HomeMy WebLinkAboutTUXEDNI PARK BLK 1 LT 12Tuxedni'O Park
Block 1
Lot 12
#041-022-06
n Municipality of Anchorage �`' Page L of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW 9B0 587 PID Number: 0q1-OZZ .p(
Name:
art/��66�� /Si1LfC
Wastewater System: ❑ New ❑ Upgrade
"dd`eaa. 97
D0heneaaDr lin 99507
ABSORPTION FIELD
Phone: No. of Bedroolrls�._
O Deep Trench O Shallow Trench O Bed O Mou O Other
LEGAL DESCRIPTION
Soil Rating.
Total Depth lro riginal grade:
GPD Ft.
Lot: /nof Block: Subdivial
I
Depth to pipe bottom from original grade:
Grave ePm beneath pipe
Ft
Ft.
Township:
Range: Section:
Fill added aboveoriginal gde:
\�
Gravel length:
• Ft.
Ft.
WELL• ❑ New ❑ Up r de-
Gravel width: }(
Numberofflnes: DaarcebHeeeoiines
Classification (Pante. A,B,CI: T Depth: CasedTo:
Ft.
Total absorption a:
FI
Pipe material:
Ft. Ft.
SO. Ft,
Driller.
{ x15
Date Drilled:
Sank Water Letel:
Instslle
Date Installed:
Ft.
Yald:
Pump Set at:
C sng Height Atom Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
P(Septic ❑Holding 0S.T.E.P.
To
From
$ptc
Tank
Aeso pt*rt
Field
Lm
Station
a W.0
Tk
m
ubIIUPMete
Sewer uses
Manufacturer_. // //
0ZX 7a,7
CaPaoaT In gallons:
/SQD
Welt
/00+
100'4'
NA
,-„
—
Material: S&GG/
Number of Compartments: n
c
Wai re
/Do'+
/oO'f
—
—
--
LIFT STATION
Lot/D
Line
�O
+
—
.—
—
Size In gallons:
Manufacturer.
Foundation
/O f
/0,1
—
'Pump on' level at:
'Pump 1 at:
High water alarm at:
Curtain
/DO t
/00 it
Pump Wke i
Electrical Inspections Performed bY:
Remarks: 5e
BENCH MARK
Location and Description: / /+
/O D t CG/YJ 74
i6 / n a
at'o sf oar
Assumed Elevation:
e o vt/
+N``�1 FN1FFFFRR S\ SUL
At 4 r�
crti�t
••%OF
e'a 'V
Tri 4
Inspections performed by: Dates:1st 9 zs-ss'Go*
' e'• "" "' "" • " i
p*✓L
61 * 2nd G -/y-94 .-L ..... /
�
Kennua fA. irui:• tu/
cn a �
7116'�v.• YV�i
Department �4Q
of Heal and Uuman Services approval 9.ay.E
F
Reviewed and approved by: Date: z D o�0 E S
•.v..t tn.r. werl ucaw as
r"�-
^ 2 01c -Z
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW980387
TUXENDI PARK S/D, LOT 12, BLOCK 1 PID#041-022-06
A -C=32.0'
CWPUTCD:
B -C=66.0'
BIX DARt
A -D=35.0'
B -D=68.7'
STURRD:
DOWLING
4
KMD
A
DOWLING
O
N
SEPTIC
"W 4� OF ALgS
e �9 �f
/ * * I
ESNET DU
CE -7119 a
��
\ fib' FESS1oN.9w
SEPTIC
H
da
Cq_ 1500 S.T.
OT 12
5 BDRM
SFD
EXISTING SEPTIC FIELD
SCALE, 1'
PREPARED FOR: SCALEi NTS
BILL 6 DEBBIE MARCHANT
9700 CHENEGA DR.
ANCHORAGE, AK 99507
(907)337-6628
FIELD BOOKS
CWPUTCD:
BIX DARt
DOWLINGMA'
KM
STURRD:
DOWLING
"mo:
KMD
450u'LF
DOWLING
DAM:
6/26
D e RC:
omo:
2042
ACM "LE:
98132.DWG
'108 R°:
98132
KslD
UllX L ENGINEERING
20441 PTARMIGAN DLVD.
EAGLE RIVER, AK 99577-8736
I
�t.1�ec,�ic�l
MUNICIPALITY OFANCHORAGE 9.30 .qo 1?0%
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Sep 28, 1998
Expiration Date: Sep 28, 1999
Permit Number: SW980387 Parcel ID: 041-022-06
Legal Description: TUXEDNI PARK BLK 1 LT 12
Design Engineer. 0070 KND Engineering Site Address:
Owner Name: BILL & DEBBIE MARCHANT Lot Size: 106934 SO. FT.
Owner Address: 9700 CHENEGA DR Total Bedrooms: 5 Permit Bedrooms: 5
ANCHORAGE. AK 99507-1204
This permit Is for the construction of:
❑ Disposal Field ❑✓ Septic Tank ❑ 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 DHHS at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-4744 (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:
Issued By:
Date: 9- 2 8—'?9
`.,EF, -IC, A WFD eros —,� P. 02
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EASEI ENTS OF CI ,rPO, 011!F -R THM r'rt�f '+ d J�
THOSE SHUN 04 THE e2COrCE0 �,,3} '.a�
PLAT, 'ARE NOT SH13,vR; GEfiEOIL � ?y ft.l S.� Ltrltrt�.
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l_QTV VEI�CRTI�1CATo 1•om$4
P SlrrL ory
IAT,%? BLOCK / -v s/wrr>w • TACK
ANCHORAGE HCCOSOING VIS iHICTREVI3i0ti:+ _ Di:TE .l lY
-FCPA:,E; IDY: DYLING- 8 A g,SGGIATF$ li?SI d2hC0 0":
6128 LAKE OTIS PARK*,'AY
ANCHORAGE, ALASKA• 99507
le
� 6C7
GAAB.ND.I GREATER ANCHORAGE AREA BOROUr#H
I, , HEALTH DEPARTMENT f
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
333- 1
NAME
LOCATION_2!:!_Z 1C,=n0/y/ LEGAL DESCRIPTION44a_ .fsG� T!/X�pNi i/��CStK,
SEPTIC TANK:
DISTANCE FROM WELL �� ' MA
L.3Y�CC xx_-Z- IIOUID
LIQUID CAPACITY Z -rte �O GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT: le
-iry4cr�X/o x3SXdS".�/o
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH LENGTH DEPTH
Fu 4,!,c C-2
LINING MATERIAL DISTANCE FROM WELL. n / ,BUILDING FOUNDATION
NEAREST LOT UNE��->e4w. 11 . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) �U SO. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF
TOTAL LENGTH
FOUNDATION , NEAREST LOT LINE , OF LINES_
LINES
AREA SO. FT. NLENGTH OF
WIDTH
IN. TOTAL EFF
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL' TYPE Com✓ �
Zn 7'
41P
DEPTH ,
BUILDING FOUNDATION. SAMPLE
, NEAREST
NEAREST
LOT UNE .-,��' �f" , SEWER UNE
SEPTIC
±f�, TANK
0 SEEPAGE i
fZ_, SYSTEM /L)O , CESSPOOL
OTHER
f: , SOURCES—
DIAGRAM OF SYSTEM
DISTANCES:
71'
A-�c.-im'
.e—
M 1,
•T2 sC:,J�y. I
a`
DATE �i�1< �'g �i ils
GAAB-IID-2 GREATER'*'ANCHORAGE AREA T")ROUGH Case No..lt"�
IIEALTII DEPARTIIIENT
327 Eagle St. Anchorage, Alaska 99501 279.2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICAN C MAILING ADDRESS !A! PHO E NO "533
RESIDENCE Al
LEGAL DESCRIPTI
APPLICATION TO INSTALL: SEPTIC TANK L� , SEEPAGE
TO SERVE THE FOLLOWING FACILITY
L' , DRAIN FIELD
OTHER
FIN�ICED THROUGH TO BE INSTALLED BYCYL-Kf— /
BEST RESULTS ! 3�p ANTICIPATED DATE OF COMPLETION gyyf. 1l/n774-,F
BELOW TO BE FILLED OUT BY. HEALTH DEPARTMENT
THIS IS TO SERVE AS
, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
C!%�L�E'6IGrar.
SEPTIC TANK SIZE SOO TYPE J� SEEPAGE AREF� ��` TYPE
DISTANCES:�Ii,°.%%%Yf�il
rA,-7c /%IivIk'
pp
CIG�I�
its �3Ct
NEA LTM AUTHORITY
O
0.1AGRArIj OF S'fSTEM
R
■■■■■■s�i■■■■►sere■■■■■■
LICENSED DESIGNER
I certify that 1 am familiar with the requirements of Greater Anc orage Area Borough Ordinance No. 28-68 and hat the
above describe system is in accordance with said code. /YOr t/gL�p Gi/ICT/L- T ST'
DATE APPLICANTS SIGNATURE.4Y��� �(6�
_ GREATER ANCHORAGE AREA BOROUGH
HEALTH DEPARTMENT CASE Y
` 327 EAGLE STREET
' ANCHORAGE, ALASKA 99501
Performed For Charles T)IckgX Date Performed 8/7/70 .'
Legal Descriptions of 12 Block 1 Subdivision Tuxsidnia i
This Form Reports a: Soi s Log xx erco ation Test
Depth
r_.« Snil Characteristics Location Sketch
2
4
�$ 6
12
S�
Was Ground Nater Encountered? °o
e
If Yes. At EI -at Depth
Reading ::.:e
Gross Time Net Time Depth To M20 Net Drop
brown clayey silt (ML)
e
gray gravelly silt (ML)
i
gray fine sand w/ few fine
gravel (SP)
more gravel with depth
—
sandy fine to coarse gravel
S�
Was Ground Nater Encountered? °o
e
If Yes. At EI -at Depth
Reading ::.:e
Gross Time Net Time Depth To M20 Net Drop
e co a•..o.� I-1 nu e
Proposed In:tal ti:ion: Seepage Pit Drain Field
Depth Of Inlet Depth To Bottom Pit Or Trench
COMMENTS:
Test Performed By: R F rarlisle These recommendations are computed
from visual observation and based
on the unified classification system.
Data Certified By: National Testing Services, Inc.
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. d •11 - 0 2 2 - O S COSA #
Expiration Date:
1. GENERAL INFORMATION
Complete legal description _Jo> 12, !3/oc4 I 'Tuxe,e*,i Pct, -le S/b
Location (site address) 9700 Ctirneaci: 0r-1ve
Current Property owners)�1 t 11 Day phone S63 -S-S z3
Mailing address
Lending agency
Mailing address
9700 C4.&7V&t Do -,we, %l c"e4a arm Ak 993!!7
Day phone
Real Estate Agent Dbc-,c Wrndlo,- Day phone -7 27— 33ob
Mailing Address )ie Max, ll to w 3& `"/) v[ 99So?
Unless otherwise requested, COSA will behold by DSD for pickup. t'1 ectr� e« ll s�@ = == 2
w ben <<LfA rre.dy {esu /� irk -"P
2. NUMBER OF BEDROOMS: _5
3. TYPE OF WATER SUPPLY:
Individual Well
10
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site 19
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water
supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes,
ordinances, and regulations In effect at the time of installation.
Name of Firm Fl erNor Ted, n; ca/ S«.%. co- Phone 3 vs'- 13 sy
Address 7NS3e Itcho SA +Acho�afe Rye 996-1,4`
Engineer's Printed Name Thtoa(o.g F. rroo�e Date S App 2ao�
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By Original Certificate Date: — ' 0 6
)RM. 7V05)
IF
5. DSD SIGNATURE
'¢ itfEO�CRF F. Rt=kHtF �� 1G
Approved for bedrooms. =.'_>.'•.
__jC _
�, •� CE -3584
06,E
Disapproved.
,,••y,{ ar
Conditional approval for
bedrooms, with the following stipulations: a.+c•?
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By Original Certificate Date: — ' 0 6
)RM. 7V05)
Municipality of Anchorage
• V
Development Services Department
Building Safety Division `
On -Site Water & Wastewater Program
4700 Bragaw Street .
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onske
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: kat Ig,, 2 lat k 1, Ta x Nain 3 Park Parcel ID: ON/ -O Z Z -06
A. WELL DATA
Welltype Pvf
Date completed x 1 9 7O
Total depth = tOB ft.
Date of test
Static water level
Well production
If A. B, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased toy YO ft.
FROM WELL LOG
Well Log (Y/N)
Wires properly protected (YIN) Y—
Casing height (above ground) $S- in.
AT INSPECTION
3/ 2d/ z&w6
ft. 69 ft.
g.p.m. 6.9 g.p.m.
WATER SAMPLE RESULTS:
Coliform _Q_colonies/100 mL Nitrate .1.31 mg/L
Arsenic: 45' ppb date of sample: 312110d -
B.
/2y/06B. SEPTIC/HOLDING TANK DATA
TankType/Material Selghe /.,SAPOI
Other bacteria 0 colonies/100 mL
Collected by: F/wf/oy, Tao Sit
Date installed 9/ Z9 / 94f
Tank size 15&0 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) iV • .!.
Date of pumping 6/ /7/ OS Pumper Den a 1; P.r'npo hl
C. ABSORPTION FIELD DATA
Date installed 8/ 7 /70 Soil rating (g.p.d./ft' or ftZ/bdrm)13� System type 2 /+#b
Length "is' ft. Width ys ft. Gravel below pipe _><ft.
Total depth 11 ft. Eff. absorption area eft' Monitoring tube Y Depression over field N
Date of adequacy test 3 /Z V /406 Results (Pass/Fail) Paw For S bedrooms
13 is, 3
Fluid depth in absorption field before lest f_ in. ry Water addedlgZ gal. New depth/.Z in.
Elapsed Time: >Y min. Final fluid depth 'Z-3 in. Absorption rate >= '7Ja g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) Noat 1-cno c -C If yes, give date N-'+.
D. LIFT STATION N. 4•
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on' level at —in. 'Pump off" level at _ in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 109 C ti. On adjacent lots I G G
Absorption field on lot /G7' is e,G, On adjacent lots cac,r
Public sewer main N • A. Public sewer manhole/cleanout N • /-
Sewer /septic service line > ZS' Holding tank ti+•
Animal containment areas N • A. Manurelanimal excrete storage areas N• 14
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation $D' 4;- C•o, Property line /I S' Absorption field 19' b e Aw, e•o. c
Water main Water service line > Io' Surface water > I00'
Wells on adjacent lots t;, I00'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line �:Zf &;' fi" C. Building foundation i"'A 4 Water main J1_*• .4.
Water Service line > to' Surface water 1 /GO' Driveway, parking/vehicle storage '> /C.0
Curtain drain Von# See^ Wells on adjacent lots > 10o •
F. COMMENTS
G. ENGINEER'S CERTIFICATION
i certify that I have determined through field inspections and r a ; _j9T11 ;+� d
n.....................:...�
review of Municipal records that the above systems are in f�
conformance with MOA COSA guidelines in effect on this date. ,„ ..............,
4 ::tKODORE F. MOORE .17
Engineer's Printed Name Th eageoee /_• r Bone
Date A4nr3/
COSA Fee $ y3o Waiver Fee $
Date of Payment 11 q�D Dale of Payment
Receipt Number g gg Receipt Number
(Rev. 11/05)
4Q,
v%
/ TRIO • CLEC. [BMY.
,7 ..OF
....................,.[�.......*.
0 SHANE A. HOLT: 0
a
LS -6914 A,
:;
EASEMENTS OF RECORD. OTFER Tj WSE S1K)WN ON THE RECORDED PUT. ME NOT SHOWN HEREON
NOTE ANY FENCELMES S1 ME LOCATED APPRO% TELY MD ME ACT TO BE USED TO DETERMINE PROPERTY MES
OR LO=E STRUCTURES.
AS -WILT SURVEY
SCALE r • W
I HEREBY CERTIFY THAT I IIAVE FERFORMED A
MORTGAGLE'S INSPECTION OF THE FOLLOWING
DESCRIBED PROPERTY.
LOT 11. KMK 1. TU%EDM PARK SUB
ANCHORAGE WCOADING DISTRICT. ALASKA AND THAT
THE WFROVEMENTS SITUATED THEREON ARE WITHIN THE
PROPERTY LANES AND NO WSIBLE ENCROACHMENTS EXIST
OTHER THAN NOTED.
DATED AT AM:HOMGE. ALASKA TMS 11TH
DAY OF MAAEN
1IOLT LAW SUMEYING 10086 173 U
TEL. U"510
MUNICIPALITY OF ANCHORAGE
97�
Department of Health &Human ServicesDIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # ntl 1 - C-7 q �'�d .+ HAA #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
LOT 12: Etoch 1: TUXEDNI PARK SUBDIVISION
Location (address or directions)
705 Noh.thmy D4i:ve
(b) Property owner Ch4kees 114cl•er; Telephone: (home) _333-5334 Business 274-2886
Mailing Address 705 Noa.thwav DRtve, Anchoaage. AK 99508
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
Telephone
(e) Mail the HAA to the following address: (or check herejz.if hold for pick up.)
List contact person and day phone number below:
5 L 5 ENGINEERING
17024 Eagle River lost. Road N*,,M
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family ISX Number of bedrooms 5
3. WATER SUPPLY
Individual Well [%X Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site CYX Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-M5(Rm 7/88( Page 1 of 2
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MUNICIPALITY OF ANCHORAGE (MOA)
• m of Ar,,"I4AUthority Approval (HAA)
F NT SekvILC1i�K61�343 4744UARY 1984
AUG 2 q 1989 Legal Description: _torr 12 r g y= 1
L)xE-nJt
A. WELL DATA RECEIVED
Well Classification ( t, P%41 DJC If A, B, C, D.E.C. Approved (Y/N) a�A
Well Log Present (Y/ST) Date Completed L 1`1-112 Yield S •'� QVI-1
Total Depth 01�Cased to v%L Depth of Grouting ( t3 - 1
Static Water Level blot Pump Set At oy---
Casing Height Above Ground IZ I+ Sanitary Seal on Casing (VN)
Electrical Wiring in Conduit (QIN) S Depression Around Wellhead (Yq%1)
SEPARATION DISTANCES FROM WELL:
i
To Septic/Holding Tank on Lot �-n 1 ; On Adjoining Lots _t m 1-(
To Nearest Edge of Absorption Field on Lot (�t-4" ; On Adjoining Lots C'b
To Nearest Public Sewer Line a �' To Nearest Public Sewer Cleanout/Manhole
1
To Nearest Sewer Service Line on Lot 25 4 -
Water Sample Collected by S * S 151* f1 tx� :Date "� 1 - en
Water Sample Test Results , * rgo&, S
Comments` I.A-,0. 'n-= TIME c94rI-0.j
B. SEPTIC/HOLDING TANK DATA
Date Installed 660' Size ANO. of Compartments _--
Standpipes o/N) y -Air -tight Caps (1G/N) � Foundation Cleanout �P/N)
Depression over Tank (YAq a Date Last Pumped
Pumping/Maintenance Contact on File (Y/N) r4/A- ; for
Holding Tank High -Water Alarm (Y/N) _r'l A Temporary Holding Tank Permit (Y/N) r A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
(
To Water -Supply Well —11 To Building Foundation
To Property Line 10 4 To Disposal Field 2A�
To Water Main/Service Line 1 C> 14-
To
+To Stream, Pond, Lake or Major Drainage Course C>� I+
Comments =Z=� #L1-► x.47. Gl��a S JIC r
72-M(Flw. 7/88)Fwt Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design��
Date Installed 46— i— '7c Length of Field 4,-6c- 1 ri se
Width of Field Ar4SP• F-C'VO4-'T' Depth of Field
Gravel Bed Thickness b 7
Square Feet of Absortion Area 1 e8o� Statndpipes Present (!P/N)
Depression over Field (YL Date of Last Adequacy Test
Results of Last Adequacy TestS 532,
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well ) �5' To Property Line ( o t }
To Building Foundation t.�or 1= To Existing or Abandoned System on
Lot A /P ; On Adjoining Lots 301
To Water Main/Service Line o (A To Cutback (if present) .Z la
To Stream, Pond, Lake, or Major Drainage Course t cr>014-
To Driveway, Parking Area, or Vehicle Storage Area ' ao ra
Comments
D. LIFT STATION
Dat stalled .
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
— Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
"Check Permitted Bedroom Rating Against HAA Request"
certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
inspection.
Signed 5 SEPIGINEERING
Company 17034 Eagle River Loop Roao r.... d
Eagle Rim Z s a11
Date
MOA No. CC S
Receipt No. a2 Z3 Receipt No.
Date of Payment ((�r_2 9 Waiver Fee: $ _
Amount: $ 126,00 Date of Payment
72-M (Rev.7/BB) Back Page 2 of 2
>e
R. Ehr!er
this
fi
CHEMICAL R GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562.2343 5633 B Street
y._ Anchorage, Alaska 99518 �•y;
•�•• Drinking Water Analysis Report for Total Coliform Bacteria y
TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY
❑ PUBLIC WATER SYSTEM I.D.11 Analysis shows this Water SAMPLE to be:
K PRIVATE WATER SYSTEM 4 Satisfactory
Name Phone No. ❑ Unsatisfactory
S b S ENGINEERIflea ❑ Sample too long In transit; sample should
not be over 30 hours old at examination
Mailing Address age River oReadNo. 204 to Indicate reliable results. Please send
Eagle River, Alaska 99595 77 new sample via special delivery mall.
City State��''j Zip Code
SAMPLE DATE: Mi LTJ LIJ
Mo. Day Year
SAMPLE TYPE:
Routine
Check Sample (for routine sample
with lab ref. no. 1 ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE
Time
Collected
NO.
LOCATION
Collected
y
21
3
1 I
41
s
l I
Date Received .1 /—
Time Received /✓ CV
Analytical Method: Membrane Filter
No. of colonies/100 ml.
Lab Ref. No. Result' Analyst
I ® __40Y_
U m
I m
U m
U m
BACTERIOLOGICAL WATER ANALYSIS F)EaCORD
. 8/zzla�
pu
READ INSTRUCTIONS Membrane Filter. Direct Count Conform/100ml
BEFORE Verification: LTB Bre
COLLECTING SAMPLE Final Membrane Filto ults t9Glil rm/100ml
Ry
�!!
eported Dy / Date d=/'/—
Time: a.m.
•� p.m.
TNTC = Too Numberous To Count
OB = Other Bacteria rwlzr i. of z R£MAINDCR TO FOLLOW
�_' 4 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
_ 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 5622303
FEDERAL TAX ID N 920040440
INALI3I3 tLPCRT DI SAMPLE for Work Order 8 15963
Cate Report Printed: AUG 22 89 4 21:36
Client Sample ID:112 E1 TSTECNI
PW31D :UA
Collected AUG 21 89 4 11:30 hro.
Received AUO 21 89 4 12:00 hs.
Preserved with :AS RECUIRID
Analysis Completed tAUG 21 E9
Laboratory Supervisor •STIPffiN C. �ID�E� �
Released By
.................................................
Special
Instruct:
Chemlob Ref S: 7078 Lab Smpl ID: I
Parameter Tested
NITRATI-N
Sample SA)3LE COLLECTED RT RI
Rannrke:
Client Nano : S G S IN2
Client Acct : SNSENGP
P.0.8 NCNE RECEIVED
Req I
Ordered Ey :
Sen: Reports to: '
1)S 4 S WR
2) i
...................................................................
Matrix: WATIR
tesult/Units
------------
1.6 sq/1
Method
IPA 353.2
..............................................................................................
1 Tuts Performed See Special Instructions Above Ul-Unavailable
ND- None Detected See Sampl• Iemzks Above
Wk. Not Analyzed LT -Leu Than, GT-Greato-. Than
Allowable
Limits
10
MUNICIPALITY OF ANCHORAGE—•
DEPARTMEI OF HEALTH AND ENVIRONMENT . PROTECTION
825 L Street, Anchorace. Alaska 99501
264-4720
#1: Time 10:30 a.m. #2: Time
Date 3-20-78 Monday Date
Insp Pratt
Insp
Date Received: March 17. 1978
#3: Time
Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
% Una Bennett
1. Lending Institution Request: First National Bank of Anchorage
Mailing Address: Post Office Box 4-2090 99509 Phone: 274-1521/42
2. Property Owner: Charles H/Marie M. Dickey Phone: 333-5334
Mailing Address: 9700 CheneRa Drive
3. Legal Description: Lot 12 Block 1 Tuxedni Park Subdivision
4: Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms: Five
Number of Bedrooms:
5. Well System: Individual Well (x) Community/Public System ( )
Permit #
Construction
Depth of Well 108, Well Log on File ( )
Bacterial Analysis
6. Sewage Disposal System: On-site System (x)
Permit #
Public Utility ( )
Installed 1971 Installer
Septic Tank Size /S-00 Manufacturer
Absorption Area Soils Rate Material Caj
3 i•-
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line
to Nearest Lot Line
Nearest Lot line
Absorption Area
n
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 12 Block 1 Tuxedni Park Subdivision
Comments:
Affadavit Attached:/7N) Letter Attached: ( )
Approved:
Date:
Disapproved: Date:
Department Worksheet: l
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(OP!, +axle e.S)—0301AONd 33VV3AO3 MUM] ON 008E W. 41 Sd z
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3003 J1Z ONV 31Y1S "0'd 00
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Sn1d) 00£-11M 031411830 a0d 1d1303H
MUNICIPALITY OF ANCHORAGE
♦ I Department of Health and Environmental Protection
825 L Street, Anchorage, Alaska 99501
264-4720
�•—:tequest for Approval of Individual Sewer and Water Facilities
1. Property Owner: C LIAR L, ES N _ [YM AR i 111.. n ►C r .a
Phone: �3-S33V
Mailing Address: 970e)l-kr~ rt/� �o � LIZ —,-
2. Name of Buyer: P r-% NA-rf C E
Mailing Address:
Phone:
3. Lending Institution: 5-- lY,f:P/ONA AAgr _Qc1 r-ffcr.✓rek
Mailing Address:cj 104 /dNCHcIt+4tc ii L�'hone:a7�FtSa/ £tY�
4VWA 4?ryVe_TT-
4. Realtor/Agent:
Mailing Address:
Phone:
5. Legal Description: (�pT- I a (j 1x Y ( I L4 XF_V&I M rK.3uB IS
Street Location: Q 706 C SFr -, A •A K
6. Single Family Residence: (tX Number of Bedrooms: d -=7 -
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply:_ *Individual Well (H' Public/Community System ( )
If Individual Well, well depth 10 8
If Community System, name of system
8. Sewage Disposal System: *'bn-site System (*'j Public System ( )
If On-site System, date of installation:' %%i/ — f 9.71
*NOTE: A well log is required on ALL wells drilled since 6/75.
**If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77