HomeMy WebLinkAboutTIMBERLANE PARK #1 BLK 3 LT 11PCL nQ )CS 1
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Municipality of Anchorage Page —L—of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: S"i'l 0�"93 PID Number: 014157Z7-00
Name: u1iA-L-rj-�_� :aii+"1Tr—
Wastewater System: ❑ New DS Upgrade
AddressQ1t�9 PP-A-tUF P—P
—
ABSORPTION FIELD
Phone.
n
-3VKC-T1otQ Cfiy{ 01`
No. of Bedrooms:
Deep Trench O Shallow Trench ❑Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
• V GPD'S FI
10ICT
Lot. Block: SubdiviVn:
11 3 T1µ6"LATJ» f>Ai ✓P-1
Depth to pipe bottom from original grade.
Gravel depth beneath pipe
Ft
Ft
Township.
Range:
Section
Fill added above original grade:
Gravel length:
• S ft3 Ft
77_ Ft
WELL: ❑ New ❑ Upgrade
Gravel width:
3
Numberoflines:
7-
Ontanaebelweenlines:
FI
REQ!ndil
Classification vale. A.P.C. Total Depth:
Cased To:
Total absorption area:
Pipe material:
W"e•� Ft
I Ft
Icios SON
PVA- ftiv 303,4
Driller: Da 'filed:
Slahc Water Level:
In Taller:
Date installed:
Ft.
p
t? 13
Yield
Pump Set at:
Casing TM Above Ground
TANK
GPM
Ft
Ft.
SEPARATION DISTANCES
(septic 13 Holding ❑S.T.E.P.
To
Septic
Absorption Ldl HomingPublic/Private
M''a,_,n•ulad re.[�I♦��
capacity in allons:
From
Tank
Field Slal.on Tank Sewer Lines
.�. /��
�.Ikvaj(• l� CA rri.v.r.
t'j,� 1 QQO
Well
1_ �^
Material. A
GONCkkT� 5il El
Number of ompartmenis:
I Z
Wai re
Nevi
LIFT STATION
Lot4o'
Line
ZSt N
Size in gallons: Manufacturer:
�
Foundation
bo,
GIS f ` 1
1V
'Pump on" level at:
"Y oil" level at:
High water alarm at:
Curtain���
pump Make a Model
Electrical Inspections De ed by:
Drain
Remarks: Or' t:A21 dt5jyx VxzJ diati,44
BENCH MARK
il
AyLocation
5"91Zt Lo„t, Old
and Description:
=100
ivini a fz:t� 5olesds wAa,^ (.e
a eFF s B = 9sr83
fbalYI'�10t� �ea„�scr4k4 ST WJ
ST. 1"fi
Assumed Elevation1010 Ft
1Oi66$
1.1
ib ¢..stet of sours. 5T pr- C 1 �S a._t wed
%
�E `L
EN
e^ .y .....
h aefsy e S fw. S f3¢�no st ...
MowktLAy. �pi�_ 9 493
Inspections performed by: Dates:1st
»» ».—
2nd 'r1
_v.
y MARK W. ►EAR ON i C ��
Department of Health nd Hut Services aptw
7760
Reviewed and approved by: Date:
72-013 (11". 9191) MOA 25
Permit No. 5w93b2AS Page Z of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: HO Sloct 3 PID No.: 0191522$
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72-013 A (19](
Permit No. SW9$o2A3 Page 3 of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
f M .1. sr• 1 1 -4-11 O 1...Y 2
72-013 A (tm)
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE b
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502 979 -
ANCHORAGE, ALASKA 99519-6650 S30
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT 9 g 93
PERMIT NUMBER:SW930293 DATE ISSUED: 8/11/93
DESIGN ENGINEER:MOUNTAIN ENGINEERING EXPIRATION DATE: 8/11/94
OWNER NAME:WHITE WALTER N & BETTY J
OWNER ADDRESS:91769 PRARIE RD
JUNCTION CITY, OR 97448
PARCEL ID:01915228
LEGAL DESCRIPTION: TIMBERLANE"PARK`#113LK73 " LT
11
LOT SIZE: 58806 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
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 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED B
ISSUED BY:
Y: DATE: 013 R3
DATE: V
MOUNTAIN ENGINEERING
3868 Shannon Circle
Anchorage, Alaska 99508
(907) 562-1500
DESIGN CRITERIA AND NOTES
Project Scope : On -Site Septic System Replacement
Legal Description: TIMBERLAND PARK kl, LOT 11, BLOCK 3
Date of Report: 07/28/93
DESIGN CRITERIA
This permit request is for the replacement of a failed drainficld on the above referenced lot. The existing
home is a four (4) bedroom single family home, originally permitted as a 3 bedroom home. Because
future owners may expand, the dminfield is being sized for the ultimate of 5 bedrooms.
Two test holes were excavated at locations indicated on the attached site plan. Percolation rates were 9
min/inch in both holes. Water was not encountered during the testing, and the monitoring tubes were dry
at the end of the ground water monitoring period.
Based on five bedrooms, the daily design flow is 5.X 750 gallons/day. The application rate will be
.8 Gal/Day/SF. The required arca is thus 750/.8,r 938 With gravel depth below the pipe off 7_��
the length of trench required will be 938/14 or 67
The existing septic tank will be inspcc to verify intcgri , a cplaccd if necessary.
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HILLTOP Drive
Mound 5 §n&s9v bg, &nchoir ■gam Agasks 562- 000
r _ i ' (ENGIAEER'� SEAL{ Itf
Municipality of Anchorage j �r
}Y DEPARTMENT OF HEALTH & HUMAN SERVICES �' r,� MARK W. Pe no- N .. •'%
825 "L" Street, Anchorage, Alaska 99502-0650 t , CE - : 60 ^�
SOILS LOG - PERCOLATION TEST
vq#Atk T�Sr
�rr
PERFORMED FOR:b tfyWt %f
DATE PERFORMED: ',IOI�I3
"irM Ir,.l F;L K 4t ) r
LEGAL DESCRIPTION:_ LV III Q10c'k 3 Township, Range, Section:
1 .o.
2-
3-
4-
5-
6-
7 3 456 7
8-
9-
10-
11 9 10it
C
12-
6
13-
14-
15-
16-
17-
18-
19
3141516171819
20
COMMENTS
PLAN
Sz,.z( wjSEI- j ('atat-fS�
12e-wLu
ILE ITD.
WAS GROUND WATER l 1
ENCOUNTERED? 1A__
S
IF YES, AT WHAT L
DEPTH? O
P
E
Depth to Water After � Ip�
Monitoring? Iy" Date:2CIS
PERCOLATION RATE
(minutes/inch) PERC HOLE DIAMETER
6"
TEST RUN BETWEEN
FT AND } FT
PERFORMED BY: 'V `OH4YUw �✓t� I ma -/C— CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:'r'73
72-008 (Rev. 4/II5)
Muntcipallty of Anchorage v 4St. •siZ P
DEPARTMENT OF HEALTH & HUMAN SERVICES ""' ' «-^ ••=
825 "L" Street, Anchorage, Alaska 99502-0650. RK Y/.
w
SOILS LOG — PERCOLATION TEST / ��
� ?� MA,ARSON ti �
y CE -7760
r ,.•
QQ�� Ti
PERFORMED FOR: F>t)% �If✓� pi �w DATE PERFORMED!!t f 1� '- =C�
l'(m6U 1-AMr)
LEGAL DESCRIPTION: Lo -f- It -7, Township, Range, Section:
DEPTH / Itbr�.ry w SLOPE � SITE PLAN
1 % "
2 d, O
3
4 0
0
5-
6-
7 6 7 c
8 "
9 O
10-
11 O
0
12 r
fI3��
17-
18-
19-
20-
COMMENTS
7181920
COMMENTS
sz,,.d wjs;i,-d��►��s
G((Of
WAS GROUND WATER q
ENCOUNTERED?
S
IF YES, AT WHAT L
DEPTH? 0
P
e E
Depth to Wrier After Q
Monitoring? Oete: l
==1�/�m®m�'off
MINN
I(
PERCOLATION RATE (minutes/hnCh) PERC HOLE DIAMETER O
TEST RUN BETWEEN 19 FT AND FT 11 ,, 1 -
PERFORMED BY: DH^ 1"' wlO .�k I _ k 1'd — IQ'��.C.9./� CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:-IT24'f 3
72-008 (Rev. 4r85)
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
PHONE ❑q NEW
0 EzP-
3 q_g q DOUPGRADE
MAILING ADDRESS
/l
19 - 051- ao
LEGAL DESCRIPTION
!-off 1/ B _
z —/ 2N ll
LOCATION
7 V
NO. OF BEDROOMS
1
/V4-
,3
DISTANCE TO:
Well
Pueyi�
Absorption area
Dwelling
PERMIT NO.
OY
�
s-2
a. 4
Manufacturer
£ /;
Material
No. of compartments
S 61
Loci. capacity in gallons
IVI IF HOMEMADE:
Inside length
Width
Liquid depth
6 YDISTANCE
-1(iZ
TO:
Well
Dwelling
PERMIT NO.
_��
Manulacturer
Material
Liquid capacity.. .gallons
O
w=
DISTANCE TO:
INell
orb
r`
Foundation
Nearest lot bne
PERMIT O.
-0 W Z
2 W
No. of line
"Length re]ch line
``Il
Total length lines
Trench width
Distance between lines
~
30 inches
_
H
Top of tile to finish grade
Material beneath file
Total effective abso�rpption area L
o
inches
�f.SU -C {
W
Length Width
Depth
PERMIT NO.
f7
i f
Wd
Type of crib
Crib diameter
Crib depth
Total effective absorption area
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
3
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
D 3o3y
SOIL TEST RATING
/7 D
INSTALLER /
S vf7ow�
sl
►1
v
f
F
REMARKS
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.....•..• •j
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APPROVED
DATE LEGAL
'/
I�
r
MIJN I C I PAL I TY OF AiV(—_"C]FRACE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
vra-E3 I TF SEWEFT FAE=FTM I T
PERMIT NO: 840966
DATE ISSUEN 11/29/84
APPLICANT: BOB DIERYCK
ADDRESS: 12221 HILLTOP DRIVE
ANCHORAGEP AK 99515
CONTACT PHONE: 349-8490
LEGAL DESCRIP: SUBDIVISION: TIMBERLANE PARI: 01 LOT: 11
SECTION: 24 TOWNSHIP: 12N ,RANGE: 4W
LOT SIZE: 49000 (SG.FT. OR ACRES)
LOT LOCATION: OFF K,LATT ROAD
MAX BEDROOMS: 3
BLOCK: 3"
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site.
TRENCH
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set.
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
1. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN QCTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY LICENSED ELECTRICIAN.
SIGNED---- DATE:
APPLICANT: D.f.IER CK
ISSUED BY /n ',,� DATE:-- �'A
9/��
13 E=D
Ltd _ I?FtA I N
DEPTH TO PIPE BOTTOM (FT.)
5.0
4.0
4.0
GRAVEL DEPTH (FT.)
5.0
0.5
3.5
TOTAL DEPTH (FT.)
10.0
4.5
7.5
GRAVEL WIDTH (FT.)
2.5
19.0
5.0
GRAVEL LENGTH (FT.)
45.0
36.0
49.0
GRAVEL VOLUME (CU.YDS.)
23.0
25.4
36.3
TANK SIZE (GALS)
1,000.0 **
1,000.0.**
1,000.0 **
SOIL RATING (SO.FT./BR)
150
150
150
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set.
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
1. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN QCTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY LICENSED ELECTRICIAN.
SIGNED---- DATE:
APPLICANT: D.f.IER CK
ISSUED BY /n ',,� DATE:-- �'A
9/��
�` Va SOILS LOG
r-gc9G&
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
825 L. Street, Anchorage, Alaska 89501 2644720 TEST
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: BOB 'D 1 ERVC K DATE PERFORMED: I I •28 .8 4
LEGAL DESCRIPTION: LbT 11, S14751F TI14315—M" 1 ff 'pqR,� !t2 SEL Qyi TIa,N e$/L&
T CaosT �SLOPE � SITE PLAN
wwI I...I., - t 7--PE—I 1 I tir-
1
2-
3-
4 34
c
•
5
6
6 r
7 D
v
8 a
9-
10-
11-0
1011 O P
12-
13
2 13
14
SANDY SILTY
G24VWL
L6111115 L E S 'To (,'I
COMME
PERFORMED
72-008 (6/79)
O
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading
Date
730TTO VA O F 1i0 LIe�
15-
Depth to
Water
Net
Drop
16-
OF• A(.,��11
—1�
17
16
i..
' ... .. ..
19
N 22251-E:
N,
1'
,;;
20
•`' ''
it
_
COMME
PERFORMED
72-008 (6/79)
O
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE VISOAL (minutes/inch)
TEST RUN BETWEEN FT AND FT
//9 heui J=.h•Z 17.. L./.•. IV - /__�
CERTIFIED
I
O
ry � E BUS
•t _
JUN 192017:r.Munici
Municipality of Anchora
On-Site Water and Wastewater Program
(907) 343-7904y6 " FET
`lr
°I 6
5�8 L9 4
Certificate of On-Site Systems Approval
Parcel I.D. 019-152-28 Expiration Date: ro -1s7
1. GENERAL INFORMATION:
Complete legal description TIMBERLANE PARK#1; BLOCK 3, LOT 11
Location (site address) 12221 Hilltop Drive*Anchorage 99515
Current Property owner(s) Mark&Debra Higgins Day phone 317-2411
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (wlwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ® Public Sewer ❑
WaiverNariance request for: Distance:
Received by:. Date: Cv/P 3 /(
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ l Waiver Fee $
Date of Payment (a— 1Ck —(-7 Date of Payment
Receipt Number 0161*GI Receipt Number
COSA# 05C-1 l !2`i( Waiver#
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,
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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date:
Q4 OF A '
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system c
in accordance with the guidelines and regulations established by the Municipality of Anchorage and d 4 -ti
industry practices. The reported results describe the condition of the system/s on the date's of the d%:,(' -'..-. VOnn
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or Q� • V
encroachments may exist that were not identified during the evaluation. The operational life of all wells * :' 9TH •-•"7 v
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 4""•'. • ..I. VD
groundwater levels (that may fluctuate during the year), quality of construction (materials and V ✓
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and ' �:. . VVAA
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the 0 '•,J ffr;y . Gar' ess" t2
•
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of 00 0 C[-79 3 p�
the well or septic system. GEG makes no representation whether an alternative well or septic system (J r '•._ jf c�0
can be installed on the property in the event either of the current systems fail to perform adequately in '4'e', ''f r J 1.'.••i' �c°a
the future. The content of this report is for the sole benefit of the person/party that retained GEG to ��Papr0/ess onaQc"
perform the evaluation. Reliance upon the information provided in this report by any other person or Q'�Q�QaQo
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
XSystem #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved `'��-``� OF AIyL^hU
Conditional approval for bedrooms, with the fn wlngDslifal1>aGons:G)
' WATER AND
0 > +ASTEWATER G
` %. PROGRAM U
"N J-St,rtil
-iii../.00/. - Original Certificate Date:
—2217
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12 doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: TIMBERLANE PARK#1, BLOCK 3, LOT 11 Parcel ID: 019-152-28
A. WELL DATA PUBLIC WATER
Well type If A, B, or C provide PWSID# Well Log (YIN)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N
Total depth ft Cased to ft. Casing height (abo - around) in.
FROM WELL LOG AT I CTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RES •
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
enic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL&CONCRETE Date installed 9/7-9/93 & UNK
1000&
Tank size 1250 gal. Number of Compartments 2& 1 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
Date of pumping 5/6/17 Pumper ISAACS PUMPING
C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE AT MT
Date installed 9/7-9/93 Soil rating O p.d.I 'or ft/bdrm) 0.8 System type DEEP TRENCH
Length 72 ft. Width 3 ft. Gravel below pipe 7 ft.
Total depth "12.2+ ft. Eff absorption area 1008 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 6/2/17 Results (Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test —69 in. Water added 923 gal. New depth ""74 in.
Elapsed Time: 120 min. Final fluid depth 72 in. Absorption rate >= 750+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN &type) NONE KNOWN If yes, give date -
"MT ONLY GOES 6.25 FEET INTO EFFECTIVE DEPTH
"LIQUID LEVEL IS APPROXIMATELY 1 INCH BELOW THE INVERT OF THE DISTRIBUTION LINE
""6 INCHES BELOW INVERT-SYSTEM 93% PRIOR TO START OF TEST(ADVISORY NOTICE RECOMMENDED)
•
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at .•• wa er alarm level at in.
• . Cycles tested Meets alarm & circuit requirements'?
E. SEPARATION DISTANCES
PUBLIC WATER
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main '.• sewer manhole/cleanout
Sewer/septic service line Holding tank
. containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO.
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line UNKNOWN Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line _ 10'+ Building foundation 10'+ Water main 10'+
Water service line UNKNOWN Surface water 100'+ Driveway. parking/vehicle storage 9
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION :�P;•• '•••. i•
•
I certify that I have determined through field inspections and R �r 0
review of Municipal records that the above systems are in • •
conformance with MOA COSA guidelines in effect on this �•••• j' ••1 • •• • �
date. • c.ni :f
• Jley A. Gorness : 1;
Engineer's Printed Na e JEFFREY A GARNESS •• V .. CE 1ta.9 1,T .c�i
Date b 1 6 tq ••eo • �•
•• FESS �.•
LICENSE Itaiis„marl•
uraECC884
(Rev. 10/12/12)
•
• Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Septic System Advisory
Certificate of On-Site Systems Approval # OSC 171246
During a recent adequacy test on the septic system for Block 3, Lot 11 of
Timberlane Park #1 subdivision, 72 inches of standing water was observed
in the absorption field. This indicates that approximately 93%% of the
absorption area is inundated. Although this system passed the adequacy test,
the remaining life expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval
EAST 155.00 4111
20' Utiity Easement
,-
Ili u;
r
r
hed
.2::".,,',. .,•!:.:::1,;i:
I:.r,
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. a .:-.7,4 )i, '..Y
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• .-<= N! •
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4110111C•
r
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`' � _r "" d' ° 57
0) 7 i . y, „ .O t`
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C `--44• - OO° c� eco 25.7— c0
vsz,;,• 0co
♦ Note This property is served by pubic water-
I— 1.:.-.. ,-;::•,.... .
O 0 o 0
z � z
Lot 12
Lot 10 ( °
t It Lot 11 .‘NAN,X
° -��,• of • A� /�i
A II
0 • 1 :-.1,\'
IIIIIV A,
•
�,, i CIS 06 `?'• 49th j� •':� �t
Septic vents o) _
o r • • • • • • `�• . • • r
> I / i, Brett A. Wilmot :• ,o s
�� 1 i� �r�•� 112392 - 15 • iplf
•�„, am
c (",pe • • .
1 • • • Pao
a�Essiar+a� N.
t I AS-BUILT NO CORNERS SET THIS DATE
1 I hereby certify that I have performed a Mortgagee's inspection
of the following described property: LOT 1 1, BLOCK 3.
TIMBERANE PARK, ADDITION No. 1
N86°58'30"W 155.21 Anchorage Recording Precinct, Alaska, and that the
0
CO improvements situated thereon are within the property lines
VE 0 and do not overlap or encroach on the property lying
HILLTOP DRI
________t_. — CO adjacent thereto, that no improvements on the property lying
'' — adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
EASEMENTS OF RECORD, OTHER THAN this 15th day of JUNE 2017
THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES
PLAT ARE NOT SHOWN HEREON. FB 72-7, pg 31 BE (907-248-1666) Engineers and Surveyors
K -z45�
MUNICIPALANCHORAGE
• DEPARTMENT OF HEALTH
8 HUMAN SERVICES
Division of Environmental Services
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 l.D.# 01915228 HAA#
1. GENERAL INFORMATION �.
Complete legal description TimberlanfJ;Park #I, Lot 11, Id9'6ck 3
B
Location (site address or directions) —Hi I k6p, Anchorage, AK
Property owner Wa 1 t e r White Day phone
Mailing address 91769 Paar i e Road, 7unct i on City, OR
Lending agency Day phone
Mailing address
Agent Bob Rink Day phone 279-1561
Address 9n7 F Northern Lights, Anch AK
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: S
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water X
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 X
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.
72-025 (e«. +AU Fwt MOA 621
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. 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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Ma^^tz�e� �"'��1� Phone Sio2-l5vo
Address
fsL
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
M
Disapproved.
K,
Date _n�jdt -�-
MARK W. PE ""ON i
,•
CE -7760 .4
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
CAUTION
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 purchasers of homes
and their lending 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.
72-0=Mw.1191) Back MOA621
�. Municipality of Anchorage JAL
Department of Health & Human Services 66
HEALTH AUTHORITY APPROVAL CHECKLIST 112005
Legal Description: � � �,k# l ,lot I(It3(d parcel I.D. b l q I SZ?_ S
A. WELL DATA A-WWU tA)a+er S JS4Q ,N
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present(Y/N)
Date completed
Driller
Total depth Cased to Casing height
Sanitary seal(Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
Wires properly protected (Y/N)
AT INSPECTION
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot N,IP. ; On adjacent lots
Absorption field on lot
Public sewer main
On adjacent lots
Public sewer manhole/cleanout
Sewer service line Petroleum tank
WATER SAMPLE RESULTS:
Coliform NIA Nitrate
Date of sample:
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA 4
t;auStiN(a - - 1,250
Dateinstalled NGW- q111413L Tank size -IV"- 1,000 Compartments
Cteanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N
High water alarm (Y/N) - NIA Alarm tested (Y/N)
Date of pumpinggIq-ICis Pumper TS27c5
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlotM&Y'v- Onadjacentlots NAv"e- Foundation (0
01
r /
To property line 4c)Absorptionfield �S Water main ervicetin 25r
Surface water/drainage W &r'e
72--026 (Rev, 7M) From CONTINUED ON BACK PAGE
0 Z
rn^
rn
--
A
_m
g•p•m
m
b
mo
cc
c�
< 0
N .(1
O ^'
2
B. SEPTIC/HOLDING TANK DATA 4
t;auStiN(a - - 1,250
Dateinstalled NGW- q111413L Tank size -IV"- 1,000 Compartments
Cteanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N
High water alarm (Y/N) - NIA Alarm tested (Y/N)
Date of pumpinggIq-ICis Pumper TS27c5
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlotM&Y'v- Onadjacentlots NAv"e- Foundation (0
01
r /
To property line 4c)Absorptionfield �S Water main ervicetin 25r
Surface water/drainage W &r'e
72--026 (Rev, 7M) From CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Nem- Manufacturer
Size in gallons
Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at - "pump off" level at
High water alarm level Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed 91 193 Soil rating • $ o��'Sf System type &?:ftv-e�
Length Z 4OW Width 3 Gravel thickness Total depth ISI
Total absorption area 1 DO $ A-2 Cleanouts present (Y/N) Y
Depression over field (Y/N) Date of adequacy test New o swlz-hsvl
��&Sw9 oL93
Results (pass/fail) for bedrooms
Peroxide treatment (past 12 months) (Y/N) NO If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot Noy -c Onadjacentlots W&VIt Propertyiine ZS r
To building foundation S r To existing or abandoned system on lot ZOt
7
On adjacent lots 100+ Cutbank n(Bie Watermain erv(ce in 25
Surface water Na`r� Driveway, parking/vehicle storage area ( O
r
Curtain drain Ney-e-
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name "49"V-
Date
49" Date MARK W. PEA SCN Z(^
�OCJ at C
-7760
,+ E
d
III:a`'...
HAA Fee $
-aro e VLl
Date of Payment 6— "q
Receipt Number S1 7 / (�
72-M (Rw. Ypn Beck MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
eov
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date S g
(a) Legal Description (include lot, block, subdivision, section, township, range)
4D7' //0 SKS T/KfFSERLRt4rC P,42✓ Mu IsGLc2Y 7-12- N , Ry uY/
Location (address or directions)
/2 Q.2./ N/e
(b) Applicants Name Bo
31/9 -BY so "A-7,467
ephone - Home Business
Applicants Address /-2;LZ1 ///447-dP
(c) Applicant is (check one) Lending Institution ; Owner/ba#4darC ;
Buyer E_1; Other � (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. b Agent
Address
3 040
/fit
S% P2 t= E i S f// I
Telephone
542.-
7&673
(f) Mail then
to the
following
address:
nHAA
00
j
'
1
U
2. Type of Residence
Single -Family = Multi -Family Q
Number of Bedrooms _%S
Other (describe)
'-Y;t71PX
3. Water Supply
Individual Well Community Public
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. _Sewage Disposal
\,`f lillill:,
Onsite Im Public Mal Holding Tank
Note: If community well system, ¢ustjave written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
qr --
[Page 1 of 2]
r
5. Engineering Firm Providing Inspections, Tests, File Search Data and Information
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 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. 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 in compliance with all Municipal and State codes, ordinances, and regula—
tions in effect on the date of this inspection.
Name of Firm %ek6.c.A S Vr_14 4"t0F Po Telephone
Address .2 o 3 Lev / g ._I hi -+a 9'5!s tj l
Date �C< ,S /q d° / ti �:.
,. , . •' ° .til
(ENGINEER SEAL) `*:4
6. DHEP Approval 2225-E
p; 1urrE 2s, 1911
Approved for bedrooms By 4,1,7 ate"' =
Approved Disapproved Condition
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIO1v.1L ENGINEER
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE
MENTS.- EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
RR4/ej/D18
[Page 2 of 21
PROTECTION
REPRESENT—
REGISTERED
HOMES AND
REQUIRE—
BEFORE A
FOR ERRORS
7-19-84
W
MUNICIPALITY OF ANCHORAGE (MOA)
MUNICIPALITY OF ANCHOPAC:
DCPT. OF HE."LPI P.
tNVI:0V7dC'4 AL K:7,1CT:C;I
DEC 0 5 1984
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 RECEIVED
A. WELL DATA PUBUC Legal Description: 1...01 II �BK3
���� TfNB�2LssNE 'PAR�G Sic Ry,T�1N�TZKtt'r
Well Classification If A, B, or C, D.E.C. Approved(YM)
Well Log Present (Y/N) Date Cmpleted Yield
Total Depth Cased to Depth of Grouting
Static Water Level Pump Set At
Casing Height Above Ground Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
Separation Distances frau Well:
To Septic/Holding Tank on Lot On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots
To Nearest Public Sewer Lire
Cleanout/Manhole
Water Sample Collected By
Water Sample Test Results
Comwnts
To Nearest Public Sewer
To Nearest Sewer Service Lire on Lot
Date
Date Installed 19&CS Size 125o No. of Conpartmerts ONE
Standpipes (Y/N) O N 9 Air -tight Caps (Y/N) )/ Foundation. Cleanout (Y/N)
Depression over Tank (Y/N) Date Last Pumped 11•1LA- 8 4
Punping/Mainterance Contract on File (Y/N) NIA ; for
Holding Tank High -Water Alarm (Y/N) K/A Temporary Holding Tark Permit (Y/N)
Separation Distances fran Septic/Holding Tank:
To Water -Supply Well K/.y To Building Fourdaticn G 3
To Property Line ?j0 t To Disposal Field .2 Z
To Water Main/Service Line I O + To Stream, Fond, Lake, or Major Drainage
Course
Ccmwnts
Receipt #
Date Paid:
Amount: :J_rar�
(Page 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 160 Type of System Design "TQF_1.1C.K
Date Irstalled 12 N • s q Length of Field 'FS
Width of Field 30 Depth of Field 10
'/ Gravel Bed Thickness b
L
Square Feet of Absorption Area 5 O Standpipes Present (Y/N)
Depression over Field (Y/N) N/ Date of Last Adequacy Test N E W
Results of Last Adequacy Test ] 7/_A
Separation Distance from Absorption. Field:
To Water -Supply well 1!.4 To Property Line z✓ D
To Building Foundation (&O To Abandoned System on
Lot 4iD ; On Adjoining Lots N o NC
To Water Main/Service Line 10+ To Cutbank(if present) UONE
To Stream/Pord/Lake/c:r Major Drainage Course N D K E
To Driveway, Parking Area, or Vehicle Storage Area 5 b
Ccmmnts
D. LIFT STATION N o N
Date Irstalled Dimersiors
Size in Gallons
"Pump On" level at
High Water Alarm Level at
Tested for
Electrical Codes(YM)
Comrents
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. heets MaN
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection„
SignedTLM
Date /S
CompanyjjddA&Z�!=�MOA
No. iS' S i —011
KBl /d5/s
(Page 2 of 21
OF At
.ty A �'Rt� • • .y ��
EA
/ N . E 22 21371 ^J
ar1'�
2-15-84
N 4PMMELANDo Pogo
ENGINEER
Municipality of Anchorage
Division of Environmental Health
Department of Health and Environmental
620 L Street
Anchorage, Alaska 99501
Subject: Lot 11, Block 3 Timberlane.
Gentlemen;
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: 1907) 279.3915
December 27, 1984
Protection
On November 15, 1984 I tested the septic system on this lot and
determined that the system did not have the surcharge capacity
required by the Municipality. Only 30 gallons could be added to
the absorption system before liquid started to back up into the
tank. After adding 225 gallons the water level in the tank has
risen 9 inches. However within 4 hours the water level in the
tank dropped 5 inches indicating that 100 gallons had been
absorbed by the system.
In spite of this high absorption rate, I recommended that a
replacement system be installed. The seller of the property
agreed and an upgrade for a three bedroom house was put in. A
trench sufficient for a three bedroom house was added to the
existing seepage pit.
The tank is a 1250 gallon tank.
This house has been used as a three bedroom house, it was
advertized for sale as a three bedroom house, and it is being
bought as a three bedroom house. Unfortunately, it has a room
that has been used as a fourth bedroom and the appraisal shows
this. FHA will not approve the transaction unless the Health
Certificate shows the septic system as adequate for a four
bedroom house.
With the surcharge deficiency corrected and with a trench
sufficient for three bedrooms and with the existing crib
absorbing 100 gallons in 4 hours, the combined system is more
than adequate for a four bedroom house.
Please show this on the processed health authority application.
The closing of this transaction :s scheduled to take place on
December 28, 1984.
A1,4 �
Yours A*y� L
r
1 222
Tobben Spurkland P.E. ,
i
111•.:•'•.,. ,
A
1)1`-1 fa -1 n) r
r l I= -
5. LEGAL DESCRIPTION
DATE RECEIVED
�. INSPECTION APPOINTMENTS
Park #1
TIME
o . pICE
TIME
1 tri V.
TIME _
'�
DATE
DATE
DATE
SINGLE FAMILY
�
— Cl l .
_q A-
INSPECTO
INS T
INSPECTO
M�JvA_i,ALIJY OF ANCHOPAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF H-.1LT:1 &
\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECVIiSIZoNMENTAL T:.OTECT(oN
1 825 L Street - Anchorage, Alaska 88801
JAPE 2 6 1981
ENVIRONMENTAL SANITATION DIVISION
Telephone 284.3720 RECEIVED
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 110) days for processing. .
1. PROPERTYOWNER
PHONE
Henry•& Sally Santeford
❑ PUBLIC UTILITY
MAILING ADDRESS
PROPERTY RESIDENT (If different from above)
PHONE
IHL,7 Ililltop Drive v
2. BUYER
H N
sober t L. & Ilary Jo Dieryck n
MAILING ADDRESS
Sitka, Pdaska
3. LENDING INSTITUTION
PHONE
Pdaska State Bork
279_7637
MAILING ADDRESS
Y.O. Box 24.0 Acnhordpes Alaska 99510
4. REALTOR/AGENT
^
PHONE
Jack Finite Co.
G� b a -
277-1553
MAILING ADDRESS
3201 "C" Street Anchora.-e, Alaska 99503
5. LEGAL DESCRIPTION
Lot 11 Block 3 Tamberlane
Park #1
STREET LOCATION
ITHII Hilltop Drive
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
SINGLE FAMILY
❑ One E7 Four ❑ Other
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
M INDIVIDUAL'
*ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
& SEWAGE DISPOSAL SYSTEM
El INDIVIDUAL/ON-SITE"
72-73 YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rw. 6/79) ^ 1
72010 (Rev. 6/79)
I
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE
❑ TWO ❑ FOUR ❑ SIX
❑ OTHER
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLICUTILITY
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
❑Septic Tank or ❑Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA -
MATERIAL
4. DISTANCES
WELL TO:
Septra/Holding Tank
Absorption Area
w
Seer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
I!d APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY
72010 (Rev. 6/79)
I
ll
CHEMICAL & GL - LOGICAL LABORATORIES ALASKA, INC.
TELEPHONE (907)•2793014 ANCHORAGE INDUSTRIAL CENTER
274-3364 6633 B Street
ALDrinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER' TO BE COMPLETED BY LABORATORY
WATER SYSTEM:
I.D. NO,
Water System Name / Phone No.
Mailing Address ^
City .. ._ ..
- - State -
SAMPLE DATE: = = " (
Mo. Day year
SAMPLE TYPE:
Zip Codo
❑ Routine
O Check Sample (for routine sample
with lab ref. no. t ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE Time
NO. LOCATION Collected
--�
3
4
5
READ INSTRUCTIONS
BEFORE
Collected
By.
f -e-
Analysis shows this Water SAMPLE to be:
I] 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
1 r �
Analytical Method:
❑ Fermentation Tube
❑ Membrane Filter
Lab Ref. No. Result' Analyst
Ir'•'... 'I � rig'.
I I m
I I m
I I m
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06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 2978
Dale Coll«tw Sow"
S.M.
EMB Broth 24 hours, arab 48 hours,
COLLECTING SAMPLE Mutnpe Tube Report, 20ml Tubes FoOtt.ertotn faml Purtloms
Membrane Feer, Direct count Conform/300m1
Vnllknlon, LTB 068
Final Membrana Fater Results - 1 conform/loeml
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Tobben Spurkland P.E.MUNICI jry CF ANCHOMGC
DEPT. O+ •' �._CTION
8155 Cranberry St.
Anchorage, Alaska 99502 ,.
Phone (907) 243.5302 0
RECEIVED
Joe Babka
Jack White Co.
3201 "C" Street
Anchorage, Alaska 99503
SLWER A D E `UAC Y T E S T
Jan. 30, 1981
Legal: Lot 11, Block 3, Timberlane Park 110.1
Location: On Hilltop Drive, off Timberlane Dr., off Klatt Rd.
Owner: Henry Santaford
Residence: Four Bedrooms, Splitt level
Water: On site well
Sewer: Septic tank and crib, no municipal records.
See attiached drawing for location.
From pumping record.
Tank: 1250 gal.
Absorption System: 4—feet diameter concrete ring crib.
6 feet deep.
Date of Construction: 1968.
Date of Test: 4an. 29, 1981
Test Procedure: System was inspected and pumped on Jan, 29, 1981.
The residence was unoccupied. 23 inches of liquid was
measured in the crib, 56 inches in the tank.
Approximately 1250 gal was removed from the tank.
Approximately 500 gal was dumped into crib. The following
readings of the water level was taken :
Start Test 22 inches
Add 500 gal 9 am. 60
9.30 am 53
1.30 pm. 37f2
8.30 am 32Y2
It ; i'\
Tobben Spurklantl P.E. rNJoe liabka
Page 2
The crib was again filled with crater at a constant rate of 4 gal/ min.
After 10 min. depth was 36yz inches, after 20 min. depth was 40➢i inches.
Discussion: Disregarding seepage from the pit, the liquid volume of the
absorption system is 10 gal/ inch or 120 gal/ foot.
The volume of a 4 foot concrete ring is 94 gal./foot.
Disregarding the drop in water level during the first 30 min„
since part of that drop is caused by flow into the rock, the
absorption rate during the next four hours was found to be
155 gal. or 38.75 gal/hour. In 24 hours the total absorption will
be 930 gal. The required absorption rate for a 4 bedroom house
is 450 gal in a 24 hour interval.
This system obviously surpasses this requirement.
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ToWn Spurkland P.E.
8155 Cranberry St.
Anchorage, Alaska 99502
Phone (907) 243.5302
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