HomeMy WebLinkAboutTIMBERLINE LT 4
Loee!lor, (address of: Tow~htp, Rsnfe~ Section, if known~ or distan~ meJn road
~" ~ TIMBErLiNE
A'~C F'-9~AGE ALASKA
S~ of .a~t.~ .. _.6'2 .Dep~ of Hele~ 41 _ ~eet C.*~ t~eet
Static water "eyelet, (b~ ~bw)land. surfa~. Fm~h of well (ch~kone)
~oc~i~ ser~ or ~ti~ It~- ~ ~ .........
Well pumolng toot aL~ga~ ~ ~ (minuS) for- 2 = hours wit~. 100%
O~te O[ compll~Lig~ -. ,,, :) ;,: ] , '
3 !'c~ 12
WILl,
penetratod~ lisa of material, color and b~rdx
--.~, 12 'tO . 16
16 TO_ 41
____
TO
....... 'ro ........
..... TO .....
__ '! 0 ....
LEY CLAY
STICKY
BLACK SITLSTONE ARG'~LITE, GOOD WATE~ {:{
F~ACrURE~
.... TO,
PAGE
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 SYSTEM PERMIT
PERMIT NUMBER:SW950246
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:MARQUISS J STAR & BILLEE JEAN
OWNER ADDRESS:il001 TRAILS END RD
ANCHORAGE, AK 99516
DATE ISSUED: 8/29/95
EXPIRATION DATE:
PARCEL ID:01516404
LEGAL DESCRIPTION:
TIMBERLINE LT 4
LOT SIZE: 49665 (SQ. FT.}
HUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
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 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.
1 OF
8/29/96
1
SPECIAL PROVISIONS
RECEIVED BY: ~
DATE:
DATE:
· . . , ..... .. · , , ·
, ........... . , . ' ........... . : ...... ·. . . ,-~¢. O~ ,4/. ~ ~,
'!:'!..,.:' .'. ~ :-.. ~ ..~ ; ,../V/¢~,~.:TM.... ,. .....',, · .. ' ..:'~
".! .'" · . '/~ .' . · .... ~( '
Kurl .~*wlhlg
.HOSE SHOCN 0 THE RECf, 'eOF'} : CP'~¢ P.¢..~¢/ ~',, ~S (~.' '
, .. .. ,. .. .... ..... -.~. ¢..,~.,~ :..._.~
..:.,: ~.~.. ..... , ~ . , ..- ~. , . . ,~}.~ ~ .
]0i' P'L~N'"(~R6P~SE6 E0rlY":'ICTI0N PLAN}' ~' :' ' , ':'1 ; "
~ LOT SURVEY CE~]~! FI C A%!_0N_"' '. ". '-' .; ~.~:'.:"'~.':',:' "~ ,..ss ,~..0,..,,, - '-,
~.=,,""-'*~"~'~,['m~'¢~,.~¢.~~""~'"'~'"? ' ' "' " ........... ' , "- · ,', ' ';' ':' ' "',
.ANCHORAGE RECORDINO DISTRICT.;'".' "'
, ' '. ." REVISIONS ~Y
ARED.BY; DOWLIN6 '~'.':A~SOCIATES .. , .... , ".
~' ';; · '': ' ." 7. ', ' :
O4 EAS% 5th Ave .8Uite.'E ; .I · . ' . .:. · . . ,
'.:'~'./:'.:':";ANCHORAGE, ALASKA B~50'I ;. .8 ,I, · ~," -'..,. ,,
~~~'[~7 ~,"' I AO:": TS", ' [ GRID: .,. '
, ENVIRONIV]ENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADD SS
LOCATION NO, OF B~DROOMS
DISTANCE TO: ~. 0 [
Material No. of compartments
[ ~ ~ IF HOMeMADe: liquid depth
0 ~ Manufacturor Material kiquid caOacltg in ~allons
~ Well Foundation Nearest lot line PERMIT NO,
DISTANCE
TO:
NO, of ]ine~
~ ~ ~ Top of tile to finish grade ~ Materia~beneath tile Total effective absorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest Jot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER ]1
PIPE MATERIALS
SOl L TEST RATING
INSTAEL[R
REMARKS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
PERMIT NO.
[:,EPFtRTMENT OH HERL. TH RND ENVIRONMENTRL PROTECT'ION
825 eL'' STREET, RNCHORRGE., RK.
264-4729
RPPLICRNT
I._OCRTION
LEGRL
J STRN MRRGUISS
TRRILS END
LOT 4 TIMBERLINE
BOX :L0-22±4
LOT SIZE
~44-.877±
49500 S~URRE FEET
'TYPE OF' SOIL RBSORPTtON SYSTEM IS: DRRINFIELD
MRXtMLIM NUMBER OF BEDROOMS = ~ SOIL RRTING
THE RE&~LIIRED SIZE OF TNE SOIL BBSORPTION SYSTEM IS:
TNE L. ENGTH DIMENSION IS THE LENGTW (IN FEET:) OF' ]'HE TRENCN OR DRBINF'IELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
'THE
THE GRRVEL DEPTH IS TNE MINIMUM DEPTH OF GRRYEL BETWEEN THE OUTFBL.L PIPE
RND THE BOTTOM OF THE EXE:RVRTION (iN FEET).
PERMIT RPPLICRINT HRS THE RESPONSIBIL. IT'¢ 'FO INFORM ]'HI:-] DEPRRTMENT DURING 'THE
INSTRLLRTION INSPECTIONS OF RN'T' WELLS RD,)'RCENT TO TNIS PROPERTY RND 'THE
NUMBER OF' RESIDENCES THRT THE WELL WILL SERVE.
BRCKFIL. LING OP' FtNY %'¢STEM WITHOUT FINBL INSPECTION RN[.', BPPRO',/RL BY THIS
DEPRRTMENT WILL BE SOBJECT TG PROSECUTION.
MINIMUM DISTRNCE BE'FWEEN R WELL RND RN? ON-SITE SEWRGE DISF'OSRL SYSTEM IS
LtE~O FEET FOE;..' B PR!',,,'RTE WEL. L OR :L50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
LIPON THE 'TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRI',/RTE WELL TO R PRIYRTE SEWER LINE ZS 25 FEET RND
TO R COMMONI. TY SEWER LINE IS 75 FEEl'.
WEL.L LOGS RRE REI~UIRED RND MUST BE RETORNED TO THE DEPRRTMENT 14iTNIN ~8 DRYS
OF' THE NELL COMPLETION.
OTHER RE6:!UIREMENTS MR¥ RF'PLY. $PECIF!CRTIONS RND CONSTRUCI'ION [:,IRGRRM:B RRE
R',,,'RILRBLE TO INSURE PROPER IN~TRLLRTION.
I CERTIFY THRT
±: I RM FBMtLIRR NITH THE: REQUIREMENTS FOR ON-SITE SEWERS RND WELL2--., RS '--]ET
FORTH B'¢ THE MUNIE:IPRLIT'¢ OF RNCFIORRGE.
2: I WILL !NS'?'FILL. THE SYSTEM tN RCCORDRNCE WITH 'THE CODES.
3:: I I..INDERSTRND THRT TNE ON-SITE ;SEWER. SYSTEM MP, Y RE6!UIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO, iNCLU[:,E MORE THRN ~: BE[:,R. OOMS.
51GNED: ~/._~_...::_.__~_~__z ........ L~ ............... '~ ..............
~F'PLICRNT ,! S'TFtN MCGLII:~;S
I$SUED E ........ DRTE ............. ',,.'4. 0
MUNICIPALITY Of ANCHORAGE
DEPARTIVlENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska §9~01 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
SLOPE
SITE PLAN
13-
14-
15
16
17
18
19
20
WAS ROU OWATER
ENCOUNTERED?
O
P
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
PERFORMED BY: ~- 2~'~1 ~f CERTIFIED BY:
(minutes/inch)
FT AND FT
72-008 (6/79)
MEMORANDUM
DATE: October 6, 1981
TO:
FROM:
SUBJECT:
Laura Crow
Senior Office Assistand
Sewer and Water Program
Request for Refund - Account #2460
Please make arrangements for the following to be refunded.
The inspections for the installation of the on-site sewer
system were completed by a private engineer rather than
this office.
Receipt #158987
Permit # 810941
Lot 4 Timberline
Subdivision
$30.00
Sewer and Well Permit
Issued 9-4-81
Billie Jean Marquiss
Post Office Box 10-2214
Anchorage, Alaska 99511
Laura J. Ward
Senicr Office Assistant
Sewer and Water Program
LJW
attachments
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. # ~ ~- IIt'L~ ~ ~-,.L_\ HAA # .
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Day phone 2~- o~ _ <55~5-~
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well ~
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 1/91) Front MOA #21
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 A' ~-~ ~ ~-7f?.jq. t ~ ~ ~ £/'f? ~ Phone
Address ~Z~ O ¢[ - [o~ ~,~ck(~'c~c ~< ~.~
Engineer's signature . ~¢,. <,'.. ~... /~-. Date
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.
72~25 (Rev. 1/95) Back MOA ~F21
MUNICIPALITY OF A NCHOP, AGE
ENVIRONMbNffAL SERVICES DIVISION
Municipality of Anchorage AU6 1 2 1996
DEPARTMENT OF HEALTH & HUMAN SERVICESRECEIVE
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744
Legal Description:
Health Authority Approval Checklist
lIVEI
/-.er/ ~// '7~/,"~,b~J'/~F.~, ~ , Parcel I.D.:
A. WELL DATA
Well type
Log present
Total depth
IfA, B, or C, attach ADEC letter. ADEC water system nmnber
Date completed J 3 ~e~. ' C:j ~'
Cased to ZO, t4 q Casing height (above ground)
Samtaty seal fi/N)
FROM WELL LOG
Wires properly proteCted (Y/N)
AT INSPECTION
Date oft·st
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform O Nitrate t4, ~> c~ Other bacteria ---
Date of sample:
Date installed
Foundation cleunout (YfN)
Date of Pumping Aff//~
C. ABSORPTION Io'~LD DATA
Date installed ,~-
Tank size IZ._~C> Number of Compartments
y Depression(Y/N) A/ High water alarm (Y/N)
Pumper
Soil rating (g.p.d./n2 or ft%drm) System type.
Length Width
Gravel thickness below pipe
Effective absorption area
Date of adequacy test
Monitoring Tube present(y/N)
Results (Pass/Fail)
Total depth
Depression over field (YfN)
For bedrooms
Fluid depth in absorption field before test (in.);
Immediately a~er gal. water added (in.):
Fluid depth (ins.) Minutes later:
Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (y/N) ffyes, give date
D. LIFT STATION
Date installed
Manhaie/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /oe, ~'-
Absorption field ou lot /Oo *
Public sewer mair~ A~/,'~
Sewer/septic service line /P///~
"Pump off' level at* .A//,~
; On adjacent lots
; On adjacent lots
Public sewer manhole/clemmut
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation .~ O ~ Properly line q 5- ' Absorption field ~t.~"
Water main/service line /0o + Surface water/drainage /CC, + Wells on adjacent lots /oo ~'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation z/~ / Property Line 2 ~ / Water malzffservice line
Surface water /!//,'~
Curtain drain A/,/,~
Driveway, parking/vehicle storage area
Wells on adjacent lots /oo+
/00 +
F. ENGINEER'S CERTIFICATION
I certify that I have determined thrufield inspections and review
in conformance with MOA .~IAA guidelines in effect on this date.
Si .a e
Engineer's Name /~x'~ ,~/,~ /~/~
Date
}'.AA Fee $
Date of Payment
Receipt Number
Rev. 8/95 eSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
P73
TIMBERLINE
LO
49,665
FOUND 5/8" REBAR WITH
YELLOW PLASTIC CAP
CAP STAMPED "LS-6091"
0
L,JZ 30' ,o' ~:
~0
FOUND 1 1/2" IRON PIPEj
~----- POWER POlE
I
I
S 89°5}
SEPTIC
EXISTING
BUILDING
GRAVEL DRIVE
S 89°48'1 (
"FINAL
AS-BU t LT
GASTALDI LAND SURVEYING
Jeff A. G~staldI, R.L.S.
4726 West 88th Ave,
Anchorege, Alaske 99502
PHONE 248-5454
GRID DATE
26~1 8/14/96
F.B. JOB NO.
95-08 TS~
'3£~O 81HI 138 SB3NBOO ON :310N
~IVB3~I ,,g/g ONNO_~ ::
(03~1) ,00'00~ .L$~
(SV-31~) ,6~"66~
3;~=,, L
Z
~IV83~1 ,,B/g ONNO._-I =
'P .LO9
L- SIN3,
(sw~) ,~9'oo~ .--~,,z~,,
(o3a) ,oo'oo~ ~,sv3
(o~) 'J's
NOISIAIC]E:IN~
L6t-
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.#
Client Name
Project Name///
Client Sampl6 1D
Matrix
Ordered By
PWSID
963289001
K & P ENGINEERING
L4 Timberline Sub.
L4 Tmbrln SD 11001 Trails End
Drinking Water
Client PO//
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
07/31/96 20:41
07/26/96 14:40
07/26/96 15:05
Released
Sample Remarks:
Nitrite-M
Nitrate-N
Total Coliform
Resutts PQL Units Method
Allowable Prep Analysis
Limits Date Date Init
0.100U 0.100 mg/L EPA 353.2 07/27/96 EMB
4.39 0.500 mg/L EPA 353.2 07/27/96 EMB
0 0 col/lOOmL SM18 9222B 07/24/96 TAV
~S~S Member of the SGS Group (Soci6t~ G6n6rale de Surveillance)
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
CT&E Environmental Services Inc.
Laboratory Division ~~'~'~
Drinking Water Analysis Report for Total Coliform Baeteria 200 w. Potter Drive
Anchorage, AK 99518-1605
READ IIYSTR UCTIONS ON REVERSE SIDE BEFORE COLLECTING SAfff. PLE Tel: (907) 562-2343
MUST BE COMPLETED BY WATER SUPPLIE. R
PUBLIC WATERSYSTEMI. D.# [ [ [ [
PRIVATE WATER SYSTEM
Send Results ~ Send Invoice
[] Send Results tn Send lnvoice
SAMPLE DATE:
~vlonth
SAMPLE TYPE:
[] Routine
O Repeat Sample (for routine sample
with lab ref. no. )
[] Special Purpose
SAMPLE LOCATION
Day Year
[] Treated Water
~ Untreated Water
Time Collected
Collected By
Fax: (907) 561-5301
TO BE COMPLETED BY LABORATORY
Analysis shows this Water S,.MMPLE to be:
Satisfactory
[] Unsatisfactory
Sample over 30 hours old, resu ts may
be unreliable
g Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sampD via special delivery mail.
Date Received
Time Received 150%
Analysis Began
Analytical Method: ,.l~Membrane Filter
~ MMO-MUG
* Number of colonies/100 ml.
Lab Ref. No. Result* Analyst
.~'~. Fb~ Jun []
Sent to A.D.E.C.
Faxed
Date: ,e~.~' / Time:
Client notified of unsatisfactory results:
Phoned Spoke with Faxed
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-tMUG Result: Total Coliform E. CMl.
Membrane Filter: Direct Count
· Verification: LTB
Fecal Coliform Confirmation
Final Membrane Filter ~Rest/Its
Reported By F
([~) ColoniesllO0 mi
· f'5, l t · Coliform/100 mi
Date ?, 2..7 - ~. Time / ~ h rs
- Member of the SGS Group (Soci~t~ G~n~rale de Surveillance)