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HomeMy WebLinkAboutTIMBERLUX #4 BLK 1 LT 11B
L-~ MUNICIPALITY OF ANCHORAGE ~,~
e~ 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 -- ' 'NEW
MA'L'NGADDR:N m
Liq. c~ ~ ' gallons IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z ~ Manufacturer Material Liquid capacity in gallons
~= DISTANCE TO:
-~ NO. of line~ [~gt~echli~ Total lengt~g~i ~ Trench wi~inches' Distanc?~e~ li~es
~ ~ ~ Top of tile to finish grade - ,~ Material beneath tile Total effective absorption area
Length W~d Depth PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth Total effective absorptio~ area
~ Well Building foundation Nearest lot ~ine
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
APPROV~ DATE LEGAL
72-013 78) /
4. : ~,-,) DEPRRTH~NT OF HERLTH FIND ENVIRONMENTRL PROTECTION
/f.-.h'~/ 8>'5 'L" STREET., RNCHORROE, AK. 9950:t
' ' 'k~ 264-4?20 /
I-..IELL RI'-.ID i_-~-~'~ T TEE '=~E~'~EF:=~4 P~--~"~'~- J l ~,~,~
LEGRL LT. &~-B BLK~ TINBERLUX ~4 LOT~ ~ FEET
TYPE OF :,O~L RBSORPT~ON _,~:,TEH Z:.. TRENCH ~ ~.y~
MR;:.~ZMLIH NUHBER OF BEBROOM~ = 3 ~OZL RRTZNG (S~ FT/E,~)-
THE REQUIRED SIZE OF THE SOIL 8BSORPTION SYSTEM IS:
E:,EPTH= E: LEI'-~GTH= t~-37 GRR%,,'EL DEPTH= 5
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
gROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
REQL! I RED SEPT I C: TRN[,:: S I ZE= 10£-i0 GRLLONS
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
T~-~O (2) I f-~SPE£:TIO[-~S RRE ~:EQLIlREC¢
BACKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION AND RPPROVRL BY THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISIRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
±00 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 8ND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYE
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRY ~PPLY. SPECIFICRTIONS 8ND CONSTRUCTION DIRGRRNS 8RE
RVRILRBLE TO INSURE PROPER INSTBLLRTION.
F'ERt4 IT E:~(F'IRES [)EC:EMBER 2;2~_.. '4982
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.
~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF TI
RESIDENCE IS REMODELED TO INCLLIDE MORE THRN ~ BEDROOMS.~0~.~{~__~.7~.
~ DI~ Fff~ fl P~I~fiTE ~LL TO fl ~IVflTE ~R LI~ ]~' ~ FED
.... ~TE
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
[ / ~'k. ~,) ~ SOILS LOG
MUNICIPALITY OF ANCHORAGE ~
,' MUNICIPALITY OFL,~NCHORAGE
DEPARTMENT OF HEALTH AND EI~'VI RONMENTAL PROTEC~I[TN OF l~,J~ LT t F~ERCOLATION
825 L. Street, Anchorage, Alaska 99501 264-4720 ENVI~ )NM!N;A. ,t ~O ~E~T~
SOILS LOG - PERCOLATION TEST
J U L 2 $ ~982
OL.)- oeqOnie,s; 14
SLOPE
DATE"E flVf'b'
Lot II - ~
SiTE PLAN
Lc+ Q
WAS GROUND WATER I~
ENCOUNTE.ED~.. r~tb .o
E
IF YES, AT WHAT
DEPTH;'
Reading Date Gross Net Depth to Net
Time Time rl~ r~ Water Drop
'~HzO q, I<i' ~?- 3:09 -~ 2.2(/
~zO 3:I~ ~ 30 ~ 2. zq
~HzO 3:3ou~ ~ 2,5
Z,27
PERCOLATION RATE
COMMENTS
72.008
CERTIFIED BY:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
SLOPE I
OATE PERFORMEO: ~/' Iq. ~'Z
SITE PLAN
Lz-FO
10
11
WAS GROUND WATER
ENCOUNTERED?
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to ~ Net
Reading Date Time Time ~ Water Drop
~HzO q.i~'~ ~:or7 ~ 2,2~
~O ~:1~~ ~ 2.Z9
~HzO 3:~OH~- ~ 2,3
PERCOLATION RATE 'k/I-/ "2_ (mi.utes/inch)
TEST RUN BETWEEN ~ FT AND ~,:~ FT
13-
14-
15-
16-
17-
18-
20-
,E.EORMED S¥: ¢~or~ne.r/J~kn~o~ OERT, P'ED"*: ~
72-008
LOCATION OF WELL
Ill ] I I
LOCATIONISK~CH:
DEPTHS MEASURED FROM:~asing top t-lground surfaoo
60REHOLE DATA: Depth
Material Type end Color From To
%
STA~rE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF WATER
WATER WELL RECORD
WELL OWNER; "
WELL DEPTH: DATE OF COMPLETION
Depth of hole:,, /~0 ~'~ ft
Depth of casino:. Ir.;, "~ ft /'~"~ I 7 I,,,~.~
DEPTH TO STATIC WATER LEVEL;
2. 7 it below j~'top, of casing
[] ground surface
RECEI' ED
SEP 2 1992
Municipality of
Dept. Health & Hu nan
METHOD OF DRILLING: ~l. air rotary E} oablo tool
[] other .......
USE OF WELL: ~ domestto [] irrigation [] monitor
E] public supply [] other
CASING STICK-UP; ft. Diam:__in, to , , ft
Casing type:, ,_~._lo. to It
WELL INTAKE OPENING TYPE~ I'1 open end [] screened
~ perforated ~[ open hole
Depths op.nin e: to
SCREEN TYPEz Dbm:,
Slot/Mesh Size: Length:,
GRAVEL PACK TYPE:
Volume used: Depth ~o top:
GROUT TYPE; Volume:
Depth: from ft to .... ft
DUmtton: /
PUMPING LEVEL AND YIELD:
~ ft after ~ hrs pumping
PUMP INTAKE DEPTH; ft Hor~epowen ~
'WELL D~SlNFECTED UPON COMPL~ION? ~ YES ~ ~O ~
CONTRACTOR INFORMATION:
S~O~ature of Aqthorized Re~p~e~tati~e
REMARKS:
PLEASE MAIL WHITE COPY OF LOG TO:
DNR/DIVISION OF WATER
PO I~OX '/72116
EAGLE RIVER AK 99577-2116
Static water Level ~ feet
Draw Down. feet
WELL LOG
Gallons Per Minute
Total Feet Of ~asing
Type Material Drilled:
0 feet to
~'Ot to
to
to
Hefty Drilli~
S.R.A. Box 1553 H
Anchorage ,Alaska
99507
BL*k _"x
~o-1-
MUNICIPALITY OF ANCHORAGE
~*~__~::::?'DI~RTMENT OF HEALTH!&: HUMAN SERVICES
~iv!sion of Environmental Services
~;'On~site- Ser~ice~'Se~tion -
....... ,--': ~, ......... P.O:-Box 196650,~, Anchorage, Alaska" 99519-6650
........ ;7 C~='RTiFi'~ATE OF HEALTH AUTHORITY
........... · APPROVAL FOR;A SINGLE FAMILY DWELLING
Parcel I.D. # - .,....~.---~-~:,-~ HAA#
~'~"' Complete. legal descrlptlbn
Location:. (s te:addres~-0r:directions)', ~... -
~wner BJz~'/,~-r", , ~l~C · Day ghone
--. Prope~y ~ ,.;,, - .. ,; ........ - -
;'. ;'-. ,_L. Lendmg.agency ....... Day phone
........ ,-: ..... · .. ~,: ........... . ............... . .. ,...
: ':::- ; ~" ¢};:'5''':~-' :-':: ~'~;'~)::~¢;~?,~[;5~5~,,',[ ,5 ~':~/ ". '~ ~ ; '
-'=:':'-:. Madmoaddress '"'-'* ......
· " Anent ...... ..... ~'~ ...... Day phone
· .~..,.; .... , ..,..,. ,.., Address _,
NOTE: .: 'l~co,~mUmty well syste~ ~prowdewr~tten confirmation from ~tat~ ADEC ~tteSt-
:: ~ ~:,~:.,.:,: .. ~,? ~.:: ,,.~...~. :~ %~.~,~?, ::,~.,~:,.'~.~:,,,:.~.:-:~:~::.~:-: .... ~ :%.;.:~,~
NOTE' ':;: 'l~:~omm~ni~'~i~atb~ ~ste~}'.p~6vi~e ~ritten confirmation from stato'ADEC
; L :~; : + ' ' ' '
5. STATEMENT OF INSPECTION BY ENGINEER i.
As certified by my seal affixed hereto and as of the validation date shoWn below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspectiom ';,
Name of Firm ,z~O~'/~50~ ~ ~/~ ~-~7/& I/'Jd., Phone
Address ~(~.
Engineer's signature ~~-~ ~ ~'~.~._-- -~ Date
, .: .... 6..: r DHHS SIGNATURE,-,
~. - - Conditional apProval for "~ bedrooms, with the following stipulatons .
'>~ 1,T~r Additional Comments
,~-~heA,, Munimpality'pf, .,. ,~ ,,,Anchorage Department of Hea th and Human 8erv ces (DHHS) ssues Health Authority
· · pproval,/~,?, Cert~ !,,~ates based only upon the representations _oiven in _esragraph 5 above by an ndependent
profesmonal engineer registered n the State of Alaska. The DHHS does this as a courteey 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'eng~neer's work.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: /~O'7'lj: ~L~'j/__ ! ParcelI.D. ~/~'
A. Wall Data
Well type ~/~.~ ~/A-'3'~ '~'" If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Y Date completed 7/J5'/~ Driller
Total depth 10 ~ i Cased to /~) ~ Casing height
Sanitary seal (Y/N) ¥ Wires properly protected (Y/N)
Date of test
FROM WELL LOG
_g.p.m.
Static water level ~ 7 ~
Well flow '~
Pump level1 {~J ~ 0 cd ,,J
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot > I ~'~ ~
Absorption field on lot ~' /Z.7 I
Public sewer main ~ / IV~ I ~¢
Sewer service line ~ i /~ ~ ~
AT INSPECTION ~ ~c
~ z~. g.p.m. ~ .~- ~ .~
; On adjacent lots '>JOb
; On adjacent lots '> / 0 O ~
Public sewer manhole/cleanout ,At/~A-~..
Petroleum tank /'J/~
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
/o ~ ~/L- Other bacteria
Collected by: /~.
B. SEPTIC/HOLDING TANK DATA
Date installed ~/Z.7.,/.~ Z.- Tank size /, 4)00 &~-~/3-/... Compartments ~ ~
Cleanouts (Y/N) /~ Foundation cleanout (Y/N) Y~ Depression (Y/N)
High water alarm (Y/N) /~J Alarm tested (Y/N) ~A,~//~
Date of pumping ~*~/~. ~ / ~ 5"" Pumper ~"/
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot / =J
To property line ~
Surface water/drainage
On adjacent lots
Absorption field
Foundation
Water main/service line
72-026 (3/93)° Fm~lt CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
V+nt (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Sudace water.
D. ABSORPTION FIELD DATA
Date installed ~/~ Z-. System type ~)L~P
Length /~,, ~, J Width Total depth ~'.
Total absorption area //~ p%- z~ 'Y Depression over field (Y/N)
Date of adequacy test -5'/z~/95~ 7>455 for -~ Bedrooms
Water level in absorption field before test ¢~ ,O ~ After test Z ~O /
Peroxide treatment (past 12 months) (Y/N) ,/~ If yes, give date
Soil rating (GPD/FF) Z/,)5- ~.~ z*
Gravel thickness E, ',5* /
Cleanout present (Y/N)
Results (pass/fail)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /~/ On adjacent lots ~,/~D / Properly line
To building foundation ~' 7-r__P To existing or abandoned system on lot
On adjacent lots ) S~O ~ Cutbank ) 5'-~ J Water main/service line
Sudace water )' ,fO ~ / Driveway, parking/vehicle storage area
Curtain drain /~0 ,~JL.~-
E. ENGINEER'S CERTIFICATION
I cerb'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect On thed~te,Qf this inspection.
Date
HAAFee$ ~¢~ '~
Date of Payment ~ '-///-~'~"~--~
Rece,pt Number 7
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3~3)* Back
MEMORANDUM
ANDERSON ENGINEERING
P.O. Box 240773
Anchorage, AK 99524
TO: Onsite Services Engineer
WITH: Dept. of Health & Human Services
FROM: Mike Anderson
DATE: June 14, 1995
SUBJECT: Lot 11, Block 1, Timberlux Subdivision No. 4
Health Authority Certification
MESSAGE:
The septic system currently in use on the subject property
passed an adequacy test and is in conformance with minimum
requirements for a three bedroom home. The drainfield trench
was constructed in 1982 in slow percolating soils and was
found to have 2.0' of standing water prior to the adequacy test.
The level receded to the 2.0' level upon completion of the test.
The trench is nearly 60% inundated and operating somewhat
below optimal capability. We recommend a warning be placed
on the certification concerning the state of the absorption
trench.
CT&E Ref.~
Matrix
Client Sample ID liB Bi TI~BERLL~( S/D #4
Client Name A~DERSON ENGIbrEERING WORK Order 15270
Ordered By ~LL~ A/~DERSON Printed Date 06/08/95 ~ 15:55 hrs.
Project Name Collected Date 06/01/95 ~ hrs.
Project~ Received Date 06/01/95 ~ 15:30 hrs.
PWSID UA
CT&E Environmental Services Inc,
Laboratory Division ~`e~`~`~`~j~e~`~`~`~-~-~jjjjJ~jJj~jJ~jJ~~
5. 17s-1 Laboratory Analysis Report
WATER
Tecb-nical Director
STEPHEN C, EDE
Sample Remarks: S~24PLE COLLECTED BY: A.H,
QC Allowable Ext. ~-~al
Parameter Results Qual Units Method Limits Date Date Init
Nitrate-N 1.89 mg/L EPA 353.2 10. 06/02/95 DJS
* See Special InstI-/ction~ ~Joove UA - Unavailable
** See Sample Remarks Above ~TA = Not ~nalyzed
~= Undetected, Reported value is the practical q~/antification limit. LT - ~ss Tha~
~" GT = Greater Than
Secondazy
dilution.
200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301
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
1. GENERAL INFORMATION
Complete legal description Z,¢7"//~ ,~// ~7~'~'5'~'.~'/_ ~x ~]
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address.
Agent
Address
Day phone ,~ ~/% -
Day phone
Day phone
=
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well ~'~
NOTE:
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1191) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm /4/~Oc/Z~;o'J ~-"¢L.j,4~z3Z.~JO Phone ~d'V'- ~5-Ef
Address ./~. ~0 /~'o~ ~'¢° 77-~ ,~ C.44, //~-Y-- ~ ~-¢
Engineer's signature ~'~r~O~,¢,.., ~¢' ~--~(-'~-<L .-_ Date ¢/2_./~ _
DHHS SIGNATURE
. Approved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional 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 DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Z<~' //Z7 ~Z/ ~/~¢,5'g'~Zu/ '-/' Parcel I.D.
A. WELL DATA
Well type /?~'/~,/2~-~ If A, B, or C. attach ADEC letter.
Log present (Y/N) y Date completed
Total depth /O Cased to /0.~ .~,~0"
Sanitary seal (Y/N) ,~ Wires properly protected (Y/N)
ADEC water system number
~_5'/z¢ ? Driller
Casing height
FROM WELL LOG
Date of te~t 7,/1~../'~?
Static water level
Well flow
Pump level
g.p.m.
AT INSPECTION
<~/2_ ~/~ Z.ML;N~CiPALiTY OF ANCHOP~GE
.2 ~ ~ ~ ,I E~IRONMENTAL SERVICES DIVISION
g.p.m:
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot fL..~' ; On adjacent lots
Absorption field on lot I 2. 7 / On adjacent lots
Public sewer main ~ t LES ' Public sewer manhole/cleanout
/Dory-
100 ' 't-
Public sewer service line
Petroleum tank /,J oN F~ Ot,..t LOq-
WATER SAMPLE RESULTS:
Coliform SAT I S FA ~-~- ~) ~,~,, Nitrate
Date of sample:
.S' Other bacteria
Collected by: L~,
B. SEPTIC/HOLDING TANK DATA
Date installed ~/~ Z/~Z~ Tank size
Cleanouts (Y/N) ,V' Foundation cleanout (Y/N)
High water alarm (Y/N)
Date of pumPing
Compartments
/'/ Depression (Y/N)
Alarm tested (Y/N) ~',/zd
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I 3
To property line ~ O:
Surface water/drainage
On adjacent lots /~) ~)/'/' Foundation
Absorption field .5" Water main/service line
72-~26 (Rev. 3/91)Front MOA21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer __
Size in gallons
Manhole/Access (Y/N) __
Vent (Y/N)
"Pump on" level at
"Pump off" level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacentlots
Surface water
D. ABSORPTION FIELD DATA
Date installed ~,/'Z
Length / (~ (~' j Width
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Cleanouts present (Y/N)
Date of adequacy test .
__ for -~ '~
Soil rating ,2 ~-5' System type ?'/~C,Vc
Gravel thickness -~ '-~ '~' Total depth
bedroom..;
Peroxide treatment (past 12 months) (Y/N)
tf yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot / 2-7/ On adjacent lots /g)O '-/- Property line
To building foundation ~- ~? To existing or abandoned system on lot
On adjacent lots ~E~-f Cutbank TO Water main/service line
Surface water /~ ~ / ¢- Driveway, parking/vehicle storage area
Curtain drain ~0~ ©~,1'
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 '~z~
Engineer's Name
Date
HAA Fee $
Date of Payment
Receipt Number..'--~ .~/
724)26 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
,I
EN 1S (101781
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
ANALTSI8 RESULTS for INVOICE t S756S
Chemlab Ref.( 92.4488 Sample ~ 1 Matrix:
FAX:(907) 561-5301
WATER
Client Sample ID
PWSID
Collected
Received
Preserved with
~LL ~A~eR 15200 ~U~FALO Client Dame :MCTADDEN.
UA Client Acct :MCTAWC$
AUG 26 92 @ 15:00 ]Es. BPO~ :
AUG 27 92 8 09:05 h~s. Reqt :
AS ReQOISeD Ordered ey
PO~ :NONe ReCeIVeD
Analysis Completed : AUG 28 92
Laboratory Supet~l~9~ :,$~ePNeN C. eDe
Send Reports to:
1)MCFADDEN, WAYNe
Parameter Results Units Method Allowable Llmlts
NITRATe-N 1,5 r~/1 ePA 353.2 lO
Sample ROUTINe SAMPLe COLLECTED BY: MCFADDEN.
Remarks:
1 Tests Performed See Special Instructions Above UA=Unavailable
ND= None Detected '* See $ample Remarks Above
NA- Not Analyzed LT:Less Than, GT:Gteater ?hah
~SGS Member of the SGS Group (Soei~t~ G~n~raJe de Survei,la.ce)
:: .~ APPLI(~NT FILLS OUT UPPER HA~_!ONLY
Proper~y Owner £N T Z~ ~ / 2 /- Pbone
M~ilingAddress .~j~2/~ ~2'..~ /A4 ,' ,/~'//~,/~'~'4z~~ //,],~ ZipCode ~:~:~50~ ,~5~ ,2'~'/~
Buyer
Address Zip Code
ILendinglnstitution / 3! /V/~]y~2///J~ /~'/~.~//.(' O/-' ..~'~'//~.~/';~/'~ Phone
Address /~/[~///~'£~//L./'-Z-- / /;]~' Zip Code ~'g" ~'S(*>O
Realty Co. & Agent Phone
Address Zip Code
Legal Description ~.~)~ // .~ ~Z'/(" .Z- / j-'/~,4¢/~,;-~./~/..~ ,~
Street Location /~.5 ZOO /~C)/c/:'//Z ~)
Type of Residence
[~.Single Family
[~ Multiple Family NO. of Bedrooms ~
[~ Other
Water Supply
[~'lndividual (~.~Z~)~L-/c~ ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
~ Community J ~"~ L~ For wells drilled prior to that date, give well depth (attach Icg if available).
[] Public Utility /~ E)
Sewer Disposal
~ndividual ~ ~/~) ~ ~-/.~ Year Individual Installed: J~)] ~
[] Public Utility L~.~ (-]. ~:~ ~..~g_ When Connected to Public Utility:
[~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
}L~°~-~' IJr'~'"q~ ,o.~ /1 ENVIRONMEN-£AL PROTECTION
RECEIVED
( ) DISAPPROVED
~--~ Well to Tank Septic T~k Size 1~0~
72.023
April 13, 1983
Brent L. Hill
SRA 475 M
Ancborage~ Ak 99507
Subject: Lot liB, Block I~ Timberlux 4
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
,~j A ~ell log submitted to this office for our files and
~ /Exposed electrical wires to the well head are in violation
~y of the Municipality of Anchorage codes and must be encased
in conduit.
%The water analysis report needs to be submitted to this
3~office from the Ghem Lab, 5633 B Street, for our review.
\%~c°/ A portion of the sewer system is under the driveway and
~ will ueed to be insulated to pr~ent f~eezin~ ~ ~ ~
noted discrepancies have been corrected. If there are ~,ny
further questions~ please call this office at 264-4720.
Sincerely,
Robert C. Pratt
Associate Environmental Specialist
RP13/ej/E1
MAY 5, 1983
BRENT HILL
LOT 11 BLOCK 1 TIMBERLUX
ANCHORAGE, ALASKA
MUNICIPALITy OF ANCHORAQE.
DEPT. OF HEALTH
F"NVIRONM~NTAL PROT~cI'ION
d U FI 2, 0
RECEIVED
SUBJECT: SEPTIC SYSTEM INSULATION
MN. HILL
WE ASSURE YOU THAT THE SECTION OF YOUR SEPTIC SYSTEM RUNNING UNDER THE
DRIVEWAY IS COVERED BY MORE THEN FIVE FEET OF DIRT.
RESPECTFULLY
CHRIS LO Y~E~
D & S UNLIMITED