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HomeMy WebLinkAboutTIMBERLUX #1 BLK E LT 10 Municipality of Anchorage Page 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 Permit Number: ,..~'/..,(.),.~.-~(.~.~ 7 PID Number: Name: ~0~ ~00~ Wastewater System: ~New ~ Upgrade Address: ~0/ ~/T ~R~ ~ ABSORPTION FIELD Phoee: ~d~_OT// N°'°fBedr°°ms:4 ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION sou Rating: Total Depth from original grade: O, ~'~ GPD/Sq. Ft. ~, Lot: Block: Subdivision: Deplh to pipe bottom from original grade: Gravel depth beneath pipe I 0 E TI~¢ERLQK ~ 4 Ft. ~ Ft. Township: ~ Range: ~ Section: ~ Fill added aboveooriginalgrade: Ft. Gravel length: []~ Ft. , / - --- Gravel width: Number of fines: Distance between lines: WELL: New Upg~ '~ Ft. I ~A Ft. Classification (Private, A,B.C): ~ Cased To: Total absorption area: Pipe material: Driller: ~ Date Drilled: Static Water Level: Installer: Ft. A~ ~'~ Date installed: [O--~ '~GPM PumpSetat: Ft. Casing Height Above Ground:Ft. TANK ( IST) SEPARATION DISTANCES ~Se~t~c U ,o~di,¢ U S.T.~.~. TO Septic Absorption Lift Holding Public/PrivateManufacturer: Capacity in gallons: From Tank Field Station Ta,,k S .... Lines A~Ci4nRA66%A~K I~¢ Well ~ 15~' ¢165' ~ 14~ Material: Number of Compartments: Surface Water N0~E ~[ ~ No.s LIFT STATION Lot ~ / Size in gallons: Manufacturer: Line ~Oi '' / ~ ~evel at~ Foundation I ¢ 30' O ~"Pump on" level at: water alarm at: CurtainDrain ~0N6 ~0~ ~0~ P~~ Electricalinspections performed by: Remarks: ~/9~/1~¢ nom~jp~ BENCH MARK , Location and Description: T~ ~ ~~ 0¢ ~ ~ Assumed Elevation: J / / ENteL Inspections performed by: / Dates: 1st 2nd/0-0[~ ~ Deparlment of Health and Human Services approval Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 Permit No. ,.~d'q._.~Z~,7 Page 2 of ~. 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: ~'~7"/Z~ ,~Z~CTX-~-'/~/~/~_-~/~d,Y~ PID No.: 7 SKLH Consultants 1700 Vashon Circle Anchorage, AK 99515 20 November 1995 Municipality of Anchorage Dept. of Health & Human Services, On-Site Services P.O. Box 196650 Anchorage, AK 99519-6650 Re: Timberlux #1 Lot 10, Block E 9305 RECEIVED NOV ~ 0 1995 [viumcd)ai,~y oJ Anchorage Dept, Health & Human Services Robbie: Following is the additional information you requested to complete your review of the construction as-built for the on-lot soil absorption system installed in tlhe fall of 1993 and serving the above referenced lot. During construction the integrity of the existing septic tank was verified in accordance with item 3 of the special provisions listed with permit number SW930267. The tank was excavated and physically inspected. This verification should not be construed as representative of the current condition of the tank. Type of ABS pipe used was solid D2751 out of the septic tank to the distribution line. ASTM 3034 perforated PVC was used in the absorption field. 3. Recorded elevations for the monitor tubes at the time of construction are as follows: MT#] MT#2 Ground Elevation 96.9 95.7 Bottom of MT 83.6 83.5 Water Table Dry Dry Hopefully, this information will allow you to complete your review of the system. If you should have any questions, please do not hesitate to contact me. Sincerely, ~'Sc~¢~4C. Henslee, P.E. NOV--17--95 FRI 18:14 DENALI EQUIPMENT INC. 90?3769701 ~o' ~mber 1Y, ~995 Mu ~icipalitF of Anchorage Del ,affment of HeAlth and Human Sewices On ~ite Se~ices Section P.(. Box 198650 An, horage, AK 995~9-6650 Sul ect: Lot 10, Block E, Timbedux Subdivision Septic System Construction To lhom It May Concern: I · ~s involved in the construction of the septic system upgrade on Lot 10, Block E, Timberlux Subdivision in late September and early Au( ust of 1993, The system was constructed in accordance with all M~ icipal regulation9 in fome at the time. I w~s not, however, on the Municipal list of approved installers. I agree to aAend the co~rse offered by the Municipatity within the next year to reir stitute my position on the list.Please let me know if you have an' questions or comments. e Berg ~ P#01 2/2 August 18, 1994 SKLH Consultants 1700 Vashon Circle Anchorage, AK 99515 (907) 344-7096 Municipality of Anchorage Dept. of Health and Human Services P.O. Box 196650 Anchorage, AK 99519-6650 Re: Timberlux #1 Lot 1, Block E Permit No. SW930267 To Whom it May Concern: The purpose of this letter is to provisions contained within the above · · Item 1: Prior to construction of advised both my client and necessary to coordinate was not on the Municipality cJient said he had contacted~ prior approval. I have atta and addressed to the DHHS this approval and advising I found the client was pres¢ the system. I inspected the installatio~ the two minimum inspections approva the engineer responsible foL I~em 2: Upon excavation of the at an upwards slope and not consequently, had the instal system and did not leave the replacement field as was my valve was installed as its installation was no Ionger necessary. The existing leachfield was excavated where it intersected the new field and native backfill installed. This effectively separated the two systems allowing only the new replacement field to be functional. If you should have any questions please do not hesitate to contact me at the telephone number above. The delay in submitting the construction as-built was the resolution of questions regarding owner installation. These questions have been resolved to my satisfaction. Sincerely, ST/even C. Henslee, P.E. CE 7604 cc: Mr. Don Moore, 4301 Rabbit Creek Road (Current prop. owner and client) Mr. Arnie Berg, Denali Equipment PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930267 DESIGN ENGINEER:SKLH CONSULTANTS OWNER NAME:LIDDELOW MERVYN W & ANNE M OWNER ADDRESS:7901 MAYFAIR DRIVE , #1 ANCHORAGE, AK 99502 PARCEL ID:01827124 LEGAL DESCRIPTION: TI~BERLUX #1 BLK E LT 10 DATE ISSUED: 8/03/93 EXPIRATION DATE: 8/03/94 LOT SIZE: 51139 (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: 1. ONLY A MUNICIPALITY OF ANCHORAGE APPROVED EXCAVATOR MAY INSTALL THIS SYSTEM. 2. SYSTEM MUST INCLUDE A DIVERTER VALVE TO ISOLATE THE EXISTING SYSTEM FOR'AMINIMUM PERIOD OF ONE YEAR. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 RECEIVED BY: 'THE INTEGRITY OF THE EXISTING SEPTIC TANK SHALL BE FIELD !VERIFIED. DATE' PAGE 2 OF 2 RECEIVED JUL 9 1995 Municipality of Anchorage Dept. Health & Human Services July 23, 1993 DHHS Municipality of Anchorage 825 L: Street Anchorage, Ak. 99502-0650 Re: Lot 10 Blk. E Timberlux Sub. 9305 Dear Sir, I am asking that Arine Burg owner of Denali Equipment, in Wasilla be given MOA approval to accomplish the excavation and enlargement of my existing septic system. Arnie Burg is a personal friend of mine, and is very qualified to perform this work as he has installed over 200 septic systems to date. His phone number is 376-9700, and 893-7200 if you need to contact him. Thank You, Don Moore 4301 Rabbit Creek Rd. Anchorage, Ak. 99516 Phone 345-0711 & 563-8680 co-£Z- ? SHL/d/~HH~- CO, GIT. ~3o5 ~6~ 2. 9S05 LOT IO BLK E TIMBERLU~( SUB. ,/ _ ~ ~200' i2v~D I U 5 ,~ {SOCLT / '~ x ~'- PROPOSED S>VSTEIV~ / UNDEVELOPED '~. NO PLff3LIC WELL~ FdYJHD. / \ / ~RD6CE O~l~A6~ // ~R PRO?OS~D JY~ --~-- -- ~ ~ ......... ~ ~~-- ~ ~ ~ . ~ ~ ~u/t ../I,~- ~o ~c~v~ ~ ~ ~,, ~ '~' '- ' ~xx OU ~sr Ho~ u~ ~H- r ~ . ENL.AR N ~N /~%~~H W> / ............ ~ ~~~ -- _ ~ ~ ........... ~ ........ ~2 . ~ ~ ~~C,O,~.D ~ ~cH cud --~' '~'~~'/~ I / ~ / T~ ~ E , ~ aM ~T O.I ~D[~ ., 3~5TE~ DETAIL ~o...,,..,. 6-Zl- ~3 5305 , ~( ~~-- 345-6947 5NEET I OF ~ GRID 315,G PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: ~.~,IT /0 ~/-~/~ ~- Township. Range, Section: 6.~/~ -.,~/,~ T//~,/"~_,,~/.-~/X SLOPE SITE PLAN 1 LOC~LFF-F-~ lot 10 WAS GROUND WATER ENCOUNTERED? S 11 L IF YES, AT WHAT DEPTH? /~& 0 P Depth Io Water Alter ~ , 13 MDniloring? / VOz?~' Date: Gross Net Depth to Net Reading Date Time Time Water Drop ~/ D ~57 I~ ~,~ q ~/~ 'Y~" ~ ./ I~Z? ~ Io,~ ,~,, ~ 5-/~-~ /057 ~0 ~,~ /~,~ '~ 14 15 16 17 18 19 2o ~ ,, PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~:~'~"' FT COMMENTS //~/~,~'),~ /-/dLE. /d~??L/~7'/~ ~/~7-~ ~,45 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN~FFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L'~ Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: 1 2 3 4 5 6 Township, Range, Section: 8 9 10 11 12 13 14 15 16 17 18 19 2O GL~CI/~L 'TILL. 5OMF_ C~R~V ~-L_. Tk~-C/5~i~G DE. HS ITy SLOPE SITE PLAN WAS GROUND WATER X/_ ENCOUNTERED.:) /vo S IF YES, AT WHAT ~/~ 0 DEPTH? /V~' p E Depth Io Water Alter, / Monitoring? /VO,UE Date: .5--~'~-D_~ -I N \ Gross Net Depth to Net Reading Date Time Time Water Drop z / II/~ 30,~m ~ ~1~' Y~' io COMMENTS PERFORMED ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ~N~'FFECT ON THIS DATE. DATE; PERCOLATION RATE ~0 (minutes/inch) PERC HOLE DIAMETER ~'' CERTIFY THAT THIS TEST WAS PERFORMED IN ~-Zl-~ 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: /'(~7'J~) ~L/~' ~ ~"/J"~:?~ - ///~ SLOPE 1 2 3 4 5 6 7 8 9 10 11 12 Township, Range, Section: ~/~/./~) SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? ~j,~ pO E Oeplh to Water After Monitoring? ~1~. Date: 13 17 18¸ 19- 20- COMMENTS Gross Net Depth to Net Reading Date Time Time Water Drop o ¢-/.~-~ o,'~O7 - ~ '~ / ..-" o~37 3o /o - 4 3//~. 2 / /007 PERCOLATION RATE ~2' (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '.-~//2,. FT AND ~ FT ~L I Z_-,'~ ,~:-/~ CD £/~ TI Z21V T~ 7' ilar iQE P~ ~.ZESU7', ~q TI ~/6' PERFORMED BY: '5: /~~ ~ //~~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACGORDANGE WITH ALL STATE AND ~UNIGIPAL ~UIDELINES IN EFFEGT ON THIS DATE, DATE: 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST /0o4/ DATE PERFORMED: LEGAL DESCRIPTION: ~'///~ Z.~/~' ..~- '~/"~,~,~Ux ,S/l q £,~*JO 5oPt' To 9- 10 11 12 13 14 15 16 17 18 19 20 Township, Range, Section: ~__~/~/D ~.~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPT.? /VR E Depth lo Water AfteN<~ Monitoring? Date: Cross Net Depth to Net Reading Date Time Time Water Drop 0 g-ZZ-~_~ /7,5Z o ~ ~/8 - -I /.'"' /~zz so .~1/~o Z"//c ~ ~-zz.~ IDz~ ~o ~1/~ I/~/~ PERCOLATION RATE /7 {minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ ET AND ~o.~ ET PERFORMED BY: ~ ~-[/~- I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES-IN E~ECT ON THIS DATE. DATE: 72-008 (Rev. 4~85)  ! 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 MAI LING ADD~E~ g~ ~ ~ LEGAL DESCRIPTION LOCATION R~¥~ ~ C~~ Cb NO'OF BEDC~MS ~ ~ DISTANCE TO: /~ ~OT 4~ ~ ~ Manufacturer ~ Msterial~ No. of compartments ~OZ~ ~ DISTANCE~'~ ~/ Well /~ // PERMIT NO. =_pO ~ . ~er ~ ~ Liquid capacity in gallons ~/ Wel ~~ Foundation . Nearestlotline¢ ......../, PERMITNO. DISTANCE TO: ~ /~ ~o'~ /~ ~O~ No. of lines j Length of I Total length o~ines ~ / Trench width / Distance between lines Material beneath ~e X ~t Total effectiv~ ~bsor~tion area Q ~ Top of tile to finish grade~ ~ ~ ~ inches %~ Length Wid~h~ Depth ~ PERMIT NO. ~ Tgpoo~ Cribdiameter ~ CriBdepth ~veabsorpdonarea~ ~ ~lass ~epth Ddller ~istance to lot line P[BMIT ~0. ~ /~/~t~ ~ DISTANCE TO: Building foundation Sewer Pine $epti~ tank Absorption OTHER/ ~ , PIPE MATERIALS ~ ~ SU EST RATIN6' / ~ / A INSTALLER ~ / ~ % .v~,~ ~ REMARKS ~ 6 APPRQVED , , DATE LEGAL 72-013 (Rev. 3/78) [:,EF'RRTMENT OF HEALTH AND EN~ !R_NMEFTPIL P~"'~TEC:]"ION PERHIT NO. ( 8i~Z~3:i8 ', ;, ~ LOC~TION . ,'~ MI R~BDIT CREEK RD LEGAL LiE~ B~TIMBERLLt;:~; ~_- ~ ~ LOT SIZE 5tt2:9 SQL[~RE FEET Tb'PE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAN!MUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= 150 THE REQUIRED SIZE OF' THE SOIL. ABSORPTION SYSTEM IS: [:.EF'TH== 1.2 L E ~-~ i]j ]- H == 2=: ;._=: 13 F-'. ~] %.' E L [:,EF"TH:: ~; THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETHEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET HIDTH FOR TRENCHES. 'THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPEC'FIONS OF ANY HELLS ADJACENT TO THIS PROPERTY AND THE NLIMBER OF RESIDENCES; THAT THE HELL WILL SERVE. BRCKFIL. LING OF ANY SYSTEM HITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCE BETHEEN R HELL AND ANY ON-SITE SEHAGE DISPOSAL SYSTEM IS tL'-~D FEET FOR A PRIVATE HELL OR 15~} TO 2EI~] FEE]' FROM A PUBLIC WELl. DEPENDING IPON THE TYPE OF PUBLIC WELL !INIMUM DISTFINCE FROM A PRIYATE HELL TO A PRIVATE SEHER LINE IS 25 FEET AND 0 FI COMMUNITY SEWER LINE IS 75 FEET. ELL LOGS ARE REg!LIIRED FIND MUST BE RETURNED.TO THE DEPARTMENT HITHIN .3:~..'~ DR'.~'S -- THE HELL COMF'LETION. YHER REQUIREMENTS MR'~' APPLY, SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE ,;AIL.~BLE TO INSURE PROPER INSTALLATION. CERTIFY THAT ! AM FAMILIAR HITH THE REQUIREMENTS FOR ON-SITE SEWERS AND HELLS AS SET RTH BY THE MUNICiPFtLITY OF RNCHORFIGE. I HILL INSTALL THE SWSTEM tN ACCORDANCE HITH THE CODES. I UNDERSTAND THAT THE ON-SI'YE SEHER S'T'~,TEM MAY REQUIRE ENLARGEMENT IF THE ?,IDENCE IS REMODELED TO INCLUDE MORE THAN 3: BEDROOMS. 'NE AF'PL I F~:f~p~ HENDLIN GLATT ....... L'b>?,,,L j:'l~.l~}~L:i~bM,>h .. I::5- )~-./ :'~ ,:,, L' (, I974 4.I 995~4 July 6, 1977 $76362 Glacier Excavating 101 East International Airport Road Anchorag~ Alaska 99502 Subj eot: Pez~,~it Ex.~ratlon Dear Sir: A permit issued by this department for well and/or on-site sewer ~stallatton on Lot 10 Block E Timb~rlux Subdivision has expired since the i~sue date exceeds one (1) year. In the event you still plan to install the well and/or on-site sewer system, a new permit is required. The original soil test may be used to obtain a aurrent permit. If the well has been drilled, a weli log should be sent to this departraent to document the installation date. If you have any questions regarding the above matter, please do not hesitate to aontaet this office immediat~ly at 279- 2511, extension 22~ or 225o Sincerely~ Les N. Buchholz, R.$. Sanitarian I~.MB.lJh FEF, I I r NC. RF'PL I CRNT L.FICRT I ON LEGRL GL~:.,.~C I ER EXCR'v'RT I RRSBIT CREEK RE:, L_:tO B~-, TIf'IEiEF.'.t .... I1::-:; .=,UE, E '"' "'" t~ t EFIST INTERNRTIONF-IL. HiF..F_F..[ 27'4-5C~'?:i. LOT SiZE ._:.ti ..... SQIJFIF.:E FEFT T'¢PE OF SOIL ~' ",-r ,-,- HB=,OF..E, 1 ION 2;VS"I'EM I2;: TRENCH HRXIHUM NUME:ER OF: E=EE:,ROOML=, = L=,OIL RFITII'-~G ,'?:;C-., FT,-'E,R..,= :t50 'f'HE REQUIRE[:, SIZE OF THE :5OIL FIE:SORF'TIEIN S'¢SI"Er,1 IS: L- E.F 1 FII -_:L;~2 ('_~F-."t:~%-"EtL_ E:.EF"TH=: F2; THE LENGTH DIHENSION IS THE LENGTH (IN FEET> OF THE 'f'RENCH OR [:,RRINFIEI_.[:,. 'T,H.,E [.',[CPTH CF FI TRENCH C,R PIT I~ THE [,IS'[~_:~..~'%g~THEEN.:% THE "2UF."FFIFE ......... "'F' GF..OUN[) RN[:, THE E:OTTOM OF THE E:=.:,CR',,,'FITION/(II'.4. Fb. bT::,. THERE I2 N] '_:,El' 14I[:,TH FCF.' TRENCHES " - 1";' - ' -~ - r-' ~ ' I ' '~ ' I'"' '"''- ' i': ...... "IHE ~RI.-t,,,EL [.EFTH I=, THE flINIt'l_ll'l [.EP'fH .;E ~F..H,~EL~, E,E"IHEEN ]HE OUTFFILL F'ZPE ~. -'t,.;\: BFICKF'ILLING OF FIN'Y c' ,,- -, ,£? ~f , :>r:,TEI1 WITHOIJI~F~lf'~/L IN--.,PECTI '4 FIND FIPPRCVFIL B'¢ "I"FII':5 [:'EPRR]'MEN]- HILL BE SUE:JECT TO PRO~EF:LIT)~ON. MINIMUM DI':;TFINF:E BE'r[,.tEEN FI 14ELL RN[:, FtN'¢ '0N-c;I~'FE SEHFIGE [:,ISF'O'_=;FtL L--.,'¢STEP'I 1OO FEET FOR t:t PRt'¢FI]"E HELL L]R 200 FEE"I" F;FiR Fl F'LIE:LiR HELL HELL LOi-~::.; FIRE REQIJIF.'E[:, :tND MIJF=-2PkBE F. ETUENE[:, T[.'I THE [:,EF'RRTMENT HtTHIN 2.:0 OF THE WELL COMF'LEI'ICIN. x'-r% ' ~ '~1-' :'~ '- j:l ....... 'E.,PEC I F I CFIT IEd':IL:; FIN[:, CON'_: RLICT I ON D 1 I-t.~RFIMz, · _ _ RE · RE ~VFIILFIE:LE Ti"'I II",~'.- -'' PF.'CPEF: ./ IN=, [HLLHI I .IN : '~ F'EE."IF'I ]: -1-' "-.-"F*IL. I [:' ':, D--CIF-.' i'_~'-AIE "'~"EF'~F.." F" E_" t], l'"it :E :-.:: .... E:,. I CERTIF'¢ THFIT ::% :L: ! RH FRHILIFIR WITH THE RE~L!.IREI' 4"1=, FOR ON-SITE =,ElJER=, FIND HELLS Rb-; '..:.;ET FORTH B'-r' THE HUNICIF'FILI"I"'Y OF FINCHORFIGE. 2: I HILL IIq=,TFILL THE =,~=.rEl't IN RCCORDRNCE 14I"I"H THE C:OE:,ES. 3:: I UNDER'-ZTFIND THFIT "I'HE oN-::,ITE =,EWER _,~:,fEH HR'.t REF. d lIF.'.E ENLFIRGEHENT IF 'THE RESIDENC:E IS .REMODEL. E[:, TO INCLUDE MORE 'rHFIN "~: E:EDROOHS. FIPF'L I C:RNT'~ GLRC I ER E~.FI',,,'FIT~ NG \ 2204 Cleveland Anchorage, Alaska 99503 Perf0~med ~0~ Glacier Excavatin~ (Geo. Hook,re Performed . Leoal Oescrintion: Lot 10 Block This~Form Renorts Soils 5/26./76 Subdivision Timberlux Subdivision Percolation Test yes ~enth Feet 6 8 10 12-- 14 .. 16~-. 18 20 Soil Characteristics Silt, ML .Gravelly Sandy Silt (SM-ML) Silty Gravelly Sand (SM) Bottom of test hole Was Ground Water Encountered? IF Yes, At what Depth? No ReadinQ Date Gross Time Net Time Depth to H20 Net Drop' i " 103'0 hrs. 0 6~" Saturate i ' · 69" ~ .0830 hrs. 22 hrs 132" . f' 0900.hrs.. 22.5.~rs. 63". 1300 hrs. 26.5 hrs. 104,~" 41.5" Percolation Rate 1"/ 6 Minute s Proposed Installation: SeenaQe Pit Drain Field De~th of Inlet Depth To Bottom Of Pit Or Trench CnU~ENTS: 150 Square feet drainage area required per bedroom NO ground watGr or bedrock encountered Test Performed By Jam,~.s D. Mack Data Certified BY: CONSTRUCTION TEST GREA ~ ANCHORAGE AREA BOR DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456 ! S~.AL--~... APPLICATION Pi NAME OF APPLICANT I NSTALLAT I C~N LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO Be SERVED PINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQ DEPARTMENT OF ENVIRONMENTAL QUALI IILLING O~ Y WILL i SEPTIC TANK MINIMUM DISTANCE FOUNDATION TO SEPT}~ FOUNDATION TO SEEF SEPTIC TANK TO SEE SEPTIC TANK __ TO NEAREST LOT WELL TO SEPTIC TANK DRAIN FIELD FIELD ~SO CONSIDER AREA WELLS. WATER MAIN TO DRAIN FIELD SEEPAGE PIT SEPTIC TANK TO RIVER, SEEPAGE PIT ., DRAIN FIELD CAS~T IRONINTO OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION ~ SOIL. 4 INCH DIAM15 CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIt FITTED With Airtight REMOVABLE CAPS. PERMIT NO. PHONE lit I$ NOT SOIL TEST M WITHOUT FINAL INSPECTION BY THE 4. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA F:~OROI~GH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE With SAID CODE. '~ GREATER ANCIIORAGE ARLA bORUUGII D~partment of Environmental Qual! ty 3330 "C" Street Anchorage, Alaska 99503 SOILS I,OG - I"EROI,ATION TEST Performed ror_____~.~Z~/___O_LZ-/_/~/~/L~q/~O_/9~.~..~__:__. ~__Uate Performed ......../~(/ Legal Description: .... ~_~- _ This form reports: Soils log Depth Feet l' - ":: ~zo~ ~'~/'L. ....................... ! Gl'zft-~z. y 8- 11 - ~D 13- 14- S grounu wa~:er encoun~erea. _ Z~ Reading / Date Gross Time .I .... If yes, at what depth? Net Time Depth to Water Net Urop [Zg'.Z~:7~--. - :'&~-~./~- -L~-~-~- ^-~-~ ~ -~-.'-'--.,--.- ~ ..... ~:-~-,--. .... 1 ..... .... L ............................ g ~ ,Proposed installa~:-S6epage Pit ................. ura~n Depth of Inle~ , Depth to bottom of pit or trenci~ MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section ,, ...__ .P.O. Box 196650 Anchorage, Alaska ~9519-6l~5~':~.;7'- .... :'?'~ ~'~' ' . ?343-4744 ~ . '.' '~..." i-". ~-%:.';' :'~' . .... CERTIFICATE OF HEALTH AUTHORITY'.; i~.'~'-.'..'." ' ' APPROVAL FOR A SINGLE FAMILY DWELLING .... Parcel I.D. # 1. GENERAL INFORMATION Complete Mailing address t'-~, ~_DLLO~,~,-~ ~%.de~'-, L~J_~, ~/~.~-.,"1~3~ Lending agency- " - Day phone · ' - '- .- ...:'- provide W~ten confirmation from ": :' :!: !: :?'.i !~,iNOTE:'~:~i~'lf comm,~mty~wastewater system, prowde written confirmation from State ADEC 72-025(Rov. 1/91) Front MOA¢~21 : i ; i " '- ' ' : ' 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 wast~water disposal system is safe, functional and adequate fo~ 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 ~4AJO6'P.5O,J Address ~,O. Eng,neer'ssignature ~ (¢----. ~" Phone Date B · ' :;': ' ',. :',:::i:':' ;;' , .... ' '; · ",.h :~,¢~.' .. '/,~,;./f-.. . . . . ~ · .'~ .: ........... , /, . ........ ~..'~ -..?.... , The Municipali~ of Anchorage Depa~ment of Health and Human 8ewices (DHHS) issues Health Authori~ ' Approval Oe~ificates 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 county to purchase~ of homes and their lending institutions in order to satis~ ce~ain federal and state requirements. Employes of DHHS do not conduct inspections or analyze data before a ce~ificate is i~ued. The Municipali~ of Anchorage is not responsible for erro~ or omissions in the profe~ional enginee(s work. . . .: 72-025(Re~.I/91) Back MOAi¢21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502- Anchorage, Alaska 99501. (907)343-~7~4C E IV E D Legal Description: A. WELL DATA Health Authority Approval Checklist ~t~tff- ~. ~'t~5~tI-L.OX Parcel I.D.: Well type ~[2;?/Z~x//~,T'-~- Log present Of/N) y' Total depth ~'~O t Sanita~ seal (Y/N) NOV 1 '3 1995 Murdc~pality of Anchorage Dept. Health & Human Servicea If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~>/~ I Cased to /~, Z. ~ Casing height (above ground) Wires properly protected Of/N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION /Z4 g.p.m. :~. q 7 g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate , i /vas /L Otherbactefia O Date of sample: [ J/i~-/t]~' Collected by: ~. /~l~ ~ B. SE~ICmOLD~G TANK DATA Date inst~led 7/g I Ta~ size IZffO Number of Comp~ents ~ Cle~outs ~ ._~ Foundation cle~out ff~ ~ Depression ff~ M ~gh water ~ ff~ ~ Dateofmumping l~)~/9~Pumper ~ ~ ~ S~, C. ABSORPTION FIELD DATA Length I I 2- t Width ~ I Gravel thickness below pipe Effective absorption area It $ ~]x[ '~' FF~ Monitoring Tube present(Y/N) Date of adequacy test ll/Z/t~>"' Results(Pass/Fail) ~2>~$S Fluid depth in absorption field before test (in.); ~ Fluid depth "'~/g/ Minutes later: O Peroxide treatment (past 12 months) (Y/N) A] System type Total depth /3 Depression over field (Y/N) For 1~'~O ~Ji)~.- bedrooms Immediately after'~0 gal. water added (in.): (in.) Absorption rate = ~/~tg~) g.p.d. If yes, give date /X]/~ Size in gallons Manhole/Access (Y/N) ~ "Pump oft" level at* High water alarm level *~'""'"/ *Datum E. SEPARATION DISTANCES Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot '~ j O0 ~ t >./oo >/00 : On adjacent lots : On adjacent lots Public sewer manhole/cleanout Lift station t > /00t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation It ~ ' Property line ~gO t Absorption field '3' 254 I Water main/service line ') Z-~ Surface water/drainage >'/O0' Wells on adjacent lots ~ lO0 ~ Building foundation Surface water Curtain drain SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 20 t Water main/service line /DO t · '>- Driveway, parking/vehicle storage area zo~gt Wells on adjacent lots ,~/O~} t ENGINEER'S CERTIFICATION I certify that I have determined thrufield inspections and review of Municipal records dh'dt~ the above systems are in conformance with MOA H/L4 guidelines in effect on this date. Signature '~"~~ Engineer's Name HAA Fee $ .~f"'~,C~) Waiver Fee $ Date of Payment U (~ \ L\"~C~ \ 5-- \~ fi~ d3 Date of Payment Receipt Number ~ kc~i*'-~c~ ] ~~ Receipt Number Rev. 8/95 OSS: baa.wk.doc CT&E Environmental Services Inc. ' Labor~tory Division ~-~-~.,~.w,~w-~.wc~r. wc~r~w-.~_w-.~-.,w~-~~~~ Drinking Water Analysis Report for Total Coliform Bacteria zoo w, vo~r o,~ve · Anchorage, AK 99518-1 605 ~ ~RD'~IO~ ON ~V~ SIDE B~FO~ COLLeCTiNG ~AMPLE" Tel: (907) 562-2~3 ',_ '. · .:' '= F~x: (907) 561-~301 m $~ndlnvo~ce S.-'d~iPLE DATE: Month SAMPLE TYPE: ~/Routin~ ~ Rep*at Sample (for routine Sample with lab re[ no. _. ) Cl Special Purpose Day Year Treated Writer D Untreated Water Time Collected SAMPLE LOCATION:" Collected By TO BE COMPLETED BY LABOP,_~kTOR. Y Analysis shows this Water S.-MMPLF.. to be: ~ Sati~ faeto,-y o Unsatisf~or:' 0 Sample over 30 hours old, results m~)' be unreliable o Sampl~ too long in [rznslt; ~amMe should nor be o;'~r 48 hours old at to indlc~'_e r~liab!e resu!;~. Pl¢~e ~end new samOle via specia de ve~' mail. Date Received Time Received Analysis Began Analytical M~thod: a::f~Membmne Filter [5 MMO-..x, ,~G ]ti / 95. 4~64 ~ent Io A.O-E.=. ..~ ~b'~ .Jun Date; ~ TJmc: , Client aotJfi,:d of unsatisfact0~- results: Phoned Spoke wi~h D~te: Time: Anolysl .- ...... Faxed [] Faxed BACTERIOLOGICAL WATER .adNALYSIS RECORD MMO-~rUG Result: Total Coliform ~. Coil Membrane Filter: Direct Count O Colonies/100 mi · Verifiqatiom I~TB. BGB COLIFLRM Fecal Coliform Confirmation Final Membrane Filter Re~j~u . Coliform/J00 mi Reported B} ~~~ Date J(-0 Lp ~' ~/ Time .. /~1~ hfs PAR f 'ONE"' OF TWO T.O ~.~~'~ ~m'el~ Member of the SCS Grou~ ($oc;~z6 G6o6rale de Surveillarmel FOLLO - CT&E R~f,~ Cl~e~t sample iD Client Name Ordered Ey Projec~ PWSID CT&E Environmental Services Inc. Laboratory Division Laboratory Analysis Report WATER L~0 E~K E TIM~RLUX $/D ANDERSON ENGINEERIN~ UA WORK Orde~ 19448 Printed Date 11/08/95 ~ 12:15 hrs. Collec~e~ D&te 11/02/95 ~ 18:51 hrs. Re~e£v~d Date 11/03/95 ~ ~9:10 hrs. Teob-nical Director STEPHEN d. EDt Sample Remarks: BAMPLE COLLECTED BY: M.R.A. QC Allowabl~ Ext. ~al ParatReter Results Qual Units Method Limits Date Date %nl~ ~£Rrate-N 0.10 U Is~/L EPA 353.2 10. 11/03/95 CMR See Special Inst~tion~ Above UA - Unavailable ** See Sable Remarks Above NA - Not ~nalyzed ~, [~d~eo~ed, Reported value is the p~acti0al q~la~tificat~on limit. LT . Less Than ~. Se=ohdazy dilution. ~T = Greater 200 W. Potte~ OtiK%.69~h~m~e, AK 99~18-16~ -- Teh J~7) ~62-2343 Fax: (~7) 561~-S3~1 ENVIRONMENTAL FACILITIES IN A~SKA, CALIFORNIA, FLORIDA, ILLINOIS, MA~Y~ND, MICHIGAN, MISSOURi. NEW JERSEY. OHIO. W~RT VI~GI~A E~ ~P~'ON 68~G~gG ~ 9NIIS~I 9WIO~NNO3 68:~I CT&E Environmental Services Inc, cT&E Ref.ff 95.~964-3 Matrix OTHER Client Sample ID LEVEL I QA/QC DATA Client Mama ANDERSON ENGINEERING Ordered By Project Name Project~ DWSID UA WOIkK Order 19448 Printad Date ll/0a/s~ ~ 12:15 hrs. Collected Date 11/02/95 ~ hfs- Technical Director STEPHEN C, EDE Sample Remarks: TECHNIC~L/COMDLETENESB REQUIREMENTS M~T EXCEPT FOR CONDITIONS LISTED. QC Allowable Ext. Anal Paramebe£ Results Qual Units Method Limits Date Dabc Init QA/QC Summary II Inor~anics/Mi~robiolo~y ..... I. Receipt Sample received in ~ood condition unles~ no=ed ..... II. Holding Tilde All holdin~ ti~nes ~s~ Regulatory ..... III. Analysis A. calibration .,,All criteria B. Blanks ...All crigeria ~tet C. Spike Sat~ple(M) ..,All criteria met D. Duplicate Sm~le(s) ...Ail criteri~ met E. LabConurol Sample(~) ...All cr~taria m~ F. Surrogate(s] ...All criteria ~et certified by: D.F. LAWRENCE * Sss Special In~tructlons ~Joov~ UA = Ul%availabls ~** See Sample R%~a~ks Above NA - Not Analyzed = L~ndetec%ed~ Reported va],ue is the ~ractlcal quantifldation litnit_ LT . LeS6 ThaD L~D . secondary dilution. ~T ~ G~eate~ Th~n £0~ ~8'DN 68£~£9~ ~ DNIIS]I q~I3~WWO3 60:~I G6/80/II SKLH Consultants 1700 V~shon Circle Anchorage, AK 99515 (907) 344-7096 Attpust I8, 1994 Municipality of Anchorage Dept. of Health and Human Services P,O. Box 196650 Anchor;igc. AK oq519~,050 Timberlux &l l.ot 1, Block Perm/t ×o. $W930267 To Whom ~ t 5lay t"on¢crf~: 1'he purpose of this letter is to address changes to the special provisions contained ~'ithin %he above referenced permit. Item 1: l'rior to construction of [he new replacement leachfield, I advised both my client and the contractor that it would be necessary to coordinate with the DHHS since the contractor was not on the Municipality's approved excavator list. My client said he had contacted tbe DHfl$ and had obtained prior approval. I have attached a letter written by him and addressed to the DHHS which was written requesting this approval and advising the DHHS that a non-approved installer would be doing thc work. During my inspections I found the client was present during the construction of the system. I inspected the installation several times in addition to the two minimum inspections require~ by the DHH$ and found the quality of work to be acceptable. The installation was installed to my approval as the design engineer and [he engineer responsible for the overseeing of construction. tom 2: Upon excavation of the existing leachfield, I found that the perforated pipe over the drain rock had been installed at an upwards slope and not installed level. consequently, had the installer abandon the existing system ~nd did not leave tho system connected to the new replacement field as was my original intent. No dlverter valve was installed as its installation was no longer necessary. The existi~lg leachfield was excavated where it intersected the new field ami native backfill installed. This effectively separated the two systems allowing only the new replacement field to be functional. If you should have any questions please do not hesitttte to contact mc at the telephone number above. The delay in subtnitting the c(mstruction as-built was the resolution of questions regarding owner iastallation. These questions have been resolved to my satisfaction. Sincerely, St/run c. lienslee, P.t'.'. CE 7604 Mr. Don Noorc, 4301 Rabbit Creek Road (Current prop. owner and client} ~fr. ^rnie Berg, l)enali Equipment ANCHORAGZE - "~V ..;.': MUNICIPALITY OF DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION . ~ . . . ' DIVISION OF.ENVIRONMENTAL HEALTH ? j~.:i'. - GENERAL INFORMATION . ' · (a) Legal Description (include lot, block, subdivision, section, township, rang~)-~ :..: .:¥:.: : t . Location (address or directions) , ~,~ ': :-"-' (b) Applicant Name~MaL;~' ~'rf:Toiephono: Home:;~r¢:~r*~ Busness:5~3:-~ Applicant Address (c) Applicant is (check one); Lending Institution D; Owner/build~r~;'Bu'y~'r~ Other D (explain); (e) Real Estate Company and Agent Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE SingleTFamily,~' Multi-Family [] Number of Bedrooms Other 3. WATER SUPPLY Individual Well [~ Community [] Note: If community well system, must have written Confirmation from the State DE partment of Environmental Conservation attesting to the legality and status. : !': :'1:.]-, .:.: :~.~,,:,..,; ::,.-:. ,,. . ..,. 4, SEWAGE DISPOSAL , .,, . .:-: ~.. :'- .'. : :: ,~<,., ¢¢:.~'::- ,',~ '~. ,': ' ' u~ ' Onsito~ Public ~ Community ~ UoldinO Tank ~ Note: If community well system, must have wri~te.n confirmation from attest ng to the ega ty and status . ':~ -' '. · ' .{',i~-:.~: ';;,::. ~'.:t-:'~:. :?~:¢~¥'~?'~%~ ~ ~ ~}tl. .,;~ ~,..(:'~?,;-,L¢,~¢.'' ' ' ENGINEERING FIRM PROVIDII~,I'NSPEC'[IONS As certified by my seal affixed hereto and as of the validation date~ Authority Approval shows that the on-site water supply and/or wastewa~er dis for the number of bedrooms and type of structure indicated her~!n. I fu~her v from the Municipality of Anchorage files and from wastewater disposal system is in compliance with all the date of this inspection. Name of Address ~ ~ ~;;z.(-~ Date //~'/~ . . . . DHEP APPROVAL Approved for ' ¢ bedrooms by Approved ~' ' Disapproved Terms of Conditi~onal App~val _ ?: :., --'. : ~.c ,\ , AND INFORMATION '.. ':' .-';? ;:.. '-. ify that myinvestigation of this Health system is Saf~,~tunctio~al and adequate that based on the information obtained on-site water 'supply and/or ulations in effect on CAUTION The Muncipality of Anchorage Department of Health and Envi[onmental,.Rrotgqtion. (DHEP) issues Health Authority Approval certificates based solely upon the representations given m paragraph 5:above by ar~ independent'professional engineer registered in the State of Alaska. The DHEP does t,his as a c'o~rtes~t~p¢icl~asers' Of'homes aod their.lending institutions in order to satisfy certain federal an~ stat~ requirementS: E'm~I.~:~f;'DHEp do not conduct in~Pecti0~s or analyze data beforea ce~ificate is issued. The Municipality of. Anchorag~ i~.no~ resPpnsib!e fo[.errors or omissions in. the BESSE, S & POTT$ January 5, 1987 Susan Oswald Deparhnent of Health and Human Services 825 "L" Street Anchorage, AK 99501 Re: Lot 10, Block E, Timberlux Subdivision Dear Ms. Oswald: Besse, Epps &Potts performed a well and septic adequacy test for the above-cited lot on December 30, 1986. The septic system accepted 600 gallons in under four hours. ~----DHHS records do not have an inspection report for this 1981 construction, only a permit. The permit has the required sizes for a three-bedroom drainfield. However, at the time of installation, the field was upgraded to a four-bedroom drainfield; but the Municipality of Anchorage inspector did not record the changes in dimensions. It appears that the septic system does meet the requirements for four b~drooms. Attached to the HAA application is a receipt for a 1,250 gallon septic tank. Field measurements indicate that the drainfield is at least 45 feet long. Based on a tested soils rating of 135 sf/br (actual perc test results are attached), 540 sf of absorption area is required. A 45-foot-long, 6-foot-deep, and 2-foot-wide trench provides 540 sf of area. Therefore, the drainfield and the tank were originally sized to serve a four-bedroom residence. Very truly yours, mgk/smh Attachments ENGINEERING, PLANNING, SURVEYING 2220 E. 88th Ave. / Anchorage, Alaska 99507 / Telephone 907-34~6451 / 344-1352 "Providing a quality personalized service to those building Alaska's future" -d O~ ~ ~cl\OO MUNICIPALITY OF ANCHORAGE (MOA) ,.~\C\s,~.? O~ ~o~ HEALTH AUTHORITY APPROVAL (HAA) ~ ~g?~ ~ CHECKLIST- FEBRUARY 1984 WELL DATA Legal Description: Well Classification Well Log Present (Y/N) Total Depth ~'J~i) '~Cased to Static Water Level ,/~-S~7~' Casing Height Above Ground _ /:~.~- Electrical Wiring in Conduit (Y/N) .~ Separation Distances from Well: To Septic/Holding Tank on Lot /?-2~'f-/~- To Nearest Edge of Absorption F e d on Lot / If A, B, C, D.E.C. Approved (Y/N) Date Completed _ ?/~! Yield Depth of Grouting Pump set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots /~L~i~ ; On Adjoining Lots To Nearest Public Sewer Line /'J/'-~/'~ To Nearest Public Sewer Cleanout/Manhole ,~/~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~'"¢8~'~t~'--L~ · Date ! ',~_./~c.~ Comments ~%';'i'5tc ,A*nTC, CcH/5~ /,d.,~7-~-~__~ ..~ ~L)/¢¢'~¢~ ~'-Z~f/9/)t-G ""T-~7~'r-- ! B. SEPTIC/HOLDING TANK DATA Date Installed '"~/_,~! Size /~'~-~ ~ No. of Compartments Standpipes (Y/N) J Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~-) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ,.~j//zJ ; for / Holding Tank High-Water Alarm (Y/N) . Separation Distances from Septic/Holding Tank: Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line Course ~'J//t To Building Foundation i~' /O'/'-~;r' _ To Disposal Field _~;"'F~-- To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026 (Rev 81861 Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date installed __ ":)/¢~/ Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /O¢¢'~'-'T To Building Foundation ?t',~" Lot /v/~ To Water Main/Service Line -'~") To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Desigr~ Length of Field "~S- t.~r- Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoinin~ Lots /C~':)¢-~ To Cutbank (if present) / D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Manhole/Access (Y/N) ~- "Pump Off" Lev~t'~-_ ,~-~ ~Pumping Cycles during Adequacy Test. Meets MOA ** ChecklSerermitted Bedroom Rating Against HAA Request ** I certify that I..have, ch e¢~;e.d.,~vCri '~e.d/Igr conformed to all MOA and Signed 7./~./~//?,.~:7,Q_5/~/// 1 Y/b,.;f Date / Company-~---~7--~%~E~· ¢~' '~ F~ MOA No. Receipt No. /O ~ / C'b (~ Date of Payment /~ ~-~ Amount: $ /(~) Page 2 of 2 72-026 fRev 8/861 Back HAA guidelines in effect on the date of this inspection. 2220 .~%.StU 88 AV62{U~: ANCHO'2AGE, AK 9950Y (901) 349-6451 SuN! i. visioa: Lot: Block: TIMF~ GP~,f Z~ YOLIF~ 5r.t'/fAL VOL~I~ Production Ra~e: ~.~G?,~.l 24-Hour Oapaci~F,~ -Gallons NORYHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST SUITE A FAIRBANKS ALASKA 99709 907-479-3115 6957 OLD SEWARD HIGHWAY. SUITE 101 ANCHORAGE ALASKA 99918 907-34§-8623 Drinking Water Analysis Rep.~rt for Total Coliform Bacteria TO BE COMPLETED BY CLIENT ~;~]"PRIVATE WATER SYSTEM Mailing Address ~" City State Zic Code SAMPLE DATE: Mo, Day Year Phone Purchase Order No SAMPLE TYPE: ~ Routine [] Special Purpose [] Check Sample (for original contaminated sample with lab reference no. E Treated Water [] untreated W.a~er 3 4 5 6 9 10 Signature of Representative ~-~//,/~,~-i~/.<~I ,/ . ;i' , FOR LABORATORY USE ONLY CASN CHARGE TO BE COMPLETED BY LABORATORY Received at: ~]/Anch. [] Fbks. Date Received Time Received Next Sample Due COMMENTS: SATISFACTORY S UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Count Verification Finsl LSB EIGB Result* *No,_of-TotaFGoliform Colonies per 100 mis. ! h' ) Reported 6y / ' Date Time ANCHORAGE CESSPOOL PUMPING ALASKA PUMPING SUPERIOR STEANI THAWING P.O. Box 110232 ANCHORAGE, ALASKA 99511 (907) 344-2632 344-2453 344.7732 1142 Cuslomer's O~'der No. ALI. Claims and relurned good,~ MUST be accompanied by fhi~'bill Rec'd by A .... 0 DATE RECEIVED DATE DATE DATE© ~UNIC~PALITY OF AMCHORAG~ ~UNICIPALITY OF ANCHORAGE DEPT. OF I':~ LT & ) DEPARTMENT OF HEALTH & ENV RONMENTALPROTECTIONENVIRON~ENL:L ; .';kCT~ON  825 L Street - Anchorage, Alaska 99501 ENVIRON~ENTALSANITATION DIVISION ,oY.¢ ~ ~c 2~ Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF I~DIVIDUAL WATER AND SEWER FACILITIES }IRECTIO~S: Complete all parts on parle 1. Incomplete requests will not be proc~sed. Please allow ten (10) days for processing. 1, PROPERTYO HER P ONE PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAILING ADDRESS MAILING ADDRESS 4, REALTOR/AGENT ~ I PHONE MAI LING ADDRESS 5. LEGAL DESCRIPTION 4.0 //o STREET LOCATION /$ 6. TYPE OF RESIDENCE [~INGLE FAMILY I~ MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] [] Two [] Five E];]~'~h ree [] Six Other WATERRSUPPJjSUPP Y [~'~NDIVIDUAL* * ATTACH WELL LOG. A well Ecg is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach Icg if available,) 8. SEWAGE DISPOSAL SYSTEM [Z~'~tNDIVIDUAL/ON-SITE** / 7~/ YEAR ON-SITE SYSTEM WAS INSTALLED, [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] S~X PERMIT NUMEER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY -- DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE iNSTALLED /% ~ []PUBLIC UTILITY~t~) ~'~( Connection Verified INSTALLER ~lSeptic Tank or []Holding Tank Size: /,~.~~b If Tank is homemade I SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ASSORPTION AREA MATERIAL a 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Lino Absorption Area to nearest Lot Line 5, COMMENTS [~-~APPROVED FOR ,~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY /~ 72-010 (Rev. 6/79)