HomeMy WebLinkAboutLot 02
~ MUNICIPALITY OF ANCHORAGE
· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENIAL ENGINEERING DIVISION
· 825 L Street Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE ~b~'~3 J~NEW
LOCATION NO OF BEDROOMS
DISTANCE TO WeJl /O~ ' t_ Absorption are~/.O ~ DwelhngJ2____~ PERMIT NO
~ Z Manufacturer /~ Material No of compartments
~ ~ L~q capamty m gallons Inside length W~dth L~qu~d depth
/~O IF HOMEMADE
~ ~ DISTANCE TO ~Well Dwelhng PERMIT NO
O ~ ~ ~anufacturer Mater~al L~qu~d capacity m gallons
~ Well Foundation Nearest lot hne PERMIT NO
~g NO ofhnes / Length°foachhne~oq T°tallongth°fh s 14--~.0 -- rrenchwldthTo inches Dlstancobetweenllnes
O ~ ~ Top of tde to flmsh grade ~ ~ Materm] beneath tde ~ roches
Length W~dth Depth PERMIT NO
~ ~ Type of crib Crib dmmeter Crib depth Total effecttve absorption area
~ Well Braiding foundation Nearest lot line
~ DISTANCE TO
~ CJass Depth Duller Distance to lot hne PERMIT NO
~ ~ Buddmg foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO
OTHER
PIPE MATERIALS ~,
SOIL TEST RATING /3~'
13 (Rev 3/78
PERM
RF'F'L Z CRNT
LOC'RT I GN
LEGRL
F~E_,] .JN :rOHNSON
T'I 4NR:tN '---, ~
~l,. NE4
LO7 SIZE
TYF'E OF =,l_liL HE,_-.,LgFTIUN =,.~..,1EM ES TRENE:H
MR::<!MUM NUMBER OF BEDF..'iOMS = 4
'.--OIL RRTING ,"SO FT,-"BF)=
THE REF..~UIRED _,I,.E QF THE SOIL FIEr=;]~'F'7ION SYE, TEI'I IS
THE LENGTH DIMENSION iS THE LENGTH ,..IN FEET) OF THE TRENCH OR DF.'RtNFiELD
THE DEPTH OF I=~ TRENCH OR PIT IS THE DI'.'fTFfNFE BETNEEN THE SUF:FRCE OF THE
GROUND RND THE BOTTOM OF THE EXCFF,,'RTION ,."IN FEE"f)
]'HERE IS NO sE'r 1.4IDFH FOR TRENCHES
THE GRRVEL [:,EP~"H IS THE" MINIhlL.II*I DEPTH OF GF:"RVEL BE"fNEEN "tHE OIJTFRLL PiPE
RND THE BOTTOM OF THE E>.',CR~.,'RTtON ,:'TN FEET':,
F'EF.'MIT RPPLIERN"f HFIS THE F.E.:,F .N.:,IE, ILiT~ t"O INF_gM THIS DEF'RF.'TMENT DUF.'ING I'NE
· '-'-' - ] ' I"
ZNL-"iTRLLFITIEIN TN.=,PELT~LN=, OF RNY JELL._-, FtDjrRCENT TO THIS PROPEF.'TY RND THE
NUME,'ER OF RES]:DE'NFEE; "fHFtT '[HE NELL NiLL':.~ERCEe','
MINIMUM DISTRNCE BE]NEEN R NELL RND RNY ON-SITE SENRGE DISPOSFtL SYSTEM t'i,
:t~}O FEET FOR R F'RIVRTE NELL OR 15~D TO 200 FEE7 FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PLIBL [C NELL
MINIMUM [:'ISTRNEE EROM R PE'I'¢RTE NELL TO R PRIVRTE SENER LiNE IS 25 FEEl' RND
70 R COMMUNITY SENER LINE IS 75 FEET
NELL. LOGS RRE REQUIRED RND MUST BE RETURNED 70 THE DEPRRTMENr N[THIN ~:0 DRYS
OF THE NELL COMPLETION
OTHER REOUIREMEN"fS MAY RPF'LY SPECtFICRTtONS AND CONS"fRUCTION DIRGRR[,'IS RRE
RVRZLRBLE TO tNSURE PROPER ~NS"fRLLRT~ON
I CERTIFY 'fliRT
I I RM FFIMILIRR NiTH THE REOUIREMENT$ FOR ON-SITE SENERS FIND HELLS FaS SET
FORTH BY THE MUNIEIPRLITY OF RNEHORRGE
2 I NiLL IF,I-~"TRLL THE. $Y2, TEM IN RCCORDRNCE Nt"fH THE EODES
3: I L1NDERSTRN[',, THAT THE ON-SITE SEI.,,tER SYSTEM MFtY REQUIRE. EHLRRGEMENT IF THE
RESIDENCE IS REMODELED 70 INELUDE MO~'E THRN 4 BEDROOMS
Y4 0
Performed for Name //~,
Mall,ng Address
Legal Description
D?pth (feet)
0
1__
2
SOil Characteristics
'EERING &
Box 90, Davis St, Eagle River, Alaska 9957~~ 694-2774 or 688-2280
~ ~ .... Earl Ellis
SOIL LO~ ~, ~.., _e ~ 688-2280
8__
9__
10__
11__
12
13__
PLOT PLAN
PERC TEST
14__
15__
Ground Water Encountered Yes
Proposed Installation Seepage Pit
Comments
~P~erformed by ,~L/~'~,~
No ~ If yes, what depth.
Drmn Field j
~.'"'=,~ ¢ ~ 0,~.~/~, ~/ ~"r-
by,
DOC Co dba
SULLIVAN WATER WELLS
P O BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688 2759
OWNER OF LAND ? ~;/~ ~ '%:' ~'~'~ ~J
ADDRESS z~~ ~ / ~'~-~ ~"/~
LEGAL DESCRI~ION'~/ ~ ~w-d ~'./J
DATE- Sta~ed c~,//~/; ,M Ended
PE~ITNUMBER ~'~ ~ 7 ~ ~/
DEPTH OF WELL /,~/7~ /
STATIC LEVEL OF WATER FT / ~ O
DRAW DOWN FT
GALS PER HR
KIND OF CASING
KIND OF FORMATION
From Ft to c~ Ft
From ~>~ Ft to f gO,. Ft
From /~5 Ft to /~' Ft
From /~.~' Ft to//(~ Ft
From.__ Ft to Ft
From ~/¢~ Ft to/5 ;~ ,Ft
From / ?'~Ft to /~O Ft
From/q~ Ft to /~TFt
From Ft to Ft,
From.~Ft to Ft
From -- Ft. to Ft
From.__.Ft to Ft
From Ft to Ft
From__Ft to Ft
From__Ft to Ft
From__Ft to Ft
From Ft to Ft
From
From
From
From
From
From~
From
From ~
From
From
From ~
From
From
From
From
Ft to
Ft to
Ft to
Ft to
.Ft to
Ft to__
Ft to
Ft to ,-.
Ft to
.Ft to
Ft to
Ft to
Ft to
Ft to
Ft to
Ft to
Ft to
Ft
Ft
Ft
Ft.
Ft_
Ft
__Ft
Ft
DEPT OF HE'iTel &
FINVIRD ............ I -
Ft [10V' 1 2 1982
Ft
Ft
MISCL INFORMATION
DRILLER'S NAME
CHEMICAL & ~LOGICAL LABORATORIES"~F ALASKA, INC.~
TELEPHONE (907) 279~4014 ANCHORAGE INDUSTRIAL CENTER
Dnnk, ng Water Analys,s Report for Total Cohform Bacteria
TO BE COMPLETED BY WATER
WATER SYSTEM
Water System Name
tD NO
TO BE COMPLETED BY LABORATORY
Analysis show,'this Water SAMPLE to be
:ESatisfactory
Unsabsfactory,~
[] Sample too tong ~n transit sample should
not be over 48 hours old at examination
Mmhng Address
City '~
Mo Day Yea[
SAMPLE TYPE
[3 Routine
ID Check Sample (for routine ~mpl~ ,:~
with lab ref no. )
[3 Special Purpose
SAMPLE
NO
~ Code~,
to indicate rehable results Please send
Date Received / I -.~" ., '~'
~!.me Received
Method
Fermentation Tube
Filter
Rev 1978
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Date Collected , Source
am
PreSumptive 10mi 10mi 10mi 10mi 30mi 1.0mi 0 1mi
24 HoUr~
48 Hours
ConflrmstmY
48 Hours
EMB Broth 24 hours Broth 48 houri
Multiple Tube Report ],Omi TUbeS~Posltlve/T0tal 10mi Po~tlmls
Membrane Filter Direct Count ~ Collform/100ml
verlflcat Ion LTB , BGB
/~ ~' ~/ Collform/t00ml
Final Msmbrane FIIter~R~sultl , /
.... .; ' , ,
Reported By ~---~'-?;A,~ ~~ ~ 'r~+ '>''' ~ Data
pm
., APPLI~'~NT FILLS OUT UPPER HAL.~~ ONLY
~ Phone
Prope~rty Own~ 7~.-..~7~~, ~..~'.h//~A./.~:~'~ ~ ~.~ ~ ~
Buyer ~
Address Zip Code
Lendlnglnstitutlon ~'~ ~ ~~~,~ Phone
Address ~0 g/~ 5~ ~[ ~ ~C~. Zip Code ~¢~
Phone
Realty Co & A~nt ~.
Address~ Z~p Code
Type of Res~nce ~
~Slngle Family ~
D'Multiple Family No of Bedroo~
~ Other
Water Supply
~ Individual A~ACH WELL LOG A w~l log ~s required for all wells drilled since June 1975
~ Community For wells drilled prior to that date, give well depth (attach log ~f available)
~ Public Utility
Sewer Disposal
Pubnc utntty ~ ~ ~ -~q- ~ e to Pubnc U~..ty -
NOTE THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED
Time Time T~me T~me
Date Date Date Date
Inspector Inspector Inspector Inspector
Jv~UNICIPALITY OF ANCHORAGE
Field Notes ![ DEPT Or ~c'*~TH
~F-
~ ENVIRONM~-i'~,A , .O, ~.TION
' 0V 2 ~ 198~
RECEIVED
I ×1 APPROWD B~DROOMS ~ ff ~ ~ "oo.~mo.~ o~
OONDITIONAL APPROVAL'
~ /
So~Is Rating Date ~wer Installed Well To Absorption Area~]~ Well Log Received
~_~__R~ Well to Tank 4/Oo Sept,c T~k S,ze /~
72-023 {3182)
O&
E ENGINEERING & DEVELOPMENT CO.
Box 90, Daws St, Eagle R~ver, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Performed for
Legal Description ~ Z"r--
Name
Mmhng Address
Earl EIII
SOIL LOG 688-228t,
)
Depth (feet)
0
9__
I0__
11
12
13__
14__
Soil Characteristics
/ ~ ~ ~ ~/~ PLOT PLAN
15__
16__
Ground Water Encountered
Yes
Proposed Installation Seepage Pd
Comments
_~_o~ .'o, ~-~c,x~I
Performed by
No ~ If yes, what depthI
Drain F~eld_ j
/
PERC TEST