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Home My WebLink AboutTIMBERLANE PARK #1 BLK 1 LT 14 DEPARTMENT OF HEALTH AND HUMAN SERVICES ; Environmental Health Division ' 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~a.,~ DISTANCES ~)ONMIE' bRISCOLL ~A. ~R¢Y P~fl~¢R~ T0 SEPTIC ABSORPTION Address~UI~1% TANK FIELD WELL ~OI ~. ~LA~ Phone(s)3~ - 211l Sw~oPerm't NO O~O3 NO~°~Bedr°°ms WELL ~ LEGAL DESCRIPTION LOT LINE ~2 Township, Range, Section AS*BUILT BIAGRA~ tSl~ow Iocahon of well, septic syslem, property I~nes, Ioundahon, TANKS ~ SEPTIC (~r/~ D HOLDING t Manufacturer Capacdy ~n galJons ~ I Material ~o. o~ Compartments ~ TYPE OF SYSTEM TRENCH ~ BED ~ W. DRAIN ~ OTHER Fill added above original grade Grave[ depth beneath p~pe / 2' ~o 0 FT O-~ FI /~ ~I~ 7' Gravel lengtl] ~ FT Grsvel width ~ FT 1'0" ~ ~ ~ SOd rallngj~ ¢'~FIELD PI mate.al ~ ,~ NoN' ~RF(D-3O3~ ~ / I I ¢ PRIVATE ~ OTHER (Identify) ~ REMARKS: K[,~~'m 72-013 (3/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT Permit Number: SW90f-~%L~ Permit Type: Date Issued:~A~/g~ Expiration Date. /~/~//~ Design E ng i ne e r: -/-~o'/~Z~)/~-- ~ ~_~. . Owner Name: /~TA~ ~ ~'o%'~ Day Phone' ~---~/// Owner Address: ~/ ~ /~,~rr ~ ///a~l/;//~_ Parcel ID: ~/~--~'Z Lot Legal: Subdivision:~/~/~f, bm~v~= /g/~/zAc ~[ Lot: /~ Block: / Section: .~ Towns~~ Range: ~ Lot Size.~ ~ or acres) Max Bedrooms: This Permit: ~ To~al Capacity: SEPTIC TANK: Minimum septic tank capacity: /O~ gallons. EaQh septic tank must have at least 2 compartments, insulation is required if depth to top of septic hank(s) is less than 4.0' Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 days of the well's completion. CERTIFY THAT: 1. I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality of Anchorage (MOA) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system~ or surface water on this or any adjacent or nearby lot. 3. I understand that this permit is valid for a single family dwelling with a maximum of ~ bedrooms. I also understand that any enlargement will require an additional permit. ~. I understand this permit is issued for the calendar year and expires on December 31 of the year issued. 5. I will notify DHHS prior to all inspections by the engineer or well driller. DATE: ~5~/21/~.o DATE: db/ll5 Flatt6p Techn~ca! Services 14530 Echo Street Znchorage, Alaska 99516 I~IU~ICIPALITY OF ANCHORAGE MEMORANDUM 91-015 (Rev. 1/81) ~ ~ ~ ~ /~ I~ . o ~ ~ ~ · 0 ~ ~. "~ ~ ~ ~1 ~ ~ ,~ z ~ · ~ -~ · , LI3 DR,~ IN 'T, IL IA/' e-'CoNCR E TO BE V/~C.A FIT pier ¢.o. LL ~'TT RD. SLOPE ,RNA L"/S ~...' A '..~, VIC IN ~T~ OF T~ pRo~o~EP~..'---TH~,~ ';~ LOT 14, BLOCK lo 7it~B/RL~I, IE SEPTIC. SYSTEM SITE PL,qN SCALE: I"= ,50 DATE: HOT/:: THis tS HoT A s~RVE~/Eb ~P/AT ALL LoC ATIo N~' ~RE ~PpRoXtM~TE PLAN VIEW 1' = lC)' SECT ION "E~ - B' ARE/iS ~//o EXISTING l~'= Sz SECTION /~-A FILL A?PLJE$ ~-o A~EAS 'WITH EXIgTIN4 Fi, L 1%, BI. TtMBERLANE SOIL Ag£. TRENCN PLAN , ~- SECTIONS SC.~LE : ~S NOT£1: bATE: E/9o D~'N B"/: ~ Flattop Technical ~erv: 14530 Echo Street Anchorage, Alaska 9~ Lot 14, Block 1, Timberlane Park S/D 801 West Klatt Road SEPTIC SYSTEM UPGRADE SPECIFICAT IONS 1. This proiect consists of the installation of a new 5' wide by 75 foot long drainfield in the approximate location shown on the site plan, and built as shown on the design drawing. The size of the drail~field is based on a measured perc rate of 3 minutes per inch in the sandy loam stratum, for which a soil rate of 125 square feet per bedroom is used. This three bedroom drainfield thus requires 3 x 125 = 375 square feet of base area. 2. All construction practices and material specifications shail be in conformance with M.O.A. requirements. 3. The existing seepage pit is to be abandoned by removing the top and completely filling the pit with unclassified soil. The existing soil absorption trench is to be abandoned in place, with the standpipe removed. 4. The existing concrete septic tank is to be retained provided it is first uncovered on the top to allow it to be thoroughly pumped and it's integrity to be verified. New plastic tee inlet and outlet b~J'fles shall be installed and grouted in place as necessary, and a new cleanout pipe installed. If the tank top is buried less than 4 feet, it shall be covered with 2" of 35 psi rigid insulation before backHll. 5. The new drainfield shall be constructed by first removing the overlying material and peat to expose the top surface of the reddish sandy loam stratum. It is important that this top surface of the loam be carefully traced to follow a level contour along the entire length of the drainfield. The drainHeld base shall be constructed by removing the minimum amount of loam material to create a 5 foot wide level bench. No vehicles shall drive on this loam material prior to placement of the sewer gravel. 6. A total of 12 inches of approved sewer gravel shall be installed in the drainfield, with the level perforated distribution pipe buried in the gravel with the pipe invert no less than 6 inches above the bottom of the gravel. The entire top of the gravel shall be covered with approved filter fabric, plus 2" thick by 4' wide rigid, burial type insulation rated for 35 psi minimum. The cover depth over the top of the insulation shall be at least 2', with 3:1 side slopes in areas where there is insufficient adiacent existing soil. Cleanouts and monitor tubes shall be installed as shown, including a cleanout in the waste line within 5 feet of the septic tank. 7. A total of 4 inspections will be needed: (1} initial stakeout, (2) after the drainfield base is ready, but prior to placement of sewer gravel, (3) after the gravel is placed, the pipes are installed and connected, and the septic tank is exposed, and (4) after backfill. PERFORMED FOR: l:'Iatt~-15 T6¢IYh{Ca! S6Y~-ic~s 14530 Echo Street Anchorage, Alaskc~ 99516 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST BONNIE DRISCOLL LEGAL DESCRIPTION: 1 5 6 7 8 9 10 11'- 12- 13- 14- 15- 16- 17- 18- 19 20 B I., TI~BE'RL/~L: pJ~.ownship, Range, Section: SEC 2~, '"r' 12 N~ R z./. ~/ SLOPE ? SITE PLAN ~ : ~M//VlL SILTY ~oI~AIVEL FtLL PT 0 R1GIN/tL TOPSOIL 5M SILTY, ~ANb¥ L~AM (~M, hL ...-qlL'r¥ G'R,qVEL GI E"/, PR',/ M,~ N~/ CogBLES TOP FEW' WAS GROUND WATER ENCOUNTERED? I~CI~E5 CL£FiNER s IF YES, AT WHAT DEPTH? ,~g.,~:~r/ -- " U I-~-'~ /~,C Moniloring? . KLATT RD. PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ T, H ,-;1~ I TEST RUN BETWEEN FT AND , FT COMMEN~S2~I~ODIqbWt~TE~ MOIqITOI~IN'~ DONE IN 'I'.H~ 14-2 ONLY, T.U~ JA~2Aj4.~,/~ bUG TO DETERMINE PERt R/ITE.~ EXTENT $ (~oNTINuIT',/' oF EANi)'/ Z0~M ETR.4TUM PERFORMED BY'. FL/~TTOP TECI-I. ~ ~C~ i CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL G~JIDELINES IN EFFECT ON THIS DATE· DATE: 72,-008 (Rev. 4/85) Reading Date Gross N'et Depth tO Net Time Time Water Drop PERFORMED FOR: Flc~tt~-~ T~ah~fiiaa! 14530 Echo Street Anchorage, Alaska 99516 Mpnlclpallty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG ' PERCOLATION TEST -1'~ ST HOLE BONNIE DR~SCOLL LEGAL oE$cR PT ON, L }Dc; dLJ · [~ ,'THEODORE F. ;,~OO~E ' ~ ~" CE - 3539 *,~.~,..'.._ ;.",~ - ~ ~ ~ Prol~W~ ~ DATE PERFORMED: ::' ' 15 17: B I, TIIViS£RL/]~ff' pJ~.ownship, Range, Section: SEC 2/'~, 'T 12 N~ J~ ~ tv/ SILT'/ GRAVEL FILL SILT'/ S./~Nb¥ Lo~P1 ~ILT'~t SANb"J ~R~VEL 8LOP~ ... SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh Io Water After Monitoring?' Dote: KLATT RD. Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN -- FT AND . FT bONE IN 'l'.fl~ 1¢2 ONLY, ~EDBY ,FL/~TTOP TECH..~VCS · ACCORDANCE W THALL STATE AND MUN CIPAL GU DELINES N EFFECT ON THJS DATE p,/8,5) · CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: PERFORMED FOR: ~'lc~ttb-~5 T~:~nlca! S6f~-ic~s 14530 Echo Street Anchorage, Alaska 99516 Municipallly of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST BONNIE DRISCOL L LEGAL DESCRIPTION: J'-I L/G M 8 9 10 B I TIM, BERL/~N£ pJ~.ownship, Range, Section: SEC 2'g "J' I2 N~ I~ u,. tv' <JILT"/ GRAVEL FtLL pT LoAN 11' 12, !::i~' 15- 16- 17- 18- 19- 20- VER"/ ~RAVELL'~ EII. T' WAS GROUNDWATER ENCOUNTER ED~ IF YES, AT WHAT DEPTH? Deplh Io Waler Aller Monitoring? SLOPE SITE PLAN KLA'TT RD. NO Date: Reading Date Gross N'et Depth to Net Time Time (?, I N~ Water Drop 12"t:'R~.~.~ ,5/2 t:m P~ ,~ 2'v 3/8 COMMENTS ~ ROUIqb i,V/~ T E I~ I DUG'To DETERMINE PERFORMED BY; F'L/~TToP TECH. ~VC<g ~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER '7 ~ TEST RUN/BETWEEN ~.O FTAND Z.f. ~' ET MONITOI~N~ DONE IN T.H~ 1~2 ONLY, T.N~ I~j~¢~ CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: PERFORMED FOR: 14530 Echo Street ,Anchorage, Alaska 99516 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-06,50 SOILS LOG -- PERCOLATION TEST T.~. 1'2 BONNIE DRI$C. OLL LEGAL DESCRIPTION: L IJ'~ B Is TI~gERLe~£ p~.ownship, Range, Section: SEC 2/"(, '3" 12 SLOPE · SITE PLAN PT BLACI< 14 15- 16 - ~ ; 17- 18- 19- 20- PERCOLATION RATE -- (minutes/inch) PERC HOLE DIAMETER __ ~' ~J*:J~2 TEST RUN BETWEEN FT AND FT COMMENTSLd~OUI~.bW,~TEff HONITOg'hV6 DONE IN ~.H~ 142 ONLY, T.U~ IA, 2A.~A . DUG To D~TER~IN~ PERQ ~gTE. E~TEHT $ CON~INuiT? oF ~ANDY Z0~ ~TR'~TU~ FL ATToP TEC~. ~ VCS i CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2, 3- 4- 5- 6- 7 8 9 12 SM SILTY, SAND"/ LoAM SILTY ~RAV~L Gt,4 K LA'I'T RD. ~j!-l,.y~ SAN~./ WAS GROUNO WATER ENCOUNTERED? ~[ IF YES, AT WHAT Depth Io Water Afler Monitoring? I ~Z~ale: Reading Date Gross Net Depth to Net Time Time Water Drop 72-008 (Rev. 4/85) PERFORMED FOR: 14530 Echo Street .Anchorage, Alaska 99516 Municlpalily o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST TEST HoJ-E BO N N I,':: DRI SC. OL L LEGAL DESCRIPTION: L I/~j BI, TI~SERL~IN£ p~ownship, Range, Section: SEC 2L/, · PT SLOPE $1T~: PIrAN : . SILT'/, SANDY LoAM LOOSE ~M/~L GRAVELLy SILT 7- 8- 9- 13 14 15 16 17 20- WAS GROUND WATER ENCOUNTERED? S YES, AT WHAT nL DEPTH? p E Depth 10 Water After Monitoring? Date: Reading Date Gross N'et Depth to Net Time Time Water Drop PERCOLATION RATE -- (minutes/inch) PERC HOLE DIAMETER -- 'T.t/, ~3A TEST RUN BETWEEN __ FT AND . FT : COMMENTs ~'ROUNbWJJTEI~ Jv~01qI'"T'O~IN6; DONE IN T,I'{~ J*,L2 ONLY, ~DUG:.'rO:DFTER~INE: P-cRC RATE> E.KTEHT $ CONTINuiTy PERFORMED BY: FLATTOP TECI-/, ..~J/(~ ICERTIFY THAT THIS TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev, 4/85) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 019-052-15 HAA# HA900267 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 14 Block 1 Timberlane Park #1 (T12N R4W Section 24) Location (address or directions) 801 West Klatt Road (b) Property owner Mary Parker Telephone : (home) 344-9895 Business 346-2111 Mailing Address 801 West Klatt Road, Anchoraqe, Alaska 99515 (c) Lending Institution National Bank of Alaska Telephone 276-1132 Northern Lights Boulevard & C Street Mailing Address (d) Real Estate CompanyandAgent Jack Blair % ReMax Properties Address 2600 Cordova Street, Anchorage, Alaska 99503 Telephone 257-0159 (e) Mail the HAA to the following address: (or check here [], if h01d for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms three (3) 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 th legality and status. 4. SEWAGE DISPOSAL On-site r~× Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 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 th is Health Authority Appi'oval 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 Flattop Technical ServicesTeleph0ne 345-1355 Address 14530 Echo Street~ Anchoraqe, Alaska 99516 Date July 6, 1990 E'ngineer's-seal Approved for three (b~rooms by Date Approved ×XX××X×XDisapproved Conditional Terms of Conditional Approval This is to replace the original Certificate of Inspection due to an error on the date. This has been corredted. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 Mu nicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88)Back Page 2 of 2 · - - ~ MUNICIPALITY OF ANCHORAGE Department of Health & Human Services ' DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# f-)\o~ _ ('-'1~jLL~ - \~ - ' HAA# ' ~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 1et, block, subdivision, section, township, range) - Location (address or directions) ~01 ~, [(LATT R~) (b) Property owner ~AR'/' PARKER . Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Telephone: (home) -3~¢~' -c/8~' '~ Business .:$ ~o" - '~ II/ Telephone ~ -/6 Z 113"z. Address Telephone -: ..... - ~5'7-~t5'~ . (e) Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and (]ay phone number below: q'Eb 2. TYPE OF RESIDENCE Single-Family ~J Number of bedrooms 3. WATER SUPPLY nd!vidual Well t~' Community [] Public [] .... Note: If comn!uni~Y~eJl syst, em,.must have written conf rmation f?.,m the State Department of Environmental · (~nse~Jb~ att~S~i~g'~-th le~alit~'ar~d~:~s. -L,~ .:-: ,,, ¢-:~,.~h.-, :~:-.:.. :~,, ~-: ~ .':-~,: ~,":~ --'. ....... ..- ~,~ ' gAGE DisPOSAL " ' ' 4. SE~ ......... :, .... - - On-site Public [] Community [] ;'~Holding Tank D:-..- · Note: If community well system, must h~W ~/~it~en'~o'n~irma~i0n from'the State Departmer~t of Environmental Conser~a;d6n attesting to the legality and status. ..,.. - 72-02~(Rev. 7/88) Page 1 of 2 '~lJO~ s,Jeeu!~ue i~uo!sseJoJd eq~ u! 9UO!SS!LUO JO SJOJJe JOJ elq!suodseJ lou s! a6BJoqouv ~o Xl!led]o[u nl~ eq/'penss! s! elso!j!]Jao B eJoJ@q ~lep ez,~isu~ JO suoBoadsu! ~,onpuoo lou op ~FIHQ jo see,~olduU=l 's),ueLueJ!nbeJ e~,s pue I~Jepe~ u!~iJeo Xjs!l~s ol JepJo u[ suo]]n~p, su[ Bu!puel J!eql puP. seu~oq jo .¢ueseqoJnd ol/~p`elJrloo e.se P`]q~ P.eop SHHC] eql 'p~selV ,to elPlS aq~, u! peJels!BeJ Jaeu!§ue IpUO!SSe,~oJd luepuedepu! up Xq e^oqp S qdeJSp~pd u] ue^!§ suoBPlueseJdeJ eql uodn ~lUO paspq pelpo!jiJeO le^mddv/qpoqinv qllpeH senss! (SHHG) seo!^JeS upuJnH pup qllpeH ,to lueuuIJpde(] e§pJoqouv Jo,~!led!olunlhl eq.L lu^mdd¥ IpUOB!pu09,to smJ~.l. ..Y'..V%I-~'/7~ euoqdeleJ. :5,.P,4y, 'lJ2~..L d, O2_..LVT.~, wJ!4~oewpN' 'uo!laedsu[ s!q~ ~o elpp eql uo ~oe,tje u! suoBelnlSe~ pup 'seaup`u!pJo 'sepoo pup [pdpiunl/~l lie ql!~ eoUP!ldLUo~ u! P`! ~uezs,~s IPsods!p ~elpt~elsP~ ~o/pup/,Iddns ~elpt~ el!p`-uo eql 'uoRoedsu! pu~ uoBpB!lse^u! /,uu ~oJ~ pu~ sel!~ aSeJoqouv ~o ~l!led!o!un~ eql moji peu!elqo uoBe~JoJu! eql uo peseq 1~ql ~!JeA Je~JflJ I 'u!eJeq Peleo!Pu} eJnlonJls lo ed~l pub swooJpeq ~o ~eqwnu eql Joe elenbepe pu~ leUO!loun} 'ei~s s~ mels~s I~sods!p. Jel~else~ Jo/pu~ ~lddns Jele~.ell~-uo eql ~,eql s~oqs leAoJddv ~l~JoqlnV qlleaH :r- ' MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) ~,~/Ip, oNMENTAL SERVICES Legal Description: L 6 1990 Static Water Level ;~ ~ ' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) A. W LL DATA R£C£ IV ED Well Classification t Well Log Present (Y/N) /¥ Date Completed ~ Total Depth 5-(2' /(Cased to ~ '10' Depth of Grouting Pump Set At IcC" Sanitary Seal on Casing (Y/N) )" Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line If A, B, C, D.E.C. Approved (Y/N) N,,4-, Yield "~ 7,¥ IV ;On Adjoining Lots '~. too' lO ~" ; On Adjoining Lots ':> ¢oo ' To Nearest Public Sewer Cleanout/Manhole ~,,4. To Nearest Sewer Service Line on Lot Water Sample Collected by F(¢4~10~ T/ch _~¢r~;¢~, ; Date WaterSampleTestResults ~c~j 0 co~,~ / ~o~/ Comments ~ll-~c ~n~ ~0~ ~ /~/ B. SEPTIC/HOLDING TANK DATA Datelnstalled I~ Size 18o0~( No. of Compartments Standpipes (Y/N) Y' Air-tight Caps (Y/N) Depression over Tank (Y/N) /N Pumping/Maintenance Contact on File (Y/N) /~h/~- Holding Tank High-Water Alarm (Y/N) /q,/il, Foundation Cleanout (Y/N) Date Last Pumped O~/ ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line 5',~- ' To Stream, Pond, Lake or Major Drainage Course Comments C.O, To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ff /l~/ ~0 Width of Field -5-f Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field 79 ' Depth of Field Gravel Bed Thickness /, 42 ' Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line ( O5" To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line '~Z ' To Existing or Abandoned System on ; On Adjoining Lots ~, 3'0 ' To Cutback (if present) A/, D. LIFT STATION Date Installed Size in Gallon,.; "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments __ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA g~j,~jn effect on the date of this inspection. ,~.-~,-- Signed ~~ ~ ~ ~t~.' ....... ' ¢ .......................... ~ Engineer s Seal MOA No. ~ -o/~ ¢ .... ,~ 7 ~ ........... :""~ -- ¢,.,,. . CE-3:;89 . Roceipt No. ~'~'V/°' ~ Receipt No Date of Payment_ ~1¢/Ca ~ ?O Waiver Foe: $ Amount: $ / ~ ~ Date of Payment 72-026 (Rev 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORAT=ORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518--TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ~.~0g~' P,? :;/~[~°LE for i¢ork Order ;i 25052 Coilectea Jtl~ 27 90 ~ i4:30 hts. Received J/]!~ 2? ~O 9 16t05 hfs, Client ~!~e Client Acct Released By Special Instruct Chemlab ~ef ~: 902tN Lab &zpi iD: 1 ~atrix: ~llouable P~rameter Tested Result Units ~iethod Limits ~I!T~ATE-I~ 2.5 m~/i EPg 353,2 iTests Per~omeO * See Special instructions Above tlA=Unavail~ble ~P=~o~e i)etected ~ ~ee 3mq)le Re~arksAbove ~= ~ot Ansi?zed ~=Less %an, OT=Greater ~han TELEPHONE (907) 562-2343 ' 5633 B Street : Anchorage, Alaska 99518 Drinking Wrater Analysis Report for Total Coliform Bacteria TO BE COMPLEVE bY WATER SUP L,ER PRIVATE WATER SYSTEM F/.ATTO~' TG;C:/~.- $u'(::$. Mailing Address City SAMPLE DATE: Phone NO. State Mo. Day Year Zip Code SAMPLE TYPE: ~ Routine [] Check Sample (for routine sample with lab ref. no. .) [] Special Purpose [] Treated Water 1~ Untreated Water SAMPLE NO. LOCATION I' 4[ 5l Time Collected Collected By I I TO BE CO~IPLETED BY LABORATORY ~sis shows this Water SAMPLE to be: r~Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received (-~ Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* Analyst I I BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTD Membrane Filter Results ~ep0rted By TNTC = Too Numberous To Count OB = Other Bacteria BOB J GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 ~' ~ FOR , ~1. Aooroval Requested B¢:~~' ' ~ -.:'~ " Address: r~o ,l ").,).Q Phone: 2. Prooert, O ner: h Pho.e, 3. Legal Description:__ 5. TYpe of Facility to be Number of'Bedrooms:_ Well Data: A. Type ~"! ~ co Oonstr,ctio Sewage Disposal System: C, Septic TanK: 1. Size B. Dspt D. Bacterial Analysi - 8. Installer 2. Manufacturer D, Seepage Pit: ].. Size 2. Material Disposal Field: Total Length of Lines Distances: A, Well To: Septic Tank /d)O . Absorption Area /~0 . 20/ Nearest Lot Line C~ , Other Contamination FoundatioD to SeotSc Tank "~ Ab§orption Area Absorption Area to Nearest Lot Line Sewer Lines Re~.gt ~fo~-~proval of individual Sewer & Water Facilities Comments: Appro~Valid for One Year From Oat~ned Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities loceted at: Signed Date ~Z~,, Purchaser (Df.Porter) HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART L--TO BE COMPLETED By FHA Anchorage Lois ?arl~h MOaTO*OEE ag_e_: SES~*t HO. First National Bank of Anchor .. PROPERTY°ADDRESS lfl~ Klatt Road SU~IVI$1ON HAME ~1 Public system [] Public system ']New installation Yes [] No E] Community system E~ Community system Individual . [] Yes [] No PART II.inTO BE COMPLETED BY HEALTH DEPARTMENT HEALTH D~PA~TM~HT INSPECTOR'S SKETCH 1, is the opinion of the [] State [] County E~xLocal Department of Health that this individual water-supply system F"'~is [] is not ~tisfactory as a domestic water supply for the subject property. It is the opinion of the [] State [] County [~ Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: q Can be expected to function satisfactorily, and [] Canno( be expected to function satisfactorily is not likely to create an insanitary condition TOL 3508 Tudor Road ,Anchorage,Alaska 99507 FROM The r.. rm.ona Bank of Anchorage BOX 720 ANCHORAGE, ALASKA 99501 Lot 14, Blk 1, Timberlane Park S/D SUBJECT:_ ~ok~ Owner Lois Parish Gentlemen: We are enclosing Health Authority Approval of the individual water & sewer system on the above captioned property. This property is rented and the rentors phone ~/ is 344-2624, if you can not reach them and need any information on the property please call Mr. Rennet of Hal Graser Realty ~/ 279-0491. We are enclosing a self- DATE:_ August 18,1972 addressed envelope for your convenience. PLEASE REPLY TO--~--~ SIGNED ....... pi-. 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