HomeMy WebLinkAboutTIMBERLUX #3 BLK J LT 8o"
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Jun 13 22 06:46p Anchorage Well & Pump Ser
9072430742 p.1
MUNICIPALITY OF ANCHORAGE
a
Development Services DepartmentPhone: 907-343-7904
On -Site Water & Wastewater Section I / Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: Date of Issue:
Parcel Identification Number: 018 271 76
Legal Description Block Lot Property Owner Name & Address:
BUSSE GARY R 50% & BUSSE KIMBERLI S 50%
TIMBERLUX #3 J 8 15040 CURVELL DRIVE
ANCHORAGE, AK 99516
Pump Installation Date: os _ 13 _ 2022
Pump Intake Depth Below Top of Well Casing: 50
Pump Manufacturer's Name: A.Y. MCDONALD
PnmD Model: 230SOV3
Pump Size: • 50
feet
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Manufacturer's Name: MARTS NSON
Pitless Adapter Installer:
Well Disinfected Upon Completion? V Yes ❑ No
Method of Disinfection: PELLETS IF
I Comments:
Pump Installer Name:. ANCHORAGE WELL & PUMP SERVICE
Company: 7640 KING STREET
p y' ANCHORAGE, AK 99518
Mailing Address: 907-243-0740
City:
State: Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage Page of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 a Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: PID Number: _01627176
Name:
Al-i,-A) L• SlnnUalS
Wastewater stem: ❑ New
System: J% Upgrade
Address: l5Cil-I0 toevcl.t QR.
ABSORPTION FIELD
Phone:
563 - 5 s oa
No. of Bedrooms:
�
❑Deep Trench ❑ Shallow Trench j(eed O Mound ❑Other
LEGAL DESCRIPTION
Soil Rating: G
D•
Total Depth from o gi?Trade:
4
v GPD/Sq Ft
Lot: Block: T Subdivision:
'r�M(i.-LrLVX
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
iD �J
3.2 Ft.
0..s Ft.
Township:
TI u
Range:
R 3w
Section:
3y
Fill added above original grade:
Gravel length:
HU Pi`
o Ft
Ft
❑ New ❑ Upgrade
G18vB1lh:w
Numines:
Dtabebeena lines :
Ft.
Classification (Private, A.B,C):
Total Depth:Cased
To:
Total absorption area:
600
Pipe material: Arc
Ft.
SO Ft,
—
Driller:
Driller:
Date Drilled:
Static Water Level:
Installer.
+A)",; 6EfCu14ES
Date Installed:
Mit
Ft.
09
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
➢!Septic ElHolding ElS.T.E.P.
To
From
Septic
Tana
Abaorpllm
Field
un
Statim(•
Homing
Tank
PublictPrivate
Seer Linn
w
Manufacturer.
n x+•I'
Capacity In gallons:
000 6AL .
Well
'LSC+
I�,(JR
Ix(t
I1/A
N it
)rt
Mated; bmf ISS 1
Number of Compartments:
2
Wai r
WAX
Fwr.xo
LIFT STATION
LotL
Line
- t
J
7, `I
V
6 C r
V
IJA
�'A J'
i✓
SIz s in 5000(19:
Manufacture r.O � tV G U
Foundation
1
21
0•
-1
,351
N/g
>1op1
"Pump on" level at:
26�nctin
"Pump off" level at:
(,.A e.
High water alarm at:
3H!nc4es
Curtain
Drain
kr/A
N/,4 I
N/A
IJ
)VIA
Pump Make 6 Model
FanNkuN
Electrical Inspections performed by:
sooms?wwS -1.it: c r2�c
Remarks:
BENCH MARK
Location and Description:
cam. w as e,-,l;eck
f{1�se
1k
y Doges e, p -( 1pI. 1Jo'm-
Auum'Elevatti
pp: Ft
r�
II I`%Scri helve been vllect.
'==`c,�wFrrw�s\�L
OF ACgs�a�
-
�• .gT .•
Inspections performed by: 5 �IC�Lur1 Sn:snrM Ko Dates: is 9/
ae ...p�,
2nd o 1 1
p1o. 10511 W
:
/�
�—''
Department of Health and Human Services approval
QFGIST'V •.
Reviewed and approved by: Date:
n-017 (1191) MOA 25
Perna Na- C tV 11 1.r„N'
2, Page 3 nF
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 19665 Anchorage, Alsoka 99516-6650 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal description: UPTE 14LKJ "I InrpXLt,k Le H7 PID No.: VIW2=1174
GREEN HOUSE
Y
i
' NEW FEILD
LOT 81
' MONITOR ,} - MONITOR
4f C.O.
EXISTING FEILD I
0
PWTTANK 'BOO
e. p. �s h� SCALE: 1' 20'
DECK 2' O.H.
1 STY. FIRM.
HSE.
..PSE N~',, � ♦i
49 i
r
r
♦♦� No.+nst-e 1 �
♦�
Permit No. SW 9 102y B
Page �:) of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: wT iF . 6 L K J TIM&PLOA- SUP,. if ? PID No.: 0182717,<
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72-019 A (2191) MOA 25 D
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RECEIVED
SEP 2 31991
h4unicip�h( Flume°'
G�
�.,
INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
3500 EAST TUDOR ROAD
INSPECTIONS (907) 569-3464 INFORMATION (907) 786-82
NAME t
STREETADDRES3w l"5^
LOT/ V BLOCK/ �
C /� If[�II77yPEHO�RMIT NO.- 9
vsa�
, PHONE � 4;
SU11:11L n^''��I^�'�" ��.ATE�-/19/
,FOOTING -- ---- -❑-ELEC.
FOUNDATION _
BOND BEAM
FRAMING
INSULATION
SHEETROCK
STRUCT. FINAL _
OTHER
TEMP.-__--`-❑--PLBG.UNDGR.�_`❑-
❑ ELEC. SERVICE / A a PLBG. ROUGH _ ❑
❑ ELEC. ROUG GAS TEMP. ❑
❑ ELEC. FINAL I I ❑ GAS ❑ .
❑ OTHER ❑ MECHANICAL ❑-.
❑ MECH. FINAL ❑
❑ FIRE FINAL ❑ PLBG. FINAL ❑
❑ ZONING ❑ OTHER ❑
O NONCOMPLIANCE OBSERVED O CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW /
❑ WILL REEXAMINE AT NEXT INSPECTION 000 NOT CONCEAL UNTIL REINSPECTED
COMMENTS
�t
_ INSPECTOR '� DATE
THEN CORRECTIONS AMC MADE. PLEASE CALL FOR INSPECTION
DO NOT REMOVE THIS NOTICE
eaax m..- nnTl
4
IMA
I
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910248
DESIGN ENGINEER:TRYCK, NYMAN & HAYES
OWNER NAME:SIMMONS ALLEN L &
OWNER ADDRESS:15040 CURVELL DR
ANCHORAGE,AK 99517
PARCEL ID:01827176
LEGAL DESCRIPTION: TIMBERLUX #3 BLK J LT 8
LOT SIZE: 49346 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 8/26/91
EXPIRATION DATE: 8/26/92
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED B
ISSUED BY:
DATE: Uy
DATE:
ENGINEERS/SURVEYORS/LANDSCAPE ARCHITECTS
TRANSPORATION ii COMMUNITY PUNNING
August 19, 1991
Mr. Dan Roth
Municipality of Anchorage
8th and L Street
AK 99501
Dear Mr. Roth
5053.0
RF.: Lot 8, Block J,
Timberlux Subdivsion Addition 3
Attached is a permit application for upgrading septic system
on the above referenced lot. A narrative description of probable
impacts to adjacent property is discussed below:
Wells - We anticipate no impact to the wells on the lot or on
adjacent lots. All wells adjacent to the new septic system are
located greater than 100 feet from the new system. No groundwater
was encountered and the wells all have sanitary seals in place.
Wastewater Systems - The proposed pressure bed system will
replace the existing system. Testing of the existing system
indicated it no longer accepted the amount of water it was designed
to. The new septic system will eliminate potential impacts to
adjacent property by replacing a failing undersized field with a
new adequately sized field.
Reserve Space - Although no formal evaluation of reserve was
completed, the lot is a relatively large one and can accept future
fields.
Drainage - The on-site well casing and septic tank had or will
have positive drainage away from the improvement. The absorption
field will be constructed along a contour interval and the cross -
slope drainage slopes range from 0 - 50. A drainage easement at the
rear of the lot was located well over 100 ft. from the proposed
system. The absorption system site had good positive drainage and
no drainage impacts to adjacent properties are expected.
Please review the attached information and issue an approval to
construct the new system.
_ OF Al. aI%
i... ...•.. qs i�
r Gj .
J
...h..,V16353
.III �.S•M rGJ
U' ?„
v
6 @ e ®ao0aaaa„'�P�~�S
Yours Very Truly
TR CKNYMAN IIAYES,INC.
Carey ; Me r, F.E.
911 West Eighth Avenue 9 Anchorage, Alaska 995013497 . (907) 279 0543/FAX (907) 2767679
A
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: p T DATE
LEGAL DESCRIPTION: L9, Ej mpp t l o v 5obrl. Township. Range. Section:
DEPTH AiA• •'^ 'f SLOPE
(FEET) OL OCbA"IC,S
14'
SAX) 0V SILT
2--
3.-
4-
5-
6
3 4 56
7-
10-
11 10it
12-
13-
14-
15--
16-
17-
18-
19
213141516171819
20
IC -res-T
SILTY SA)i0
S ILT
S07 -r -M OF
fIOLE
Al LLTL3T5
ArTC1',741`13
%k'1N7 i7.1i?7
lo6 n
WAS GROUND WATER ND
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
it" r War
New"?jo ala
SITE PLAN
■■■■■■■Rt��t.■
Gro"
Time
Net Deed+ to
Time Wear
Net
Drop
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NEMEENNEE
NEENNNEMEN
NOMEMEN
ENNEENNEEN
ENEENNEENE
NEENNEEMEN
Reeding Date
Gro"
Time
Net Deed+ to
Time Wear
Net
Drop
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PERCOLATION RATE Im,nutminchl PERC HOLE DIAMETER ^
n TEST RUN BETWEEN FT AND FT
COMMENTS R1160LATIOij ffOLt tyAS P2G 5OAKtO .211001?" .
PERFORMED BY:-)flAtu" ,SA)ISARFUrr(� 1 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCOROANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.
LvT 71 It 6crty{ SoB.. .
- - -----
i DESI(w FLOW S0,2 1.4&j
- i bfSIVtJ "INFILTICA7/OL> QATt=' � :. - ..
PEruowoTIOAL,:.FATE .:�,3$ 'r)l,^/n
-- ---- - -- , fAeLe 1 cl+Ac�rele 15.6s
CLaik5rd WAT614 'Q13^3r^L
Rew L,y TIo us
H0wCvtp_, A , vALue OF �cvat..'dl:. casco A,7 -rm L`:
I
F-Dowd :.1 P4 At Lot PCOK: Te -sr AGPtgR.rro 6E Ot A StlemrLv
i
Bco 512.0; (AQ,SoRBT/oN�
`1501 pal 562.:Sf+z
UsIN61,4 IS'.&40a cwlorH ;L 37.Sf+ 'U.sc cloFi t3L�o
i
USr IS' erowlorH (NI rl1 A `/oryor Ltucrrl.
THE 6xUTW6 . SEPTIC T^uK HAS 1000 6A CAPACITY' Aun kllLL ,
BE v5j�0 .IF 1r IS fvv NO To QE .10 ..CATIJ rAC•Tc>)Zr ;COa0ITloA.)
AF-rck IuIPEc'flvU.
AIJ ACPLAbc SlesreAjs LIF'TSTAT/ON -CIIALL'et VTIL17E0 Ia -rHC
PEW SY-ITCN Tit PCANIT- 000 4Ac2 is
�' O A`.gs'�9
_ F
_ _ . -- ---- — -- J• �P�.
..:
CMR. DARE ,•wV•E�•T,'_� �,� ��• CO a $�.5 y ! : � f
F.S. SHEET OF • _ •�n`//11//_`` Y^U^�' Q �<C,9•• •�V�_�
JOB NO. SCALE \P±D.E1111 ? +
Permit No
�a0e nF
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 19665 Anchorage, Atsaka 99516-6650 Telephone, 343-4744
On -Site Wastewater Disposal System and/or Well inspection Repori
Legal doscriptio s PID Nor
woswwv Karr
w Wawa[ a vn.. anc
------------------
ZMT.woiime
WRLL ra t
rm tnrwTna
oar Kuc�
Lev reu
LOT 81
1,.
y aa:rac �� 1
smc r ax
I M. rift
vai
WELL w K or or v Karr �y
of 44. 1�
:'�F� � ••......,., •QST i
rhe:' 97
jw '97" •:*fie
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S. Mey
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i
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PRESURE DISTRIBUTION SYSTEM
ACREAGE TANK LIFT STATION
TIBERLUX SUB. N3
15040 LURVELLE DRIVE
MONITOR
MONITOR
MONITOR
i
SYSTEM SHALL HAVE 3' COVER OR
INSULATION OVER FABRIC. ACREAGE TANK
PRESSURE DISTRIBUTION
FIELD
LOOPING LINES OF 1 1/4" PIPE WITH HOLES AT 48"
wL6 5 HM.& 3c Lilt • ¢'
40'
PVC SCH 40 PIPE
1I5'
1
'OR
IE
Figure 1.
ACREAGE SYSTEMS, INC. RESIDENTIAL LIFT STATION
Finish
Grad
Pump Power Cable 4" i 'd styrofoam
High Water Level A ar 1-bd
Cable to Hous
—4" Inlet
7
High Water Alarm
� e
7
Pump on /off .0i
Cp��'OF,q�q�'��•�+ E
r
Carey S. Meyer
�. " • N6753
�vFFOFESS';�;\i� 1'
Lid
150 gal.
Reserve Capacity
N
O
N '
CV
4"
r-
0
.',
12" gravel or crushed stone backf
s
m
M
s
N
io
M
1. All connections through manhole wall to include rubber gaskets
2. If commercial use, then all underground wiring in conduit.
3. J -Box to include control panel for pump operation.
4. Manhole steps can be added as an optional item at'time of const.
L
curves � I .eLB�
eff luent■■■■■■■■■■■■■■■■®
pumps
■c.■■.■■■■■■■■■■■■■■■■
ON
■■■■iurrrnrarr..r�����
Watertight cable entry
_ materials of construction
High tor0ue capacitor
start motors for
Single phase
is I .
Built in thermal protection in
tingle phase units
Dynamically balanced rotor
• Upper lip teal angle
mounted for long life
-Seal oil Chamber
0
All O-Rmg
Motor Housing
Cost Iron
hell
420
"Upper Seal
LI
Lower Seal -
Carbon
and Ceramic
Beerin 9
Heavy Duty Ball
Impeller
Cast Iron
Bottom Plate
Cast Iron
Volute
Cast Iron....
Hardware
304SS
Dual voltage
.Oversized sell lubricated ball
bearings
Oil filled motor
All external hardware 304SS r
2" or 3•'.dscharge flange
Open 2 vena L•:•i-}-..., .'yK:.
u:•
nOn•CIOg impeller
with back Wneb
Carbon ceramic mechanical seal
%..
Spiral bottom plate, a0jusla010 Adjusting screw
and self-cleaning
• 3-0 W SESK 1.5 tr4 2.0 He SJs. W Y SJE messy,
Note: SEVH and SJV Vortex models not Shown.
J
^' Municipality of Anchorage
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION POUCH 6.650 ANCHORAGE, ALASKA 99501
INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL
NAME NIs lAlwKE LOCATION tk%Uet.- �s1 S 7-7838
ELmOR�
ADDRESS g�,ja, �o�( �1Z� -� LEGAL DESCRIPTION PERMIT NUMBER
PHONE(S) Z4 -d.-5`( 7-"'j 1--a %-S *�-5
*OF BEDROOMS
SEEPAGE SYSTEM
N
❑ TILE DRAINFIELD
T
i 'OIJ'E loo
¢r
ECL
NUMBER
H -
0 1A
ITRENCHWIDTH
LV
%(
DISTANCE BETWEEN LINES ��
DEPTHS:
rr n
SF -T s 1(
TILE TO GRADE
FILL BELOW TILE
FILL
ABOVE TILE
❑ SEEPAGE TRENCH OR ❑ PIT
WIDTH 01fk LENGTH M
DEPTH NIA
k\ FE
❑ LOG CRIB
1
❑ RINGS- DIA.
I I
FILL MATERIAL DEPTH
I I
(
4uC GO
FF CT-IVE ABSORPTION AREA:
CXR SO. FT.
WELL !
CLASSIFICATION DEPTH PIPE MATERIAL
INSTALLER ��LF
REMARKS
DISTANCES
N
C�Rv e`LL,_
T
mimpTrulffim
:
TO i
-
LV
M."mNE"
mmEN"
M
WEENNEN
! i i [§-u -A)
SYSTEM DIAGRAM
N
C�Rv e`LL,_
T
:
TO i
-
LV
! i i [§-u -A)
I I
•. i'
I I
(
4uC GO
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- 3So--
--- -- • -
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---�— 1.-- ---- —
lira
la-nAl—
ZuDATE V�7�f APPROVEDLOT; S! BLOCK:SUBDIVISION�LYYIemwit'�''S
72+012 (9/77)
t•1UtJ I G I F=FIL_ I TY OF= F=3t-40FZ1=11:3E �; iDa
DEPARTMENT OP"NEALTH AND ENVIRONMENTAL P'"TECTION
825 'L` STREET. ANCHORAGE, AK. 995oo' nNi
264-4720 -'s -
WELFL 1::;I" 7 01t -J—_ I TE �_-,EWEFT P SII T
PERMIT NO. ( 77936
APPLICANT DENNIS HANKE SRR BOX 1722-5 31' 344-5727
LOCATION CU : EL/� L
LEGAL L-8 B -J TIMBER.LUX #3 LOT SIZE 49346 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR.)= 190
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C7EF}TH= o LEt4C3TH= 15-S: rRFlti{EL F7EF}TH= S
THE LENGTH DIMENSION IS THE LENGTH (IPJ 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).
FQECALJ I F= EO SEPT I CT IFFIt4PC S 121 En == 1CAEDCA C3F=4LLO64i
F" FA CT PCFIGE PLF r4 IF OPT I C1tJ
A PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE
FOLLOWING CONDITIONS:
1. EITHER. A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED.
2. A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE
AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL
ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION.
----------------------------------------
--- TLJO C 2 ] I I OtJS FIFE F2ECA-U I FRED ---
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. 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PEFerl I T EXP I FcE� DECErl0E:F2 31s Z=+i- IF
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 IPJ ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED:-----ArAWL&1 ---------------
APPLICANT DENNIS HANKE
ISSUED BY 1xis1 _ti� L_-----DATEle _/? _� �- V3. 0
i�J
GARY PLAYER VENTURES
CONSULTING GEOLOGIST
BOX 476-M, STAR ROUTE A • ANCHORAGE, ALASKA 99507 • PHONE 744-7071
Performed
Locat
10
2
—4
6
8
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H 10
a
12
c' 14
16
18
20
SOILS LOG
C Pay. n doaly.
Soil Type Water Level
Remarks
10/x/-1-)
� A ^
Total Depth of Excavation_LMaterial at Total Depth S M
Groundwater Bedrock
Not.Reached Not Reached
Depth, if Reached Depth, if Reached
Classification Method
(� visual
( ) Sieve Analysis
( ) Gary F. Player, Consulting Geologist
Cly c.eW s , Gvv.d� I a%kQ'nx-S
SM
-
.4 yv�fnPS/�OwC
� A ^
Total Depth of Excavation_LMaterial at Total Depth S M
Groundwater Bedrock
Not.Reached Not Reached
Depth, if Reached Depth, if Reached
Classification Method
(� visual
( ) Sieve Analysis
( ) Gary F. Player, Consulting Geologist
P -C,
�Do y--� S
vo Co
o
d �
J
o '
a�S
�ilCd�c. S�/y
l� L/MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH 8 HUMAN SERVICES
Division of Environmental Services wti
On -Site Services Section
P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ^i5 27 17 6 HAA # 11 CAS I n Ll q 1
1. GENERAL INFORMATION
Complete legal description 1-0-r 4A &ccK -T Tin 6CCL0,( 0 21
5�3�►vis)vN� ArJtli�tour 3 5w'/4i s3`I illN a3w SOA
Location (site address or directions) 15oyc Gu(e uc c� 10 1e Iyt-' .
Anclona3 . A
Property owner /-� L tt u t• 5 t M M o Ns Day phone S F 3- S S S
Mailing address A; Aboue
Lending agency
Day phone
Mailing address
Agent E. e 1 I A n n L e y Day phone 31i 1- 76 f3
Address ("v I&r Qea, I
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 y
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-023 (Ra. 1191) Front MOA 021
5. 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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. l 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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm 1 (
Address
Engineer's signature
it,
6. DHHS SIGNATURE
Approved for Tti 4S_'e 3)bedrooms.
0
Phone %-27—y'y'
AK X1e150
_ Date C'9 4& A/ �
<� OF Atc ya
tJo.1051•� : `�tu�
NAN-��
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Date 4— r9/
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasersof homes
and their tending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72.= (Aw. 1/91) 8r MOA KI
� 7, Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: l01 0 A)W T Ti'Tterj„k &(% #13 Parcel l.D.0182-7 /-7 G
A. WELL DATA 0/,A', SbF7L UFGRAoE
Well type Fr,va 4-,-- If A, B. or C, attach ADEC letter. ADEC water system numbers
Log present (Y/N) r Date completed 0210`/ 17g Driller b -CA e �' 11' Aq L�'•
Totaldepth Casedto �10/-(- Casing height 11
Sanitary seal (Y/N) 7 Wires properly protected (Y/N) r
MUNICIPALITY OF ANCHORAGE
FROM WELL LOG AT INSPECTI(SWIONMENTALSERvias DIVISION
Date of test 021 10-117s U --/ %/`/ A l SEP 17 1991
Static water level . )_S "OFF P
Well flow S
Pump level 7 'o CF (3oiiyrn,
SEPARATION DISTANCES FROM WELL TO:
g.p.m. s r -f --RECEIVED
9 -
p.m -/jot Oe(r�u Jt��
Septic/holding tank on lot 13 o f t ; On adjacent lots
Absorption field on lot 1 20 T4 -;On adjacent lots 7 702 �f
Public sewer main NoaC !N ARtcA Public sewer manhole/cleanout /vo G !u 4tcA
Sewer service line 1100C !N A/zCA Petroleum tank /010 (/J Ai2e,4 .
WATER SAMPLE RESULTS: r
Coliformy Nitrate QOther bacteria /
Date of sample: Z) 1 121 Collected by: _ dee
B. SEPTIC/HOLDING TANK DATA
Date Installed 03//0/7-7 Tank size l UCG rti 1 Compartments 2
Cleanouts (Y/N) Foundation cleanout (Y/N) V Depression (Y/N)
High water alarm (Y/N) N Alarm tested (Y/N)
Date of pumping Qq Z I j Pumper _ A+ liCltL -' E C-VIGG- S
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlotOnadjacentlots > 200,E Foundation 21 f -f
To property line 57 Absorptionfield -Watermain/serviceline lI/OVC lN/(p�q
Surface water/drainage 7?O0;
72-026 (Rev. 7/91) From - CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed 09/07 12 1 Manufacturer 0 RN Ca '
Size in gallons 800 Manhole/Access (Y/N) Yes
Vent (Y/N) _ "Pump on" level at 2- lb I ^ car "Pump off" level at r )A c4Ct
High water alarm level 3y: n sties Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot 130 �+ On adjacent lots 7 20OPt Surface water POP /N APEA
D. ABSORPTION FIELD DATA
Date Installed �� ��% A Soil rating "JI'd�-Pf1 System type Rei
Length y0f� Width �5Gravel thickness � 5'� r Total depth yf-4
� 1
Totalabsorpi6i'atea a00 ff Cleanouts present(Y/N) Y
Depression over field (Y/N) Date of adequacy test NIR New Fc; JeA
Results (pass/fail) VIA for bedrooms
Peroxide treatment (past 12 months) (Y/N) N /A If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 130f t' Onadjacentlots 72c2'f+ Propertyline 70f+
To building foundation 30�� To existing or abandoned system on lot 1 S Ff
On adjacent lots 72U0q Cutbank 22-00 i} Water main/service line IP MEA
Surface water LULL: Iu ArXA Driveway, parking/vehicle storage area 0
Curtain drain NOPC IN AQ
E. ENGINEER'S CERTIFICATION
I certify that I ha Qg checked, verified, or conformed to all MOA and HAA guidelines In on the date of this Inspection.
11 ► i� 'Wit,
R�"` 144. -4 Ilk
Signature / �� a rf ' r9�
<9
Engineers ame S0 I' ^ 016 -to rnavl a •• • •'
i2
DateAle-\ v1 •' � • • No. 1051' • �
Q^ �FGIST��•• • �:.
u�
HAA Fee $
Date of Payment
Receipt Number �g33U)
7226 (Rev. W) Beek MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
NORTHERN TESTING LABORATORIES, INC.
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 • FAX 274-9645
=0 INDUSTRIAL WAY FAIRBANKS. ALASKA 99701 (907) 4563116 • FAX 456-3125
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
❑ PUBLIC WATER SYSTEM I.D. #
PRIVATE WATER SYSTEM
Mailing Addreae
CRY
State
SAMPLE DATE: ._i_ _t.L q ( Phone a27f--0-5Y-5
Mo. Day Year
SAMPLE TYPE:
Routine
❑ Special Purpose
Purchase Order No,
❑ Treated Water
R� Untreated Water
TO BE COMPLETED BY LABORATORY
Received at: x Anch. ❑Fbks.
Date Received _M ( 1 rq
Time Received
Next Sample Due
Zip Cdde 11 COMMENTS:
ACheck Sample (for original contaminated
/(\/'jy Jample with lab reference no.
ws. T1nte
No. Loeatbn CWMnaed Cooll6irted 4y Laboratory FW. No.
1 movo6ryefiyr.
2
3
4
5
6
VA
M
9
10
Signature of Representative
FOR r USE ONLY
rAun
CwuWE
normo IMeSmittel
mcm WSlaunroei
Nw
Holt) we
r¢sue
SATISFACTORY
UNSATISFACTORY
U
RESAMPLE
R
OTHER BACTERIA
(9q0�
TOO NUMEROUS TNTC
TO COUNT
Q��r<� ill
n
Direct ve,"Ication
Count LS8 I BGS
O+Iqvb
"No. of Tota Colifor Col nies p r 100 mis.
LJ
Re on it
Date 13 O 0
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 (907) 456-3116 • FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE. ALASKA 99503 (907) 2778376 . FAX 2749645
Tryck, Nyman & Hayes
911 West 8th Avenue
Anchorage AK 99501
Attn: Shawn
Our Lab /: A114018
Location/Project: -
Your Sample ID: Timberlux Subdivision
Sample Matrix: Water
Comments:
Method Parameter
EPA 300.0 Nitrate -N
Reported By: William E. Buchan
Anchorage Operations Manager
Report Dates 09/18/91
Date Arriveds 09/17/91
Date Sampleds 09/16/91
Time Sampled: 1617
Collected Bys -
Definitions
MDL - Method Detection
Limit
B - Below Regulatory Min.
H - Above Regulatory Max.
E - Below Detection Limit
Estimated Value
Units Result Flag
mg/l <MDL
Date
MDL Analyzed
0.1 09/17/91
NORTHERN TESTING LABORATORIES, INC.
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99509 (907) 277.8378 • FAX 274-9645
3330 INDUSTRIAL WAY FAIRBANKS, ALASKA 99701 (907) 456.3116 • FAX 456.1125
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
❑ PUBLIC WATER SYSTEM I.D. #
9qRIVATE WATER SYSTEM
NAME
Mailing Addrau
city
State
SAMPLE DATE: _2_ _a Y Phone 27 1- 65!!5
Mo. Day Year
Purchase Order No.
SAMPLE TYPE:
TO BE COMPLETED BY LABORATORY
Received at: inch. ❑ Fbks.
Date Received 1:2j 91
Time Received 132 y—
Next Sample Due
Zip Code 11 COMMENTS:
❑ Routine ❑ Treated Water
lApecial Purpose ❑ Untreated Water
❑ Check Sample (for original contaminated
3 sample with lab reference no.
Sample Time,
No. �• Location Collac4d Coilo tod by Lebontory Bel. No.
1 I4/e46 r tX < '� l2: 97 A 110lD2
2
3
4 s�M nN'341teownw 0
5 jam Z a3s
8 A 1
7 U7
8
9
10
Signature of Represent ' e
LABORATORY USE ONLY
44M CtueG1 MI140 IMhS41I1N ERCW FStI41CT10M4 Mol
NIU
M
a1fJll
SATISFACTORY
G)
UNSATISFACTORY
U
RESAMPLE
R
OTHER BACTERIA
OB
TOO NUMEROUS TNTC
TO COUNT On /76,ID
DInaN Yar9katlon Final
Count LSB BG8 ita i CemmanIS
0 7
o. of Total Coliform Cotgnies per 100 mis.
Repor
Date b
C)
/ (�
Time
0-0 t-rAtAt ck, P -
9,3Uan1
/liel l�-
S. LEGAL DESCRIPTION
MUNICIPALITY OF ANCHORAGEDEPT• OF HEALTH b
DEPARTMENT OF HEALTH A ENVIRONMENTAL PROTECTION��{y IRONMENTAL PROTECTION
./. S- a- ;7- 3
826 L St..et • Andsorapa, Alaska 99601
•
OCT 2 1978
ENVIRONMENTAL ENGINEERING DIVISION
_ NUMBER
Telephone 2644720 RECEIVED.
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on pope 1. Inoornpiew rgoaab will not M pr000ssad. Please allow ten (10) days for processing.
1. ►ROPE Y OWNER
❑ MULTIPLE FAMILY
PHONE
EN/ S
/✓�t/�ar
3 5/ 9' S 7,7 %
MAILING ADDRESS
❑ COMMUNITY
,r5:/N'/a y!;'ax
X71 z-5 /�,✓'%/ AL k. 995 7
PROPERTY RESIDENT (if different from above)
PHONE
2. BUYER
56 INDIVIDUAL/ON-SITE"
"If individual/on-site, give installation date /d ` 7 7
flGc c-�/
Si n�.no ,fvr
PUBLIC UTILITY
MAILING ADDRESS
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
LENDING INSTITUTION
V. e � I C`
-4t
PHONE
->-t
MAILING ADDRESS
AL REALTOR/AGENT
PHONE
MAILING ADDRESS
S. LEGAL DESCRIPTION
"c
./. S- a- ;7- 3
STREET LOCATION
G'U crL G ,O.C,
IL TYPE OF RESIDENCE
_ NUMBER
D' SINGLE FAMILY
❑ One ❑ Four ❑ Other
❑ Two ❑ Five
❑ MULTIPLE FAMILY
0 Three ❑ Six
7. WATER SUPPLY
�1 INDIVIDUAL'
' ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1976. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
56 INDIVIDUAL/ON-SITE"
"If individual/on-site, give installation date /d ` 7 7
C3
If system is over two (2) years old an adequacy test is required
PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
1
a THIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
DATE RECEIVED ,
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER
Aq
❑Septic�T}ankor ❑Holding Tank
Size: I X66 If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
1
4. DISTANCES
WELL TO:
Static/ (ding Tank
Altaorption ArW
Se~ Line
ren Lot Line
Absorption Area to newest Lot Line
5. COMMENTS
APPROVED FOR 7� BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY (Title)
LEGAL DESCRIPTION
72010 (Rev. 3/78)
r n
A-
-s CKZ�*b,3A Q CEOLOCIat' L LAr0. lei 0rZM 0. ALrStCN t.;C. TELEPHONE
M37) 27C-4014
d '
Lan"Alp R1 P.O. BOX 4.1276 ANCHORAGE, ALASKA s$JDg 4649 BUSINESS PARK BLVD.
Drinking Water Analysis Report for Total Coliform Eacteria
TO BE COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM:
I.D. NO.
-Z-)rY1Tv
Public Water System Name
72.z.—
City Slate Zip Code
SAMPLE DATE: FI O
Mo. Day Year
SAMPLE TYPE:
❑ Routine
❑ Check Sample (for routine sample
with lab ref. no. ❑ Treated Water
lZeSeclal Purpose ❑ Untreated Water
SAMPLE Time Collected
NO. LOCATION Collected By
, t t, e 43 t J:
2 fa I q•'S�d ��
3
4
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Form No. 18-310(178)
TO BE COMPLETED BY LABORATORY
LABORATORY:
CHEM & GEO LABS CF AK. INC.
NAME
4649 BUSINESS PARK BLVD.
ADDRESS
ANCHORAGE, ALASKA
-CITY
Date Received ID -q -?8`
Time Received
Analytical Method:
❑ Fermentation Tube
R Membrane Filter
Lab Ref. No. Result- Analyst
I ET]
I I M
I m
I I p]
�Ro..f colmle, I IN TI. or we, of P9610N wt",
06-1220 lot BACTERIOLOGICAL WATER ANALYSIS RECORD
no.. i97S
Dat. Source
EMB_Broth 24 hour$tBroth 4e hours,
Multiple Tube RePPrt, 20.1 Tubes Positlw/Total loml Portion
Membrane Ful.r• Dlr.ct Count Collform/looml
Verification, LTB BGa —
Flnal Membrane FNA
R.Portw
Dale
�•t'.,o jT�IZ " /�liC 7 �C ,L�J;'111) ic� �'�.
j; � �•L �
�jj; c-> �a� �;
`)TA77c
z�ii