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HomeMy WebLinkAboutSCHROEDER EAST BLK 7 LT 5S�a���� ����- f�� _ _� I f �� lL . -_ _ _ L� •i _� f �1. i _ F \' MUNICIPALITY OF ANCHORAGE 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 NAM1PHONE NEW - U/��l I=XC-Cr (/cf/�'✓ ���1`oZ i/3 ❑UPGRADE MAILING ADDRESS - Q��t 773-Z % _ � lc' lveY �Ji.S �J _ _C), LEGAL DESCRIPTION 5- /?,/,/r-7 Sc_Ak-vcwe, N _�vf LOCATION NO. OF BEDROOMS Well Absorption area Dwelling DISTANCE TO: a U / �� / U PERMIT NO. �% 0 % C7 Y. Manufacturer V .rte /✓r MaterialS 7-ee / No. of compartments Liq. capacity in gallons IF HONIEMADE� Inside length Width Liquid depth W ells Dwelling PERMIT NO. Q C7 2 DISTANCE TO: _..-- CIZ _ __ ____ Manufacturer y Material Liquid capacity in gallons 91 wy DISTANCE TO: Well i �6U Foundation , /O Nearest lot linePERMIT 16 e NO. ' O !� u Z No. of lines Length o; e ch line Total length of linef T --width Distance between lines w //-- -z / inclTs �. F- Top of rile to finish gr def Material beneath the Total effective abs�jrption area inches -- Length Width Depth PER R4IT NO. w C9 Q h- -type of crib Crib diameter Crib depth Total effective absorption area A� w ul ___ _ Well Building foundation Nearest lot line DISTANCE TO: Depth Driller e Distance to lot line PERMIT NO. w w [Class Building foundation Sewer line Septic tank Absorption area sl DISTANCE TO: � OTHER i PIPE MATERIALS — _ SOI L TEST RA TING J a s- � - -33y INSTALLERf I REMARKS s 15 Z / G U V'CiV' /;2dton '.moi/ T� fcc/ /ae J ( f -- 1 -- — az �. s o. APPROVED DATE LEGAL-' fj7�'�r ''="� PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE LEGAL DESCRIP LOT SIZE: MAX BEDROOMS: �UK�U�������� �� ����f P���� DEPMRTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIO� 825 L STREET, ANCHORASE; AK 99501 264~4720 LOT: 5 BLOCK: 7 R�NGE: 2W Listed below are the optio:s avai1�blc to yo: in desig/zing your septic syste�. Choose the o�tion tha� best �iis your cito. DEPTH TO PIPE B/]TT�M (FT.) 2.0 ** 4.0 2.0 ** TOTAL DEPTH (F�.) 5.5 4.5 5.5 GRAVEL WIDTH (FT.) 2.5 16.0 5.0 GRAVEL LENGTH DRAVEL VOLUME (CU^YDS.) 18.9 1O.4 30.4 TANK SIZE (GALS) 1;0�0.0 ** 1,000.0 ** ��000.0 ** SOIL RATING (SQ.FT./BR) 119 1�0 125 ** DEPTH TO PIPE BOTTO� < 3,5 FT. REQUIRES INSULAT�ON ** DEPT� TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certi�y 1. that: I am {amiliar wiLh the requirements [or on~site sewers and wel1s as set forth by the M:nicipIla lity o[ A:chorage (MO0) and the State o[ Alaska. 2, I will install Lhe system in accordance wiLh all MOA codes and ragulati�ns, and in compliance wit� t�e desig: criteria o� this permit. 3. I will adhere to all MOA and State o� Alaska requi/emenis {or the cet back distances �rom any existing well� wastowater �isposal system �r public sewerage system on this or any adjacenL or nebrby lo� 4. I understand that this �ermit is va]id �or a �a,imum o� 3 �pdPooms and any enlargement will require an addiiional permit. J J X, SOILS LOG i== MUNICIPALITY OF.ANCHORAGE �/ • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION \� 825 L. Street, Anchorage, Alaska 99501 264.4720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: DATE PERFORMED:- /8/cf' $� LEGAL DESCRIPTION: l07L ,S ��if % SG�j yo �� r �4 S• 7- LiW lml. 7-14W /Z Z W Sec #.a — SLOPE. SITE PLAN 1 r/7/ O/? C-/ A,1I r T�•L �'uc. K - I. Mlx'INk 12 6ecsr leo e X C7 'C'�bo„aa2caoa fl IOi9j,'.1 o 1 N NTENQ an oo�oaovr,eeooF'"`a° once �n eaeuaeoo baEyPTl 13 lnui; A. But �® ea CL -6736 14 pppp e S7` PR0 15 A. L0 16 17 Louis A. Bulera r� It i� CE -6736 ��00 l . FDp........�`�P�Faai 19 ,%�®4d�a��� eV�H AT � r rL a I'VE _/ S v °I L 0 P E I.��. Date Gross Net Depth to Net r Time - Time Water Drop S vAt s'ti' '�► J'...�:C /x:49 /o..., ME 41' a _/ S v °I L 0 P E I.��. Date Gross Net Depth to Net r Time - Time Water Drop S vAt s'ti' '�► J'...�:C /x:49 /o..., S_ 41' a fi, 20 — PERCOLATION RATE • 3 (minutes/inch) /aS" x / TEST RUN BETWEEN �3 FT AND FT COMMENTS_ p or�sn., pe he /�u le d 5c S/�,pe,g Y” „�eY•C Yii: ,�e�i•xc.%T �nc�•... PcC�f PERFORMED BY: Eagle River Englneering Services CERTIFIED BY: DATE: S �r oz 793— Eagle River, AK 99577 72008 (6/79) 694.5195 s 114U1dCGC AIL1T OR F,NCHORAGc DEPT. OF tHEACfH & O VIRONMENTAL PROTECTION i 15 1985 RECEIVED LOCATION OF WELL (Please complete either la, Ib or Ic.) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological Q Geophysical Surveys Drilling Permit No, A.D.L. No. lo. Borough Subd' si 1. t B11oc�k Ib. I/n gtrs. Section No. Townshlp sa Range Wa Meridian 15f(12O � Ve0 2 ✓ / _or—ar—or — Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Address: Lr ttfl 96130 11 k pt dC I Al CT I I /! Street Address and Area of Well Location A Q(H A —/1 2. WELL LOG Feet Below Surface q. WELL DEPTH: (final) 5. DATE OF COMPLETION - Material Type Top Bottom ^7 y—"�—ft' 4.�t PE/l I Z % 6. ED Cable tool Q Rotary E] Driven Dug 11 Auger E)Jetfed C3 Bored E]Other �_ -(�02 AI .i1L 1r S�i, PC PIT- 4 6�L�liy ilL.it �i!(fV1%F rll 1'A�E Imo' 17. USE: Q Domestic Public Supply Industry 0 Irrigation Recharge commerical , Test Well Other: 13 F I V E s,�i to P CFI/l'Zf Ij17� Q 7 7^" 8. CASING: E] Threaded rB Welded diam._ In. to_ 2 ff. Depth Weight _lbs./ft. `•-dlom. in. to rt. Depth Slickup ft. rL1I�t t� K ° Ili g.0y"Itl 0/u7 Z. my 1 %.ry % 9. FINISH OF WELL: Type: Diameter: SIo1/Mesh size; Length; �. Sot between fl. and ft. Backfilling Grl1ovel pack `ry 10. STATIC WATER LEVEL JC y i1 ft. — --"- O Above or a Below land surface Dote Equipment used: (f IAA 6P.jlt -� NA _ ;7 tl-(_ 121 LI l r• I r_/. J< II . PUMPING LEVEL below land. surfocAak``Y ELD �ff. after I :hre.ipum piy�g/� .g.p.m. It. of let'hrs;pu=r_g. p. M. �1 12. GROUTING Walt Grouted! Yes1 Q No Material; E] Noat Cement ❑ Other: 13, PUMP: (if (I`vailable) HP Length of Drop Pipe ft. capacity g. p.m. Subm. . �I- Jet O Cenlrifical Other _ 19. REMARKS: - -------- — k f Q L.. 1 I V C^ . IJ IZ I C I- 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperature -- ° C] F C This Well was d,, [led under my jurisdiction and this report is true to the best of my knowledge and belief; �nir�c_I�c��ccicliC� A rn7F'C� Re Sisterea Business Name Contract License Number lddr-ss..C !" r f� > If u r I I `7 1 I Signed:.- yA/ Dole:_ t Aul orized Representative Form 02-WWR 01/81) Copy Distribution: WHITE-Stote DGGS, PINK -Driller, CANARY-Cusfomer J Soo Pal /ldt la Cf��tifi�� �rtllin.� log 6p DOC Co. dUa SULLMN WATER. WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 668.2759 OWNER OF LAND Ad"i �iq i cs ADDRESS T') l �L LEGAL DESCRIPTIONI,,,lnl S 14-x 1 .r5H996.4e4 DATE.. Started Ended' CI PERMIT NUMBER "I � DEPTH OF WELL STATIC LEVEL OF WATER FT. F�•a uJ%N to DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From. D Ft. to Ft. C'�5��6 S%/!L,4Jl !� From Ft. to Ft. _ From, a' Ft. toFt. From Ft. to Ft. _ From.t Ft. to -3 Ft. Qrl�� /%=r¢ t <A— From Ft. to_ Ft. _ From 1.3 Ft. toRF' Ft._ From Ft. to_ Ft, From --/-?—Ft. to 31 Ft. 64cl,tx-4: ��l'� From Ft. to --Ft _ From Ft. to Ft. _ele"'It"t SozeeFrom Ft. to— Ft. '.,From - _?-Q Ft. to 10 Ft. (5440e.'L " 6h_ c1j , _From . Ft. to --Ft. _ From'Y 5 _Ft. toFt.to--Ft._f�t=!%�JC �� QO�). From Ft. to --Ft. From.�3 _Ft. to_Ft— Q G O��C!< Co QF= CN From Ft. to_ Ft. i From-L-G.5—Ft.to—/ 7-1—'Ft._ 6cJA)C-< 13A`3 Vw From Ft. to_ .Ft. �s From :757�Ft, to 13 Ft. — !j O Q n c 4 E� From Ft. to—Ft. From_Ft. to Ft41 �A � C t/'r "'6 E From IX FtP- o ICL IFtV l-- D _ From: Ft. to 4 9c' Ft._ From Ft. t""�t. 1994 From. _Ft. to Ft. I'SAc i 4s 0 LjA/� -From �IVItu711<;fy�� From Ft. to Ft. From 138 lil ltll F+ I Aman Sai'viccu _ From Ft. to Ft. From Ft. to ---Ft. _ From Ft. to Ft. _ From Ft. to— Ft — MISCL. INFORMATION: DRILLER'S NAME 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 SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920215 DATE ISSUED: 8/11/92 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 8/11/93 OWNER NAME:KENNEDY-PENNINGTON KARIN MARIE OWNER ADDRESS:PO BOX 771686 EAGLE RIVER, AK 99577 PARCEL ID:05007107 LEGAL DESCRIPTION: SCHROEDER EAST BLK 7 LT 5 DAN CATES, EXECUTOR 384-0811 LOT SIZE: 26100 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION 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 (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: / DATE: // Louis Butera, P.E. Registered Civil Engineer August 6, 1992 John Smith, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Schroeder East, Lot 5, Block 7 Narrative Dear Mr. Smith: The proposed well upgrade will have very limited impact on adjacent properties for the following reasons: 1. Site of proposed well does not infringe upon Lot 6 replacement septic system area. 2. All other adjacent lots are vacant. 3. Well is being upgraded due to perforations in the casing of the existing well. 4. Existing well to be abandoned to MOA code 15.55.060. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907)694-5195 • FAY rami RUM07 FIELD O+H+HT"""o CLOSEST M.T. TANK APROX. HOUSE WELL w I � > I 100.00' �a W Y a o � o o NEW WELL W � LD Z EXISTING VELL TO CE BE ABANDONED D_ m GRAVEL DRIVE VACANT LAND TO WEST NO KNOWN CURTAIN DRAINS WELL SITE LEGAL: LOT 5 BLOCK OWNER: DAN CATES CONTRACTOR: SULLIVAN JOB # 88-070 DATE: 0 LE:CHIELD 0 0 0 HOUSE 6.4• X 24.3' GAR �.1 24.3• X 24.3' 262.40 'TO 6 51.90' w VACANT LOT 6 261.09 N 86' 0' W LOT 5 PLAN 7 SCHROEDER EAST ADDN. WATER WELLS 07/24/92 SCALE 1" = 50' EAGLE RIVER ENGINEERING P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) SERVICES VICES w 0 a o m o N o N Z VACANT • - MONITOR TUBE 0 - SEWER CLEANOUT 4 - WELL +++t++H+lh - LEACHFIELD -- — - EASEMENT 694-3297 p�Cg MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES o 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. # 6S0 07/ 07 nom HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) i 4 6-" . 2� Property owner o,'- /i/3/tl,t7 &' _V'nl t/ Day phone Mailingaddress_�81 e6K %7/6�14� Z�c,cr� Lending agency Day phone Mailing address Agent 0"�,r I e� �� t,� �> % <,� Day phone C 6 azo Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well 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 % 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 021 5. 6. 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. David R. Dayton P.E. Name of Firm _ 28��9�emrfez st_— Phone Address C'hugiek, Aiaska 99567 Engineer's signature _�� ��--' _ Date 1 �D DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: 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. 72-025 (Rev.1/91) Back MOA A21 Municipality of Anchorage Department of Health and Human Services it HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /v 7 °,S ✓ ��/f 61�Parcel I.D. C)S, D 0 7/ 07 r>O(fJ A. Well Data Well type 'el L)A nim If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Date completed / JAy Driller >u t vsr:J Total depth J? Cased to Lv ' Casing height j " Sanitary seal (Y/N) _ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION r c 0-0 0 Date of test Go /q y, 3��y .��, Static water level Well flow z Pump levell - p V G v, c O m SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /D ; On adjacent lots Absorption field on lot I z ; On adjacent lots loo r - Public sewer main AJ 119 Public sewer manhole/cleanout Sewer service line /Y'�o Petroleum tank �/tyv WATER SAMPLE RESULTS: 0 0-/7/9`% Coliform Nitratey ip Other bacteria N % 4„�cv2i, T • ,� _sjaCy.bi Date of sample: i`�7��j 4 & /, �/ p � 7_�x�= Collected by: �l7 f�"lrY7 ' in15173GL �YTiclitl 8. SEPTIC/HOLDING TANK DATA Date installed 2,//' kJ- Tank size i oe-)o Compartments 'e, Cleanouts (Y/N) V Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) /' //J Alarm tested (Y/N) _ Date of pumping V -3%/9Y Pumper N 2 -5 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot (moo On adjacent lots j v c` ' Foundation =� To property line L Absorption field .3 - Water main/service line Z Surface water/drainage _ /00 72-026 (s/ss)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed >S r I Length Width On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Soil rating (GPD/Ft2) / 15 �, `///,e_System type to Gravel thickness o -t'' Total depth Total absorption area �37) Cleanout present (Y/N) Date of adequacy test 51)1) > Results (pass/fail) Water level in absorption field before test 0 Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot j Z„l 'To building foundation On adjacent lots IOL -1 On adjacent lots , 0 k I- /0 /D Depression over field (Y/N) /✓ for a Bedrooms test d If yes, give date Property line /4' To existing or abandoned system on lot Cutbank /V /j Water main/service line s Surface water ! Driveway, parking/vehicle storage area Curtain drain A'& /iuc •�: E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effgct-.on-the,dag of this inspection. David R. Dayton P.E. " b�rtis 20210 Donalar St. Signature Chugiak, Alaska 99567 Engineer's Name n Date HAA Fee $ �� r� Waiver Fee $ Date of Payment T ` `� G/�� ) Date of Payment Receipt Number °2 (Yy CF (�D U / Receipt Number. 72-026 (3/93)' Back D. R. DAYTON, P.E., R.L.S. x�6 C,hugiak, Alaska 99567 (907) 65aAR4>$c7 20210 Donalar 696-2417 April 9, 1994 WELL FLOW TEST Legal Description: Lot 51 Blk 7, Shroeder East Subd. Date of Test: March 30, 1994 Well Depth: 498 ft. Static Water Level: 7 ft. Casing Depth: 50 ft. Requirements: 3 BR - 450 gallons per day ; 0.31 gpm Test: The well was tested with the existing pump through a meter installed at the well head. The water level was pumped down to the level of the pump level where a Flow Tech pump protector shut the pump off. The pump was re -started after a recovery period of 1 hr, and the volume recovered in 1hr, was measured. The process was repeated for 4 cycles. Results: The well recovery was 1.42 gallons per minute. The well is currently producing adequately for a 3 BR home. d''Psri4.6 a®y.ocoAap�. y+ f- RC LY {[ O �d ��at /a/fn n/qai/,}�ejooeomo �^ K? �.-ts>f N" B�uBCO1LVl.O 0B •�-94y41�C O David R. CU000 f « vVt ��©��eo�aas �i Q,�• `© j^PROFk:Sa`�� v D. R. DAYTON, P.E., R.L.S. dtwiasa9� Chugiak, Alaska 99567 (9p7) 20210 Donalar 696-2417 ADEQUACY TEST Legal Description: Lot 51 Blk 7, Shroeder East Subd. Date of Test: March 30, 1994 Septic Tank: 1000 gall n, 2 compartment, steel tank (DHHS Records) Absorption System: 550isq ft bed (DHHS Records) Soils Rating: 125 sq ft per bedroom (DHHS Records) Requirements: 3 BR - X150 gallons per day I Test: A5 the house has been vacant for some time, the bed was pre-soaked with 780 gallons on March 29,:'.1994. On 3/30/94 water was pumped into the bed while measuring volume, time and water level rise. Results: The bed accepted 700 gallons with no rise in the water level in the system. The system is currently functioning adequately for a 3 BR home. CT&E Ref.R Client Sample ID Matrix Client Name Ordered By Project Name Project# PNSID Commercial Testing & Engineering Co. Environmental Laboratory Services.�y��-��.�������;r9,.s,�,���r��� 1 ,. LABORATORY ANALYSIS REPORT 94.1360-1 L5 B7 SHROEDER EAST S/D NATER DAVID DAYTON, Y.E. DAVID DAYTON UA WORK Order 77025 Printed Data 04/04194 n 12:21 hrs. Collected Date 03/30/94 'a 09:30 hrs. Received Date 03/30/94 ^x;12:00 hrs. Technical Director STEPHEN C. EDE Released Bv: �a Sample Remarks: ROUTINE SAMPLECOLLEC"1TD BY: D.R.D. --- --------------------------- QC Allowable Est Anal Parameter Results Qual Units tvlethod Limits Date Date Lrit ----------------------------- r itrate-N 0.10 U mS/L EPA 3532/300.0 10 04/01/91 CMR * See Special vtstnictionsAbove UA = Unavailable See Sample Remarks Above NA =Not Anal vzed U = Undetected, Reported value is the practical quantification limit. LT= Less Than D = Secondary dilution. GT=Greater "Ihan -- 5633 R StrAP.t Anrhnrana AK QQR1 Q-9 Rnr) T -I 10n�i Gal ooAo r...,. /nn -n =ci cern. CAI\/IQnAIAACKITAI CAIII 1111 111 AJ Arlin r.ni �... .�.. �. �..�._ .. ..._._ .. _. %'ul1"IvatMCIAL TESTING & ENGINEERING Co. ENVIRONMENTAL LABORATORY SERVICES Drinking Water Analysis Repor, for Total Coliform Ba,- -'-D INSTRUCTIO,�'S 0"1 REVERSE SIDE BEFORE COLLECTlh'G SA.IIPLE -� 1 zu EY \VA TIER SL-PPLLEER ❑ PUBLIC NATER SYSTEM LD, g EF PRIVATE WATER SYSTEM ❑ Send Resr� ❑ Serd Invoice ❑ Sen �: Invo;�. c?-MPLE DATE: ( 1 z Month S:A_\iPLE TYPE: ,amu Routine D Repeat Sample (for routine sample With lab ref. no. � Special Purpose SAA PLE LOCATION Da} Year ❑ Treated Water 10, Untreated Water Time Collected Collected Bc oxlJ ?icxsc �� cl: (�-7) 552 2343 TO BE CONTLETED BY L.! — .BOR4TORY .nal}'sis shows this 1Vater S -\,!PLr to be: ' V1:ja�jla CtO tZ' ❑ Sample o�er.0 beers oid, resulo :::zr be unreliable ❑ SaMOIC too lona in tra-:,t; ja,-nDie Should not be o er AS :)Urs Cld at e\a�-',C:�au0i7 to indicate rclizoie resu;ts. pl_ seta =...r; sample Via Special C i�:er; .ail. Date Received Time Receised �Zop .-analysis Began .final} -tical Method; i .`O__f,`G N=t),: ofcolon'ej/;00 1r1. Lab Ref. No. Result* -------- Ann aB s t 94.1360 Sent to .A-D.L.C. .=1r;cIF'b.aVI c Top I Client notified of unsatisfactorn' results: hhnned -_..�— 0 Spcke,lith Fazcd Da._ BACTERIOLOGICAL, WATER A-NALYSIS RECORD 3L�10-1'IliG Result: Total Coliform E. Coli Membrane Filter: Direct Count — 7%Gr�r' Colonies/100 ml Verification: LTB- c BGB COLIF{�� ��p =A1�1 O. ..'•7C = � ao \'u.. �ro_r , o Cove: Fecal Coliform Confirmation N2cja�r (/c—_ �— os Final 3------1embraneFilterResu is / Reported By Gc_- � Coliform loo ml Date Time Q� Co;rmcn - h rs Held fior Confirmiati�n PART ��.:,.•.- _ ^, - �• :�= scs ONE OF T _ �: -,-:. _"•. ;� REMAINDER Tn I-=ni i nw ZIL�COMMERCIAL TESTING Be ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Drinking VVater Analysis Report for Total Coliform Bacteria READ I=VSTRCiCTIONS 0.1Y REVERSE SIDE BEFORE COLLECTI.,VG S,4.1-IPLE `BUST BE CO,\fz-LETED BY 1V -TER SUPPLrcR ❑ PUBLIC WATER SYSTE Tl I.D. <PR VATE WATER SYSTEMS ❑ Send Results ❑ Serd Irsvoice El SerdRs,LL, ❑ Serdlr.:oice David R, Dayton P.E. -•.-_ — :.z.neW_: !20216honah21. Chugiak, Alaska 99567 S NITLE DATE: r I I> i @qp Month Da- Year S.A SLE TYPE: -Routine ❑ Treated Water ❑ Repeat Sample (for routine sampleUntreated Water with lab ref. no. C Special Purpose SA:YIPLE LOCATION Time Collected Collected By ?iosso pnn: I Da._ Tine. BACTERIOLOGIC4L, WATER �\.-'CLYSIS RECORD TO BE CONIPLE i D BY L _BORA. OORY Analtisis shows this Nater S as r''LE to be: Sausfacton- ❑ Unsaus,acton: Sa.-nole over 30 hoa s old, resulLmav be unreliable ❑ San, ole too long in tra.-tsit: sa.-nole should not be over 48 hours old a. exa,;,inauo to indicate reliable .esuls. please Bene 11--W sa_;tple iia special Date Received << Time Received _ .-final}sis Bean Analytical Method:a 7,C L, �V fMo_`.=i :C \umber of coioctiesnoo F, Lab Ref. No. Result- Analcst nn Sent to A.D. E.C. Pbl, .A\nc Jun i I Date:-ir.,c Clii-e-nt notified of unsatisfactor} u reslts: Phoonned Spoke with Faxed A310-.+IUG Result: Total Coliform E. Coli _ 3fembr2ne Filter: Direct Count v Colonies/100 ml Verification: LTB BGB C0LLFR_N1 Fecal Coliform Confirmation Final 'Membrane Fuer Results / / Coliform/loo ml Reported B} /, Date y — (� ( L l % a a Tine hrs Cor !gents: — PART ONE OF TWO- REMAINDER TO FOLLOW �_ sc ou.. s MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-5720 Application Date I. GENERAL INFORMATION -- (a) Legal Description (include lot, block, subdivision, section, township, range) Blk -7Schroeder-East Addition T141qR2b11 Sec .1 Location (address or directions) _ Sprin�.�roo}=Drive__ (b) Applicant NameRon Klinkhammerr_ Telephone: Home341t=66 —�3--- Business4iI-66_ Applicant Address - 8030 1Jedellin Circle Anchora e Alaska�9�7 (c) Applicant is (check one): t -ending Institution ®; OwneribuilderU ; Buyer LJ, Other 1 7 (explain); _ (d) Lending Institution . Secur. i A'Iortae _ -- Address telephone _ 215 Dena7_i Tolti�ers_ AnchoraE;e, Alaska__ _ (e) Real Estate Company and Agent_N1A --- ---- Address ----- ---- ------ ---- Telephone _- —.-- ---- --------- ----------- (f) Mail the HAA to the following address: - __—P1C1�-Ufj{- 2. TYPE OF RI_SIDENCE Single -Family L�j Multi -Family E} Other Number of Bedrooms _ 3 3. MATER SUPPLY Individual WellEj Community EI Public E 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 Onsiteft Public f_l Community ❑ Holding Tank El Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 12 W5 ( 1 1 04) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILM SEARCH DATA 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 compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Fit rn EAOt�Wfft_LNGWEEW�_,wa:S-- Telephone _-- Address — GI_� RIVFg AI! 99577 Date JC") ,� f - P. 0. BOX 773294 -- -- — Engineer's Seal '-0 ) nI_1. 6. DHEP APPROVAL \,^ Approved for -4 G -JL o_/<d 1 c. bedrooms by 7 / �, �n Le_e Cl _c_ Date f)� Approved_ Disapproved _---__—_ Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is riot responsible for errors or omissions in the professional engineer's work. Page 2 of 2 i ,,, . MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH a MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 284-4720 E ' 1f Legal Description: ��' T " Q/, ,4..r A. WELL DATA Well Classification 1�lel uq 7"'_' If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) _� Date Completed /> J S _ Yield lPio S_ G -r -m Total Depth —3C>-7 � _ Cased to 3,?l kar&epth of Grouting Static Water Level "G- 'ia pp r- cr. r .+; r Pump Set At Casing Height Above Ground -5 Electrical Wiring in Conduit (Y/N) _y Separation Distances from Well: To Septic/Holding Tank on Lot __Z2�6) Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots /e©z _ To Nearest Edge of Absorption Field on Lot On Adjoining Lots _/40 7` _ To Nearest Public Sewer Line IV1� To Nearest Public Sewer Cleanout/Manhole _. _1�14 To Nearest Sewer Service Line on Lots _ Water Sample Collected by ' ,�� ; Date Water Sample Test Results �` t'' reA' /a S Comments B. SEPTIC/HOLDING TANK DATA Date Installed<{� Size I�UG' 6a / No. of Compartments = Standpipes (Y/N) y Air -tight Caps (Y/N) —k Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) /tJ _. Date Last Pumped fie`' Pumping/Maintenance Contract on File (Y/N) ;for __ - Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well BUD To Property Line _/o --"- To Water Main/Service Line Course 19'�9 1 e Comments Page 1 of 2 72-026(11/84) Temporary Holding Tank Permit (Y/N) /U_ To Building Foundation j 7 To Disposal Field _'6 To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata — �-�'� Type of System Design Date Installed Length of Field �3 a Width of Field Depth of Field _ Gravel Bed Thickness t!6 zye Y� Square Feet of Absorption Area Standpipes Standpipes Present (Y/N) Depression over Field (Y/N) —A1 Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well — la4 J To Property Line J� / i To Building Foundation To Existing or Abandoned System on Lot On Adjoining tots To Water Main/Service Line 16) y To Cutbank (if present)�"� To Stream/Pond/Lake/or Major Drainage Course /% !1'1c To Driveway, Parking Area, or Vehicle Storage Area /u f Comments D. LIFTSTATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** 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 Date Z'Q & `Sf Company lr S MOA No. Receipt No. Date of Payment Amount: $ �j5 ui� F , Engineer's Seal r Page 2 of 2 Jvfe,a 72-026(11/84) r "- Cr 67 6 r. r1, -