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