HomeMy WebLinkAboutJ K LT 46B-1
.... . , 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 .~ ~, ' --
MAILING AD~)P~I~SS r.'~
LOCATION
Manufacture~ . ~
DISTANCE TO: ,Well
Manufacturer
No. of lines I Length of each lin~
~ I
Top of tile to finish grade
Length Width
Type of crib Crib diameter
Well
DISTANCE TO:
icings Depth
DISTANCE TO: Building foundation
Absorption areai 0 !
Inside len§th
Dwelling , h
Dwelling
Total length of~,
Material
Nearest lot linq~.~ #
Trench widt~7~inches
Material beneat'~ tile
Depth
NO. OF BEDROOMS//
PERMIT NO,
No. of compartments~,
Liquid depth
PERMIT NO,
Liquid capacity in gallons
PERMIT NO,
Distance between lin.~
Total effective ab~orp.ti.qn~rea
PERMIT NO.
Crib depth
Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line
Sewer line Septic tank
PERMIT NO.
Absorpt on area(s)
OTHER
PIPE MATERIALS
SOl L TEST RATING
REMARKS-
72-013 (Rev. 3/78)
DATE LEGAL
' ~ 825 ~'~3 Street, Anchorage, AK. '~9501
264'4720
* * * HANDWRITTEN PERMIT
permit ~ WELL AND/OR ON-SITE SEWER PERMIT
Applicant: ~i~ ~_., ~,'/~£~c~ Mailing Address: 3~8~c~
Lo~ation: Phone Number:
Le'gal Description: T~S--A) ~f~3 ~fc~ k~ Lot Size: ~3;~AC~.
T~pe 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 Absorption System Is: '
DEPTH 7~ LENGTH ~/ .,. GRAVEL DEPTH ~-8~ 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(HOLDING) TANK SIZE = /~oo 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.
Backfilling of any system wi ~proval by this department
will be subject to prosecuti 7~'~ K~u~_ ~a~ ,q-
Minimum distance between a w ~c~ ~_~ &c-~c~ ~L~. ~_~/ .sposal system is 100 feet
for a private well or 150 to depending upon the type
of public well. Minimum di ~[{ {~_ ) a private sewer line
is 25 feet and to a communit '' ,~11 logs are required
and must be returned to this )f the well completion.
Other requirements may appl9 ~ction diagrams are
available to insure proper ~
I certify that: .
(1) I am familiar wit1 ~ ' = sewers and wells as
set forth by the ~ .
(2) I will in,stall th~ odes.
(3) I u~er~and~th~t~- ~- - require enlargement if
tY ~~//,~d ~o include-more that 3 bedrooms.
Signe-d,~,.C~//~. / ~/~_~' ~"~_ Issued by:
Appi~iC ant Date:
SWP/024(1/81)
0 0 0 0 0 0
MUNICIPALITY ~OF A.'"NCHq)RAGE
~ DE~T. O~ H_~ALTH
EN~IRO~M2N~AL P~.OTr-~TION
RilEC![ 1 ...V~D
:
..~ SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTR AND ENVIRONMENTAL PROTECTION LJ PERCOLATION
TEST
82.5 L, Street, Anchorage. Alaska 99~01 264-4720
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION:
1
SLOPE
DATE PERFORMED: '~ ~ ~-~:~ ~;~ __.
SITE PLAN
2
3
4
8
9
10
11
14-
15-
16-
17-
18-
19-
20-
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Del)th to Net
Reading Date Time Water Drop
Net
'rime
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN
CERTIPIED B~~~
72~OO8 (6/79)
~ APPLI¢' 'NT FILLS OUT UPPER HA~ ' ONLY
A:~dress Zip Code
Lending institution / ~.~_~"
Realty Ce. & Agent
Address Zip Code
Legal Description
Phone
Phone
Phone
Type of Residence
~' Single Family ~'
[] Multiple Family No. of Bedrooms
[] Other
Water Supply
[~lndividual ATTACH WELL LOG. A well 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
¢lndividual Year Individual Installed: /? ,~.-.,'7
[] Public Utility When Connected to Public Ut'iii[y:
[] Holding Tank
NOTE; THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Inspirer Insp~tor Inspirer Inspirer
- ~uNiCipAtI~
GONDITIO~S OF
~ ~,
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
Soils Rating Bate
~ '
72-023 (3/82)
=.,CHEM. ICAL & G1%LOGICAL LABOR~TORIES,..,£ ALASKA, INC
lng lysis Report for Total Coliform Bacteria
WATER SYSTEM:
Water System Name
TO BE COMPLETED BY WATER SUPPLIER
Phone No.
Mailing Address
Zip Code
City State
MO. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
3 I
LOCATION
Time Collected
Collected By -'
TO BE COMPLETED BY LABORATORY
Analysm shows thru Water SAMPLE to be:
r~ Satisfactory
[] Unssti sfactor¥
[] SamDm [oo long in transit: sample should
not be over 48 hours old at examination
to indicate reliable resuks Please sene
new sample. '~
Date Received
Time Received
Analytical Method:
I~, Fermentation Tube
,J~Membrane Filter
Lab Ref, No. Result* Analyst
I I
*No. of colonies/100 mi or No. of Positive portions
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
READINSTRUCTIONS '
BEFORE ""
COLLECTING SAM PLE
Date Collecte~t Source _
Date Received Time Recelve~l
Presumpt lye Z0ml Z0ml 10mi 10mt Z0ml /.0mi 0.1mi
24 Houri
48 Hours ~ ~?
Confirmatory
24 Hours
48 Hours
EMB. Broth 24 hours= Broth 48 houri:
Multlbl;i Tube Report: 1Omi Tubes Positive/Tot;il 1Omi Po~tlOlll
Membrane Filter; Direct Count Collform/100ml
Verification: LTB BGB
Final M;imbrane Filter ReSults ' ~') *! Collform/lOOml
"?~ '' ' ':- Time:. "" ' ' -" I,m.
MUNICIPALITY OF ANCHORAGE
· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
t Environmental Health Division
CASE REVIEW WORKSHEET
CASE NUMBER: DATE RECEIVED: COMMENTS DUE BY:
S-7217 July 27, 1983 August 15, 1983
SUBDIVISION OR PROJECT TITLE:
Lot 46B-1 JK Subdivision
(~rI~"PUBLIC WATER AVAILABLE (~"~) PUBLIC SEWER AVAILABLE
(~' } COMMUNITY WATER AVAILABLE
COMMENTS: