HomeMy WebLinkAboutBIRCH ROAD ESTATES LT 5
'-' :' Municipality of Anchorage Page / of
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
Name:
.~ ~/ ~.,~.~/~ Wastewater System: D New ~pgrade
Address:
~. ¢ / .~.~ ~/~~ ~'~- ~ ABSORPTION FIELD
Phone: ~ ~ ~ ~ No. of Bedrooms:
~ ~ Deep Trench ~hallowTrench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION ~o~, Rating: Total Dppth from origi~l grade:
Lot: Block: Subdiv~ion: Depth to pipe bosom from griginal grade: Gravel depth b~eath pipe
Number of lines: ~ Distance between lines:
WELL: ~x~'~ew C Upgrade Gravel width: ~ Ft. ~I /~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area:~~ ~ ~ Pipe material:
Static Water Level: Installer:'
Date DriJled: Datejnstalled:
Yield: ~ Pump Set at: ~ Casing Height Above Ground:
SEPARATION DISTANCES ~e.~i~ ~ HoUri.. : S.~.....
To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons'.
From Tank Field Station Tank Sewer Lines .~/J~d~' ~ .
LOt Sizein gallons: Manufacturer:
Line ~'~' ~''~ ~ ¢' ~O~ "Pump o~~~"'eve, at: ] High water alarm at:
Cu~ain ~ ~)-~ ~ Pummel J Electrical Inspections pe~ormed by:
I
Location and Description:
Assumed Elevation:
ENG~~AL
Depadment of Hea~.,and Human S~ices approval ¢~;'~,;., _ . _CE8176
72-013 (Rev. 9/91) MOA 25
Permit No. SW960557 Page ~-- of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DNISION
P.O. Box 196650. Anchorage, Alaska 99519-6650. Telephone 545-4744
On-Site Wastewe. ter Disposml System rand/or Well Inspection Report
Legal Description: LOT 5, BIRCH ROAD ESTATES PID No.: 015-494-05
72-01,5 A (2/91)MOA 2,5
Permit No. SW960557 Page '~/ of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650a,~chorage, Alaska 99519-6650. Telephone 343-4744
On-Site Wastewater Dispoeal System ~tnd/or Well Inspection Report
Legal Description: LOT 5, BIRCH ROAD ESTATES SUBDIVISION PID No.: 015-494-05
' . . .... i ..... ' , , . t ~ il iiiii iii i i i i i ii i i i i . ,,, , ,!!1,ill i
72-013 A (2/91)MOA 25
/.//X'../////./~//////'r///Z/,/.//////// . :
~=
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960337
DESIGN ENGINEER:DOUGLAS T. KENLEY, P.E.
OWNER NAME:WINN WANDAL W &
OWNER ADDRESS:6101 MOOSE MEADOW LANE CIR
ANCHORAGE, AK. 99516
DATE ISSUED:10/04/96
EXPIRATION DATE:10/04/97
PARCEL ID:01549405
LEGAL DESCRIPTION:
BIRCH ROAD ESTATES LT
5
LOT SIZE: 70452 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK 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 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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:
RECEIVED
ISSUED BY:
92'
/
/
I
/
/
/
/
/
/
Z
LOT 5 BIRGH ROAD ESTATES SUBDIVISION
ANCHORAGE, ALASKA
IDOUGLAS T. KIENLEY, P'~'! " ' '
;::~
zO
MR. TIMOTHY FINNIGAN
//////////////////////////.6
LOT 5 BIRCH ROAD ESTATE8 SUBDIVISION
ANCHORAGE, ALASKA
DOUGLAS T. KENLEY, P.E.
I ....... I
Dot~glas T. Kealey, PE . HCO1 Box 6054, Palmer, dlasl~a 99645 (907} 7. d6-1075
September 3, 1996
Municipality of Anchorage
Health & Human Services
On-site Services
Re: Percolation Test Results and General
Estates Subdivision.
Owner~
Mr. Timothy Finnigan
Site Investigation Report of Lot 5, Birch Road
On August 16, 1996 the above referenced 1.6 acre parcel was inspected for the suitability of installation
of a replacement on-site wastewater disposal system. The site is located in Southeast Anchorage, north
of Birch Road on Moose Meadow Road. The replacement system is being designed to meet the
requirements of an existing four bedroom home. The planned system will include the installation of a
new 1,250 gallon steel septic tank. The proposed absorption system will consist of two deep trenches,
40 ft long, and 23 ft. designed in accordance with municipal standards. The existing 62 foot deep trench
will be left in place and isolated from the new system with a Bullrun valve or equivalent for possible
future use.
The developed parcel is relatively flat with grade ranging from 0-2%. The immediate area that has been
selected for the waste water disposal system has an average slope of 1% towards the east. The site is
sparsely treed with birch, spruce, and alders. It appears that there are no obstructions that would prevent
surface water runoff. There is a 25 foot creek maintenance easement approximately 150 feet to the east
of the proposed new site.
On-site observation and field measurements show that there are no neighboring water wells within a
10ft radius of the proposed system. The proposed trench replacement will not impede replacement of
neighboring systems in the future. No surface water was observed at the time of the inspection and it
appears that there is no potential for contamination of future water wells.
One single percolation test was performed at the site in determining an adequate location for the
replacement waste water disposal system. An initial test pit for soil classification was dug to a depth of
16-feet. The substrata consisted of 1.5-feet of organic overburden overlying 7-feet of silty gravel
interspersed with 4 to 6 inches of sand layers. From 8-1/2 to 16 feet the substrata consisted of silt with
gravel. Neither bedrock nor ground water were observed.
MOA Lot 5, Birch Road Estates Subd.
Sept. 3, 1996
The percolation rate for the test pit was found to be 11 minutes per inch at approximately 5-feet below
grade.
If there should be any questions concerning the percolation rates or characteristics of the site please call
Doug Kenley at 746-1073 or 243-5372.
Sincere~l ~
CE #8176
/
/
/
MR. TIMOTHY FINNIGAN
LOT § BIRGH ROAD ESTATES SUBDIVISION
ANGHORAGE, ALASKA
DOUGLAS T. KELLEY.
//////////////////////////X
2'-0" 4'-0"
MIN.' MIN. '
6'-0" 3'-0"
MR. TIMOTHY FINNIGAN
LOT § BIRCH ROAD ESTATES SUBDIVISION
ANGHORA~IIE, ALASKA
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: '~ ~ ~,~-d-/-~ ,~::~,.,¢~:, ~C~'r.~'~.~ownship, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED7
S
L
IF YES, AT WHAT __ O
DEPTH? p
Depth to Water Alteh
Monitoring? ,Z-~'e~/O~"~ Date:
E
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
__ {minutes/inch) PERC HOLE DIAMETER
~FTAND ~""///2. ET
- ' / C,,,," 0¥ -- ! - /t / ~ WAS PERFORMED IN
,,ooo~o^,o~ w,'~H ^.,. ~',,~-~,,,.,o ~,.,,,c/,~,,,. ~,.,,o~.,,~s,, ~c-~ o,,.,~ ~^~. ~^~: ~/'~/~
72-008 (Rev. 4/85}
A
seo!Mes u~l. unH '~ qlleeH .Ideo
e§eJoqouv ~o ~l!led!o!unlN
9661. 0 ~ d3S
~O'd ~£0£
RECEIVED
SEP 2.0 199G
TIM FINNIGAN Municipality ot
1.1711 S. IGambell Dept. Health & Human
Anchorag~e,. , AK 99515
EDUCA~.. ,;ION
1995 BiS. Civil Engirteering, Uniiversity of A~eska Anchorage
(1997) MIS. Environmental Engineering, University of AlaSka Anchorage
t995 C~rtified Asbestos WorkerlCertificate
1996 8 .-iHr. Hazardous Waste Response Refresher Certificate
1989 4Q-Hr. Hazardous Waste Response Certificate
1978 J~umeyman'card lUOE, Certified Welder
~ ,
EXPERIENCE
· 1989 - Present ChemTrack,
Project ~Ehgineer - Demolition of QIU Bethel Native Hospital, asbestos and hazardous waste
removal. '
Operat0r~ab Technician - Responsible for field testing in mobile lab for field documentation
of hydro,Carbons and various other water quality parameters include pH turbidity, Total
Dissolved Solids (I'DS), and co(nductance. Also operated a groundwater :remediation
.system fdr removal of jet fuels frorin the Indian Power Station Jet Fuel Spill.
EnvironMental Technician - Beluga Oil Fields: Insitu Bioremeciiation. Built and operated
bioremediafion module. This included the recovery, monitoring, and supervision of onsite
culturing of Indigenous hydroca~on degrading bacteria. Responsible for tea,ting dissolved
. oxygen,I lqitrate, phosphate levelS., and Most Probabie Numbers {MPN) for heterotrophs.
Utilized )sheen screen field testing iand sample testing for DRO 81
Environmental Technician - Resp¢)nsible for maintenance'of Omni 8weep Hydro Cteaning
System quring the Exxon Valdez 0il Spill. System included: generators, hydraulic booms,
pumps, ~apd 150,000 BTU heaters',
1986 - ~9~89 , OwnerlOp~ator
Comple!~:i small contracting job~, which included: excavation and remodels, equipment
repair, ~elding, freight and equipment hauling. Owned 2 Kenworth traCtors including
lowboy trailers.
1986 : McDonald Crane
Mechanic - Responsible for corlnplete rebuiids specializing in power~hiit transmission.
Completed Hitachi School on hydraulics.
1983 - !!)85 . A.G. Construction
Equipment Superintendent - Respbnsible for complete rebuilds on heavy equipment.
1.976 - 1~!~81 ~ international Unioh of Operating Engineers
Various!North Slope' Companies. Journeyman welder and diesel mechanic.
GRE,-,,ER ANCHORAGE AREA BOt,..UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL MANUFACTURER ~ MATERIAL
INSIDE LENGTH ~ INSIDE WIDTH /'/ LIQUID DEPTH
COMPARTMENTS
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION l~"'~l
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPTION AREA 7~
DEPTH: TOP OF TILE TO FINISH GRADE
NEAREST LOT LINE_ .~O~ TOTAL OF LINES LENGTH ~.
~/4 TRENCH WIOTH~,~ I.. TOTAL EFFECTIVE
sQ, FT, LENGT. OF EACH L,NE / ~ : G 2 /
MATERIAL BENEATH TILE IN. ABOVE TILE IN,
WELL:
TYPE _
BUILDING
FOUNDATION
CESSPOOL
APPROVED
..CONSTRUCTION
NEAREST NEAREST
LOT LINE__, SEWER LINE__
OTHER SOURCES
DISAPPROVED
REMARKS
_DEPTH
SEPTIC SEEPAGE
, TANK__ SYSTEM
DISTANCE FROM:
DISTANCES:
PIPE MATERIAL:
REMARKS:
Form EQ-032
DIAGRAM OF SYSTEM
.,.~,, ,, ,$, ,,,,,,~ r ~o'+'I ~.
I '
~ G.A.A/
'*t"I41E. F..:l.:.i: :;! J I F;:tEI:::, '..:ii; I ZE OF '1"HIE :E;O I L. HE,.:. JF:.F I ]. Jl',l : T .: I EH I ::5 -
'THE L. ENCYI"H [:.', :[ HEN?.:; :[ ON I :~; ']"HIE: I....ENGTH ,:: I N FEET::, OF THE TRE:NCH OF.'. DI:;.'.FI :t: NFI lEI....[::,.
TFiE: E:,EF'TH OF FI ']"F.'.EI'.~CH r"~F,'. PIT '.[:5 THE DISTFII'4CE: E~ETI.,.IE:EN THE '..:.;I...IF;:FF-IC:E: OF" THE
GF..'OUN[::, FINI:.':, THE: BOTI"OH OF THE E:NCFI'v'RTION ,::IN FEET.':,.
THERE .T.'.i5 1'.40 SE:']" I.,.II[;:,TI4 FOFJ: "['RE:I",ICHE"Z,.
THE (:~iF.'.R'v'E:L. [::,EPTH .IS THE: HINIHUH I.".:,EF'TH OF GRR',,,'EL BE"I"IqEEN THE OUTFFtL. I .... F':[F'E
Ri'.,I[::, THE': BOTTOH OF' :T'HE E;=.,',CFI'v'FIT I ON ,:: I N FEET>.
t"'11 I",11 I"'1t...11',1 I:.':' I STFINCE..' BIE:TI.,.IE:EN R NELL.
.':1..~;i)6~ I::'E':E'T' FOF.". FI I::' F~: :[ ',,,' R "[' E 1.4E;LL. OF.'. 2OE~ FE'ET F'OI:~'. FI F:'UE:L..IC HELl .....
I.,.IEI....L t....OC:i2:.; FIRE RE:C!UIRE[::' RI'q[> f'IUST BE F.'.ETUF.':I"4E:D TC)'T'HE I)EPFIRTHENT klITHIN ::~:E~ [::, Fl "r".~i;
OF:: THE: 14EL. L.. COI"IPLETION.
:~i;I='EC ]: F:' :1: ]:::Ff"[' :[ ()1",12.:, FII",ID C.:ON'.'.:.;*'I"F.".UC.:T :[ ON [:, I F:IGF.'.FIH'.E; FIF.'.E: R',,,'F1:1: I....FIBI....E: 'TO :t: t'*,I:i.:.;UI:;i'.E t::'F;'.OF:'EF.'.
]: I'.,t'.i".:;T RI....L. FIT ]: O1",1.
I CEI:;.'.T I F"r' I"HFIT
::[.: t FIH i:::'RI"III....IF~I:;i: 1.4ITH THE:: REC!UIF::E:P1E:I'.~T:E; F:*OR Ot'.,I-E;ITIE :E;E:I.qER:E; RN[.':, 1.41ELL.::=':; FEii; SET
F:'OF:'.'T'H B'T' THE I"1U1'.41 C :[ F'FIL t*1"'¢ OF RI'.,ICHOF.:RGE.
;;.:..:: :[ 14:1: L.L. I N2i;-I"F~L.L. "I"HE S'T't:+.';TE:H I N FIC:COF.:[>RNC:E I.,.I :["f'H THE CC)DES.
:::..":: I UN[::,E:Fi:L=TT'FIND "I"HFFF THE CJt'-,I--.2;ITE '.ZENEF.: :5'T'S"f'E:H I"IR'T' RECC!UtF.'.E EI'.4L.F~F~:G[.:.:HIEI",H" IF 'T'HE
Fi'. E: '.'5 :1: I:::,E'NCE: I S I~:EI"ICd)EL. ED TO INCL. UI:>E I"IORE THRN 4- BE:E:,F.'.C)OI'"I2!;.
:~i; I Gt'.4E:D ~
' .............................................................................
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
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address ~"'-{ O
Agent
Address
Day phone
~~;'~Day phone ?"~"~ - ~5
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ¢
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the. legality and status of system.
4. TYPE OF WASTEWA, TER DISPOSAL:
Individual on~-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) 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 ~(~i~ ~, ~'~1~(~ Phone
Address .~O ~,..,~i2L~l~ ..~,' ..~L,P~L~i~ ~,~,~
Engineer's signature [.~'~.z~T.i~~~ Date
DHHS SIGNATURE
~ Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
3'he Municipality of AnChorage Department of Health and Human Services (DHHS) issues Health Authority
Approval CertificatesJ3ased only upon the representation~ given in paragraph 5 above by an independent
professional engin?er'registered in the State of Alaska. The DHH$ does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH$ 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 engineefs work.
72-o25(Rev, 1/91) Back MOA~21
EIWICEi OI¥1IlON
Municipality of Anchorage &ECE I VE D
DEPARTMENT OF HEALTH & HUMAN SERVIC
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: Z,~,' :~ ,~'¢.,/.~.~,~:~ ~--~-'~-*..~r'"~',~"' Parcel I.D.: O/~'"- ~/'~z/'_ o~'"
A. WELL DATA
Well type ~,~,¢,~"~=' If A. B. or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth
Sanitary'seal (Y/N)
Date com~31eted ~-'~-~'~: ~ / ~ ~'~
~r ~ ~
Cased to '~,~ Casing height (above ground)
Wires properly protected (Y/N) ~
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well production
g.p.m.
WATER SAMPLE RESULTS:
Coliform ~
Nitrate
Other bacteria
Date of sample: .-'~'~. ~ / ~"~d
Collected by: /_.c2..,~,,~.~.~.~.~.~.~.~.~., ,, ~c.~,~,,~../
B. SEPTIC/HOLDING TANK DATA
Date installed ~/x.J~' ~/~'Tank size
Foundation cleanout (Y/N) ~v' Depression (Y/N)
Date of Pumping -- Pumper --
x',~"'~ a~,~Number of Compartments ~ Cleanouts (WN) ~,,,~"
~ High water alarm (Y/N)
C. ABSORPTION FIELD DATA
System type ~,,~.~.,,~,,~z..~
Date installed ,~'c.,'.~./~/~'~'~ Soil rating ~ or fF/bdrm)
! / /
Length .~"~ ~"~-- ~Width ,.~--,~-,,z Gravel thickness below pipe ~/~"~-~z Total depth ~"~'~
Effective absorption area /.,.~--~-~'," Monitoring Tube present (Y/N) /~ Depression over field (Y/N) ,4.2'
Date of adequacy test Results (Pass/Fail) For~~' ~
Fluid depth in absorption field before test (in.); ~add~d' (in.): _
Fluid depth (ins) Minutes ~~.' Absorption rate = g.p.d.
If yes. give date
P~mxtd~f'~tment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N)
High water alarm level at*
Cycles-tested
"Pump on" level at*
___._____....~--~
---~--"~)atum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ?/.,-r",~-,~
AbsOrption field on lot /
Public sewer main
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer/septic service line
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation 2' ,~'.~ Property line ,-~ ~:~ Absorption field /,~
Water main/service line -~' ~//-/Surface water/drainage -~,~ ",~'/Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ?'g ./'/ Building foundation /-~"' .'~"/ Water main/service line ,'~-~*
Surface water ,~o,~ ~",~'~ Driveway, parking/vehicle storage area
Curtain drain ,'~,~,'~ ,~,z.~x,.~ ?-'~ ~'x'/.r',~-- Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name
Date I~'
of Municipal reco~or~;~, o'~f~, alfio~.e systems are
. *
· : :~::::.,,::;~::~ ~ ~: ~:~ :::: .... ~-" :: ~: ~ '~: ~
HAA Fee $.
Date of Payment/
Receipt Number ~-~
Waiver Fee $
Date of Payment
Receipt Number
72,026 (Rev. 3/96)*
zTL
CT&E Environmental Services Inc.
Laboratory Division
200 W. Potter Drive
Anchorage, AK 99518-1605
Tel: (907) 562-2343
Fax: (907) 561-5301
CT&E Ref.# 963516001 Client PO#
Client Name Douglas Kenley P.E. Printed Date/Time
Project Name/# L5 Birch Road Estate Collected Date/Time
Client Sample ID L5 Birch Road Estates Received Date/Time
Matrix Drinking Water Technical Director
Ordered By
PWSID Released By
Sample Remarks:
08/07/96 12:21
08/05/96 07:30
08/05/96 15:45
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Nitrate-N 0.100U 0.100 mg/L EPA 353.2 08/06/96 EMB
Total Coliform 0 0 col/lOOmL SM18 92228 08/05/96 TAV
ember of the SGS Group (Soci6t6 G6n6rale de Surveillance)
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
~ ~. ' DATE RECEIVED
.- NSPECTION APPOINTMENTS ~Z -'~ ' ~
TiME TIME TIME -/
DATE DATE DATE
~UNtC~PALI~ OF ANCHOEAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF H;ALTH
~~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~IRONMENTAL F~OTECTIO
~ I__~ 825 L Streat - Anchor~, Alaska 99501
REQUEST FORAP ROVALO NDV U A D W R AC[
DIRECTIONS: Complete all parts on page 1, Incomplet~ requ~ will not be procmed. Please allow ten (10) days for processing.
1. PR~RTYOWNER " ' I PHONE
~AI LING ADDRESS I
PROPERTY RESIDENT (If different from abo~e) ] PHONE ~
2, BUYER ~ ~ . PHONE
MAILING ADDRESS I ~ · - ~ v-- j,~ ,
4. REALTOR/AG2NT ~ ~ONE
MAI LINGADDRES~ ·
$. '~EGAL DESCRIPT'ION ' ' '
STREET LOCATION
.
6. TYPE OF RESIDENCE ' NUMB'ER OF,BEDRoOMs '
[~ SINGLE FAMILY
[] MULTIPLE FAMILY
1: WATER SUPPLY '
[] INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
8. ~EWAGE DISPOSAL SYSTEM
.[] INDIVIDUAL/ON-SITE**
[] PUBLIC UTI LITY
[] One [] Four [] Other
[] Two [] Five
[] Three [] Six
*ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
//~' 7 ~ YEAR ON-SITE SYSTEM WAs INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
2-010 (Rev, 6/79) ~ '..,
TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
THIS SIDE FOR OFFICIAL USE ONLY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] I NDIVI DUAL/ON -SITE
r--I PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: /~.5'O If Tank is homemade
give dimensions:
TYPE OF TANK
PERMIT NUMBER
4. DISTANCES
WELL TO:
DEPTH OF WELL
DATE DRI L LED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
!
Septic/Holding Tank
Absorption Area to nearest Lot Line
INearest Lot Line
5. COMMENTS
[~;}~APPROVED FOR Z~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
72-010 (Rev. 6/79)
O'~OZ
g989 ~
0
9 ~89~ - ~
OOHOS
I
Z
~8888
Ld
II
,t
il