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Home My WebLink AboutCONIFER HEIGHTS BLK 2 LT 9MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ 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 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE / ~'~ MAILING ADDRESS LEGAL DESCRIPTION LOCATION~//~ ~ NO. OF BEDR~O&MS~ __.vDISTAN '~1 AbsorPtiona~_._~ Dwelling~""~ 1'O f PERMIT NO. I- 2 Manufacturer · Liq. cap~c~y~, (~) ~)in gallons IF HOMEMADE: Inside length Width Liquid d?.~pth ~rgZ~ DIST__'. Well Dwelling ~ Ma-'~terial Liquid capacity in gallons ~ Well Foundat~ ,:~O Nearest lot lin~ O PERMIT NO. ~ =: DISTANCE TO: ~OO ' I-~~c~ No. of~n~ ~ Length of ea~Ji(~ Total length of~i.~(s.~ Trench. uvidth~,_~o inches Distance bet~7~e I ~ I- Top of tile to finish grade Material beneath tile Q ,~ ~ ~ , ~? ~ Total effectiveaJ)sor~er~(~ Length Width Depth PERMIT NO. ~ I-- 'Total ~,~ ef~ti°n area DISTANCE~T,-t~. ""Bruilding foundation ( a'q~rest lot line ' ~ '~ ~ Depth Driller Distance to lot line PERMIT NO.~c) 0~ ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PI PE ~E~LS SOIL TEST RATING INSTAL - '~~__ _ REMARKS . · _ APPROVED . D&,TE LEGAL 72-013 (~ v. 3/78) Certified Well Date completed..:.i...AU,g~l-''~.L., !..1.9.g0. ................................................................ Depth of Well ...... :.: .?-.5.~..~ .~ ................. ]....: ........................................................... Size of casing - 6:" I.d. , ' Distance to water ..... .1,2.7..!...i') .................. : ................................................................ Distance to water..while pumping. ..... ~22'Q!. ...................................... . ......... at rate of ............ .s;...1B0 .................. g31lp ·: - Descnptlon ut Forma~l'on.~ ~- F ~'," , from to Brown ..t:~ ..... ~ ,-,-.~',--'/,~,x:~~,, -~-'," t 52 I 1 g2 -';' :"":= '. ...... ~'-:' -'~":i-"~ ''= :'./ .~ .,,~ ~ k_. ':,.-. ,.'..~ '-: ': ITc~rfify.th~ above:'u:he 'and correct. · . .:,. ';,;;. ~ :";~:lt.:: ,. ~. ~<---- ..... ; .................................. ~ .......... :' "/ DEPT. OF H:AkTi- & :::; :,..:,;.,: .... ::-. :,.::.:/..sPENARD,:~.EASKA DEC a: 1980 : :~e 'advis;':~0u"t~' :a'tt~bh"~hi'i"'cert'ificate to your .e~.E C El V t D PERbllT NO. ,.,~ L STREET., ANCHORAGE,, AK, 264-4720 "-" APF'LICRNT TIMBERLINE HOMES INC. LOCIqTION SURGRR ¢:IROLE LEGAL BOX ~i-L LOT SIZE 28000 SQUARE FEET TYPE OF =,OIL ABSORPTION SYSTEM IS' TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FTZBR)= 1~5 ~ :¥=,TEM THE REQUIRED SIZE OF THE :OIL ABSORPTION ~ c IS' DEPTH= ~4 LENGTH= ----~-1 13Ri:IVEL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R 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 OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET), REG~..IJ I RE[) SEPT I C TRt~IK $ I ---~E= :1.000 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENm;.E:, THAT THE WELL WILL SERVE. ............. TL.,ICm < ~ ) I I'-.I~PE'DT ION$ lIRE REm-.'.~U I RED B~L:KFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND RPPROYAL BY THIS DEPARTMENT WILL BE aUBJE~%,T TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVRTE WELL TO R PRIVATE SEWER LINE IS 25 FEET RND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEAr'1 I T EXP I RES DECEMBER 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 IN ACCORDANCE WITH THE CODES. ~; I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE - ' AFPLICANT--TI [T 6MES-T 7 ....... // . V4. 0 4040 "B" STREET ANCHORAGE, ALASKA 99503 (907) 278-1551 July 28, 1980 W.O. #A19378 Grid: 2440 Mr. Bob Lutje Timberline Homes, Inc. SRA Box 31L Anchorage, AK 99507 Subject: Subsurface Investigation for Suitability of On-Site Waste Water Disposal System Lot 9, Block 2, Conifer Heights Subdivision Dear Mr. Lutje: Transmitted herein in accordance with your instructions are the results of the above referenced investigation as per- formed by us on July 24, 1980. The scope of this project is an investigation for suitability of on-site waste-water disposal system. Included in this transmittal are: Test Hole Location Sketch Test Hole Log Explanatory Information Figure 1 Table A Sheets 1-3 The exploration was conducted using a continuous flight solid stem auger. The rig is owned and operated by Denali Drilling, Inc. Drilling was supervised, the test hole logged and percolation test performed by Mr. T.L. Barber, engineering geologist with Alaska Testlab. The log of this test hole is included as Table A of this report. In interpreting the log, it would be helpful to utilize the explanatory information contained in Sheets 1 to 3 of this report. When drilling was completed a 3/4" slotted PVC pipe was inserted in the hole to aid in determining the free water level. For the percolation test, the test hole was filled with water and left overnight to saturate. On returning the next day, the hole was refilled with water and the drop in water level carefully monitored over the next 80 minutes. Mr. Bob Lutje Timberline Homes, Inc. July 28, 1980 Page 2 This procedure is not a standarized percolation test, how- ever, we understand that the Municipality of Anchorage, Department of Public Health and Environmental Protection prefers test performed in this manner to evaluate a site for a proposed on-site sewerage system. Using the above test, the observed minimum percolation rate was 10 minutes per inch. With the above percolation rate we suggest that the system be designed for an absorption area of 165 square feet per bedroom. This recommendation is based on criteria in the "Manual of Septic Tank Practice", U.S. Department of Health Education and Welfare, Public Health Service. We recommend that the seepage trenches be inspected prior to installing the system as the above recommendations are based on the results of a 6" test hole. The seepage trench will provide a much clearer picture of the subsurface condition encountered in the test hole, it may be necessary to lengthen or enlarge the trenches. No water table was observed during drilling. Therefore, it does not appear that the water table will interfere with the construction or operation of the system. We hope this report meets your present needs. If we can be of further service, please feel free to contact us. Sincerely, ALASKA TESTLAB L. Barber Geologist TLB:rb Enclosures APPROVED Melvin R. Nichols, P.E. Laboratory Manager Test Hole Depth in Feet From To 1.0' - 6.0' 6.0' - 14.5' 14.5' - 20.0' Table A WO #A19378 Date: 7/23/80 Logged by: T.L. Barber Soil Description NFS, brown Sandy Gravel. F-2, brown Silty Sand F-4, brown Sandy Silt. Bottom of Boring: Frost Line: Free Water Level: 20' None Observed None Encountered ,7. /! ® ! ./'TN: /g W.O. 96250 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & 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 GENERAL INFORMATION Complete legal description Lot 9 Block 2 Con~ifer Heights Location (site address or directions) 9420 Suqar Circle Property owner Kerry: Mark Hennings Day phone 346-1294 Mailing address 9420 Suqar Circle, Anchoraqe, AK 99516 Lending agency Alaska USA/Alaska Home MorgaqeOayphone 563-3033 Mailing address Agent Address Gene Bruner Dayphone 563-3033 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 3 Individual well × Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: X Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 friar I/qll r..~nl MOA #21 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 o1' structure indicated hereh3. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves!igation 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 DHI Consulting Engineers Address 800 E. D~~Blvd. S~it~e 3-5~45 Engineer's signature ~'~.....~ ~ ~--~ DHHS SIGNATURE .~ Approved for --~ Phone ~44-1 385. Anchorage, AK 9951 Date ~'~-?5 bedrooms. Disapproved. Conditional approval for bedrooms, with the folloWing stipulations: Additional Comments By: '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-~2~ (Rev. 1/91} Reck MOA i~21 W.O. 96250 Municipality of Anchorage ~ DEPARTMENT oF HEALTH & HUMAN SERVICES ~ ', Environmental Services Division _~ - · .~ 825%' Street, Room 502 · Anchorage, Alaska 99501 · (907) ~[IN~ITY oF ANC;H(JI~A~ ENVIlJONMENTAL SERVICES DlVi~ll~iiJ.l~ 0 6 1996 Health Authority Approval Checklist Legal Description: L 9 B 2 Con~ifer Height Parcel I.D.: A. WELL DATA Well e RE ~) If A B or C attach ADEC leter ' E¢ w ter stem number tTp $ , , , ~t,,AD a sy I Lo~ present (Y/N) Ye~(~) Date completed 1 9 8 0 Total depth 232 ' ~ Cased to 1 97 ~) casing height (above ground) I , 1 ' Sanitary seal (Y/N) Yes ~) Wires properly protected (Y/N) Yes FROM WELL LOG AT INSPECTION Date of test 8 / 80 __~L./_2.9,/q ~ Static water level 1 77 ' 1 ~ ~ ' Well production 3 g.p.m. 0,76 . g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate 2,2 Other bacteria 0 Date of sample: _.. 'JJ~2_ ~9_ J. 96 . Collected by: Dustin High B, SEPTIC/HOLDING TANK DATA Date installed ~ Tanksize 1 , 00 0 Number of Compartments 2 Cleanouts (Y/N) Ye Foundation cleanout (Y/N) Y~ ~ Depression (Y/N) No High water alarm (YfN) DateofPumping 7/14/95 Pumper TSSACS Pumpinq C, ABSORPTION FIELDDATA Date installed q 11 ~/RO~ Soil rating~(g,p.d,/ft~orftafodrm) 1 fi5(~ Systemtype '~) TO~ depth 14.45 Length a ~ ,(~) Width Gravel thickness below pipe Effective absorption area 576(~ Monitoring Tube present(Y/N). Y~ DepresSiOn over field (Y/N) No Date of adequacy test ~/31/96 ~ Results(Pass/Fail) pass (~) For 3 (~ bedrooms Fired' de th tn' abso don riel' befo tes in "(~) p rp' -. a : re t(' .); ~2 Immediate~yarter243_gal. wateradded (in.): Fluid depth 87 "~ (ins.) Minutes later:- 24 {~ Absorption rate --- 6 ~ 480~ g.p.d. Peroxide treatment (past 12 months) (Y/N) No~9 ffyes, give date Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons "Pump off' level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1 0 5 '~(~) ~ ; On adjacent lots Absorption field 9n lot I ~0.~ .p ~ ; On adjacent lots Public sewer mmn None Public sewer manhole/cleanout None Sewer/septic service line None Lift station __~gn~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1 0 ' +t~ Property line 31 ' + {~, ~_ Absorption field ,3 Water main/service line __~.,O,'fii~ Surface water/drainage bl,0r~e Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 3 5 ' + Surface water__N,one Curtain drain .... No'ne t~ Per DHHS Records ENGINEER'S CERTIFICATION ~Per DHI Records Water main/service line Nohe Driveway, parking/vehicle storage area 3 0 ' + Wells on adjacent lots 1 0 5' +~ Property line Signatur~ Engineers Name Date HAA Fee $ ,.~C~ Date of Payment Receipt Number Rev. 8/95 OSS: haa,wk, doc Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO.~~ /~-I~-~6 During a recent Health Authority Approval on-site inspection and test of tile potable water supply well on Lot ~ Block ~ of ~,f~[ ~/~rS Subdivision, the well's productivity was determined to be 0,~ gallons Der minute. The minimum well productivity required by this Department (AMC 15.55) for a ~ bedroom residence is 0,~1 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. CT&E Ref.# Matrix Client Sample ID CT&E Environmental Services Inc. Laboratory Division 96.0306-1 Laboratory Analysis Report WATER L9 BLK2 CONNIFO HEIGHT Client Name D H I CONSULTING ENGINEERS WORK Order 20895 Ordered By D. HIGH Printed Date 02/02/96 ~ 10:10 hrs. Project Name Collected Date 01/29/96 ® 16:30 hrs. Project~ Received Date 01/29/96 ~ 17:25 hrs. PWSID UA Technical Director STEPHEN C. EDE Released By "-~"~~~/~ / ~'~ Samp].e Remarks: SAMPLE COLLECTED BY: D. HIGH. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 2.2 mg/L EPA 353.2 10. 02/01/96 BMW * See Special Instructions Above UA - Unavailable ** See Sample Remarks Above NA ~ Not Analyzed ~ ~ Undetected, Reported value is the practical quantification limit. LT = Less Than ~ = Secondary dilution. GT - Greater Than ,ii 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 F~x: (.907) 561-5301 Fh~VII:~td~4FNT~I FACt!ITIF~ I~,l AIA~K^, £^~IF~PNIA. FLORIDA, ILLINOIS. MARYI.AND. MICHIGAN, MISSOURI, NEW ,IFR~FY, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & 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 I.D. # kf'")~, ~ - ~"3c~?~- ~-~(~ 1, GENERAL INFORMATION Complete legal description HAA # Location (site address or directions) Property owner Mailing address Lending agency Mailing address ~01~ERT' Day phone Day phone Agent [:EA~tK g'IE~L'( ('¢~'r'uR¥ 21 Address 22 13 E. TL,,DoR /'{~. ,, A/VcfY-OR,d~--,~/ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Com .munity well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- {,ng to the legality and status of system. 4: TYPE OFWASTEWATER 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. 72-025 (Rev. 1/91) Front MOA #21 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 ?L/~TTDP TECI.-I ~u,'¢ $ Phone '~5'- Address }~5'~O ECHo ~'T , /~.NC/-/. .~../~' ~/.~ ,5-/4 Engineer's signature '~~ ¢" ~ Date ! 6. ~ bedrooms. ,2S SIGNATURE /, Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /_ c]~ ]~2 Cokll 1:'~1~ J-JT~ Parcel I.D. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Y If A, B, or C, attach ADEC letter. Date completed Cased to 1 9 '/ ADEC water system number N ,~', P,/~O Driller D O1-T E=N BE])£0C/C Casing height 1~'" Wires properly protected (Y/N) '/' Date of test' Static water level Well flow Pump level FROM WELL LOG ~/~o g.p.m. AT INSPECTION MUNICIPALITY OF ANCHORAGE W J.,?.o Jq r ENVIRONMENTAL SERVICES DIVISION 0.7~' OCT 4 1991 E I V E D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 10'7' Absorption field on lot Public sewer main Public sewer service line ll~'" To C,O. ~' I0o ' ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform 0 c~,l Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed 9 J~$/80 Cleanouts (Y/N) "/ High water alarm (Y/N) Date of pumping 'f/'//~Jl Nitrate "~ff ("~ Other bacteria Collected by: ~,~.~r3'of' TeC/~ Tank size iooo Foundation cleanout (Y/N) Well(s) on lot Io-7 1F~0, c.0. Onadjacentlots loo' ~ ndation II To propertyline 3.~ Absorption field .5' ~'~ ~ ~T Water main/service line ~ 70 Surface water/drainage ~1oo' 72-026 (Rev. 3/91) Fronr~2~~ ~ 8~ CO~ ~RUC~O ~Um? 5~C ~l? CONTINUED ON BACK PAGE ~'4 c Compartments ~' Depression (Y/N) I'(,/~. Alarm tested (Y/N) Ro'to- ROOT,~I~ C. LIFT STATION N./~,, Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at Manhole/Access (Y/N) "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 ~/15/80 Soil rating 1~o,.5' ~'/5'PA:'.*, System type Length 3 (~' ' " Width . ,~ t Gravel thickness ,~' Total depth Total absorption area .~ 7& '~ Cleanouts present (Y/N) '// Depression over field (Y/N) N Date of adequacy test q/2o Results (pass/fail) ~',~,~.¢ for ~ bedrooms Peroxide treatment (past 12 months) (Y/N) )Io~' K/Vo~'N oF. If yes, give date N,/i. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: I Well on lot J I ~, To building foundation 2'2. ~ On adjacent lots ~ Surface water Curtain drain No~ ~ '-~:' ' E. ENGINEER'S CERTIFICATION On adjacent lots '~ /oo Property line lO To existing or abandoned system on lot Cutbank N.A- Water main/service line Driveway, parking/vehicle storage area $0 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 Date ~ ~ (' ~ / ~ / Date of Payment ReceiPt Number .--~-~/ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION ~)F COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS REPORT BY SAMPLE Eot WORKo=dext 38S13 Date Repo~t ?~lnted: SE? 24 91 ~ 10:04 FAX: (907) 561-5301 Client Sample ID:L9 B2 CONIFER HTS REAR'HOSE BIB Client Name PWSID :UA Client Acct Collected SE? 20 91 @ ll:O0 h~s, BPO # Received SEP 20 91 ~ 14:30 h~s. Req S P~eserved wSth :AS REQUIRED O~dezed By :FLATTOP TECHNICAL SRV :FLATTOT PO # NONE RECEIVED :TED MOORE A~alysls Completed :SEP 23 91 Send Repoxts to; Laboratory Supe~v~so~ :STEPHEN C. EDE 1)FLATTOP TECHNICAL SRV Chemlab ~ef #: 91~969 Lab Smpl ID: 1 Matrix: Allowable ?a~amete~ Tested Result NITRATE-N 2.2 mg/l EPA 353.2 lO Sample ROUTINE SABLE COLLECTED BY: CHRIS. Reread:ks: 1 Tests Pex£o~med ' See Special Instructions Above UA-Unavailable ND- None Detected ** See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-G~eate~ Th~n ~BGS Member of the SGS Group (Soci6t6 G6nerale de Surveillance) 12 / / / W DUE TO SNOW COULD NOT FIND THE SEPTIC SYSTEM AT THIS TIME. 35.9' TWO sTORY ~ous~ 28.0' 6,0 LOT 9 / / 10' 8 LEGEND: 5/8" REBARR SET (~) FND 0 1.5" PLASTIC MONUMENT SET-~- FENCE- X X ~ OVERHANG- ~ WOOD DECKS- I I CONCRETE- I ' .. ' '1 ASPHALT- t.' ",'",";'-".!::. ;J EASEMENT LINE- ~EPI~C STANDPIPES- (~) WATER WELL- ~) ELEV (DATUM ASSUMED)~ --RANIK BYF-R with CENTURY LAND &: CONSTRUCTION SURVEYORS-PLANNERS-ENOINEERS 4-40 WEST BENSON BLVD. # 103 ANCHORAGE, ALASKA 99503 562-5291 (F)561-6626 ORDER g2-L-81A FEB. 18, ]gg2 SCAL[: 1"=30' GRID NUMBER: 2440 AS--BUILT LOT 9, BLOCK 2 CONIFER HEIGHTS SUBD Under no circumstances should any data heron be used for construction or for establishing boundary or fence lines. EXCLUSION NOTES: it is the owners' responsibility to determine the existence of ony eosements, covenents, or restrictions which do not appeor on the recorded subdivision plot, DATE RECEIVED INSPECTION APPOINTMENT, S ~J~O.z~3~, '~..~ T'ME T'ME '~ /~/(~ · T'ME DATE DATE ~'~ "~.~ DATE INSPECTOR INSPECTOR ~ ~ I NSPECTORpx~x MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF H~AI.T;t 825 L Street ' Anchorage, Alaska 99501 ENVIRONMENTAL ENVIRONMENTAL SANITATION DIVISION ~0 ~ 1980 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. MA'IL~G ADDRESS ' ' pROpErTY RES'DENT (If different fF~ma ¢ ~ / PHONE 3. LENDING INSTITUTION I PHONE I MAILING ADDRESS 4. REALTOR/AGENT PHONE' MAI L, NG AD DR ESs STREET LOCATION ' 6. TYPE OF RESIDenCE rl~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [--I Two [] Five ~, Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~] INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) .~. ~..~ THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] I NDI VI DUAL/ON -SITE I-]PUBLIC UTILITY Connection Verified []Septic Tank,pr []Holding Tank Size: '10OO If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER INSTALLER SOl LS RATING MANUFACTURER MATERIAL Septic/Holding Tank IAbsorption Area Sewer Line [] OTHER INearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS DATE [~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accom~t~3~7~certificate) // [] DISAPPROVED 72-010 (Rev. 6/79)