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HomeMy WebLinkAboutTIMBERLANE PARK #1 LT 1A i ' ,~ 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 I [~] NEW ~ UPGRADE MAILING ADDRESS LEGAL DESCR ' N ~ I LOCATION NO. OF BEDROOMS I Well I Absorption area Dwelling PERMIT NO. ~ ~ Manufacturer Material ~ No, of compartments ~ ~ Liq, capacity in ga]Ions Inside?len~ ' Width Liquid depth , ~ Well ~ Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in galJons ~ Well Foundation Nearest lot line PERMIT NO. STANCE TO:// 7 ?' / 7 ~ ~ ~ No. of lines / Length of each ]ine Total length of lines Trench width Distance between lines Top of tiJe to finish grade Material beneath tiJe I Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Tote] effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: PIPE MATERIALS SOl L T EST RATING REMARKS APPROVED DATE kEGAk 72-013 (Rev. 3/78} - r"Ei::L!30L[) _,l:.J..1. ,I..[.. Hl.,l"r' LO'T' :B ]: ZE I'"II::IX :[ i"! ._ !"! I'.,II_.II"IE:EI:;;: OF B[E[)F~:Cu31'"!:E; = 4. -I"HE LEIqG"!'H [:,ZMEN:E;:[OIq Z:~, "['HE I...ENGTH (:iN F'EET) OF' THE TF?.ENE:H OI~: 1"HE DE:I::>TH O1::' FI 'T'f~:IENCH Ot:;'. PiT I:B THE DI27['I:tNCE E'~=E-f'!,.IIEEI",! "f'PIE SI.JI:i:FI:::IC:E!; OF THE: (:!iF?.OUND FIND THE: E=O'f'TOP1 OF TH[E E'XCRVRT]:ON ,::IN P'IEE-I'). I"HEIq:E I'Z-'; NO ~;E':T 1.4;[D"['H F'OF,.': TF?.ENC:HES. 1-HEi: EiRFI',,,'EL. DEF'TH ;iS THE i"IINII"IUP! DEF'TH OF GRFIVEL [3ETNE~:EN THE OL.ITFF!LL F'IF'E I::'I?',fD THE E',O'I""i'OI"! O1::' -['I--IE [~;',:':',Cl::l'v'FIl" ]: OF,I ( I hi I-'-['-::E-[' ). E: t::I C: I<: F* Z~...~-*, ,..~ ~ 'r ~.j -. OF t::lt",?'r~ S"¢'.:~:TEP1 ['-! ]i THOUT F - I'~ '- L .......... ]' '.J':::;pF: -' T T ~ll'.~ ]::iN[:' Rt::'F'F~:OVRL. E','¢ TI-! ]: S [:,EF:'I::4[;'.T!"IE:NT I.qZL. L E:[.~; ~;I..IB..ZrEC'F TLq I"I!'NIt"IU["I D.!i.'.-31"FiNC[E B[ETP.IEEN F:l I.,.IEI_L. FII'-,.ID !q!'q'.P ON....SZ'f'E :L:;EP.IFIGE DI:E;PO:~SI::IL.. :S'.PS-I"EM al_Eli:_:![ I::'l_:i;E-I- FOR l=t F:'R:[',,,'I=ITE NELl...; O[~'. ::t. SEI "FO 2~.'_"tC~ FEET Fl:ROt"1 f:t PUBLZC P.IELL. DEI::'ENDZ?,IG UF:'OF,! THE T'-/F'E: OF I::'LIEd_ZC !.4EL.[ .... I.,!EL.L L. OG~':; I::IF;'.E FRE6:!U:[I';.:EB, FII',ID P!U:'~T E~ t'4%'['UF?.NED TO THE DEI:::'FtI:;:TI"IENT I.,.!ZTH;[N 2i:E~ DFt'¢'.'_'..1 OF' THE.:: 1.4[ELL COf'1F'LETZOI",I. O-I"HE;I:;?. F?.[E6]U Z F?.E!"1EI",FF:E; P1Fl"r' IRPF'L"/. SPE:C ]: F'Z C:F:!"I' Z CI?.,I% FIND ('-:OF,I2;T!:;?.UCT ]: Oi",l IL'):t; FIC'iI~:F]P'I:!::; F:IRE FI',,,'FhT. L. FIE:L.E -!-O .~N:E;URE P[ROF'Ei;t:E: Z C:ER-FI'F'T' q"HFFI' :_t: Z RPI F:RI'dZL):RR 14Z"t"H THE F~:Ef_:.iUZREi"IEi"CF':S FOF;'. OIq-"S]:TE SEHE:!:R:~; F:II'4D I*IEL.L.':3 FI:'-:; 'SET F'CIRTH 13'-r' THE I"iU[qZCZPF!LZ'T'-r · 2.":: ]: !4:[1_.1... ZNSTI::ILL TH[:-' :E;"r'~;'FE["I ]:N F:IC:C:C~Fi:f.)f:INC:E I,.IZ1"I'"I THE CODES{;. :S: Z IJi",ID[EI;i:L::;TFINI3, TI'"!FIT THF£ f~'.E~;]:DENCE: ]:~i; I~'.E'I"!OD[CL. ED FIF'F'L.. Z C:I:::INT !3'GN i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRQNMENTAL PROTECTION Pouch 6650, Anchorage, Alaska 99502 276-2:221 SOILS LOG -- PERCOLATION TEST SOILS LOG PERCOLATION TEST LEGAL DESCRIPTION:/(: ¢/ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? t ....... · J J - Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT AND FT .h /' //- :' T/ ~ ,' ,:'I~' CERTIFIED BY: F[t::'F'L.. I C:F:it"~,T MCI',,,' :[ t'q 01",.I COF,!:S'I"F,?.LIE:'I' Z t".)N i!] 7Ii~I::LI-;) Cd..E:, SE'_'!.,.II':tRE) t-II4~'r' ?,~!.'.L~:~ :'UL~]?.,"[. L.OE:FIT ;[ 0I'-,! I':.'.L.f::IT T ,._ :, ,::,, Ell H:I:NZP'tU['"I [:: L.'f -:fi-,, : ~i,:::-", EE:r,t FI HEL.L. F!NF_:, FII'-,I*T~ OI'-~-.--:i; ): TI:; '_'E;[~f.,.IF:IGE: [', " ':: P '; 'E I:::IL~ -'~ ~,'" r ~'.,. :~JT.~;':~ FE::F:T[' F'O?. [::t F'F?.:I_",/I::tTE !4ELL.~ Eft;: :I.!Z;E'.~ '/'O ;E:E~E~ F'EE:'[' FROH FI PLIE~L :I: E: !4ELL DE:PE:N[::']:NG UPON TI'!E T'.¢F'E: OF F'UEfl_..ZC t4EI_..L.. !.'.I[ELL. L.OG'.E; Fff;?.!E F;'.E:(;!UZ[4'.E:I) F:IND ["ILIE;T BE: F;:E'['UF?.NED TO rile IDEF:'F:tI~:;'.'I"f"If:ZI~,!-I- P~Z'f"HZN 7_.::el Of:: THE: 1.4EL. L EriHER RE:(;iUL(FE:L::FIE:NT'.FJ; !'dFl"r' F:IF'F'L"r'. :L:;PE;E:]:F':[CFI'T'ZCINE; RND Cr_)!'.,1E;TRUCT:[Of.,I E,.t'FIGF;'.RPI~E; FtRE: I::i',,,'t:::IZ!_.!::t[3!_[-Z 'l'Ei :f.~'.,l:-'.;I.J[;~:[:~ F'I'4:C~F'EF,..' F:I:5 :!ii;ET Lending agency . .: . : .~" ~ii!il.i~.i._iJ ,,,<~Ao-u"" address ;' - ' - ' : ' : -:'?:':-:~-,,- ~ ' '"' '" Agent .... )hone ' 2. NUMBER C ~:~ -"-~ 3:::"?TYPE OF:WATER ~c Municipality of Anchorage ~N(~NT^~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~..--c,'C \ ~ ~>~.~..~-- Parcel I.D. RECE!U,"n A. WELL DATA Well type "'~-~,',[,oa ~ If A, B, or C, attach ADEC letter. ADEC water system number Log present ~N) Total depth ~ ~ Sanitary seal~)'N) ,/ Date completed .,, ~ ~-~-_-"] ~ Driller Cased to L~,~ ~ Casing height Wires properly protected~TN) FROM WELL LOG AT INSPECTION Date of test "~ -'1 ~:~ '~{ ~ - ~ ! Static water level J o' ~ ~ Welt flow I¢'. O g.p.m. ~ ,'~ + g.p.m. Pump level ~_')'~- "~ ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main '~ ~'C Public sewer service line ~ ; On adjacent lots ; On adjacent lots ~ J,~ Public sewer manhole/cleanout ~ ~-C~'~ Petroleum tank ~""[//N WATER SAMPLE RESULTS: Coliform ~ Nitrate //-~ /~/?/// Other bacteria ~ Date of sample: '~ - ~? - ~/ Collected by: /~. 5'/9'/~ £~'~ B. SEPTIC/HOLDING TANK DATA Date installed Tank size Compartments Cleanc~~.~ Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) ~ ~ AI~ Date of pumping Well(s) on lot ' ? ~ne ' ' Absorption field Water main/serVice line Surface water/drainage '::i:: -, .,~'~ ~: :~. 72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C, LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent-GY~ _ "Pump on" level at : . ~ High water alarm level _ ~ ~..-~-"~ycles tested Meets MOA electrical codes (Y/N) ~ ~ SEPARATION D.~~STATIO[~ To: --. Well on~ On adiacent lots Surface water D. ABSORPTION FIELD DATA Date installed Soil rating System type '--L~ Width Total ab'~.~area Depression over ffe~.) _ Dat~acy test Results (pass/fail) ~ Peroxide treatment (past 12 mon~_ ~)~''''''~ If yes, give date SEPARATION DISTA~ORPT~- Well on lot __~~ On adjacent lots Pr~O~ To bu~undation __ To existing or abandoned system on lot ,:..~.adjacent lots Cutbank .Water main/service line Surface water Driveway, parking/vehicle storage area Gravel thickness Total depth Cleanouts present~ bedrooms Curtain drain 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 5 & 5 t[N(~l['~i~i;:ii',iG Engineer's Nan~034 Eagle I,~iver Loop Road No. 204 E~g[e River~ Alns~a ~// Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA99518 TELEPHONE (907)562-2343 ANALYSIS REPORT BY SA~LR for WORKozdor! 32965 Date Report Printed: APR 3 91 @ 17:25 FAX: (907) 561-5301 Client Sample ID:L1A E2 TIMBERLANE PARR S/D PWSID :UA Collected APR 2 91 @ 15:00 RecelYed APR 2 91 @ 15:25 Client Name :S ~ S ENGINEERING Client Acct :SNSENGP BPO { PO { NONE RECEIVED Req ~ O~dered By :R. SHAPER Analysis Completed :APR 3 91 Send Reports to: I)S & S ENGINEERING Laboratory Supervi~o~ ~PI{EN C. EDE Released By : ~ "~.~ 2) Chemlab Ref $: 911193 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units ~ethod Limits NITRATE-N 1.9 m~/1 EPA 353.2 10 Sample HA}dPLE COLLECIED BY: RAY. Remarks: ! Eest8 Performad See Special Instructions Above UA~Unavallable ND~ None Dote@ted "See Sample Remarks Above ~UNC PALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. O,: H;JALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~JI~)~qMENTAL Pd©'I'ECT[QN 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION NOV 2 ? 1978 Telephone 264-4720 S~E~FA~Ji LVi~ _~S 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, PROPERTY OWNER MAILIN~ ADDRESS PROPERTY RESIDENT (If different from above) 2, BUYER 3, LENDING INSTITUTION MAI LING ADDR ESS PHONE PHONE PHONE 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION E. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ One ~' Four ~ Other ~' SINGLE FAMILY ' ' ~ Two ~ Five ~ ' MULTIPLE FAMILY ~ Three ~ Six 7, WATER SUPPLY ~ INDIVIDUAL" * ATTACH WELL LOG. A well log is required for all wells drilled ~ COMMUNITY since June 1975. For wells dri[l~ pri~to that date, give well ~ PUBLIC UTI LITY depth (attach log if available,) 8. SEWAGE DiSPOSALSYSTEM ~' INDIVI DUAL/ON-SITE~* **if individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ~ PUBLIC UTI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~10(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS IME TIME TIME DATE DATE DATE NSPECTOR INSPECTOR I NSPBCTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE -,. · r · [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3, SEWAGE DISPOSAL SYSTEM ~JlN DIVI DUAL/ON -SFrE t~ PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: /~.~0 If Tank is homemade give dimensions: TYPE OF 'rANK TOTAL ABSORPTION AREA 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line [] ONE [] , THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL/ Septic/Holding Tank Absorption Area Sewer Line [] OTHER Nearest Lot Line 5. COMMENTS /1 [~-,'¢APPROVED FOR Z'.-1t''~ BEDROOMS [~ CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED /') .DATE ~ '~ ' ('1 '1 BY (Ti~ 72-010 (Rev. 3/78) November 30~ 1978 ~4ovin' On Construction Lyl~ Paszek, Don Hannah 7010 Old Seaward Highway ,~z~chorag~, Alaska 99582 S~bject: Lot 1 Block 2 TLmber Lane Park Subdivision Approval for your individual sewer m~d water facilities will not be gr,%ted ~util th~ follo%~lng items have been eompleted~ C~,(X) A well log is submitted to this department. ( ) The top of the w~ll casing is sealed with a sanitary seal so that it is water The dopression or pit around the wall casing should be filled wi~h impervious ~ype soil so that it slopes a?~ay from the w~ll casing. ( ) The woll casing is extonded twelve(12) inches aboV~ groun~ level. ( ) Expose the ~-~ei! for our inspection to determine proper constr~etion~ a!so~ to insure the minin%um for protective radius fro~a w~ll and ( ) ~'he Septic tank is pu~%%pe~ with a receipt submitted this office. () () A four(4) inch east iron cleanout be installed to the septic tank or leachinq area. A p%)rcolation test b~ petrol, ted on the existing leaching area. This will deter~..~.~ine if the system is adequate according to National Standards. A list of private firms who i~rfor~ the test is enclosed. ~4ovin" On Construction Movembar 30~ 1978 Page Two ( ) Your appl~caulon ~hows the n%~ber of bedrooms exceeds the n%u~er the ~ew~r system was originally approved for, therefore, an upgrade will be required. · e ( ) Connect to ~he public sewer which is avallabl to you~ Notify this degartment for a re-inst~ction when descrepaneies have b~en correc~edo If there are any further questions~ please contact ~his office at 264-4720~ S~cerely, ~lob~rt C. Pratt, A~sociate Specialist ac /ljw CC: Alaska Statebank ~rtgage Lo~% Depar~%ent 310 East Northern Lights Boulevard 99503