HomeMy WebLinkAboutKINCAID ACRES LT 2COnsite File
~ 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 ,~,/~ ) --/ IPHONE
IMAILINGADDR SS -- ,~ / ]
Absorption are¢
We~/l~.~ / f~.
Men.fectarerc¢
in gallons
IF HOMEMADE:
Well
Inside length
Dwelling
Dwelling
Width
NO. OF B .F~OMS
No. of co~=~,tments
Liquid depth
PERMIT NO.
DISTANCE TO:
Manufacturer Material Liquid capacity in gallons
Well
DISTANCE TO: / ~(¢) j
No. of,,nes /
Top of tile to finish grade
Length Width¢
Nearest I~l~e
Trench ~t~ inches
~ inches
Foundation ~
Total length of Ii s
Depth
Bistance~F~n ~ines
;;:lM;'~sorption area
Type of crib ;rib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
d_.. puc..
REMARKS
72-013 (Rev. 3/78)
LEGAL/
]"HE LEN(%r'H [.', t i"iEh,IS I ON i S THE [...E:N(~i'T'Fi ( ~ N FEET ::, C','F THE T.,'q:ENCH OR E:,Fi:FI I NFl E:LD.
THE I::,EF'TH 0!::' f:I TRENC:Fi E,:F4 F'i'T I:/5 THE L':,!STF!NCE BETklEE:iq THE SURFRC:E OF THE
GI::;:OL.ti'.-,.'D FIN[) THE EK:rT'TC"ii"i (_"iF' THE EXC:ffv'FITiOi'.,i (?',i FEET).
'T'HER,E iS i".iC~ SET P.iiDTH FOR T!:~:ENCHES.
THE GF;:FIVEL, DEF'TH Z :.::.1 THE Pil N I PILIM DEF'TH OF EiRF!',/EL. BE'TP.IF.::EN THE OUTFF:iLL P
Ri'.,ID THE E~ErT'TOi"! 01": THE EXCR'v.'RT~Obl (!rN
F'EF:[',! I "F ':~P~:' ................. "r-c,l,.¢T Hf:fS THE RE:SPONS Z E~ I L. Z T? T,.-' ............. T F F' '" ?j',' TH :[ S r'-¢:'pc~[. ....... ,'""?[~', '* 2I',, ....... [;:,i_I[[: :[ i'4(~i ,r.4~',...
! NE;TF!i...L.F~T i EtN.,.,,, _,,'r, c'c,,:" ..,'-'~' .'r _.,,,'",, ,= .... "' F' FIN'.¢ ~.iFZL..~':J; F~E:,.:FI:~E:ENT "FO TH I S; F'F4:OF'E?.T~.' RNE:, THE
i'.~L t,!E ER OF RES t DENE:FJ:S; "FHFCF 'T'HE HFL [. b.i i LL. SERVE.
i'dlb!tMUi"l D!STRNCE E~ETI.,.!EEI'.,i R k!EL..L. RiqD R.i'.,!'.r' Cd",!-"'SZTE :SEk!FIGE: D!S.;POSRL SL,"STE?! IS
:.I.00 FEET F'OF?. F:! P.¢;~:?:',,,'F~TE i4EL. L.. OF.'. ::t..5Ef TO 20E? FEET FF.'tCff'I R F'UE;LiC HELL_ DEF'E?'.iD!NG
UPON THE Th-'PE OF:' F'UBI....IC i4ELL.
MZNZP!U!'d D!:.E;TFI?qC:E ,r'"-F.!ON I::! F'I:;i:I',,,'!::!TE HEL.L TO R F"F.:!Y'"FFFE :'SE!.,IER L. Ih!E ZS 2L':-.' FEET F!ND
7'0 .FI C:OHHLIh!i"F'¢ SEI.,.!ER LINE: IS ;'"'5 I"-"EE2F.
OT!-LFZF.'. REt~:!UiREMEN'F:iE; MF!"¢ F!F:'PL'~-'. '.::!;F'EC:ZFZCFITZON'.:; FqhiD C:ONSTf~:UCTZON D!F-iGRFiI"!'.:.:i
Fi'v'R_i.' L. FIE~L.E "!"C~ I i'.,kSLIFLE P!~:OPEF.': I NSTFILL. FFF Z ON.
i CERT!F'T' THRT
:i.i: I Fi'!"! F'Fi.t'!IL!FIR !.,Ji"l"k.l THE: F..'EQU!!:~:EMENTS FOR Oi'.,I-':_:;iTE SE!,.iEI:i:S FIND P.iELL. S iris SET
FORTH E~'¢ THE MLtN!CIPRL:!T'¢ OF R!'.JCHORF!GE.
;2: i PIiLL_ II'-,!STFILL. 'ride S'.¢S;TEi',I Ii'.,! RCCEiR[.',RNE:E P1iTH -,rilE CC'iDES.
3:: i L.tNDEi.-%STI:::Ii'.,![::, THFIT THE: ON-...SITE S:;E!4ER S"r'.'.'STEM ,~'Ifa"¢ RE6!UIiE:E Ef',!LF!f;~:(:~Ei"!EI"4T '!'F "f',""IE
~!ES ! DEb!CE ! S I:;.:EHC~[:'ELE:D TO ! NC;L.U[)E !"iOF;:E 'THRN ::J: E:EDROOF!S.
'-7.-:[ 3,~..EI::,: ..................................................................................................................... ,---~-c~. ~c-/Cc-,_O CZ_' c -c~,--* 'ct.
F:IPF'L. I C:FII',I'T !;7:~::tEi:[.:..:i:;::'T E', HOFFMF4. F,! ..TF;: / / C , A ,
r" 7 ·
PE¢!."I:i: "F NO.
RF'F'L :[ CF!NT
L O C R T ~ O
L.E'
::* ;;?1¢. .,--3 S(;:.!jFIRE' FEE'T
....... ...::, 'r .::, ~:r,1 ..... TF:ENCH
SO;iL F,;:F!T):f',!G ,:,-,r..~ F ,,. z,, ..... .!Fiia
'T'HE LE.NG"F[-! [)ZHENSZCd'.,I :iS THE LENGTH (iN F'EE"i") OF '1"HE "FRENCH OR DRRZi',iF;r. EL£:,.
THE DEF'TI--! OF' FI TRENE:H OR F':t:T iS THE DiSTRNC:E DETHEEN THE Si..IF:FF!CE OF-' THE
GROUND Rt',I[)THE: BOTTOh'! OF TIqE EXE:[:i',/RTI'ON (:iN FEET).
THERE :l:S 1'.40 '.:.;E:;T i,.!.T.E:,TH FOR TRENCHES.
THE GRRVEL [::,EF:'TH ZS THE: H!NI.HUH DE?TH OF GRFiVE;L. BE'TP.!EEN THE OU"f'FI:;','i....L. PiPE
FIND THE BO'T'TOH OF THE EXCR',/RT;[ON ,.';:t:i'4 FEET).
F'ERHZT .:tF'F'LZE:FIN"I" Ht::r:'~ THE F.:ESF'EN'E,)r.F:~*~LiT'¢ TO Zi',!F'Oi;::H 'T'F!:I:S [:,EF'FIF::'THENT r':,l, r;? 'r h,! 3 THE
" ' _ .............. 1 I",,::.
Zi",ISTF:iL!....F!TiEff',I ii",!SF'EC:Ti3i",!'~; CF MN'¢ '~,.!EL....':_:; l:::ll":,'rFl-:P'i~.,rT TO "l'Hi:~; i:'~;?":IF'Ei-'~'T'.? F:!h,ID '" .~r.
r4L,'IEEF. OF -'F":' .... F.." F'F.":' 'T'H[:!T THE F!EI~.L 1.,.!]:t i .::,.:.r~..,,,,:.,.
.....................,,,4..~. ?., L, ~ ~.,ll.:, [3F' l"if'4'T' '::?::;Tl:'t"t t,.!TTFi[)UT !::'Zi'.,tF:IL ~i',I:ii.:,F'E'C:T:[Cd'-,! FiND F!F'F'F4t[3VF:IL *"::, i- TIJ '-'' ';..;'. , , .~ ..,
DEF'F!F::THENT H :1:I. L. F.~E: .:,UE;..., ,:. _. [ TO F:'F:OE;EC:UT ]: FSi
.h!!htZHUH D!STFINC.:E BE'T'I,!EEN FI HEL. L F!ND F!N'¢ ON-SiTE SEHRGE D).:~';POSRL. :F.;'¢STEPi iS
:;[.~3!3 FEET FOF.: i::i [::',r~::i:.',,,'Fl"i"E HEL.[~ L!R ;;t.t!SE'!. TO 2i3F't FEET FF.'OH R F'U[.:.',[..ZC; HELL DEF'ENDZNG
LiF'ON THE T'-.,-'F'E (.';il:::' F'UD[...iC HEL! .....
l"liNit'!Uhi DZSTFINC:E FF.'.[)i"! F.! Pi:;~:IVFITE !.,.IELL TO Fi F'F:tVFiTE S[:7. HER LZ.NE iS 2?5 FEET F!i'-,i[:,
TO R C:OHH[JNi'Tk' SEHEF.: LiNE ZS 75 FEET,
OTHEF? REQUIF..'[.~:HEN'FS H. FI'T' FIF'F'L',:.'. SF:'E[::.'[FZE:FIT:[ON21; RND OC~N:i!;Tri:LIO'T'i0N DIRGRF!HS FiRE
R',,,'FiiLRDI_F: TO .iNSUF::E F'!'.C'OPEF.': ,T, NSTRM.,.F!T.iON.
Z CERT I F:".i.' TH[:tT
._1.: i RH FFIP!:[LIFIR H:[TH 'THE REQUII:;:E.'.""!ENTS FOR Of,F-SITE SEHERS FIND HEL,[...S RS SET
FOF:T!q E,"¢ T[.'IE HUN i C I F'FtL. :[ "!"'¢ OF F!NC:[-ICIF.':F!GE.
2: .T..L!ZI...L. ZNS'!"FILL THE Sh.'STEH iN F!E:C:ORDF:!NCE HZTH TFIE CO[::,ES.,.
21:: .T. Ui'.L[)EFit:E;TF!ND THFIT THE ON-S]:TE '.SEI.,.!E.r..-:! S'¢E;TEH i',!Fi',..' F?.EE.!U ]: RE Ei',ILFfi:4tGEP!ENT IF' THE
REr:7;IE:,ENC:E :ES REP!O[)ELEE:, 'FO ]:h,ICLLt[:,E HOF:E THFIN 3: !3EDF%)OHS,
V4. ¢,
~-/
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10-
11
12
13-
14-
15
16
17
18
19
20
COMMENTS
SLOPE ~'~; SITE PLAN
WAS GROUND WATER
0
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
(minu{es/inch) !~ ~
PERFORMED BY: ~-.? .)(5 '~,-~
TEST RUN BETWEEN FT AND ~ FT
i ~ ' /:,-,. :.¥ , ,;, ,-,-~,.-'? ,~ ,iI
? ' ' ~z~
72-008 (6/79)
any,
o~
Jr__ INGRAM_ STREET
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plans for the construction of
public water system ocated
Alaska, submitted in accordance with 18 AAC 80.100
-~,'~, -' - have been reviewed and are
[] approved.
[] conditionally approved (see attached conditions),
BY TITL~ 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. Approved by
or descriptive reference)
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 ? ' , ; public
water system was completed on , ~ , ; (date). The system is hereby
granted interim approval to operate for 90 days following the cpmp et on date.
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
final ~.pproval to operate,
APPLI¢ 'NT FILLS OUT UPPER HA[..· ONLY
~Proper~yOwner'~4~/~¢.,,t" ~. 'Holri:~ d~. Phone
Buyer
Address Zip Code
~n~,n~,n~,,,u,~on ~/~ ~/~_/~/ /~ .~on~
Adagios ,~ ~. ~ /Y/~??C,~,_ zip CoDe
Realty Co. & A~nt Phone
Address Zip Code
StreetLocati~ ~ / -~-~ ~ ~.~c~r~.~ /'~
Type of Resi~nce 'J .......... ~
~ single Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply O Y,~,~, J o ~:~,-, e ,'
~ Individual )~O~;~a_~ ~?~,C~O~ A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ CommunitYPublic Utility' ~ ~' ~ ~ ~c~ ~'~' For~Owells.~drilled prior to that date, give well depth (attach log if available)~
Sewer Disposal
~ ~ndividu~ ~ ~ / ~. Yea~ ~ndiv~ua~ ~.~t~,~d: /~ ~ ~
~ 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 c~L~_ .~ ~.
Date Date Date Date
Insp~tor Inspirer Insp~tor Insp~to~
PALt~
Field Notes:
D~PT
( ~ ) APPROVED BEDROOMS *CONDITION8 OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE I i--~
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
72-023 (3182)
CHEMICAL & Gi~.,~LOGICAL LABORATORIES ~ ,~. ALASKA, INC.
TELEPHONE (g07)-279,4014
274-3364
ANCHORAGE INDUSTRIAL CENTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE .COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
· · .. £~ I.D. NO.
· /]' {) Phone No,
Water System Name
* :' I (/:, - /::, ,.. :'., ~n -.:-~'.
I
Mailing Address
City State
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
Zip Code
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
Time Collected
Collected By
3 I
4 I
TO. BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to oe:
[] Satisfactory
[] Unsatisfactory
[] Sampmtoo ong qtransit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample
DeiCe Received ' :>'
Time Received '--
Analytical Method:
[] Fermentation Tube
· :l~."Membrane Filter
Lab Ref. No. Result* Analyst
I
I
*No of colonies/lO0 mi. or No. of Positive Do~t~ons
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (bi
Rev. 1978
BACTERIO LOG ICAL WATER ANALYSIS RECORD
Date Collected Source
Time Recelvee __ ).m, Lab. No,
Presumptive 10mi 10mi 10mi 10mi 10mi 1,0mi 0.1m1
24 Hours
48 Hours
Confirmatory
24 Hours
48 HOURS
EMB Broth 24 hours: Broth 48 hours:
Multiple Tube Report: 10mi Tubas Positive/Total 10mi Portions
Membrane Filter: Direct Count Collform/100ml
Final Membrane Filter Results " Collform/lOOml