-E..E:.-_" i"t ~ -T" E~:-:~F" ii F,",EiS [)EE:E~'-'!E:EF:: 2~: :.,t..,
I CERTIFY THBT
~: I BM FBMILIFIR NITH THE REC!UIREMENTS FOR ON-SI]'E SEWERS AND NELLS BS SET
FORTH BY THE MUN!CIPFIL. ITY OF BNCHORBGE.
2: I NILL. INS'TSLL THE SYSTEM IN F~CCORDBNCE WITH THE CODES.
~: I UNDERSTFIND THBT THE ON-SITE SENER SYSTEM MFY~' REC~UIRE ENLBRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THBN 4 BEDROOMS.
BPPL..ICBNT MERLE 8EE'T'ER
MUNICIPALITY ¢ F ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 I.. Street, Anchorage, Alaska 99501 264-4720
,SOILS LOG -- PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
4
/_o7-
SLOPE
DATE PERFORMED:
SITE PLAN
12
17
20.
COMMENTS
PERFORMEOBY:
.tTY"%~ '° ,' -~- '% '~gAS G[iOUND WATER
? ~0 o°° ~- .... Y ( '.' ~OUNTERED?
...,...~:~ - ~S ATWHAT
H~
Reading Date Gross Net Depth to Net
Time Time Water Drop
I
TEST RUN BETWEEN FT AND -- FT
' - / d -4
~1 ·
/
72-008 (6/79)
RETURN TO: DIv[sTon of Geological and G fslcal Surveys (DGGS) STATE OF
3OO1 Porcupine Or{ye ~ele~_,e: 277-6615) ~ j DEPARTMENT OF NATURAL RESOURCES
Anchorage, Alaska ~9501
WATER WELL RECORD
?
~ !~ ~ '!-~! : ~ ~ U.S.G.S. Local Ilo.
Drilling Company Name
Orl))ing Permit No.
LOCATION OF WELL I Please complete either la, lb, or lc. A.O.L. No.
la. 8orough Subdivision Lot ~lock lb. Fraction Section No. Township Range Meridian
. h · ,, / / / N/S E/W
lc. D{stance and Direction from Road Intersections 3. OWNER OF WELL: . ·
Address: '
2. WELL LOG Feet Below lt. WELL DEPTH: (completed) Surface E)evatlon Date of
Surface COal~ I e t i~)n
Mater~al Type Top Bottom i ! 'i, ft.
(~' ' ' " ' ~Test Well ~O~her:
~. 7. CASING: ~ Thr~ded ~Welded
' in. to ' : ft. Depth Weight Ibs/ft,
' ~ :' ~ ~ ~ in. to ft. Depth
8. FINISH 0F WELL: '
Slot/Mesh Size: Length:
Set bergen ft, and
~. STATIC WATER LEVEL: ft.
ft, after ,hrs. pumping g.p.m.
ft. after hrs. pumping g.p,m.
,~O~,~[ 11. WELL H~D COMPLETION: ~ In Approved Pit
~EFT (~ '' :'- ~,~.,, ~Plt)ess Adapter inches above grade
12. GROUTING: Well Grouted: ~ Yes
I~. PUMP: ({f available) HP
R~C[ IV ~ ~ Length of Drop Pipe ~ ft. ca,clty g.p.n
Type: ~ Sub~rsible ~Rec ijrocat lng
~ Jet ~ Other:
lq, REHARKS:
15, ~ATER ~ELL ~ONTRACTOR~S CERTIFICATION:
Address:
~thor~ed ~e~e~ t ive / /
Date
Date I Da
Inspector Inspector
Comments Conditional Approval
1. ~ ~/~9 ~ ~--
Inspector
Date Sewer Installed Permit No. Septic Tank Size
~ --~/ Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
I -~-.~-~ Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner
Mailing Address
Buyer
Address
Lending Institution
Address
Address
Legal Description
Street Location
Typ~f Residence
~ingle Family
~ Mulfiplo Family
D Othor
WateF"~U pply
[] Individual
[] Community
[] Public Utility
A'Iq'ACH WELL LOG. A well Icg is required for all wells drilled since June
1975. For wells drilled prior to that date, give well depth (attach Icg if
available.)
S ewcj[e Disposal %] Individual
[] Public Utility
[] Holding Tank
Year Individual Installed:
When Connected to Public Utility:_
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
- ~ CHEMICAL & GEt )GICAL LABORATORIES (~.~_ALASKA, INC. ~
TELEPHONE'~ i~i(g07}-279-4014,c~ ANCHORAGE INDUSTRIAL CENTER
" 274-3364 5633 R Street
Drinking Water AnalYsis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
I.D. NO.
Water System Name Phone No.
Mailing Address
City State Zip Code
MO. Day Year
SAMPLE TYPE:
D Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE Time Collected
NO. LOCATION Collected By
TO BE COMPLETED BY LABORATO RY
Analysis shows this Water SAMPLE to
~'Satisfactory
[] Un satisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
[o indicate reliable results, Please sen~
new samole.
-. Date Received
Time Received .' - ' .
Analytical Method:
[] Fermentation Tube
[] Membrane Filter
Lab Ref. No. Result* Analyst
/~':''-:''~;~'~ ;':'~1
I CT-]
I CFI
I F-Fi
*No of colonies/lO0 mi or NO. of Positive 3ort~ons
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1978
BACTE R IOLOG ICAL WATER ANALYSIS RECORD
Date Collectect Source
Date ReCelve¢ Time Received D.m, Lab. No.
Presumptive 10mi 10mi Z0ml /0mi },Omi 1.0mi 0.1mi
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
EMB Broth 24 hours: Broth 48 hours;
MUltiple Tube ReDort: 10mi Tubes Positive/Total IOml Portlona
Membrene Filter: Direct Count Collform/ZOOml
Verification: LTB BGB
Final Membrane Filter ReSults Collforrn/Z00~nl
~-/ MUNICIPALITY OF ANCHORAGE ~-/
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL HEALTH CASE REVIEW WORK SHEET
'. [] PLATTING BOARD [] PLANNING & ZONING
CASE NUMBER NAME
S-5691 Jayne's Place Subdivision
DATE RECEIVED
April 29, 1981
COMMENT TO PLANNING BY
May 14, 1981
FOR MEETING OF CASE OF
~'PUBLIC WATER N~.~VAI LABLE TO PETITION AR EA
~8LIC SEWER~VAILABLE TO PETITION AREA
REVIEWER'$ COMMENTS:
71-014 (Rev. 2/78)
"-~IUNICIPALITY C'F ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
E] PERCOLATION
TEST
PERFORMED FOR:
~.'' O~-.-.~I~NIC k Jg} ~I"'E~'~' SLOPE
1
2
3
4
5
6
7
8
9
10
11
SITE PLAN
~,~.~'~.; ......... ,~ .- ..:. %
~-,('~".'* ,~ ' ¢. '~'AS GROUND WATER
t'~' ~O .' ~ ~ ~"' ~ *.' ENCOUNTERED?
~ ~ ~S. ATWHAT
~ ~ ', CE-4483 .' <"' .~
12
,3i,
14
15
16
17
18
19
20
COMMENTS
PERFORMED BY:
Gross Net Depth to Net
Reading Date Time Time Water Drop
72-008 (6/79)
S 5 6 9 1 JUN 3 1981
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5-
6
7
8
9
10
11
12
13
14
15
17-
18-
19
2O
COMMENTS
PERFORMED BY:
72-008 (6/79)
"'--~VlUNIClPALITY OF ANCHORAGE "--/
DEPARTMENT OF HEALTH AND ENVlI~:ONMENTAL PROTECTION
825 L. Street, Anchorago, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
Lo'-/'
SLOPE
DATEPERFORMEO=
SITE PLAN
0 ~ t4 ~
..o.... YAS GROUND WATER S
~COUNTERED? a/0 L
· ~ o
:E-44,38
:S, AT WHAT
~H?
E/,,,' ~ /4o kE'
[J Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
'C,
TEST RUN BETWEEN
/ ~v ,,~o
he Municipafity of
*_his plat have been
VICINITY MAP SCALE: / "= ] i~tlL:£
(81-312) EO.
LAKE OTIS PARKWAY
mz--
--NO
.to
NORMAN STREET
~o
DT1000767