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HomeMy WebLinkAboutUS SURVEY 3043 LT 70A0cl \ - \q ~ MUNICIPALITY OF ANCHORAGE~ ~' Department~ ~ Health and Environmenta ?rotection 825 ~ Street, Anchorage, AK. 99501 ~'' 264~4720 * * * HANDWRITTEN PERMIT * * * Permit # WELL A~E~ PERMIT Applicant: _ ~C ~C~>'r~P<-A~'<~>~'~'~ Mailing Address..IC> Location: Phone Number: .~ ( J~ Lot Size: Type 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 --' LENGTH ..... GRAVEL DEPTH 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 = '------" 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 departmen~ 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 1 9 8 3 * ~ * I certify that: (!) 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 residence is remodeled to include more that 3 bedrooms. Signe~: Issued by: Applicant . ~ Date' swp/024 -~ M N~C~PALI Y OF ANCHORA~ . ~ D~pa~tm~ of H~alth and EnVironment~ ~roteo~txo~ ~2~ ~ gkree%, ~chora~e, AK. 99~01 ~4~720 ~e~m~ .~ ' ~LL ' ~ . P~RMiT ~¢~ion: ~ ~ Phone Nu~: ~: ~?- Maxim~ N~b~r of Bedrooms: ~ Soi~ ~at~g(aq.ft/br) ....... WIDTH LENGTH GRAVEL DEPTH ~the boC~om of ehe e~cava~ion(~n eeoc). ~re i~ n0 ~t w~d~h for <The grave~ depth is ~he min~ depth o~ g~av-! b~ween the out~a~l ~Bhe ~tom of the excavation(in ' ~ fl~QUIR~D SEPTIC HO~IN TANK ${ZE ~ GALLONS e of residences that the well will ~erva. - '' ' ' for a prmva~e w~li or l~0 to ~00 feet ~rom a publi~ w~%l depending upon ~: ~ p~b~'~c we~.- :'M~n~ ~a~an~a from a.pr~vate well to a przva~e ~ certify th~ (~) ~ ~ f~illar with the retirements for on-si~ sewers and set forth by th~ M~pal~y of .~cho~age. ~~[~ ~em°d~l~ to ~nclude ~re ~hat 3 ~rOO~S.. Well Owner D_A2q~5 rvI-W DRILLING, Inc. P.O. Box 10-978 · 10500 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Use of Well lt~nmstic Location (address of: Township, Range, Section, if known; or distance mmn road Lot 7OA USS ~h't043 Size of easing 6" Depth of Hole 82 feet Cased to 80,7 feet Static wate~ level 46 ft. (l~lfoV~)" (below) lane surface. Finish of well (check one) Semen ( ); Perforated ( ). open end ( XX ); Describe screen or perforation ?,lone- Well pumping test at 5. gallons per of drawdown from static level. (minute) for 1 hours with Date of completion Depth in feet from ground surface 0 TO 2 2 TO_ 4 4 .TO_ 15 15 TO 20 Give details of formations penetrated, size of material, colo s Org~e 20 .TO 75 Gray silty 75 TO 83 .TO. .TO_ ¸TO_ TO_ TO_ TO __TO TO NWW,~ Gertifl~i ~{~ "ertificate No','. 814 ~ F~ 3--CONTRACTOR HAL. : APPEIC-~NT 'FILLS OUT UPPER ~ONLY ':~ :,'t. ~. * ~ :~ '-~ .~: .~..I ~-;~ .{-~/'~ ~!\1~'[ ]?'~ Phone Buyer ~ - Address , ~ ,:, , :,, L~.~ L,':, ~; ~: ~Lk/b ~ (~ ~ )~' / /-~ ~0~-~.~ -~ pCode Address ' /~J ~ ' · Zip Code · Type of ~esi~nce ~ Other Time Time Time Time Date Date Date Oate ~//-~L~C~ ~~ \' Inspector Insp6ctor Insp6ctor Inspector ~ ~ FieldNotes: ~//~ ~ ~ ~=~ ..... OF ._ ~ ENVIRONMENTAL PROTECTION JUL 5 1983 ( ~PROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CON DITIO NA ~ML' Soils Rating Date ~wer Installed WePTo ~sorption Area Well Log Received Well to Tank Septic T~k Size · CHEMICAL & Gl LOGICAL LABORATORIES tJF, ALASKA, INC. TELEPHONE (907) 552-2343 ANCHORAGE INDUSTRIAL OENTER · 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Mo. Day Year SAMPLE TYPE: [] Routine ~ Check Sample (fol' routine sample with lab ref. no. [] Special Purpose r- Treated Water [] Untreated Water SAMPLE NO. I I I I LOCATION I Time Collected Colleoted TO RE COMPLETED BY LABORATORY .~,~alys~s shows this Water SAMPLE to be: ~"~t isf act o r ¥ [] ~nsatisfactor¥ [] Sam 31e Too ~ong in transit; samole should ~bt ee over 48 hours o1(~ at examination to nomate reliable results Please send new sample. Date Received '~- 7-7 3 Time Received t~,~ ~ Analytical Method: [] Fermentation Tube ~ /[~embrane Filter Result* Analyst J Lab Ref. No. -. ~?~7-/~ I I J READ INSTRUCTIONS ' BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Lab. NO. Presumptive 10mi 10mi :[0ml 10mi 10mi 1.0mi 0.]mi , 48 Hours Confirmatory Time* 7.F~'~. ~,~ (~') a.m.