HomeMy WebLinkAboutSPENDLOVE VIEW HEIGHTS BLK 2 LT 1
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 e Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: '~,3q~OO1~' PID Number: C>'7..t.-. O"2,1 -- 'Z.,'~,
Name: ¢~O ~-,~.m" E~ ~AC--P_,A-P--¢. L,C_va~g Wastewater System: ~ New [] Upgrade
Address:
Phone: ~-- ~7 NO. of Bedrooms:
~ ~ Deep Trench D Shallow Trench B Bed DMound BOther
LE GAL B ESOR I PTI O N so, Rating: Total Depth from original grade:
8lock: Subdivim'on: D'epih to pipe bgttom from ordinal grade: Gravel depth beneath pipe
WELl.: ~ New ~ Upgrade G~ave~ width:~ f~ Number of,nas:
Classification (Private. A,B.~): Total Depth: Onsed To: Total absorption area: Pipe material:
SEPARATION DISTANCES ~eptic U Holding ~ S.T,E.P.
TO Sr, ptlc Ahsorphon t lit Holding ~ublic/Pdvate Manufacturer: Capacily in gallons:
Lot ' ' : :
Houndafion ~?~ ~ ~ "Pump on" level a~er a~am~ at:
Curtain Drain ~ ¢/~ ' "/~ ~ IElectrical Inspecti°ns perf°rmod by:
Remarks: %~% t~ ~~ BENCH MARK
Location and Description:
Department of Healt~ and Human Services approval 'a-~"- ~',~ ~ ,~ ~_ ..,",:..,~'~
Reviewed and approved by: Date: //- ~ _ ¢¢
72-013 (Rev. 9/91) MOA 25 ,.
Permit No. ~ ~ ~oo ~' Page ?-- 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: LOT t.~ ~-~ 5t~_~C,U~. V~ ~rT~ PID No.:
Permit No. ~ ,,~,~5' c;oL~' Page ~ of 5'.
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
tOn-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: uo-r ~ a %~?,j sr~-~0~uF_ we._~ H~5, PID No.:
cio ialo
7~.01~,^ (1/93) ·
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950015
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:LEWIS ROBERT R & BARBARA A
OWNER ADDRESS:2440 E. TUDOR ROAD ~428
ANCHORAGE, ALASKA 99507
PARCEL ID:02102124
PAGE 1 OF
DATE ISSUED: 2/14/95
EXPIRATION DATE: 2/14/96
LEGAL DESCRIPTION:
SPENDLOVE VIEW HEIGHTS BLK
2 LT 1
LOT SIZE: 43319 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL 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 (18AAC?2) 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)
SPECIAL PROVI~///
RECEIVED BY'
ISSUED BY: ~
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
THE FOLLOWING SPECI~ PROVISIONS.
DATE:
DATE:
unicip lit of nchora ¢
Department of Health and Human Services
825 "L" Street
P,O, Box 196650 Anchorage, Alaska 99519~6650
343-4744
July 13, 1994
Robert R & Barbara A. Lewis
2440 E Tudor Road ~428
Anchorage, Alaska 99507
Subject: Lot 1 Block 2 Spendlove View Heights Subdivision
Permit #SW930217, PID #021-021-24
The subject permit, issued July 13, 1993 by this office for a
single family well and/or on-site wastewater system, has
expired as of July 13, 1994.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
~ames Cr ss, . .
Program Manager
On-site Services
cc: Alaska Water & Wastewater Services
Jeff Garness, P.E.
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930217
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:LEWIS ROBERT R & BARBARA A
OWNER ADDRESS:2440 E. TUDOR ROAD
ANCHORAGE,AK 99507
DATE ISSUED: 7/13/93
EXPIRATION DATE: 7/13/94
PARCEL ID:02102124
LEGAL DESCRIPTION: SPENDLOVE VIEW HEIGHTS BLK
LT 1
LOT SIZE: 43313 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL 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
RECEIVED :. k~/,~. -~
IS SUED BY:
DATE:
DATE:
Tom Fink,
Mayor
] unicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
April 22, 1993
Robert R. & Barbara A. Lewis
2440 East Tudor Road ~428
Anchorage, Alaska 99507
Subject: Lot 1 Block 2 Spendlove View Heights Subdivision
Permit #SW920064, PID ~021-021-24
The subject permit, issued April 22, 1992 by this office for a
single family well and/or on-site wastewater system, has
expired as of April 22, 1993.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. Ail inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $200.00 for an
on-site wastewater permit; $75.00 for a well permit and
$275.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
enc:
Copy of Permit
cc: Alaska Water & Wastewater Services
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW920064
DESIGN ENGINEER:JEFFREY A. GARNESS
OWNER NAME:LEWIS ROBERT R & BARBARA A
OWNER ADDRESS:2440 EAST TUDOR ROAD #428
ANCHORAGE, ALASKA 99507
DATE ISSUED: 4/22/92
EXPIRATION DATE: 4/22/93
PARCEL ID:02102124
LEGAL DESCRIPTION: SPENDLOVE VIEW HEIGHTS BLK
LT i
LOT SIZE: 43319 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / WELL 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 (18AACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1. ENGINEER MUST VERIFY RESULTS OF WATER MONITORING DURING
INSTALLATION.
RECEIVED BY: ~.~ ~~..~ DATE:
ISSUED BY: /~ ~a~ DATE:
Alaska Water & Wastewater Services
"Preserving the Last Frontier"
April 7, 1992
Municipality of Anchorage,
Department of Health and Human Services
Divlslon of Environmental Services
On-Sits Services 8ecL/on
P.O. Box 196650 ~]
Anchorage, Alaska 9951~-,-6650
Re'f: Well and Septic System for Lot 1, Block 2, Spendlove
View Heights.
To whom it may concern:
Attached is the application, site plan, and design drawings
for the subject well and septic system. Comments regarding
the proposed system are as follows:
1. SEPTIC SYSTEM: As can be seen f rom reviewing the
at, tached percolation tes~ results, the soil "perked" at 4.7
minutes/inch at the location proposed for the original
system, and "perked" at 12 minutes/inch at the location
proposed 'for the replacement field. For design purposes I
censervatively assumed a peroo;Lation rate o¢ 12 minutes/inch
for both systems, For a trench system, this corresponds to
an application rate o¢ .8 gpd/ft2. Since the preposed home
~],1 have five bedrooms, the total design 'Flow is 750 gpd.
Based upon this, the minimum amount of absorption area
9(~7.5 pt2. The proposed system provides 960 ft2 ef
absorption area.
2.. TOPOGRAPHY: The differential elevation of the ground
was "shot" within lO0 'Peet of the proposed "trenches".
bhere were no slopes in excess of 25~ within this area,
except 'For a cutbank, down to the road, approximately 70
feet west ef the repl, aoemen~ trench site. This should not
be a problem since the separation distance between the
trench and outbank is greater than 50 feet.
I am unaware of any impacts that this installation would
impose c)n ad,jacent wells, or septic: systems. If you have
any questions, feel free to call me at 5S7-6179.
SS,
(:]'~e r/Censu 1 tart
JAG/jag
],ewisl.
Telephone - Fax 338-3246 ® 8471 Brookridge Drive · Anchorage, Alaska 99504
M unlcipailly of Anchorage
D EPARTMENTOFHEALTH&HUMANSERVICES
825 %" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL OESCR[PTION: %~>'P~.J-3OLO'q~.. '~ ~T~ , Township, Range, Section:
-- SLOPE SITE PLAN
9
p. p *- E0..¢¢~. pole.
WAS GROUND WATER
10 ENCOUNTERED?
s
11 IF YES, AT WHAT ~,~ /A' ~)
DEPTH? P
12 r-
13 ~ ~onito/ino? ~ ~ ,, flale: &
14
Gto:s Net Depth to Net
Reading Date Time Time Water Drop
3 ~, ~o ~0 ~m. NIA 2Y6"
20~ BoT'"c~ t-~
~ 6~ PERCOLATION RATE ~ ''7 ' (minules/inch) PERC HOLE DIAMETER ~:~ '/
TEST RUN BETWEEN "~ FT AND . ~ ' ~ FT
PERFORMEOBY: _~___~:~--qCF:.'~ ~-J'-J~C¢', i ,.~¢k¢ ~fi~-..M~-..~ CERTIFY THAT THIS TE~T WAS PERFORMED IN
ACCOROANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON T~IIS DATE' DATE: "~'/7 /
72-008 (Rev. 4~85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502~0650
LEGAL DESCRIPTION: 5¢~OLO~ ~ ~mS, Township, Range, Section:
SLOPE SITE PLAN
1
2
3
4
5
6
7
8
g
~0
11
12
13
14
15
16
17
18
19
20
% o'1L., k,.~ ~%
WAS Gr~OUND WATER
ENCOUNTERED*
p,p ,, powE~, p~ce,
s
IF YES, AT WHAT //~
DEPTH? ~'[ . P
E
Oeplh lo Waler Aller.
~eniLodng? hl/~ ,, Dale'.
Gross Net Depth to Net
Reading Data Time Time Water Drop
~ V~,I'~=- ~o 3o ~,IA ~
?_ ,, (,~ '5o N/A ;2. V~
PERCOLATION RATE ~ '2. (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN '-7 _ FT AND "7' ;~' Fm
PERFORMED BY: '~~~7/ ~'~"~'~-]~ I ,.~::~¢_~ ~/5155'. CERTIFY TNAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON T~IS DATE. DATE: .2./"7,/~.2...
72-008 (Rev. 4/85)
LOCA~
OG p~-4)P~:BE:O V~F_.LL
LOT ~; I~LOC~ 7__
Cot~TOt~ P~.
. f.
.J
~ou
LOO~o~a OF
ELL --
~of-~. LOd~e~'~lO~ of=
Robert R. Lewis
2440 E. Tudor Rd. #428
Anchorage, Ak. 99507
(W) 276-3624
(M) 345-7767
fax 276-8255
February 28, 1995
Municipality of Anchorage
On Site Services
825 "L" Street, Room #502
Anchorage, Ak. 99519-6650
Re: L1B2 Spendlove View Heights
Dear Sirs,
Attached are two copies of septic tank drawings and calculations
for the construction of a 1500 gallon septic tank for use on the
above lot. This tank is one that I have had on hand and am recon-
figuring to meet the requirements set forward in Section 2 of
"STANDARDS AND SPECIFICATIONS FOR COMPONENT PARTS AND MATERIALS
USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS."
These drawings and calculations are being submitted as required
in section 2.1. Engineering data is provided per section 2.1 and
2.11. All other sections have been revfewed and the tank is
designed to comply with these requirements.
Please mail one copy of the approved drawing to me at the address
listed above.
Sincerely Yours,
Robert R. Lewis
RECEIVED
I 1995
~u*~icipality of Anchorage
Dept, Health & Haman Services
Wright-Alaska Engincerlng $crvices· 6004 Glenkerry Dr. · Anchorage, AK 99504
February 22, 1995
W.O. 95007
Mr. Robert Lewis
2440 E. Tudor Rd. No. 428
Anchorage, AK 99507
Re: Septic Tank Depth
of Bury Calculations
Dear Mr. Lewis,
Following this cover letter, please find 4 sheets of calculations to determine the maximum
depth of bury of the steel septic tank measured by myself at your shop on 2/21/95. The
dimensions for the proposed septic tank were measured as 5.375 ft. in diameter by 12.25
ft. in length, and the tank material was noted as 3/16 in. steel. The baffle location has
been taken from the sketch you provided, and the largest compartment is noted to be
8.22 ft. in length.
The formulas for the calculations for depth of bury, which means depth of soil above the
crown of the tank, have been taken from two sources:
Formulas for Stress & Strain, by Raymond J. Roark, McGraw-Hill, 4th Ed., 1965
Formulas for Stress, Strain & Structural Matrices, by Walter Pilkey, Wiley-
Interscience, 1st Ed., 1994
As actual burial conditions are not known at this time, the calculations have assumed
some conservative parameters under which the allowable depth of bury has been
determined. The soil density of 150 PCF is a very high figure. The tank has been
assumed to be empty, allowing no hydrostatic forces to assist the shell in maintaining its
structural integrity. The tank has been assumed to be buried with the long axis
horizontal, and these calculations are only valid for the tank in that burial configuration.
The maximum depth of bury calculated is 14.66 ft. of soil above the crown of the pipe.
The tank should not be utilized under conditions which increase the soil Icad or live loads
above that level.
Should you have any questions, or require additional information, please contact me at
the numbers shown.
Sincerely,
Wright-Alaska Engineering Services
_~t W. Wrigh, t,//P.F_/.//
Telephone (907) 338*6230 · Fax (907) 337.5182
pL,47'"~',S ,~, 6-N~'L.L..S ('PP..¢.¢4.,)
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14~I' /~r's
TANK:
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~O,L:)~ ~7~'- ~'- ~ 7~-~T'=
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DEi~Tt-t OF' 21u, PY
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
Parcel I.D. # (D'P_t - O ?_j - ?-4-
1. GENERAL INFORMATION
Complete legal description
J
Property owner
Mailing address
Lending agency.,
Mailing address_
Agent _
Address
L°cation (site address or directions) _ C.o(~__.~¢_ CC- 'd~F6-~j FL-~-IGZ-pT~
~ ~ Day phone_
Day phone _. r,J/(/4-
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.
TYPE OF WASTEWATER 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) Fronl MOA ¢t21
STATEMENT OF INSPECTION i~Y 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 invest_Lgation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with alt Municipal and State codes,
ordinances, and regulations ~-~e~[ie6.tc~n,~the date of this inspection.
_ Phone "~
Wastewata? ~)c:rvices
8471 B roo].?~i~'~.D r' /
Name of Firm .~..nct:., A'r,. 99:._.4
Address ~- Date
Engmeefs signature' ~/',~ ,~,v '~
DHHS SIGNATURE
~ Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
Date _
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
Alaska. The OHHS does this as a courtesy to purchasers of homes
professional engineer registered in the State of and state requirements. Employees of DHHS do not
and their lending institutions in order to satisfy certain federal not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) ~i~ck MOA #21
MUNICIPALIIY OF ANCHORA~I!
~NVIRONMENI'AL SERVICES DIVISION
Municipality of Anchorage i.!0V 0 '? 1995
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division g ~4¢4~,4J4V E D
825"L" Street, Room 502 · Anchorage, Alaska 99501· (90
Legal Description: DoT I 3
A. WELL DATA
Well type "p ¢-~xak--~'-b~
Log present (Y/N) ~.~__5 Date completed
/ ~
Total depth ,g.--/_~m' Cased to 2'7 I 4-'"
Sanitary seal (Y/N) ~[~-- ~
Health Authority Approval Checklist
) xl, .~-,~ ¢-n~-~.' Parcel I.D.:
If A, B, or C, attach ADEC letter. ADEC water system number
Casing height (above ground)
Wires properly protected (Y/N)
Date of test
FROM WELL LOG
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ¢
Date of sample: I 0/Z.(=,/O ¢
T INSPEC/...XION
g.p.m. % g.p.m.
Collected by:
u'JI' SEPTIC/HOLDING TANK DATA
Date installed ct/14'/c:Z-¢' Tank size I ~'OO Number of Compaxtments
Foundation cleanout (Y/N') M~% Depression (Y~ Mo ~gh water alam
Date of Pumpillg ~ Ptlmper
C. ABSORPTION FIELD DATA
Date installed q/i+/~/X'' 9/~'/.;Soil rating (g.p.d./ft2or ft2/bdrm) "{~ System type ~ q"g.C-aY-~
I
Length ct O Width ~ +- Gravel thickness below pipe ~'- ~ 8, Total depth ~,. 2- 9. z:;- ~___~
Effective absorption area °l/o ~ Monitoring Tube present(Y/N) "/ Depression over field (Y/N)
CDate of age q"~~. Results(Pass/Fail, For __._______._..__~ooms
5Fluid depth in ab s or p tie n~~added (in.):
X. Pero ' ment (past 12 months) (Y/N) If yes, give date
"Pump off' level at*
High wat~
Cy~sted ~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
/
Septic/holding tank on lot I O ~ 4- ' On adjacent lots
Absorption field on lot t ~ ~ / 4-- ; On adjacent lots ~'>
Public sewer main ~,3 (t~- Public sewer manhole/cleanout P'J [~'
Sewer/septic service line cz;j' O/~ Lift station /,d/t
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~-- O/~ Property line ~ rD t ~ Absorption field (o
Water main/service lin~ > ~Ot ~
Surface water/drainage > ~ oo Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water ~>
Curtain drain
Water main/service line >' > ID
Driveway, parking/vehicle storage area '20/+
Wells on adjacent lots ~ 2> I DO
F. ENGINEER'S CERTIFICATION
1 certify that I h~e determined thrmfi~'~spections and review of Municipal records
inconforman~/~~linealineffectonthisdate.
Signature C~~
Engineer's Name '~~ a'
..............................................................................
HAAFee $ x~D/fi
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
CT&E Ref.~
Matrix
CT&E Environmental Services Inc.
Laboratory Division ~%~¢.-..~,~.~~Z,.,~"-~/Z:/.~:~Z/~.~,z~,,~'~,~/zZ;'z.;,'~J~
95.4852- Laboratory Analysis Report
WATER
Client Sample ID L1 BLK2 SPENDLOVE VIEW HEIGHTS-KITCHEN
Client Name AK WATER & WASTEWATER SERVICES WORK Order 19276
Ordered By JEFF GARNESS Printed Date 11/01/95 ~ 14:54 hrs.
Project Name Collected Date 10/26/95 @ 18:00 hrs.
ProjectI~ Received Date 10/27/95 ~ 15:45 hrs.
PWSID UA
Technical Director
STEPHEN C. EDE
Sample Remarks: SAMPLE COLLECTED BY: GARNESS.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
Nitrate-N 1.09 mg/L EPA 353.2 10. 10/30/95 CMR
* See Special Instructions Above UA = Unavailable
** See Sample Remarks Above NA = Not Analyzed
[3~= Undetected, Reported value is the practical quantification limit. LT = Less Than
~.:= Secondary dilution. GT = Greater Than
200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
CT&E Environmental Services Inc.
L a b o r a t o ry P i v i s i o n r.~'.ar. ~'.,~.~:~:ar.~;,r.,~:~,:~:~:ar. ar. ar,,~r~r.~:~.~~fjj~jjjjjjj~j~jt.
Drinking Water Analysis Report for Total Coliform Bacteria .,00w. po,er Drive
Anchorage, AK 99518-1605
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE 'lei: (907) 562-2343
~ax: (907) 561-5301
MUST BE COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM I.D. #
PRIVATE WATER SYSTEM
~ SendResults ~ Sendlnvoice
Contact n~n~
Phone ~umber Alaska Wa[er & ~-,, ~.n,~,.
Wastewater SPliCeS
Anch., AK 99504
SAMPLE DATE: ~
Month
SAMPLE TYPE:
.~ Routine
U Repeat Sample (for routine sample
with lab ref. no. )
[] Special Purpose
Day Year
12 Treated Water
~ Untreated Water
Time Collected
SA~LPLE LOCATION Collected By
Please Pfin~
TO BE COMPLETED BY LABORATORY
Analysis shows this Water S.,VMPLE to be:
,D---' Satisfactory
Unsatisfactory
[] Sample over 30 hours old, results may
be unreliable
o Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample via special de,very maiL.
Date Received - ; 0/"~7
Time Received [ __,C' q~-~,
Analysis Began
Analytical Metbod:
,.13---'Membrane Filter
~ MMO-MUG
* Number of colonies/100 mi.
Lab Ref. No. Result* Analyst
95. 4852
Sent to A.D.E.C. ~--~ch~ Fb~ Jun
Date: ](~5/~ Time:
Client notified o1' uusatisfactory results:
Phoned Spoke with
Dale: Time:
Faxed
Faxed
Comments:
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Result: Total Coliform
Membrane Filter: Direct Count
Verification: LTB
Fecal Coliform Confirmation
Final Membrane Filter Results
Reported By /'~'xtLo ~J~
/
BGB
E. Coil
C) Colonies/100
COLIFIRM
Coliform/100 mi
Date [0.'~/~. '~'~ Time /~02) hfs
TNTC = Too Numerous To Caunt
OB = Other Bacteria
Member of the SGS Group (Soci~t~ G~mSrale de Surveillance)
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
RECEIVED
NOV 2 0 1995
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