HomeMy WebLinkAboutMORGAN LT 2Mor'gan
Lot 2
#051 - 154-45
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak, us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: ..~ ~/' /&-" O g; ~ ~ PID Number:
Name. ~
Z_,,/04,~_.~) (~, /~/~ Wastew~ter System: ~ New '~ Upgrade
Address:'~, ~, '~ ~ 72 5~2/ ~/~ ~, ABSORPTION FIELD
Phone:~ Num~r~f~edrooms: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~er:
Soil Rating: ; Total D~ginal grade:
LEGAL DESCRIPTION ~+/ ~.
Block: Lot: ~ Subdivision: ~~ Depth to pipe bottom from original grade: ~ ~1 depth beneath pipe: Ft.
Township: Range: Section: Fill added above original grade: / Gravel Length:
*~ ..................... ~ ~ ........... / Ft. Ft.
Well: ~ New ~ Upg/ Grave, width/ Ft. Number of lines: ~ Distancebe.eenlines:Ft.
Classification ~. B. C); ~al ~~ Cased to: ~ption area: Pipe Material:
Driller:~~ Date Drilled: StaticWater Level: Ft, ; lnstaller:,~~ ~~ Date~,,Installed:~ ~
'~ GPM ,umpSetat:". C~'*g".'g"~ov~rou.~: ~ANK~,
¢ Ft.
SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. ~ Qther:
T~ Septic Absorpt,o~ Li* Holding 'ublic/Private,~cturen ~~
Tank Field Station Tank Sewer Line ~ t'~ 6% Gal.
Well 1~¢ /~¢ -- ~ ¢5~ M · _ Number of Compa~ments:
SuffacoWater IPO & /~ .... LIFT STATION
i / ~ Size: Manufacturer:
Foundation 5~, /¢~ -- --~~ "Pu~p o~ levet at: ~at: High water alarm at:
in.
in,
Electrical Inspe~ions pe~o~ed by:
Remarks:
BENCH MARK
Lo~tion and Description:
Assumed Elevation:
~ Englneed~ : / / Engineer'sS~
Inspections pedormed by: I~! S. Birchwood ~. ~ Dates: 1st ~/~//~
Development Se~ices Depa~ment Approval " '
......
PERMIT NO SW100025 PAGE 2 OF S
iVlunicipc~kidsy of Anchorage
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER'AND WASTEWATER PROGRAM, AT00 BRAGAW STREET
P,D, Box 196650 ®Anchorage, A~aska 99519-6650 I TeLephone', (907) 343-7904·www,ci,anchorage,ak,~:
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR'
LEGAL LOT 2; MORGAN S/D P.I.D. NO. 051--154--45
TARIKA AVENUE
"( ;'::1 UTILITY ESMT.
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:':.,.,:':;.\ ~~:.:i.:':;i,,~..i:N'.::;!:i!i:/ ,
,', DBL2ml I I
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'!.':.:':"5':':' B MTNEW 1000 GAL. ~II
LOT 1; MORGAN S/D ~,,:~o,
EXISTING
PERMIT NO. SW100025 PAGE S OF 4
HunicipeLJty or¢ Anchopege
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, ~700 BRAGAW STREET
P,D, Box 196650 I Anchora9e, A~osko 99519-6650 I TeLephone,, (907) 343-7904 ·www,ci,onchora9e,ak,u:
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR'
LEGAL LOT 2; MORGAN S/D P.I.D. NO. 051--154--45
TAR~KA AYENYE ~,~
'~"~" ~''~'~'' .~._o:
Ki.::;:..'...:....-. ; :" ' '
:,,,., ..,...~ .....,,... ....
.... , :' ,~:.:/' ':.,* '. k'/,".,/.,,t., ,,.q ,:h?" I I
'.~' ,'" ...' :'}.'~':~2'{" ';'" I I
~- EXISTNG TRENCH I O
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I
~T I
NEW 1000 GAL
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I
/ ,
LOT 1. MORGAN S D ,
' ,
PERMIT NO. SW100023 PAGE 4 OF 4
Municipc~Li~cy o¢ Anchor'o, ge
DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM, &700 BRAGAW STREET
P,D, Box 196650 t Anchoroge, ALaska 99519-6650 I Tetephone: (907) 343-7904 ·www,ci,onchorage,ok,u_~
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR'
LEGAL LOT 2; MORGAN S/D
P.I.D. NO. 051-154-45
FINAL
95.
ST1 ST2 /-GRADE - 99.1
n'~ I 1000 GALLON I ~
v I POLYETHYLENE I ~- 94.8'
A4, B7,
ST1 19. 11.
ST2 25.4' 1 0.0'
DBL1 24.4' 9.6'
DBL2 25.5' 9.4'
TMT 24.8' 10.5'
N. T. S.
ENGINEER STAMP
~_'~.,,,~/',~. ~,~.~ _./~
/
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Mar 26, 2010
Expiration Date: Mar 26, 2011
Permit Number: SW100023
Legal Description: MORGAN LT 2
Design Engineer: 0003 S & S ENGINEERING
Owner Name: DONALD G. HOMAN
Owner Address: PO BOX 672382
CHUG1AK, AK 99567-0000
Parcel ID: 051-154-45
Site Address: 020924 TARIKA AVE
Lot Size: 46653 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] DisposalField [] SepticTank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:,
Date: ~'~/~"~-')/~-~
Date: ~'~/~,~
Municipality of Anchorage ~qr~'
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage. Alaska 99507
www.munLorg/onsite
(907) 343-7904
ON-SITE SEVVER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parce, ,.D. DSI -/5q- q 5
Mailing address ~ '~72~ Zip Code _
Site address ~q--/~ h~.&~'~r, ZipCodo e~¢
Legal description (Township, Range & Section)
Lot Size_ ~ _Sq. Ft. Number of Bedrooms ,~
THIS APPLICATION IS FOR (~ all that apply).' THIS APPLICATION IS AN.-
Absorption Field ~ Initial ~
Septic Tank ~ Upgrade ~
Holding Tank ~ Renewal ~
Priw ~
Private Well ~
Water Storage ~ ~
~ . ./
I cedi~ that the ab~ information i~orrect. I fudher cedi~ that this application is being made for a
Single Family Dw ordance with applicable Municipal Codes.
Permi~Rush Fees: ~, ~ Waiver Fees:
Date of Payment: ~/a ~0 Date of Payment:
Receipt Number: 0¢~ ~ RoceiptNumbec
(Rev. 11~5)
ROBERT C. COWAN.
CIVIL ENGINEERING
PH: 907-694-2979
TEST
March 16, 2010
FAX: 907-694-1211
MUNICIPALITY OF ANCIIORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 2, Morgan S/D
It is requested that you issue a permit to replace the existing septic tank currently
serving the existing three bedroom dwelling on the referenced proper~y with a new
1000 gallon IlDPE septic tank. The existing septic is in failure and needs to be
replaced.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage pattems by the installation of the proposed septic tank. The construction
of this system will not prevent any future development on any ofthe adjacent properties.
Ifyou~nal information, please contact us.
Enclosure
15861 S. Birchwood Loop Road - C. hugiak, Alaska 99567
1" = 70' DESIGN SITE - PLAN
/ f \~ '~ ,
.-'.- '"
--~ m i~
-~
'i
. I I
~ ..... ',.s, ~n,~or -- -- --I ',.s, xzn,,n .o, J
,
mO O0 ~c~ ,
SITE-PLAN
'].~9S3 I11911~9 ,0 ~,
DESIGN
50'
'l~S3 Allglin
!.%
SO~L TEST
ROBERT C. COWAN.
CIVIL ENGINEERING
PH: 907-694-2979
FAX: 907-694-1211
ON-SITE WASTETVATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 2; Morgan Subdivision
March 16, 2010
GENERAL:
The scope of this project includes the replaccment of the existing !000
gallon steel septic tank with a new '1000 gallon HDPE septic tank to serve
the existing three bcdroom residence located on thc referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and
all applicable State and Municipal Wastewater D sposal Regulations.
3. The contractor shall be responsible for obtaining any necessary
underground utility locates.
Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling.
o
Contractors installing xvaste~vater disposal systems must be certified by the
Municipal Development Services Department or ADEC if required, for
system installations. Owners installing their own systems must also receive
prior approval from the respective agency.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access. All HDPE
septic tanks are required to have a 4" monitoring pipe installed next to the
tank extending to the bottom ofthe tank.
15861 S. Birchwood Loop Road - C. huglak, Alaska 99567
Page 2
Lot 2, Marvin Subdivision
March 16, 2010
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final
grade.
Septic tanks installed with less than 4 ft. of cover shall be insulated. All IIDPE septic
tanks are required to be covered with a minimum of 2" direct burial insulation, and a
maximum of 4 feet ofcover.
A foundation cleanout shall be installed one to four feet from the building foundation.
In the line between the tank and the leachfield thero shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic tank). These cleanouts
shall be located on undisturbed soil not more than 10 fl. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield. ]'he second cleanout shall be
to clean toward the septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
The following pipe materials are approved for use in septic system installations in the
Municipality of Anchomge:
Type of Pipe Perforated .Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM FSI0 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use. of a type of pipe other than listed above must be approved by the inspecting
engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco,
or equal).
Page 3
Lot 2, Marvin Subdivision
March 16, 2010
INSPECTIONS:
Typically there will be a minimum of two (2) inspections required during the installation of the
septic tank. These inspections will occur as follows:
I. The first inspection must be conducted after the septic tank is set in place, but
may not be backfilled until after this inspection.
2. The final inspection is to occur upon final grading of the property.
The inspecting engineer is to be contacted at least 24 hours prior to the start ofconstruction. If
necessary, a pre.-constmction meeting will take place on-site. Thc inspecting engineer will not
coordinate, direct or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance vdth the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S & S Engineering. S & S
Engineering shall be the owner's representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions o£the
contractor or any other persons performing work on this project or the failure of the contractor
to carry out the work in accordance with these construction documents. S & S Engineefing's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
i~_~ 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 PFLO N ~)~, ,~NEW
MAILING ADDRESS
~ Z Manufacturer~ __ .
~ ~ ~¢-e~ M~e / No. of compartments
Liq' 7~tY¢ ~°n' IF HOME.DE: Inside length Width Liquid depth
.~Z~ ' DISTANCE TO: Well ////~/ -- Dwelling PERMIT NO.
~_~O ~ ~ Manufacturer I Material Liquid capacity ~n gallons
~ ~ ~ No. of lines / Length 'o~n'~ Total ~rf,i~ Trench wm 'finches Dis~nc~
~ ~ ~ Top of tile ~i~sh~ade ~e~jal b~ath tile / ¢ Total effective absorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diamet Crib depth Total effectiue absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
j Class ~ 5e pt~.
~ ~ ~ / ~ ~ Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s}
OTHER
PIPE MATERIALS
SOIL TEST RATING ] ~.
REMA '
72-0 ~ev. 3/78)
· Eld"11 '[
DEPFtRTMENT ! HEFILTH FIND ENVIRONMENTAL OTECTION
825 ."~'-""STREET., RNCHO.RFIGE., FIE. 9Si~,~±
264-4720
( 8±F!802 )
RF'F'L I E:F{N'F
L-3C'RT ! ON
[_EGRL
CHFILES MOWER
TRRKIFI RD
L2 MFIF.'Gf-IN _-,LB
F'O B::.:: 647 ER
I_OT SIZE
68832 :.'~ Z.':
40000 SQLIFIRE FEE]'
T'YPE OF SOIL -IE, z, LF..FTIEI',I SYSTEM IS: DRFflNFtEL[:,
NUMBER DP" BEDROOMS = 7~:
SC;IL RRTtNG ,::SQ FT,.-'E:F.!)= 95
THE REQUIRE[:, SIZE CF ]"PIE SOIL RESERF'TION ~T.:,TE!I IS:
Ir-:. F
THE LENGTH DIMENSION IS THE LENGTH ,::IN FEET) OF THE TRENCH CR [:,RRINFIELD.
THE DEF'TH OF R TRENCH OR F'IT IS THE DISTRNCE BETWEEN THE SL.IRFFICE OF THE
]ROUND fiND THE BOTTOM OF THE E>(CR~,,'FITION ,'IN FEET).
THE TRE~4E:H l.-I I C. TH I.:.'--' -_~. El88 FEET.
THE ~H~EL"" DEPTH I_,': THE MINIMUM DEPTH OF GR.'eEL 8ETHEEN THE ntlTFiBIi ..... PIPE
~ND THE BOTTAM OF THE E,..,..H~H]ILN ,:'IN FEET)·
PERM I T RPPL I CRNT HRS THE RESF': NE;I BI L I T'¢ 'FO INFORM THIS [,EF'RRTMENT r_':,URI NG 'THE.'
INS-TRLLRT!ON INSPECTIONS OF RNY I.,.IELLS RDJRC:ENT TO THIS PROPEF.:TY FIN[:, THE
NUMBER OF .RESIF, EN]ES THRT THE WELl_ WILL SER',,,'E.
BRCKFILLING OF RNY _-~.: FEr! WtTHOU'F F!NRL INSPECTION RND FIPF'F.:O',,,'RL BV THIS
[:,EPRF.'.TMENT HILL BE EI_tE:.TECT TO PRZSEZ_TION
MINIMUM DISTANCE E:ETWEEI',! R WELL RND BNY ON-SITE SEWRGE DISPOSAL SYSTEM IS
Jj-.-:-~F~ FEE]" FOR R PR I ',,,'RTE WELL OR J. 50 TO 2El0 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM [:,ISTFINCE FROM FI PRI',,,'BTE WELL TO FI PRIVBTE SEWER LINE IS 25 FEET RND
TO FI COMMUNIT'¢ SEWER LINE IS 75 FEET.
klELL LOGS FIRE REQUIRE[..' FIND MUST BE RETURNED TO THE DEPFIRTMENT WITHIN Z::O DFI'¢S
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MFIY FIPPL"r'. SPECIFICRTIONS FIND CONSTRUCTION [:'IFIGRFIMS FIRE
RVRILFIBLE TO INSURE PROPER INSTRLLFITION.
I CERTIF"r' THFIT
::L: I FIM FRMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND 14ELLS FIS SET
FORTH B"r' THE MUNICIF'RL. ITY OF RNCHORFIGE.
2: I WILL INSTRLL THE SYSTEM IN FICCORDFINCE WITH THE CODES.
3: I UN[:'ERSTFIND THFIT THE ON.-SITE SEWER SYSTEM MR"r' REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS F.'.EHODELE[." TO INCLUDE MORE THRN 3 BEDROOMS.
S ! GNED: ............
R-F'PLICFINT F:HRLES MOWER
i ..... ,_,El. .... _< ...... ................. ....................... i
Russell Oyster
694-2774
Performed for:
O & E ENGnqEERING & DEVELOF-MENT CO.
Box 90, Davis St,, Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOG
Mailing Address:
Earl Ellis
688-2280
Depth (feet)
0
4__
6__
7__
8__
9__
10__
11__
Soil Characteristics
PLOT PLAN
12__
13__
14__
15__
16__
Ground Water Encountered:
Proposed Installation: Seepage Pit
Comments:
Yes / No If yes, what depth
Drain Field ..
PERC. TEST
II.
Performed by:
Date:
SOILS LOG '~/
PE RCOLAT i ON ' 'FE-S~T
Performed for Charles C. Morgan Date PerfoLn~ed
~_c~_, ,Description Lot 2, Morgan Subdivision, Sec. 8, T15N,
o/7 6
SM
Red-brown, san~l~ Silt wi~h topsoil - Parc rate A--' 275 ft.Z/bdrm.
Red-brown, sandy, well-graded gravel (GW)
with some lenses of sand and poorly graded
gravel (GP)
Parc rate = 100 ft.22bdrm-
Small inflow from perched water table at -10 feet.
~otal D6pth = 13 feet
A\PE~.GE PERC P~ATE FROM SOILS LOG = 132 ft.2/bdrm-
Date
Time
Dep th
Net Drop
Percot:~tion~,-~P ~._u ~ minute
Performed
NORT[E~F, ST EXPLOPuATION SERVICES, tk'C.
{ger ifiei Drilling4 og
by
DOC Co. dba
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
ADDRESS ?
LEGAL DESCRI~ION
DATE - Sta~ed
DEPTH OF WELL
STATIC LEVEL OF WATER FT,
DRAW DOWN FT. ? -J~
GALS. PER HR :2 C 0
KIND OF CASING ~ -~,~ ~)
KIND OF FORMATION:
From ~) Ft. to c:'~'. Ft.
From :~ Ft. to ~ Ft.
From '~:? Ft. to ] q' Ft.
From /'? Ft. to z~,,? 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__.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 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 Ft. to Ft
From Ft. to .Ft.
From__Ft. to .Ft.
From Ft. to Fi
MISCL. INFORMATION:
DRILLER'S NAME
APPLi( ',NT FILLS OUT UPPER HA~ ONLY
'"Property Ow,~er ~././?~?.,~? ?'-- C/ ' (~.?./---~£ .A~'//~L.~'_~-~'~ ~ Phone
Buyer '
Address Zip Code
Lending Institution Phone
Address Zip Code
Realty Co. & A~nt
Legal Description
Street
Locati~
Type o~si~nce
~ingle Family
~ Multiple Family No. of Bedrooms
~ Other
wa? s~ly
~dividual
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Public Utility When Connected ~o Public Utility: ~ f[~
~ Holding Tank
NOTE: THE INSPECTION F~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING OAN BE INITIATED.
Ti e Time Time
Date Date Date Date /~"'~
Inspector Inspector Inspector Inspector
Field Notes: I~_~ C_~ ~' ~ ~
P~PI'. OF
RECEIVE
2
DATE [ / -- 7-- g ~
Soils fl~ting D~e ~wer [nst~lled Well To Absorption Are~ ~ ~ ~ Well Log ~eoeived
CHEMICAL & GI~LOGICAL LABORATORIES ,,_~ ALASKA, INC~
TELEPHONE (907) 562-2343 ANcHoRAGE INDUSTRIAL CENTER
5633 B Street% .
/~-~-~ Drinking v~/ater Analysis Report for Total Coliform :B~'cteria
TO BE COMPLETED BY WATER SUPPLIER
WATER
S/_ ./M:Y .$-~E I.D. NO.
-~ Phone No.
Water System Name
Mailing Address
City State
MO. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
SAMPLE
NO. LOCATION
2 I
I
READ INSTRUCTIONS
BEFORE
~;OLLECTING SA MPLE
TO BE COMPLETED BY LABORATORY
AnalvsiS shows this Water SAMPLE to be:
r~Satisf~ctory
[] Unsatisfactory
[] Samp'l~too long in transitj sample should
not b~ over 48 hours old at examination
to ndicate reliable results. Please send
Zip Code
[] Treated Water
[] Untreated Water
Time Collected
Collected
new samole.
Date Received
Time Received
Analytical Method:
{~ Fermentation Tube
~[~'-Membrane Filter
Lab Ref. No. Result* Analyst
I F-FI
I r-I-]
';No. o; colomes/lO0 mi or NO. of Positive poruons
06-~220
Rev.[gTB
BACTER IOLOG ICA[. WATER ANALYSIS RECORD
Date Collected Source
~e~umptlve [Omi ]Oml ~Oml ~.Oml ~.Oml 1,0mi O.Xml
24 Hours '
48 Hpurs
r.onflr rrmtory
24 Hours
48 Hours
EMB Broth 24 hours: " Broth 48 hours:
Meml~rane Filter: Olre~t Count Collform/t00ml
Verification: LTB BGB
'L' )'FAnII MsmPrane Filter ReSults ~'~ Coliferm/~00ml
OctOber 3~ i983
Auton and ' ' ~' .
P. O o i~ox 6'7'7
EaWle }~iver, AK 99577
Subject: Lot 2, i~lorgan Subdivision
A~provai ~or the individual sewer and ~ater facilities cannot
be granted until the folio%~in9 items have been compieteda
it
~/The top o~J the well casin9 should De se=~led so that
~ue~ t19~~t-
Plea~e notify this Department for a rei~lspection w~~en the
noted discuepancies have ~jeen corrected, if the~e are any
' . ...... ~ ' office at 264-4720.
Cory Willis, i{.S.
Actin9 Sewer & %'~ater
Program ;4anager
'"~f DATE RECEIVED
INSPECTION APPOINTMENTS
TIME '"'~( ' TIME TIME
DATE DATE DATE / I
INSPECTOR I NSP ECTO~,~ INSPECTOR
DEPT. OF HEALTi{ &
BUNIOIPALIT? OF ANOHORAGE [NVIRONMENTx~L P:,O[ECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street- Anchorage, Alaska 99501 ~ ~"
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 ~ E C E
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) / ~ PHONE
PHONE
MAILING ADDRE~8
3, LENDING INSTITUTION J PHONE
I
MAILING ADDRESS
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOC^T,ON 0'" 3o . Co-
NUMBER OF~BEDROOMS
~ One ~ Four ~ Other
~ Sl~Gkfi FAMIkY ~ Two ~ Five
~ MULTIPLE FAMILY ~ Three ~ Six
7. WATER
~ I~IVID~Ak~ ~ATTACH W[k[ kOG. A woll Io~ is required for all wolls
[] COMMUNITY
[] PUBLIC UTILITY
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DIS~OSAL SYSTEM
[~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTI LITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
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 BEDROOMS
[] SINGLE FAMILY [] ONE [~ THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SiX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY "~__ ~ f
Connection Verified INSTALLER
[]Septic Tank or [~]Holding Tank
Size: ,"~?~-~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL _~
4, DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~[~,"~'AP P R O V E D FOR ~,~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must acc/o~npany certificate)
[~] DISAPPROVED ~
DATE BY /~
72-010 (Rev. 6/79)
CHEMICAL & G)zciLOGICAL LABORATORIES',~F ALASKA, INC.
TELEPHONE (907)-279-4014 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.
Mailing Address
City State Zip Code
Mo. Day Year
SAMPLE TYPE:
· [] Routine
[] Check Sample (for routine-sam
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
2 I
I
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analys~s snows this Water SAMPLE to be:
[~1, Satisfactory
[] 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
E3~-Membrane Filter
Lab Ref. No. Result* Analyst
i ~ ~.....,~ ~ ..,-,-,~.
I r-I-I
I cci
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 lb)
Rev, 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
Time Received -- =.m, [-ab. No.
3resumptlve 10mi 1Omi 10mi 10mi 10mi 1.0mi 0.1mi
24 Hours
48 Hours
:onflrmatory
24 Hours .
48 Hours
EMB Broth 24 hours: Broth 48 hours: ,
10mi Tubas Positive/Total 20mi Portions
Col~form/100nll
BG B
, ' . '~ Collform/100ml
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: LTB
Final Membrane Filter Results
MUNICIPALITY OF ANCHORAGE
DEPARTME~ OF HEALTH AND ENVIRONIqEN' PROTECTION
825 L 3treet, Anchorage, Alaska 99501
279-251]., ext. 224 or 225
...... Date Received: June27
#1: Til'ne __iA~_- ~2: r. Pime _ 1~9~Zl]__-
R~QUES'.~ ~O~ A~OVaL OF ZNDZWDUAn S~ AND Wa~EN
1. Lending Institution Reques%: Alaska-~an.k-of Co~erce~
Mailing Address: ~z~s ~ Phone:
2. Property Owner: Charles Morgan Phone:
Mailing Address:
265-8384
3. Legal Descrzphion: T15N R1W Section 8 E½of Lot 159
Single Family Residence: ~ Number of Bedrooms: three
Multiple Family Residence: ( ) Number of Bedreoms:
Well System." :[ndividual Well (x~ Con~nunz~y/Pub]ic Sysnem ( )
Pernlit ~ Depth of Well 62' Well Log on File
Construction Bacterial Analysis
( )
Sewage D:isposal System: On-szte System ~>0 Public Utility ( )
Permit ,, Installed Sept. 1975 Installer~, (. '.~,4.~z ....
...... , ~ -~[ . '~ -
Septic Tank Size _._~ )00 Manufacturer __~-~43~
Absorption Area
Soils Rate _.~$~' Material.
Distances: Well no Septic Tank ~']-. to Absorption Area t..%~)
to Sewer Line Nearest Lot line Absorpu:Lon Area
to Nearest Lot Line
· ~UNICIPALITY OF ANCHORAGE
Department of Health and Environmental ....
Protec~j.~
825 L Street, ~chorage, Alaska
9950~
279-2511, ext. ~24, 225
~Request for Approval of ]'ndJvidua] Sewer and Water
Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
Lending InstJ_tution:
Mailing Address:
Phone
Phone:
Mailing Address:
Single Family Residence:
Multiple Family Residence:
Number of Bedrooms:
) Number of Bedrooms:
7. Water Supply: * Individual Well ~ Publie/Conm]unity System ( )
If Individual Well, well depth _~ ~
If Co]mnunity System, name of system
Sewage Disposal System: On-site System
If On-site System, date of installatJ.on:
Public System ( )
*NOTE: A well log is required on ALI, wells drilled since 6/75.
3/77
Page Two
Reques't
Department of
for Approval
Health and Environmelltal Pro'hection
of Individual Sewer and Water Facilities
Legal Description: T15N R1W Section 8 E½ of Lot 159
Coi~neIlt s:
Affadavit Attached: (Z~ Letter Attached: ( )
Disapproved: Date:
Depar ~ment Worksheet
7//t,/77
~ ~0,~, ,,~, Eagle '[ver Area
,, GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
~,~ 3330 "C" Street, Anchorage, Alaska 99503 274-4561
"d/~[ ~ ,~,~-u.~ Date Received Sept. 1, 1976
~'~ ~. tO' Date of Inspection 9-7-76 Tuesday
, O~.-"~x~! ' REQUEST FOR APPROVAL OF /~J~L/
~]~ f' J INDIVIDUAL SEWER & WATER FACILITIES
FOR
Cony.
1. Approval requested by: Alaska Mutual Savings Bank % Chris Anderson
Mailing Address: Post Office Box 1120
Phone:
2. Property Owner: Charles Morgan
Phone:' 265-8587/688-9137
Mailing Address: Box 192, Chugiak
3. Legal Description: T15N R1W Section 8 E½ Lot 159
4. Location: See map
5. Type of facility to be inspected
6. Well Data: Individual
A. Type
C. Construction
7. Sewage Disposal System:
A. Installed July,
C. Septic: Tank: 1.
D. Seepage Pit: 1.
E. Disposal Field:
8. Distances:
A. Well to: Septic tank
Nearest lot line
B. Feundation to septic tank
Single Family
No. of bedrooms 3
13. Depth
D. Bacterial Analysis
On-site system
1975 B. Installer
Size 2. Manufacturer
Absorption Area 2. Material
Total length of lines
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines
C. Ahsorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Re~ st 'for Approval of Individual ' er & Water Facilities
Legal Description T15N R1W Section 8 E% Lot 159
Comments
Approved
Date
Approval,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
~ccurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received ]~/~/~/l~~/'~
Time of Inspection
1. Approval requested by:
Mailing Address:
Date of Inspection
EQUEST FOR APPROVAL
INDIVIDUAL SEWER & WATER FACILITIES
FOR
2. Property Owner: ,~.~C4
Mailing Address: 7~,~?/~A~,;~
3. Legal Description:
Location:_
5. Type of facility to be inspected_
6. Well Data:
A. Type
B. Depth
No. of bedrooms ~--~
C. Construction
7. Sewage Disposal System:
D. Bacterial Analysis
A. Installed
B. Installer
C. Septic Tank: 1. Size
2. Manufacturer
D. Seepage Pit: 1. Absorption Area
2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to:
Septic tank
Absorption area
, Sewer Lines
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Re~ st 'for Approval of Individual S ~r & Water Facilities
legal Description
Comments
Approved 4, . Disapproved Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify 'that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE %//,, ~,c;'/
DEPARTMr;NT OF HEALTH AND ENVIRONMENTAL PROTECTION ~Y~
2510 Fast Tudor Road, Anchorage, Alaska 99504 276-2221 - .~/
REQUEST FOR APPROVAL OF
INDIVIDUAL. SEWER and WATFR FACILITIES
1. Type of Inspection:
2.
CMRO __VA__ FHA
Property Owner'. ~-'~O//q/~ ~/.__/~..~
Mailing Address:~ O'
3. Name of Buyer: ~
Mailing Address:~ g ~
4. Name of Lending Institution:
/
6, Legal Description:~ ~) ~z~ ~r~- ~/~/~
7, 'Type of Facility to be Inspected:_
8, Water Supply
Type of Supply:
Public Utility
_Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation_ ~'~-~/
.Individual (on-site)
72-OO3(3/76)