HomeMy WebLinkAboutRANSOM RIDGE LT 8
-~MUNICIPALITY OF ANCHORAGE ~
HeaL~:~ and Environmental Prote~ ~,on
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
REPORT ON-SiTE' SEWAGE DISPOSAL, SYSTEM
LEGAL L g '
SEP¥1C TANK:
DISTANCE NUMBER OF
FROM WELL ............... MANUFAC]URER .~¢_~ .... MATERIAL .__~'¢'..J,, COMPARTMENTS
TILE DRAIN FIELD:
TOTAL LENGTH
£)15't ANCE i ROM t-^/EtLE .............. FOUNDATION._~._~_. ....... NEAREST LO'F LINE.~...~_~ ........... OF LINE _~
~ O~ L~nes (~..O¢~-DISTANCE BE'f WEEN LINES __~_b ...... ;_TRENCH WIDTH~.., IN. TOTAL EFFECTIVE
Af}SORPIIOP-! AREA .... :~ ........ Sq. FT, LENGTH OF EACH LINE
:1~ DEPTH OF FILTER
OEP'Itl: ~ OP ()t TI LE '10 FINISIt GRADE }_~ ...... MATERIAl, BENEATH ]'LE .., .,., ........ IN, ABOVE: 'riLE ..... .., .....
SEEPAGE PIT:
DIP, M ET EFt ........... OR WIDTIt ....... LENGTH ....... DEPTII
Log Crib Rings
BUILDING FOUINDATIOIW
Crib Size: DIAMETiR ...... DEP/'It ....... D RTANCE Ff:!OM; WELL ..........
TOTAL EI F'ECTIVE
NEAREST LOT LINE ............ Af3SORPTION AREA (WALL AREA) SD, FT,
~11
Lass: Depth:
:11 D'istance To: Lot Line
Sewer Line:
i,pe Materials:
of Bedrooms:
~staller:
~marks:
t}EPRRTMENT' C¢;*"".4ERLTH AND ENVI~!ONMENTAL
27¢-25:1.'1
RF'PLICRNT NElL L. RMANN 67'28 WEIMER DR #2 ~ ~ '~'-~':"- ~'* ':'""- -"
_- _
L..OCATiON GLLDEN ~¢].EW & RANSnM RIDGE L
LEGAL [.28 RANSOM RI[GE ..... L. LOT ~Iz.E 98888 SQLIRR~ FEET.~
'¥YPE OF' SOIL HB_,CRE, fION _.,~=,IEM : TREN~.H -
MRXIMt]M NUMBER [)F BEDROOMS = 4
SOIL_ RATING (SO FT?BR)= '.1.25
THE REOUIREC, SIZE OF' THE SOIL. ABSORPTION SYSTEM IS:
ii:. E'; p-r H=
]"HE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF 'THE TRENCH OR DRAINFIELD.
THE [:,EPT'H [)F R TRENCH OR PIT" IS THE DISTANCE BETWEEN THE SLIRFACE OF THE
GROLIND AND THE BOTTOM OF THE EXCAVATION (1N FEET).
THERE IS NO SET' WIDTH FOR 'TRENCHES.
THE GRAVEL [:,EPTH tS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AN[:, THE BOTTOM OF THE EXCAVAT'ION (IN FEET).
F:: E t:'.,~ l.] I tF;~: E: []:, S; E] F' "l- :'[ C: "T" R 1'4 K: _91 ;£ Z b-'] = ."J_ ;;.3~ 5 ¢._]-i L--.4 F-~ b. b. £1 t-,il
P A L--..: t'4 A,3 E P L. A I"-,I T Ln. F"-¥ I
A PACKAGE PLANT MAY BE INSTALLED RT THE PERMITf'EE'"S OPTION SUBJECT TO THE
FOLLOWING CON£~ITIONS:
:t_ EITHER A CL. ASS I OR II NSF APPROVED PLANT MAY" BE INSTALLED.
2. R CONTINUOUS MAINTENANCE AGREEMENT IS RE~UIRED. IF A MAINTENANCE
AGREEMENT IS NOT' KEPT CURRENT YOU MAY 8E RE~UIRED TO ENLARGE THE SOIl.
ABSORPTION SYS'TEM AND?OR YOU MAY BE SUBJECT TO PROSECLITION.
--- -::. -. -- ---' RE~;!i.J I AEC,
]-i.4~tTZa ,;] ,,~..: ::, ][ t'-,t._ F FZ_ L- 1- I Lq N S RI:;;-: E
BhluI.Ftl...LIN;~ OF ANY .~.=,[EM WITHOUT FINAL INSPECTION AND APPROVAL BY THI':;
DEPARTMENT WIL..L. BE SUBJECT' TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
J. 00 FEET FOR A PRIVAT'E WELL OR 200 FEET FOR A PUBLIC NELL.
WELl_ LOGS ARE REC4UIRED RN[:, MUST BE RETURNED TO THE [)EPRRTMENT WITHIN 3:0 DRYS
OF THE WELL. COMPLETION.
OTHER REQUIREMENTS MAY' APPLY. SPECIFICATIONS AND CONSTRIJCTION DIAGRAMS ARE
AVAIl_ABLE TO INSURE PROPER INSTALLATION.
F'EEF-:I~il ][ -¥' ES :--'-:," F' ]] t~.'. E] .'SE; [."..',E:C:EI'-'IBE. Zt;-: 2'¢ :lj~.., :lL S.-~';;";~'
I CERTIFY THAT
:1.,: t AM FAMIL. IAR WITH THE RE[~.UIREMENTS FOR ON-SI'TE SEWERS AND WELL. S AS SET'
FORTH 8Y THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF 'THE
RESIDENCE IS REMODELED TO iNC:LUDE MORE THAN 4 BEDROOMS.
APPLICANT NElL L AMBNN
V.~. 0
performed For
i e~al ~escri~tion: Lot 8
This ~orm Renort_~ Soils Lon
"0~ tm~ is worth a ~hou~a.d
2204 Cleveland Apchorage, Alaska 99503
(N~I
__p B & J Comp_a~n_Y Am-ana~k-oate
Performed
B]0ck 5ubdt¥ision
yes
6/2/75
Percolation Test
ne.th
F~et
Soil Characteristics
Or_qanic Overburden
Coarse Sandy Gravels, with
occasional boulders
[GP-GM]
Ground water
level
Bottom of Test Hole
--
Was ~roun~ Water Encountered?__~es
IF Yes, At what Denth? - 12 feet
Readinq Date
Grnss Time
Net Time
Depth to H20
Percolatinn Rate ~linute
Prnposed Installation: Seenaoe Pit Drain Field__
Deoth of Inlet Depth To Bottom Of Pit Or Trench
(~u~ENlS'._~__S~are Feet drainaqe ar_D_a rD_qlLi ~
Net Dron
Test Performed By James D Ma~k Data Certified B~: CONSTRUCTION TESLTA
164 th AVENUE
~ L/4'' BC on 2 1/2" P~pe
flush v,/~r ound
L;b~',o .
R= 20.0
L : 2'9.9
T: t8 5:
8
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
0 ~-0 ~OC~ "~.~ {'7---' HAA# ~C~,
1. GENERAL INFORMATION
Complete legal descriPtion
Lot 81 RanSom Ridqz Su§division
Location (site address or directions)
Property owner
Mailing address
Lending agency
16600 Golden View Drive
Anchora~¢~ AK
J~ff Byrne
P.O. Box 230044 Anchoraq~,
Day phone
AK 99503
Day phone
248-533[
562-2575
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well X×X
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 XX×
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·
')pOM s~eeu!6ue leUO!SSe~.oJd eq), u! SUO!SS!LUO JO s Jo J JO JoJ elq!suodseJ
~,ou s! e§eJoqouv ,to ~l!led!o!unlAi eq.l. 'penss! s! eleO!l!lJeo e eJo,teq m, Ep eZ~l~U~ Jo suop,:)adsu! lonpuoo
1au ap SHHQ ,to see~oIdLu3 'mueuJeJ!nbeJ elm, spue leJepej u!~ldeo/gs!l~s o), Jap Jo u! suop, nlp, su! §u!puel J!eq~, pue
sewoq ,to sJes~qo~nd ol ~sap naa ~ se s!q~, soap SH Ha eqj. '~)lS~l¥,to el~lS eql u! peJe~s!6eJ Jeeu!Oue i~uo!sse,toJd
3uepuedepu! ue/,q e^oq-, cj qd~J6~Jed u! ua^!§ suo!lm, ueseJdeJ eql uodn XlUO peseq seleo!~!lJeO le^oJddV
Xl!Joqlnv qlleeH senss! (SHHQ) seo!AJeS uewnH pue qll~eH ,to lueLup~deQ e§eJoqouv ,to Xl!l~d!o!unlAI eq.L
elec]
s~uewwoo leUOp,!pPV
:suo!lelnd!ls 6U!MOIIO,t eql q),!M 'swooJpeq
b~ b~- ~5~ euoqd
'swoo~poq
· uop, oedsu! s!q~, ,~o m, ep eq~, ua ~,oeLle u! suop, eln6aJ pus 'seoueu!pJo
'sepoo re, elS pue led!o!un~ lie Lp,!M eoue!ldLUO0 u! s! wm, sXs lesods!p Jo:JeMOlSeM Jo/pue Xlddns
JeleM el!s-ua alp, 'uop, oadsu! pue uo!le6!lse^u! Aw LUOJ,[ pue SelU a6eJOLIOUV JO Xl!led[o!unlAI aU1
LUOJI pau!elqo uop, ewJoju! eq~, ua peseq ieLp,/gpo^ JeqldnJ I 'u!eJeq paleo!pu! oJn~,onJ~s Jo edX1 pue
SLUOOJpaq ~tO Jeqwnu eq~, doJ m, enbepe pue leUOp, ounj 'ales s! walsXs lesods!p Je~,eMelSeM Jo/pue
Xlddns JO:JaM O),!S-UO el.J), ~,eLp, SMOLJS uoReo!ldde leAOJddV ~poq~,nv LP, leOH s!ql ,[o uo!le§p, soAu!
~W leql/~J!JOA I 'MOlaq UMOqS elep uop, ep!leA eql to se pue oleJoq pexuje leOS ~w ~q pe!j[ldeo sV
'9
I:Fa:aNIIDN=1 AG NOIJ.O:IdSNI dO IN::I~:alV.LS 'g
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /_ol~ ? ,~/'~/~-~ ~)/~I /~/L~'~ Parcel I.D. /J/~
A. Well Data
Well type ~)/'~'1 ~'~7-~-~
Log present (Y~
Total depth '~ '~
Sanitary se~q)
A, B, or C, attach ADEC letter. ADEC water system number
~ Date completed CU (,~ Driller
Cased to ~ Z ~ Casing height
Wiros proporly protecto )
FROM WELL LOG
Date of test
Static water level //~" /~ ~ ~'J /~,J F-~ ,
Well flow 0~"~ F~/-- ~-~
Pump level1
AT INSPECTION
¢¢:~//0 A~ .~
g.p.m. ~ 0
SEPARATION DISTANCES FROM WELL TO: ~.~
Septic/t~ank on lot /~ ~ / J
Absorption field on lot ~ ~"
; On adjacent lots
Public sewer main ~ ///~
Sewer service line ~'- /-/'- .x
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform (~
Date of sample: ?//' ~/~-~
Nitrate
~), 2- ~ fi'/¢'/~- Other bacteria ~
/ S & S~NGINEERiNG
Collected by: ..... ~-. "= .... L~2 ~-~ ......
Eagle R~ver, Alaska ~577
Date instal~..~ //~ / ~ -'~'~ ~
Cleanout~/Y/N)
High water alarm (Y/N)
Tank size
Compartments
Date of pumping
Foundation cieanout (Y~. Depression (YN~
/L./' ~//'./~)- ,, Alarm tested (Y/N)
Foundation
Water main/service line
SEPARATION DISTANCES FROMSEPTIC/~TANK TO:
Well(s) on lot /2-~ On adjacent lots
To property line /0 ' Absorption field
(
Surface water/drainage ./'¢)-0 -/-
CONTINUED ON BACK PAGE
72-026 (3/93)* Front
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level ~
Meets M~)
SEPARATION DISTANCE FROM LIFT STATION TO:
Manufacturer
Manhole/Access ~ ~
"Pump off" Level at
Cycles tested
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed // // ¢/2
Length /'7 ") Width
Soil rating (GPD/Ft2) / ~ S
!
Gravel thickness ,.~, ~-
System type
Total depth
Total absorption area
Date of adequacy test ~//o /
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Cleanout present (Y/N) Depression over field (YO
Results~fail) p/'J/.~'~ for
~ After test
If yes, give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ,,/,~ '7 ' On adjacent lots //¢~ ~'/- Property line
To building foundation 2. ~ ~ To existing or abandoned system on lot
!
On adiacent lots 2 o -/ Cutbank ~ c9 ,~'~ Water main/service line
¢
Surface water ~'~0 4- Driveway, parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA
Signatu~~~m,~ ........ m~
DateEngine='~9'=170.34~''~'"'E~gle, ,-,,..~,..~i¥'e" r L~o~o~p..E~ o a d.... · No. 204 ~./~,~,~".?
HAAFee$ /7¢
Date of Payment
Receipt Number
72-026 (3/93~* Back
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHO RAGE ~
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ,--'~'
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~t~)~b - I I C~ ~
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date /¢" (? ~ ~'
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
,~,I~PJ c~rName' '~,~'~<~', ~,¢~4~. Telephone: Home ~Y~-
(b)
, ~ ~... , , ,?., , ~ ~
(c)? App~ ....... cant ~s (check one):'Eendmg'" ' Institution ~; Ow~r/builder~ Buyer
(d) ',[_~'p, diqg Institu{ion ·
Address' '
(e) Real Estate Company and Agent
Address
Telephone
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE./
Single-Family,[~'. Multi-~amily [] Other .
.... , :., ~,
Number of Bedrooms?C;~,~ ,'
WATER SUPPLY
Individual Well~' Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status,
4. SEWAGE DISPOSAL
onsite,,~/ Public [] Community [] -Holding Tank
Note: If community well system, must have writte~ ~n from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA'IA AND INFORMATION
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 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 con: pliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection. ~.:
Telephone
DHEP APPROVAL
Approved for -~ bedrooms by
Approved .,~ Disapproved
Terms of Conditional Approval
~'~ Date
Conditional
ION
The Muncipality of Anchorage Department of HealthI and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an ir)dependent professional
engineer registered in the State of Alaska. The DH EP does this as a courtesy to purchasers of homes and their lending
nstitutions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct inspections or
analyze data before a certificate is f Anchorage is not responsible for errors or omissions in the
professiona! engineer's work. i.
Page 2 of 2
WELL DATA
Well Classification
Log Present
Well
Total Depth ~''"' (~) Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit//~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
RECEIVED
If A, B, C, D.E.C. Approved (Y/N)
. ¢~ 5. ~, ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /~? '~o ~.~; On Adjoining Lots
To Nearest Public Sewer Line ~"//~ To Nearest Public Sewer
Depth of Grouting
Pump Set At
' Sanitary Seal on Casing~N)
Depression Around Wellhead (Y/~}
Cleanout/Manhole /~/,~ To Nearest Sewer Service Line on Lot
Water Sample Collected by ~¢~/,~ ~::~ ; Date /(~-
Water Sample Test Results
B. SEPTIC/HOLDING TANK DATA
Date Installed
StandpipesON) / Air-tight Caps CN)
Depression over Tank (Y~)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well [~0! '/.o
To Property Line /f~
To Water Main/Service Line
Course /'~o
Size /r~ ~'~ No. of Compartments ,,~
Foundation Cteanout (Y/(~
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N) /~
/
To Building Foundation '7
To Disposal Field
To Stream, Pond, Lake. or Major Drainage
Comments
Page I of 2
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /[-I&- ? 7
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well 1'~7 t -~o ~. ~
To Building Foundation ~-~? ~¥
Lot /~/~
To Water Main/Service Line ~'~' r~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field 7'7
Depth of Field
Gravel Bed Thickness
Standpipes Present CN)
Date of Last Adequacy Test
I
To Property Line /O
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed Dimensions
Size
in
Gallons
_ Manhole/Acc,,ps~(Y/N) __
"Pump On" Level at _ ~ "P.,~COff" Level at __
High Water Alarm Level at . I ~ ~ Vent (Y/N) ___
Tested for l~J.~ Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~/~J~b¢,~ ,~r~--~ Date /~-/7'~'
Company /J~'~' _'~"~. MOA No.
Receipt No. _,~r) 0 (
Date of Payment /0'~1- ~
AmoUnt: $ (~ ~. O~
Page 2 of 2
72-026 (11/84)
ALASKA e,,dlROFImI FITAL COFITROL IFIC.
~n§in¢¢rin§ $ ~nuironmcnlol $1u(Jies
JEFF BYRNE
16600 GOLDENVIEW
ANCHORAGE ALASKA
99516
SELLER-
JEFF BYRNE
16600 GOLDENVIEW
ANCHORAGE ALASKA
99516
10/17/86
60511
LEGAL:RANSOM RIDGE LOT 8
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE-lO/2/86
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 539 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 450 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 10/2/86 .
THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER
SUPPLY OR WASTEWATER SYSTEM.
FLOW TEST ON WELL
WELL FLOW DATE-10/2/86
A FLOW TEST WAS PERFORMED ON THE WELL.
PUMPED AT A RATE 0F 1.8 GPM OVER A DURATION 0F
THE DRAWDOWN WAS 6 ' WITH A RECOVERY TIME OF 60
AND THE STATIC WATER LEVEL WAS 2.5 FEET.
THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME.
450 GALLONS OF WATER WAS
4 HOURS.
MINUTES
1200 LLJcst 33rcJ Aucnu¢. Suite [~oAnchoraq¢, Alas 99503 , [907) 561-5040
ALASKA ENVIRONMENTAL
CONTROL SERVIC:-", INC.
1200 West 33rd Avenue. Suite B
ANCHORAGE. ALASKA 99503
(907) 561-5040
SHEET NO. OF
CHECKED BY DATE
sc^LE_ ! -"
'"'"'-"'-'" N_° 354
M-W DRILLIN3 INC. DA*E_
P.O. BOX 1103
UNIT
ANCHORAGE, ALASKA 99511 QTY, MATERIALS PRICE AMOUN~
PHONE 349-B535
'4AME
LEGAL DESCRIPTION
OF WORK
DATES
All charges shall be paid in full within ten
days unless other arrangements are made
prior to drilling. The customer shall pay in-
terest at the rate of 1 ~ % per month on any
amount not paid within ten days. Failure to
pay may result in a lien against the property.
WORKMAN
CUSTOMER SIGNATURE
DATE
OUT
LABOR I HOURS 1 RATE
I ; I
MATERIALS (FROM ABOVE!
OTHER CHARGES
PAY THIS AMOUNT
ANCHORAGE
BACTERIOLOGICAL )lATER -~*k ,~..m. ".~
__
FOR
[] RESUBMIT SAHPLE
Sample rejected because:
CHECK ONE ORNORE
0
0
0
[]
[]
LOCATION WHERE SAMPLE WAS COl /
'COLLECTED BY:(SIGNATURE
TYPE OF SAMPLE
(CHECK ONLY ONE THIS COLUMN)
~DRINKING WATER
·/CHECK TREATMENT
I-]CHLORINATED
-~FILTERED
[:]UNTREATED OR OTHER
ri RAW SOURCE WATER
r'l NEW CONSTRUCTION OR REPAIRS
0 OTHER(Specify)
IS THIS S~HPLE A CHECK SAMPLE TO A PREVIOUS NON-CONFORMING SAMPLE?
YES ~"~'0 PREVIOUS COLLECTION DATE
ANALYSIS REQUESTED' (IF OTHER THAN TOTAL COLIFORM)
'~ND REPORT TO:(PRINT FULL NAME,ADDRESS AND ZIP CODE
Sample too long in transit.
Sample should not be over 30 hours.
Sample received too late in ~ek
Not in proper container
Leaked out
Insufficient information provided.
Please read instructions on form.
Other (Specify)
RECEIVED FROM
RECEIVED BY _
DATE /o-r?- ~ ~ TIME
ANALYT~L METHOD:
~MB~NE FILTER
~ ~R~NTATION TUBE
Date & Time Started ~'
Date & Tim Completed
ADDRESS /.~O(~ ~,1./ ~ '~ ~'
CITY STATE ZIP C~7 .~ '~
BACTERIOLOGICAL )LATER ANALYSIS RECORD
FOR, LAB USE ONLY
'~ TOTAL COLIFORNS
--] FECAL COLIFORNS
~ OTHER
LABORATORY RESULTS
[] Other Bacteria
D Test unsuitable because:
Fl Confluent Growth
[] TNTC
SATISFACTORY E~ UNSATISFACTORY []
CD Coliform/lOOml
BGB ,~t
Coliform/lOOml
Date
Time
Membrane Filter: Direct Count
Verification: LTB
Final Membrane Filter Results
Reported By
READ SAMPLE COLLECTION INSTRUCTIONS ON BACK OF FORM
APPLIC~NT FILLS OUT UPPER HAL'S'ONLY
Mailing Address 5~ A' "g(jx -472A
Address '~ ~,~ 3 Z A kX cL'~ 0~-'f A¢'I (. [% A~ Zip Code
Lending Institution .A~j~yk~ m,~)~Lu O t Phone
RealtyCo.&A~ent ~;~E/~'I~]~/~ ~',,oeec'tie~ !ac.. - 5oS etc~,¢~t Fhone
Address ~ 70 ~, G (.' Y"t~, -~'~ e ~ \ ~2U i ~C ZOO At'~ (.~ 0(' 03 {~ ZiP Code q qso..~
Type of Residence
Single Family
~ Multiple Family No. of Bedroom~
[] Other
Water Supply
[~ Individual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
[] Community For wells drilled prior to that date, give well depth (attach Icg if available).
[] Public Utility
Sewer Disposa, iq
~i~ Individual Year Individual Installed:
[] Public Utility 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 J // ,'"-'x
Date Date Date ~- '~ ~. - (~---~ Q~-',,~¢(~.73
Insp~tor Insp~tor Insp~tor Insp~torx
DEPT. OF HEALTH
ENVIRONMENTAL PROTECTION
RFCFIVED
d
( ) DISAPPBOVED
( ) GONDITION~ APPGOVAL'
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
/' ~ ~¢ //- /~ ~ / F Well to Tank .[ ~ ~ Septic T~k Size
MUNICIPALITY OF ANCHOr ~E
DEPARTMENT OF HEALTH & ENVIRONMEN,..~. PROTECTION
TELEPHONE 264-4721
NOTICE OF VIOLATION 1 7 9 2
Please take notice that the undersigned authorized representa-
ti~ of th~;)irector has reason to believe that on or about
~ --/~ , 19 ~, at or near the follow_ing:
APPROXIMATE LO~ATION ~'~ ~/ '
ADDRESS:
WITHIN THE MUNICIPALITY OF ANCHORAGE DID UNLAWFUL[
which is a separate violation of §
of the Anchorage Code of Ordinan-
ces each and every day such condition exists.
A COPY OF THIS NOTICE HAS BEEN SERVED UPON:
IN THE FOLLOWING MANNER:
1. by personal service
2. by certified mail
~y posting this notice on or about the location described
~'~herein when such person cannot be found after diligent
effort to do so.
If the violation or vioJ,ations referred to herein have not been
~orrected bye, 1~_, legal proceed-
~ngs may be initiated as provided by law.
Dated thisZ _~ day of ~i-~, 19 ~'3
NAME
70-004 (Rev. 5/78)
· .. . CHEMICAL. & Gl LOGICAL LABORATORIES ,_ £ ALASKA,
· ~' ' TELEPHONE (907) 562,2343 ANCHORAGE INDUSTRIAL CENTER
/~%~ / ~4// ~ ~ .5/633 B Street
z/- ......--,~/ D~'r~k'l~'g Water Analysis RelSort for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIEF
TO BE COMPLETED BY LABORATORY
WATER SYSTEM:
LD, NO.
Water System Name
SAMPLE DATE: ~' ~
Mo, Day Year
SAMPLE TYPE:
cOUtine
beck Sample (for routine ~mple
with lab ref. no. )
[] Special Purpose
SAMPLE
NO.
, I
2
3 I
LOCATION
C~llected
Analvms snows tins Water SAMPLE to be:
[] Satisfactory
[] Sample too ong in transit; sample should
not be ever 48 ho. ur%o~d at exam ~at~on
to indicate reuaom results Please send
Fermentation Tube
~embrane Filter
L~ib Ref. NO. Result*
~ ]
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Rev, 1978
Date Collected source
PresumPtive 1Omi /0mi 10mi 1Omi 10mi 1.0mi 0.1mi
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
EMB Broth 24 hours:
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: I.TB ,
Final Membrane Filter Res Its~
Broth 48 hours:
ZOml Tubes Polltlvefrotel 1Omi Portions
Coil form/100ml
BGB
Collform/i00ml
. ,.CHEMICAL & Gl LOGICAL LABORATORIES',~ ~'~ ALASKA, INC~
.,~' TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER
/~,il~t, ¥ ~ 5633 B Street
/~'~ Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
I.D. NO.
Mailing Address
City
Mo. Day
SAMPLE TYPE:
StYe Zip C~
Year
Special Purpose
SAMPLE
NO.
2
TO BE COMPLETED BY LABORATORY
,~alvs~s snows this Water SAMPLE to De:
XSatisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old az examination
, to indicate~ reliable results. Please senc
n'~w; sam ~e: ........
Date Received
Time Received "~
Alia!ytical Method:
~ Fermentation Tube
~embrane Filter
Lab Ref. NO.
Result* Analyst
EMB Broth 24 hours:
MuItlole Tube ReOort:
Membrane Filter: Direct Count
Verification: LTB
Fln,, Meml)ran, Filter ReSult~S {~
Broth 48 houri:
_10mi Tubes PoSitive/Total 2Omi Portions
Collform/100ml
BGB
Collform/100ml
COLLECTING SAMPLE
BEFORE
READ INSTRUCTIONS
Presum0t lye 10mi 10mi Z0ml 10mi . ]~0ml 1.0mi 0.1mi
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
Date Collected Source
ecelvecl Lab. NO.
Rev. 1978
ALASKA I IidlI OFImI FITAL CO[1TROL St l UlCe$, Il'lC.
En§ineerJnq 6 (~nuironmentol $1udies
AUGUST 26 1983
NEAL L. AMANN -
6720 WEIMER DRIVE #2
ANCHORAGE AK 99509
SELLER - NEAL AMANN BUYER -
SUBDIVISION - RANSOM RIDGE BLOCK - 0
ADEQUACY TEST FOR SEWER SYSTEM
LOT - 8
MUNICIPALITY OF ANCHoRA(~E
DEPT. OF HEALTH &
~NVI~ONA~NT^t. PROTECTION
RECEIVED
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 539 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 600 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 8/25/83 .
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.