HomeMy WebLinkAboutBRANDEE LT 4 ALPINE DENTAL CLINICo5o
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% 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 i~ , ~6>,w,~N EW
MAILING ADDRESS
LEGALDESORIPTIO~" 0 ' ~OX /0--¢ ~ p
~ Menu factu ret ~¢¢
~ r M~Fee / NO. of com~rtments
L%~~gallons IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~_~0 Z ( Manufacturer ~ Material Liquid capacity in gallons
¢~ ~ DISTANCE TO: We,~ '+_ Foundation/ /~__ Neare~ li¢~__ PE~~
'~¢ TopN°' of~ielineSCto~h ¢*Length ~ li~ ~,ialT°tal --~fben~'~il~lit¢ Trench~ /r t/inches TotDistance b ~t. ~X¢¢ti~bsb~
-- -- Z~ ~ ~ inches
Length Width Depth PERMIT NO.
Type of crib Crib Crib depth Total effective absorption area
~ Well Building foundation Nearest lot Hne
~ DISTANCE TO:
~ ~ Class ~X/S ~?~ Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS '
REMARKS
~' '/2 ~/ / DATE LEGAL ¢~"'.' " '
.___
3 (Rev. 3~78)
L..OC:FtT ! ': .H
t....EGRL L4. BF-IFINE:,EE
E:,EF'FIF.':THE:NT F'"': HEi:RL 'T'.'-I Ffl",IE:, ENV i F:ONHENTFIL '~ c,..:O"f'ECT I ::: N
2 6 4- 4 7 2 0
C'.':~ ~"-,! ..... ...... =",, X -T" E: ST,, E£ ~,.-~ E: ~.':: ~-,-" E:::. ....... .~:;,i~: ~h."~ :.~:: 'T
,::: :? E~6':L E ::,
L. 0 T :..:.; I ,'.._"' E 9 9:9 9:~:? S :;! ... Rt:4:E F'E E T
'T"¢F'E CF:' SOIL FtE'FOF.':F'TION -_.,~.:TEf. IS' TF.:ENCH
HF~XiI',tI..H I'.a..IPI[:::EF~'. C;F E;EE:,F.:C,DP1S = E;
S 3 '[ L F.':RT I NG ,:: ':2. C,. F"I",-."E:F;i: ::, = ZOO
THE F.:E(;¢.J I F.:E:E:, S I ZE OF 'THE SCi I I .... FIE:
THE LENGTH DII"iENSION IS THE LENGTH (IN FEET::, OF 'THE 'T'RENCH OR Dt:~:FIINFIEL, D.
THE E:,EF'TH OF Ft "r'F.:ENCH OF.: F'!T IS THE [:.:,IST[:~.f...IC:E.: BETP~EEN THE :...:.;LtRI:.".'FI(::E OF "FIDE:
GROLfNE:, RF,tD THE BOTTOH OF THE E',:.::CFI',,,'FtTION ,::IN FEET::,.
THEF..'E iS NO SE"[' P.I]:[::,TH FOR 'TF.:ENC:HES.
THE GRFi'v'EL E:,E:PTH IS THE HINIHUH DEPTH OF GRFIVEL BE'I"HEEN THE OUTF~L.L t.':'ZF'E:
RND THE BOTTOH nF' THE EXC:FI',,,'FITION ,:::IN F:'EET',.
/.goo
'~" "- ,C:"
~ ,... Cz. ~': ......." ~ ~ X E;.:.." E: IE::, .".i~ E: F" ~T' I C:: 'qF I~ P-,~ IF::'.' . ..... I,,=: .... E ::'-=:: ~ ,~ ~:-"'i L. IL.,.,. ~'""~. ~"-,,~ ~,,T,,
F'ERH I 'T' F:IF:'F::'L I C:FIi"4]" Hr:ts THE F:ESF' 3~',1S :[ B ! L I 'T'"r' TO :[ NF('.'ff;.:H TH I S E:,EF'FIF..:"FHENT E:, I...t F;;: I NG 'T'HE
....T. NSTFILL. F~T. ]: ON Z N=,F E _. I :1: L t4::, OF FIN"r' P.EL.L=, RE:,-..TRCENT TO I"H Z S F"'""- ~ ...'" r"'-'""""'"".r:.~- ~ 'r' FIND 'T'HE'.'
NLIHE:EF: OF ....... PF'i:" i E:,ENCES 'THFIT THE I.,.IELL. P.tILL. '.':.,ED.",'"','E.
E:RC:KF" l t....L I 1'dG OF FIN.'¢ '-" "- -" ' ' ' ' '~' ' '"' '
· ", ~'.:,TE[ 1 P.I :[ 'I"HOLIT F I NRL I NSF'ECT I ON FdN[:, MF F F. I L E, ? 'I"H :[ S
E:,EF'FIF.:THENT 1.4 ~ L.L BEC
H I I'-,! I HUH [:' ! STFINCE E:ETI.,.IEEN A I.,.!ELL AND FtNY ON-"'S ITE '.:."".;EI.,.If:!GE D I SPOSt::~L S'¢L=;'T'E:'H I S
:1.00 F'EET FOR R F'RI'v'RTE: 14E.'LL. OF.: :250 TO 20¢~ FEET FF.:OH R PUBLIC t.,.tELL. [:,EPENDING
LIF'ON THE TYPE OF F'LIE~LIC !dELI. ....
HINIHI...IH [:'ISTFINCE F'RCd'"I R, PRIVRTE 1.4EL. L TO R PRIVATE SEI.,.IER LINE :IS 2!5 F'EET FIN[:,
'T'O FI C:OHHLI.N]:T'¢ SE:FIEF: L. INE I:E; 75 FEE'r.
OTHEF.': F?.EQU I I;.:EI'"IEI"dTS HFt'¢ FIF"'F'L'TL SPEC: I F I C:I:IT I Ot'..~E; RI'.,ID C:ONS'T'F:UC:]"I ON [::, I F:tCiRF~.HS FIRE
FF,,'RIL. F~BLE TO INSURE F'F.:OF'EF.: INSTRLLRTION.
I C:ERTIF'¢ THF!T
:;L: I RP'I FRMIt...IRF.~ I.,.tI"FH "['FIE RE:QU!F.:EF!E.'NTS FOR ON-SITE SEI.,.IERS RN[.', .[,.tELL:5 [:~S; SE:T
F'ORTH .E?¢ THE Ht. JNICIF'RI_IT'¢ OF RNCHC¥;.':RGE.
2: I t.,.IIIJ... INSTRL. L THE S'¢STEP! IN RCCOR[:,RNC:E I.,.IITH THE: C:ODES.
::~:: :[ UN[::,E:F.:STF:IN[::, 'T'HFFr THE ON-:~",:[TE E;E!.,.IE.F.: S'¢STEH HFlY' F.:E6!LIIRE ENLFIF.:GEP!ENT IF THE
F.':ESiE:,ENCE.~ISiCREHOE:,EL.E[:, TO :t:NC:LUDE HOF::E THRN 6 E:E[:,ROOHS.
t :.:.: '5.' f [::'E, E r ......... ~, E .............. :1.. 0
O & E ENG,,~IEERING & DEVELO~ ,vlENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 686-2280
Performed for: Name: ~'--'~/~.~--~-~ xJ ~ ~'~___/z'/-/&:> ~-"-- Tel. N o. ~ ~/~ ~'~'~'~?cD
Mailing Address: ~/~ ~c ~:)~);~ d ~:/-~g,~ '~'~...- ~,/~ ?~>'~--~,~'7
Legal Description: ~- ~)7-- ~ ~__ ~'~-¢~z::) ~_~--~ ~-~u/'~:) ....
Depth (feet)
Soil Characteristics
9~
10~
12~
15~
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
PLOT PLAN
PERC. TEST
No ~ If yes, what depth
Drain Field
Comments:
Performed by.'~/. ~~ ~~
James Yassik
P.o. Box 154
Eagle River, AK
Permit ~ 811162
99577
Subject: L4 BRANDEE S/D
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
~;;gNr~mB~;hnha;el~~'
Sewer and Water Program
Enclosure: Copy of Permit
Department
MUNICIPALITY Of ANCHORAGE
Health and Environmental rotection
~825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL A;:~'--_,-~,'< ON-SITE SEWER PERMIT
~/~/~, Mailing Address: ~, ~0/ /~g
, Phone Nu~er: ~ -~ ~,~
Applicant:
Location:
Legal Description: ~ ~, q ~~ ~ ~
Type of Soil Absorption System Is:
Trench: t~ Drainfield:
Seepage Bed:
Lot Size:
Holding Tank:
Maximum Number of Bedrooms:.~_~Z~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH /~) ' '
LENGTH ~ ~ GRAVEL DEPTH
· WIDTH
The length dimension is the~ength(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 = lEO0 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.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 1 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the red,enos is remodeled to include more ~ 3~b~.drT~..~
Signe~: /~///~,~ J~~ Issued by:
appli%a~-t -"----7 v~/M"~"'Q~'~""~>_
Date: ~/ ~
SWP/024 (1/81)
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the Construction of
in
e (,,'ID l
2.21 - FIG- 0(¢1~_ public water system located
Alaska, submitted in accordance with 18 AAC 80.100
have been reviewed and are
approved.
conditionally approyed (see attached conditions).
TITLE
DATE
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (contract order no.
or descriptive reference)
Approved by Date
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public,
APPROVAL TO OPERATE
The construction of the ~ I~vl c.!e~' ~/b
water system was completed on
granted interim approval to operate for 90 days following the completion date,
(date), The system is hereby
BY TITLE DATE
As-built plans submitted during the interim approval period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
fTpproval to operate~
' TITLE ~ DATE
by
DOC Co. dba
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND /j].~Jeqt, f' 4~'~,~0 ,'0 ~d/~ F~C/'~ DEPTH OF WELL '7~
ADDRESS LT~z /3~ ff ~ STATIC LEVEL OF WATER FT.
LEGAL DESCRI~ION ~ 4 /~~ DRAW DOWN FT.
DATE- Started / [ / 7/~ l Ended l/'/7/~ / GALS. PER HR
PE~IT NUMBER .<~ v>~,. KIND OF CASING
KIND OF FORMATION:
From
From
From
From __
From <'7- 3
From __
From_
From
From
From
From.
From
From
From
From
From
From
.. Ft. to ~ Ft. 0 O~"',~'_t~',d~'g?~'~,~ :~ From Et. to Ft.
Ft. to vt. ~~ ~ ~'~< From Ft. to. .Ft,
... Ft. to~ Ft. ~,0~ g~~k~ From__Et. to Et,
Ft. to -Ft. ~~ ~t ~ - ~ From Ft. to. Et.
Ft. to--Ft. '~/~ ~~ .~ ; / From Ft. to Ft
Ft. to ,Ft. ~ ~ ,~/'~ ~ff~ From__Ft. to Et,
Ft. to ~ O Ft. ~ O ~ J~ From Ft. to. Et.
Ft. to Ft. ,U/, ~ ~ ~ From__ Ft. to.__ Ft.
/
. Ft. to--Ft. ~%~.~ t~e~ ~OFrom__Ft./to Ft
?~.:2 Ft. to 7~ Ft. ~ ~ ~O ~ From Ft. to Ft,
Ft. to Ft. ~ ~ ~ ~ ~ ~~ From Ft. to'Ft.
-- ~. ~/~
Ft. to - .Ft; From Ft.-to~F~
Ft. to Ft From Ft. to~~
Ft. to Ft From
Ft. to Ft. From
Ft. to Ft. From__Ft. 'o '~
Ft. to Ft. From Ft. to ,Ft.
MISCL. INFORMATION:
DRILLER'S NAME
APPL' ,NT FILLS OUT uPPER "ONLY
Realty Co. & A~nt ~/~.~ Phone
Address Zip Code
Type of Resi~nce
: Single Family
: Multiple Famt[yf No. of Bedroo~
Water Supply
~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
: Community For wells drilled prior to that date, give well depth (attach log if awllable),
D Public Utillty
Sewer Disposal
~ Individual Year Indiv~ual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank , , . ....
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
.~,~ O¢~~ Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: ~
( ~kOVED BEDROOMS ~ ~ ~ 'CONDITIONS OF APPROVAL
( )DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE ~) ~5- ~> ~
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3182)
. CHEMICAL & )LOGICAL LABORATORI, :'gF ALASKA, INC.
· LA~ 274-3364 5633B Stree,
//"~';;;:~,-'~,,~(" ~king Water Analysis Report for Total Coliform Bacteria
,~ ';~, \~ ,,,
~ BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY
~r~/s~s~,~ I I I I I I' '1 ~.,,~,,s shows this Water SAMPLE to be:
ciw
State Zip Code
Mo./ D&y Yelr
SAMPLE TYPE:
I~-'Routlne
i-t Check Sample' (for routine sample
with lab ref. no.
[] Special Purpose
E]/Treated Water
Untreated Water
[] Satisfactory
D Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
D~te Received
Ttme Received
Analytical Method:
I-I Fermentation Tube
[] Membrane Filter
SAMPLE
NO. LOCATION
2 I
3 I I
, I I
Time Collected
Collected By
Lab Ref. No, Result* AnalyBt
I FT~
EZ:]
I
eno of colome$/lO0 mi or No o! Pos*bye porbonl
READ INSTRUCTIONS
BEFORE
COLLECTING SAM PLE_
06-1220
Rev. 197e
BACTERIOLOGICAL WATER ANALYSIS RECORD
Data Collected Source
Data Received ..... Time Received p.m. Lab. No.
IWesumpt lye lOml 1Omi 1Omi 10mi 10mi Z.0ml O.lml
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
EMB. Broth 24 houcs:
Multiple Tuba Raport~.
Membrane Filter: Direct Count
Verification: LTB
Final Membrane F#tar Results
Reooa't ed By
Broth 4B hours:
1Omi Tubas Po~tlv~/Total 10mi Portlo~l
Coil form/lO0ml
Date
Time. ,,, &.~
p.m.