HomeMy WebLinkAboutROLLING HILLS ESTATES BLK D LT 7 ' MUNICIPALITY OF ANCHORAGE
, HEALTH & ENVIRONMENTAL PROTECTION
DEPARTMENT
OF
~ ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 09501 Telephone 264-4720
ON-$1TI: $FWAG£ DISPOSAL SYSTfiM ~D/O~ ~Ekk I~SPfiCTIO~ ~EPOBT
Liq. cap~gallons IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
0 Z ~ Manufacturer Material Liquid capacity in gallons
~}~ inches Total ~.f~~ area
No, oflnes Length o~n' Total Iongt~e~ T renc~ DistanceZw lines
~ Top of tile to finish grade y Material beneath tile 7~ inches PERM~
Length Width Depth
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m ~ell ~uildin~ foundation ~earest lot line
~ DISTA~C[ TO:
~ Class Depth Driller Distance to lot line ~EBMIT ~O.
~ DISTA~Cfi TO: Buildin~ ~oundation Se~er lin~ Septic tank ABsorption
OTHER
PIPE ~TERIALS
REMARKS
,~ I~
/'
~ , ~,~ ~ '"~' ~i~~
~,'~
I
Box 1369. STAR I~OL*TE A ANCHORAGE. ALASKA 99502
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED AT THE RATE OF ~0°50 PER FOOT.
PROPERTY OWNER /~o ~e~.~ $o~c~ 27~0-~0007
LOCATION Of WELL SITE
DRILLER
WELL LOG:
0 ..... 28 '
28 .... 43' A ~ ~
43---119'
779--74~~
14~--7~6~
120 ~e~ o~
Coo~ o~ ~,t,~/.2Ar~¢: $79.50 X 146 .fi~?,: $2847.00
Co~ off We.A~$ex~: $20°00
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
$2557.00
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
ATE ........................
[:,EF'FIRTMENT E,. HERLTH RND ENVIRONMENTRL F,..;OTECTION
' . ~ °25 '"L'" STREET., BNL. HORH~E.,
~ * 2e]4-,4720
F'ERMIT NO. ( 810~,::.5 )
RPPLICRNT JERRY SOWR 2:2ii LOIS DR',,-('!~q'~-~l ~ 279-~
LEGRL L7 BLOCK D ROLLING HZLLS EST L. OT
TYF'E OF SOIL RBSORPTZON SYSTEH LS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 9]: SOIL RATING <SQ FT/BR)=
[:, E F' T 14 :- ~ b E:t;~ [~ T i :: 42
THE LENGTH ' , '~' q ' "
DIHEN=~I{N IS THE LENGTH (IN FEET) OF THE T6EN..H OR DRflINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUN[:, fiND THE BOTTOM OF THE EXCRVRTION (IN FEET).
TREN ...HE_,.
THERE IS NO SET WIDTH FOR , .n
THE GRRVEL DEPTH¢ IS THE MINIMUM DEPTH OF GRRYEL BETWEEN THE OUTFRLL PIPE
RND THE'E:~]TTdtd~ i~F THE EXF:R',,,'RTIF~N (IN FEET'.',
PERMIT RPPLIC:RNT HH- THE RE~PON_,IE, ZLIT~ TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION IN~P~CTION_ OF RNY WELLS RDCRCENT TO THZS PROPERTY RND THE
N IMBER OF RESIDENCES THRT THE WELL WILL
- . c'--- ~ -- - ':' I:;:E6ILIIF,,:E
-?---- Thio <: ,,? ':' I NI_.F EL-T I b,l'.l.;, I=tF-:E
BRCKFILLING OF RNY q '"; ''
_~r.=TE. fl WITHULIT FINRL INSPEL-:TION RND RPPROVRL BY THIS
DEF'RRTMENT WILL BE SUBJECT TO PRFISECUTIDN.
MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL. LOGS RRE REQUIRED RND MUST 8E RETURNED TO THE DEPRRTMENT WITHIN 30 DRYS
OF 'THE WELL COMPLETION.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIAGRRMS ARE
RVRILRBLE TO INSURE PROPER INSTALLRTION.
I CERTIFY THRT
±: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
3: I UNDERSTAND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS.
S I GNE[:,: .....................................................
APF'L I CANT .ZEF.'.R'¢ SOWR
V4. E1
~dELL ~-t~-~ ~--S I 'TB SE~ER PERM I T
DEP TH: :L~D L~!'~'-~.?~ 'FH~ 4 2 8R;IVKL OEP TH ~ ~
I)~ 'I'-C:: G -- 2 2 -. '7 ({
pep-th in Feet
}? r C)ril To
0,0' - 1.5'
t.5' - 10,0'
10,0' - 16.0'
Soil Deseri. E~i~oZ ...........................
Brown Peat (Pt).
F-4, brown SandZ p.j:[lt:_~ (ML). Trace organics
5' P1- to
P-4, brown Silt (HL) with t:race Sand. Pl.-.
Bottom of" ~"
Ie~t Hole:
]: .~ ()st Line:
Free Water Level:
16.0'
None Observed
None (.b,~e_ved
1 5.0'
2 10.0'
· 3 15.0'
Type of Dry
2 8 · 9 G L-N ML
2 3.6 G L-N ML
23.1 G N ML
Remarks: I .
3.
4.
5.
6.
Type of Sample, G=Grab, SP = Standard Penetration,.
U =: Undisturbed.
Dry Strength, N=None, L=Low, M=Hedium, H=:High.
Group refers to similar material, this study only.
General. Infermation, see Sheet 1.
Frost and Tex%ural Classification, see Sheet 2.
Unified Classificatien, see Sheet 3.
2
TABLE B
Lot NO.
Minimum Observed
Percolation Rate,
Minutes/inch
Required
Absorption Area,
square feet/bedroom
4 6.7 140
5 3.7 110
6 ~jC~ -~ 10.0 165
8 6.7 140'
15 5.7 130
16 10.0 165
17 8.0 150
Because of the silty nature of the site soils and since silty
soils sometimes tend to clog with use, we recommend a more
'conservative design value of 165 square feet/bedroom be used
in spite'of the above ratings.
Ut_ ,~ . -f H~...~--,~...ll, .u ....... i~l .t~ ~ ......4 ,t 1-tt,..~ ~.,t ,.I ,lti*-~ ,,~.~
COPY
i.. I3C,,:~'[' :I; t3r..l
IVi,~l.:~i.,r. tVlLli'"t r',i!..tl~1Bi'ii}:{ I;'i!F' !3t!;i'Dt::~E}ii-.li','I~; :: .;3
'['k't£~,~ L.ENii:;T'H D.fi','IEt';,tS.[(iN .iS 'I"F.li~i. L.EN,1t:;'I"H ! .iN !::;'EE'I") t31:::' THE
'f"HEI41i!( 1~:; bio SE]" ti.lil~)'l"H FtJR TRENC;HEi~.~,,
'I"HE i;I:~,~'.*,,VEL DEf:~'I-H .I'.S '['HE I*,I.(N.t't',li..~F! !;;~,EI:.~f~'H [;ii::' ¢;R~¢,,,'I:,~;L. I~.!I:,:!'I"i4~.EEN
'IE) ,."'.:!'30 F:E:E.-"t" FDR F'-', PL~I31.. .[ ,;:.': (¢~!::t._L.. £:>f~PENDIN¢ LJi:.'l~]i~4 'i'HE 'I'YRE DF t:;~LJt~il...[~;:;
'[hie ~,tELt.. C'QFiPL.E '1" J' Ot',1,
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
72-Z)/ NAA# ~,~ ~ ( ~.~.. C',~, "~
1. GENERAL INFORMATION
Complete legat description
Location (site address or directions)
Property owner ~O?/'C/~/ ~ /~-~;//~ ~-~ Day phone
Mailing address
Lending agency
Day phone
Mailing address.
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
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
Public sewer
NOTE:
?
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
o
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify thai 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 ~,/4-~/~ - ~/ ~-ft~','f)~--¢-~/'~_¢ Phone ~¢~ - ~2-~'
Address
Engineer's signature l I Date
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
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 DH HS 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~)25 (Rev, 1/91) Back MOA
Legal Description:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division MUNI~,iPALI]'Y Ot' AN
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)~¢~L'~At SERVICES O~VISlON
Health Authority Approval Checklist NOV '1 0 1997
A. WELL DATA
V~/ell type -r/'-~ ~(~?~'cc'~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) ~'/'~"¢~ Date completed ~'~"' / '~/ / ~
Total depth /~/~' ~, Cased to /4'/~ -~ Casing height (above ground) 02-~2 //
Sanitary seal (Y/N) ¢~'~ Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
7¢/
Nitrate
g.p.m.
Collected by:
Other bacteria
Number of Compartments
Depression Hi
__ Cleanouts (Y/N)__
(Y/N)
Date of test
/
Static water level /
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample: /~/?~/~'7
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size
Foundation cleanout (Y/N)
g.p.m.
Date of Pumping Pumper
C. ABSORPTION FIELD DATA
Date installed
Length Width
Effective absorption area
Soil rating
ickness below pipe
g Tube present (Y/N).__
System type
Total depth
Depression over field (Y/N) __
Date of adequacy test
Fluid depth in absorption
Fluid depth / (ins) Minutes later:
Peroxide tre~ent (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
Results (Pass/Fail)
(in.); Immediately after
Absorption rate =
If yes, give date
For
gal. water added (in.):
.g.p.d.
bedrooms
D. LIFT STATION
Date installed
Manhole/Access (Y/N).
High water alarm level at*
Cycles tested ~
E. SEPARATION DISTA~
"Pum~' level at* "Pump off" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO: ~ ~
Sep. c/ho.d~ng tank on ,ct ~, ~/~/~//;~ ~/~ ~On ~U]~cen~ ,o~
Absorption field on lot ~l On adjacent lots
Public sewer main ~~ ~/~'¢ Public sewer manhole/cleanout
Sewer/septic sewice line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT~~
Foundation ~ ~ Prope~yline / ~~i~ield
Water main/sewice line _ __Sudace water/drainage _~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION~~OT TO:
~r~ I~f~; B~~~~ ~p~c~e~t~i~S~r~i~e line
Cu~ain drain ~ Wells on adjacent lots
.
ENGINEER S CERTIFICATION
I cedify that ~ave determined thru field inspections and review of Municipal record~~~ms
in conforma/ ~e With MO~HAA guidelines in effect on this date
_f I '
Engineer's ame
HAA Fee $ ,~(~(:::~, L.~L.~
Waiver Fee $
Date of Payment
Receipt Number
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
/
,/
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN PUBLIC SERVICE OFFICE
555 CORDOVA STREET
ANCHORAGE, ALASKA 99503
TONY KNOWLE$, GOVERNOR
FAX: (907) 269-7506
Mr. Kenneth M. Duffus, P.E.
KND Engineering
20441 Ptarmigan Blvd.
Eagle River, Alaska 99577-8736
Subject:
November 4, 1996
REC£1V[
APR 2:7 19~~'
Munic pality of Ap'.... '~'?
Oept, Health &Hu~na~, :~' ~ ~-~
Rolling Hills Estates Sewer Line Improvement, SeParation Distance Waiver
Requests; Anchorage, Alaska, AWPSA Project Number 9721-WW-283-134;
Review
Dear Mr. Duffus:
This letter is in response to your submittal received in this office on October 9, 1996 in
which you requested 16 different horizontal separation distance waivers between existing
private water system source wells and components (manholes and laterals) of the
proposed sewer line project. The 16 separation distance waivers range from 39 feet to 88
feet between private source wells and sewer laterals and 64 feet to 90 feet between private
source wells and sanitary sewer manholes (SSMH). I have completed my review of the
submitted information and information in this office's files regarding Rolling Hills Estates,
Based upon this review, I have the following comments:
The on-site geological and hydro-geological information was very limited and not well
presented. However, once the soils information from the well logs and test pits was to draft
a profile of the soils in the area, some trends were visible, such as tight soils (sandy silt to
silty sands) throughout the section of the subdivision being impacted by the proposed
sewer line improvement. With the mitigating construction methods being proposed as
noted in your submittal, the requested waivers are reasonable.
Therefore, in accordance with the provisions of the State Wastewater Disposal and
Drinking Water Regulations (18 AAC 72.015 and 18 AAC 80.030), the following separation
distances have been granted:
Between the Private Water System Source Well on Lot 3, Block A and the lateral
sewer line from 75 feet to approximately 64 feet.
Between the Private Water System Source Well on Lot 3, Block A, and the manhole
Rolling Hills Estates
November 4, 1996
(SSMH#7) from 100 feet to approximately 64 feet.
Between the Private Water System Source Well on Lot 4, Block A and the lateral
sewer line from 75 feet to approximately 39 feet.
Between the Private Water System Source Well on Lot 4, Block A, and the manhole
(SSMH#7) from 100 feet to approximately 81 feet.
Between the Private Water System Source Well on Lot 4, Block D, and the manhole
(SSMH#4) from 100 feet to approximately 93 feet.
Between the Private Water System Source Well on Lot 6, Block D and the lateral
sewer line from 75 feet to approximately 50 feet.
Between the Private Water System Source Well on Lot 7, Block D and the lateral
sewer line from 75 feet to approximately 70 feet.
Between the Private Water System Source Well on Lot 7, Block D, and the manhole
(SSMH#1) from 100 feet to approximately 85 feet.
Between the Private Water System Source Well on Lot 8, Block D and the lateral
sewer line from 75 feet to approximately 44 feet.
Between the Private Water System Source Well on Lot 4, Block B, and the manhole
(SSMH#3) from 100 feet to approximately 88 feet.
Between the Private Water System Source Well on Lot 7, BlOck C, and the manhole
(SSMH#2) from 100 feet to approximate y 90 feet.
Between the Private Water System Source Well on Lot 8, Block C and the lateral
sewer line from 75 feet to approximately 52 feet.
Between the Private Water System Source Well on Lot 8, Block C, and the manhole
(SSMH#2) from 100 feet to approximately 80 feet.
Between the Private Water System Source Well on Lot 9, Block C and the lateral
sewer line from 75 feet to approximately 50 feet.
Between the Private Water System Source Well on Lot 9, Block C, and the manhole
(SSMH#1) from 100 feet to approximately 76 feet.
Between the Private Water System Source Well on Lot 11, Block C and the lateral
sewer line from 75 feet to approximately 52 feet.
The above noted waivers are granted with the following requirements:
The lateral lines as designed will have joints shrink wrapped and the line
encased in 8 mi., polyethylene.
The manholes will need to be watertight in accordance with Municipality of
Anchorage Standard Specifications. In addition, manholes will be hot
mopped and sealed in 8 mi., polythene. Both of which was noted in your
submittal.
For the two private system source wells that have the sewer lateral within 50
feet (Lot ~4, Block A~ and Lot 8, Block D), the sewer line joints will need to be
double shrinl~ wrapped.
Installation of all manholes and sewer lines will need to incorporate extra
precaution during installation.
Due to the lack of water quality data from the source wells in question being
submitted, one set of test results from each well for total coliform bacteria
and nitrates (as nitrogen) will need to be submitted to this office before
starting installation of the sewer line. This Department has one nitrate
sample result from the source well on Lot 6, Block B showing nitrates at 1.3
mg/I.
These waivers do not imply granting of any additional authorizations, nor obligate any
state, federal or local regulatory body to grant required authorizations.
Thank you for your cooperation with this Department. If you have any questions, please
do not hesitate to contact me.
Sincerely,
Keven K Kleweno, P.Eo
Environmental Engineer
KKK/ka
cc: Jim Cross, P.E., MOA, DHHS, On-Site Services
~t~_ CT&E Environmental Services Inc.
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
Sample Remarks:
982259001
PARA-1 Engineering
Lot 7, Blk D Rolling Hills Est
Lt 7, Blk D Rolling Hills Est
Drinking Water
Client PO//
Printed Date/Time 05/20/98 22:24
CollectedDate/Time 05/14/98 16:30
Received Date/Time 05/14/98 16:40
Technical Director: Stephen C. Ede
Released By ~ ~
Results
PQL
Units
Allowable Prep Analysis
Method Limits Date Date Init
Nitrate-N 0.100 U 0.100 mg/L EPA 300.0 10 max 05/15/98 05/15/98 RMV
Total Coliform 0 col/lOOmL SM18 9222B 05/14/98 TMW
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. # <~)//- ~)7~-~'~/
1. GENERAL INFORMATION
Complete legal description ~--~/ ~
Location (site address or directions)
y . ~ . y Day phone
Mailing address. 7¢ ¢0 ~/
Lending agency ~/~ ~ ~~ / Day phone
Mailing address ~ ¢/ ~,
Agent Z~/~ Z~~ ~ / Day phone
Address ~/ ~-~'~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
Community on-site
Public sewer / ~'~ 17~-~~ 1//"'('~/':;] '~
NOTE: If community wastewater system, provide written confirmation from State ADEC
o
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 disposalsystem is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm /¢::2/,,~/~/__~ .-- / ~--~'/'4,~-/'/~ Phone
Address
Engineer's signature'/~-~4~~/'c9'¢- --
DHHS SIGNATURE
Approved for
,.~ Disapproved.
Conditional approval for
bedrooms.
Date
bedrooms, with the following stipulations:
By:
,~dditional Comments
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 DH HS 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 i¢21
NOU-O4-19ST 09:2? CT&E ESI ANCHORAGE 907S615501 P.OJ×05
CT&E Environmental Services Inc.
Laboratory DiVision i~a~~,ar~r~4,~,a,:~r~,a~r~:a~amKa,/~ar~.or,~'~r~aro~.
)rinking Water AnalYsis Report.for Total Coliform Bacteria :~
Anchorage, AK
MUST Bt[ COMPLETED BY WATER
O PUBLIC WATER SY~IM I,.D,
~'" PRIVAT~ WATER SY~[M
SAMPI.~ DAT[;
SAMPLE TYPE:
Mont~ Day Year'
R~at ~amplo (for murine manplw Q' Unt~Wn~
with lab ~. n~ )
Special P=~
$A~L[ L~ATION % '~ Colt~.
Fan.' (907) !561-~301
TO BE, COMPLETED BY LABOF~,TO~Y
Analysis shows this ~acer ~AMPLE to be:
Satisf~t~
S~ple over 30 hou~ o1~ resole may
be u~mli~le
0 Snmpl~ too long in tmn~it~ sample
not be Over 48 hou~ o~d at examination
Co indi~te reliable result. Pt~e se~d
n~s~ple~a sp~lai ~ ~ma'
...,,,,, ...
A~l~cal M~I~r ~ Mcmb~ FiI~
* Num~of~l~iegtO0
Analyst
97BB?8
[]
· Memt~r ~ the ~ou o~ m~'nlo CiO Sit~lilllt~(le)
TOTRL P. 03
NOU-04-1997 09:29 CTgE ESI ANCHORAGE
.~l~ CT&E Enu, ro nm. nta~ S,,vices,nc.
CT&E ReL#
Client Name
Proj~t Name/#
Client 8ample I13
Matri~
Ordered By
PWSID
976678001
PAIRA-I Engineering
Lot 7, Blk D Rolllng Hilla Eat
Lt 7 Blk D Rolling H~II~
Client
~rinted Date/Time 11/03/9'7 16:10
Colleetod Date/Timo 10/29/97 12:15
Received Date/Time 10/29/9'/16:30
Technical Directovt Stephen C. Ede
Total
6) 0)/ 100 ail/ NO :OL)
0.100 ~s/L
EPA 30B,O
'--~- i ~-~ .... ir / · DATE ~R ECEiVED
~. · INSPECTION APPOINTMENTS
TIME ~1 ,?gQ} ' TIME TIME,~.
DATE ~
'N ~ ~l~)~d~ PATE DATE
MUNIcIPA~I~ OF ANCHOrAge
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~MENTAL
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S I
DIRECTIONS: Complete all parts o~} page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing.
1. PROPE~YO~ER, , PHONE
MAILINGADD~ESS ~ ,~ '
PROPERTY RESIDENT(Ifd~erentt~o ab ) ~ ,,O. ,~ . , . ~ ~ __ PHONE
2, BUYER ., ' . .~ ~ r . ~ PHONE
4. REALTOR/AGENT ~ PHONE
I
MAILING ADDRESS
6. TYPE OF RESIDENCE ~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
E~]. Two [] Five
Three [] Six
[] Other
7. WATE~R S.,UPPLY
~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 197§. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
X INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
-oto (,,.. 6/79) """ "f ......:
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[~'~SINGLE [~.~FH R EE [] FIVE [] OTHER
ONE
FAMILY
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[~iNDiviDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
F-]J4~tl~VI DUAL/ON -SITE DATE INSTALLED
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: / ~ ~ ~ If Tank is homemade SOILS RATING
give dimensions: / ~ ~
TYPE OF TANK ~ MANUFACTURER
TOTAL ABSORPTION AREA. ~ MATERIAL
4. DISTANCESwELL TO: Sept~/H~in~,Tank Absorp)io~)A~ lSewer
Line I Nearest Lot Line
I
Absorption Area to nearest Lot Line
5. COMMENTS
APPROVED FOR -_ BEDROOMS
CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED