The URL can be used to link to this page

Home My WebLink AboutEAGLE RIVER HEIGHTS 1957 ADDN BLK 3 LT 2A# aIR \, �s r PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MU I C I P AL I TY OF" ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 M N— S I -VE: 840617 07/24/84 WELL F� FEE FZM I T CINDY SIGLER 13040 BACK, ROAD ANCHORAGE, AK. 99515 345-3216 SUBDIVISION: EAGLE RIVER HEIGHTS LOT: 2A SECTION: 14 TOWNSHIP: 14N RANGE: 2W 21702 (SQ.FT. OR ACRES) BLOCK: 3 I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulat.ions, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any,existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. SIGNED APPLICAN DATE: ISSUED BY - DATE: -M -M !g f§/ w > rm - r}\ 0 � { { � { � { � { \ko � � M 0 (D)\\ 0 00 0 0 / ))�) } } }\/ \ ( :71 � / / / / / ��/ \ \ / � L pi , / [ ƒ -M -M !g f§/ w > rm - r}\ 0 � { { � { � { � { \ko � � 0 0 (D)\\ / ))�) } } }\/ \ ( 7� n C7 !g f§/ w > rm - r}\ \ ) �\ �j cm 0 m m m !(r r M rzIn C m U) z :00 R m < (�( 0 MUNICIPALITY OF • :' DEPARTMENT OF HEALTHTH & HUMAN SERVICES Division of Environmental Services 91 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 l.D. # 11M - AR\ - 1 n �S HAA # 0 Q9 _") Q n� 1. GENERAL INFORMATION Complete legal description hr f,4 uz- L;ieze 12,4,ew Location (site address or directions) lo3 2•/ D Ag�,e_ Property owner c'�Q Awl-FirDay phone 604'-30 Mailing address f032-/ / HZ?L"✓ 69 '0 t c ��1<< r - JL�A Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well t✓ " Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer 54— � NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. n-025 (A" 1/91( Front MOA 621 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 furtherverify 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 ')"In nonall ,r sr_ Phone c 9G --'$117 Chvgiak,Alaska "S67 Address I Engineer's signature '` Date µ Z l3 6. DHFjS SIGNATURE ,L/ Approved for bedrooms. Disapproved. Conditional approval for M Additional Comments ry. 1, �J 1 bedrooms, with the following stipulations: ax_.0 uz — Date 4Z- X —i 3 • 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 p•)fessional 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 engineers work. 72-025 (F... +91) 5Kk MOA 821 Municipality of Anchorage Auk Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: to -T- ZA &4- "Z) Parcel I.D. 94 r.c'a -'' 4'0x i'S A. WELL DATA Well type b IJ4yr If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed _'"Ly I Y4 /'91T Driller 610-Alowsz.1 Total depth %y Casedto X41 Casingheight �1 Sanitary seal (Y/N) y Wires properly protected (Y/N)y Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION -luny 14. SK `K g.p.m. T SEPARATION DISTANCES FROM WELL TO: 57 3,67 9.p -m. 7 ;V rr7 T C v " z C � m O A T �O — GI 0 / � m Septic/holding tank on lot : / A ; On adjacent lots '-1'� Absorption field on lot On adjacent lots L�45 Public sewer main too Public sewer manhole/cleanout ivo y . Sewer service line ZS Petroleum tank A10'e Tc✓.vp WATER SAMPLE RESULTS: Coliform Nitrate %� Other bacteria Date of sample: ¢1119%93 Collected by: B. SEPTIC/HOLDING TANK DATA A -) Date installed A% ank size Compartments Cleanouts(Y/N) High water alarm (Y/N) Date of pumping AIA Foundation cleanout (Y/N) Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: // Well(s)onlot On adjacent lots / Foundation To property line Ab_arptionfield Surface water/drainage Water main/service line 72-026 (Rev. 7,51) Front CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed N _ Soil rating Length . Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) "Pump off" level at Cycles tested Gravel thickness Surface water System type Cleanouts present(Y/N) Date of adequacy test for Total depth If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: N Well on lot Onadjacentlots Property line To building foundation On adjacent lots Surface water Curtain drain E. ENGINEER'S CERTIFICATION To existing or abandoned system on lot Cutbank Water main/service Driveway, parking/vehicle storage area 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in e David R. Signature Engineer's Name Date 0 HAA Fee $ 7 Waiver Fee: $ 2 Date of Payment —. —c7 3 Date of Payment Receipt Number Z 3 O Receipt Number MOA 21 bedrooms the date of this inspection. 14. 22CZZ D. R. DAYTON, P.E., R.L.S. WHMMM29 Chugiak, Alaska 99567 (907) t!JNNaVX 20210 Donalar St. 696-2417 April 20, 1993 Well Flow Test Legal Description: Lot 2A, Block 3, Eagle River heights Date of Test: April 20, 1993 Depth of well: 141' Static water level: 87' Drilled by: Joe Gielarowski Drilling Co. Requirements: 3 Bedroom - 450 gallons per day Test: The well was pumped with the existing pump through an outside hose bib. The flow was varied until the drawdown was constant. Volume, time and drawdown were monitored throughout the pumping period. Results: The well produced 3.87 gallons per minute with a maximum drawdown of 31.4 ft. A total of 943 gallons were pumped in 241 minutes. The well is currently producing adequately for a 3 bedroom home. {• Wnd :L CwXra �i . •, N.C7. iZC.S� CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 6 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FAX: (907) 561.5301 Chemlab Ref.# :93.1678-3 REPORT of ANALYSIS Client Sample ID :L 2A B3 EAGLE RIVER HTS Matrix :WATER Client Name :DAVID DAYTON, P.E. Ordered By Project Name Project# : i PWSID :UA I Remarks: Parameter NITRATE -N COLLECTED BY: QC Results Qual ------------ 1.76 Collected :04/19/93 @ 19:00 hrs. Received :04/20/93 @ 10:45 hrs. WORK Order :65160 Report Completed :04/23/93 Technical Director :STEPHEN C. EDE Released By : /'� Allowable Ext. Anal Units Method Limits Date Date Init mg/1 EPA 353.2/300.0 10 04/20 LLH xzzzzaxzxzzxxxxze____r-_xxz_z.�-___-__z___-___z_______-xzzexxz___z______zzzzszxzzexxz�xzxxazzxxzz * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D x Secondary dilution. GT = Greater Than 1 11,%767.7 Member of the SGS Group (Socidtd GAn6rale de Surveillance) y.pY.q�• I COMMERCIAL TESTING & ENGINEERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 1 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D. * t PRIVATE WATER SYSTEM Analysis shows this Water SAMPLE to be: 694 ayi7 i Satisfactory Martr Phar Ma (� ❑ Unsatisfactory C;20 -;2/O ❑ Sample too long In transit; sample should Maim Maw Cm A� 9 s z 7 not be over 30 hours old at examination L /A -K- to Indicate reliable results. Please send cay sur zoco" new sample via special delivery mail. SAMPLE DATE: =� ® ® ,20 Date Received Mo. Day Year - C* SAMPLE TYPE: Time Received Routine Analytical Method: Membrane Filter ❑ Check Sample (for routine sample with lab ret. no. ) ❑ Treated Water ❑ Special Purpose i 'Untreated Water • No. of colonies/100 ml. SAMPLE No. LOCATION Time Collected Collected By Lab Ref. No. Result* Analt zAGtr lc::z, rs II z m 3� u m 4� u m 5. BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count Collform/100 ml BEFORE lVerincaaon:LS8 BGB -Fecal Collform Confirmation COLLECTING SAMPLE 1 TNTC = Finet Membrane Filte *suits //'�'� CColiform/100 mi Reported! elL it Date 7—Z I ( P Too Numerous TO Count Time: (6 3 0 a.m. OB = Other Bacteria PART ONE OF TWO Member of the SGS Group (SC REMAINDER TO FOLLOW n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH d HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 2644744 Application Date Dcc¢m6¢lr_ 23, 1987 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2A; Bfock 3; EagCe Rim Haght4 Location (address or directions) 10321 Chain o6 Rock (b) Property Owner Judy Hansen Telephone: Home 694-2493 Business Mailing Address 10321 CWn o6 Rock (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent __JACK WHITE COMPANY/Canotyn McPhee Address P.O. Box 771699, Eagte Riven, Alaska 99577 Telephone 694-5500 (e) Mail the HAA to the followino address: or. Check here IN. If hold for pick up List contact person and day phone number below. 17034 Eagle Rivet Loo2 Road, Suite y04 Fanfe- Rivet, Afaska 99577 2. TYPE OF RESIDENCE Single -Family Q Number of Bedrooms 3. WATER SUPPLY Individual Well V Community ❑ Public ❑ 1 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 ❑ Pu iNCommunity E3 Holding Tank ❑ NoteAfcommu ity Its system, must have written confirmation from the State Department of Environmental Conservation attesting to the ality and status. Page 1 of 2 77-075 tar, B M Front W 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE 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 Firm S A S ENGINFFRING Telephone G/�! Z el -7 </ Address 17034 Eagle River Loop Road No. 204 Eagle louver, as ka 9957-1 Date b" % r............... No. 14-474 6. DHHS APPROVAL f / Approved for ro1 bedrooms by 7 Date 4 Zf? _ Approved , Disapproved Conditional / Terms of Conditional Approval CAUTION 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. Page 2 of 2 . 72o25 iar„ e'661 Back ITY OF ANCHORAGE M�NtCtPCLt Ao` , HEALTH ALUTHORITY APPROVAL (HAA) ENttRCCHECKLIST - FEBRUARY 1984 OEC 31 X981 264-4744 Lecpti-��2-/-SL—te— RECEIVES gal Description: 2 �6- a A. WELL DATA Well Classification(.1 0 1 I /--I— If A. B, C. D.E.C. Approved (Y/N) t Well Log PresentON) Date Completed 7 - 19' --94- Yield Q-• 8 61?r'1 Total Depth 14'1 r Cased to Depth of Grouting Static Water Level Pump Set At JI(__ of Casing Height Above Ground IIZ -t Sanitary Seal on Casing (VI) Electrical Wiring in ConduitfVN) Separation Distances from Well Depression Around Wellhead (Y.(® To Septic/Holding Tank on Lot t-3 1A ; On Adjoining Lots r -%/A To Nearest Edge of Absorption Field on Lot; On Adjoining Lots /A To Nearest Public Sewer Line I L'_01 h To Nearest Public Sewer Cleanout/Manhole 1 oc" It To Nearest Sewer Service Line on Lot ZS 4 - Water Sample Collected by Water Sample Test Results Comments ifs• - B. SEPTIC/HOLDING TANK DATA tJ Q Installed Depression over Tank Size Air -tight Caps (Y/N) Pumping/Maintenance Contract on File Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line Course No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped for Holding Tank Permit (Y/N) To Building Foundation To Disposal Field _ To Stream, Pond, Lake, or Major Drainage Comments-lro�—' �—'�� 10 PJ$t,t L -5f;-% )is.0 bj 1 '=i —.6c� /-tOI.JU V/�-t2�r� t — .4_ Le_ ��L-� ► t -f b�2� �eo. Page 1 of 2 72-M IRw B'B61 Rory C. ABSORPTION FIELD DATA N/� Rating in Absorption Strata Date 1115 led Width of Field Type of System Design _ Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Property Lin To Building Foundation To Ecisti r Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 'iLR TO !– Lc�9j�0� P-t•�w � JP -R -t � t �-�j . — SG-�-rtc, � �-t D. LIFT STATION . Ij A 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) �p'nn 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 g uideli nes in effect on the date of this inspection. Signech, g SENGINEERING Date 1Z – 30 –ff Compp.34 Eagle River Loop Road No. MOA No. 9%— `" 3 Eagle RTvsr, t"It" s77 — Receipt No. C) 0 U Date of Payment Amount: $ Page 2 of 2 72.026 IS" 8t61 Back 'A wo CHEMICAL &GEOLOGICAL LABORATORIES OFALASKA, INC. r } - d:>-- � 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 5622343 ,,,,o„ �,,,�� FEDERAL TAX IDM 920040440 i Client PC* : VEPB-L Req t: Client SSpI ID: LDT 2A BU 3 EAGLE RIVER EEIGETS Sa^ple Rec'd : DEC 24 87 CcCered By : R. SCI AE?ER Send Recorts To: S d S ENGINEERING R SC!L-EPER 17034 EAGLE RIVER LOOP RD., *204 EAGLE RIVER, Al. 9957 Specia! CCLLECTE3 12-24-87 1000 BY JP.". Instruct: Che -lab Pef t: 8699 Las SSI ID: I Parar^eter Tested NITRATE -N M'i1.LYSIS REPORT BY S M"3LE York Order No. : 4501 Client Accaunt : SlisrNCP Date Report Printed: DEC 30 87 9 07:36 Released By : 3 or— Reports Address t2 Matrix: Hater Allowable Result/Units Method Limits --------- — -------------------- — — ------- — - — - 1. -- -------------------------------------- 1.1 m9/I 10 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION ')EC 31 1987 RECEIVED S?--PIe ROUTINE S-iPLE Re.arks: A!LALYSIS CCP-LrTED: 12-28-87 UKPATOP.Y SLPERVISCR: STEPEE71 C. EDE G �� I Tests Performed See Special Instructions Above 83= None Detected +x See Sacple Remarks Above A-= Not Ara!y±ed LT -Less Than, GT ---Greater Than Vb I` CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. A.... TELEPHONE (907) 5622343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.11 Analysis shows this Water SAMPLE to be: 914PRIVATE WATER SYSTEM Satisfactory Name 5 & 5 ENGINEERING Phone No. Unsatisfactory ❑ ❑ Sample too long in transit; sample should 17034 Earle Riye oop_RoadNo.204 not be over 30 hours old at examination Mailing Address Eagle River, Alaska 99577 to Indicate reliable results. Please send new sample via special delivery mail. City State Zip Code EKE Date Received (clay jg7 SAMPLE DATE: Mo. Day Year Time Received L/0 SAMPLE TYPE: Analytical Method: Membrane Filter ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. 1 ❑ Treated Water No. of colonies/100 ml. ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected Lab Ref. No. Result' Analyst NO. LOCATION Collected By 1 Immo—tea ® P1,4 — z l EAUE z,,,�� •�a,�.,;sl �l m 3 I IG ITLN ca.! Stu/L I U m 4I U m MUNICIPALITY OF Ab:CHO7A E I 5 I ENVIRONMENTAL SERVICES DIYISICN U m DFC 31 1987 RECEIVED BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter. Direct Count Coilform/100ml BEFORE Verification: LTB BGB COLLECTING SAMPLE Final Membrane Fit r suits Coilform1100ml Reported By Date�� Time: �/�. a.m. TNTC = Too Numberous To Count D la 9 I t OB = Other Bacteria PART t of 2 REMAINDCR TO FOLLOW • 4 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRO%%1ENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIROMIENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date c3 S (a)f�(egal Description (include lot,lock, subd sion, section, township, range) lt/ t- o7A jqQw�L/ Location (address or directions (b) Applicants Applicants. Address - Hone / o (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer ; Other Q (explain); (d) Lending Institution ��(,'.Telephone Address (e) Real Est Address Telephor L�/� (f) Atef1 i e HAA to the following address: 2. Type of Residence Single—Family M�l Multi—Family Other (describe) Number of Bedrooms 3. Water Supply 'Individual Well Community Public Note: If community well s7ste5, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. b. Sewage Disposal /:,yt (J✓ w �d Onsite Public Community Holding Tank Q Note: Iffcommunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. (Page 1 of 2] n Engineering Firm Providing Inspections, Testa, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date show below, I lr verify that my investigation of this Health Authority Approval shows that the on-site' �. eater 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 regula- tions in effect on the date of this inspection. Name of Aaaress ,•�� - --- p Date 3 — �l> .,'�E OF .4(,p �l lOFi s (ENGINEE�',rt . �Z.., 6. DEEP Approval Approved for u Y bedrooms By Approved _-4- Disapproved Terms of Conditional Approval CAUTION Conditional Telephone ."3 THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN INN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONLIL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE MEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS TY THE PROFESSIONAL ENGINEERS WORK. (DHEP SEAL) RR4/ej/D18 (Page 2 of 21 7-19-84 n MLIPAIm OF ANCFIpRAW .:PL OF HEALTH & MUNICIPALITY OF ANCHORAGE (M9oNWNTAL PROTECTION HEALTH ALTIHHORITY APPROVAL (HAA) MAR 19 198--) CHECKLIST - FEBRUARY 1984 it A. WELL DM CFA Well Classification d'K If A, B, or C, D.E.C. Approve (Y ) Well Log Present AC) Date ted r 19Y 3�6 Yield Total Depth Cased to / 'el / Depth of Grouting --�� Static Water Level _ Rump Set At L.c tr � Casing Height Above Ground '57 Sanitary Seal on Casing (Y ) Electrical Wiring in Oonduit (Y/N) Depression Around Mllhead (Y Separation Distances from Wells To Septic/Holdtng Tank on Lot Af /a 1 Cn Adjoining Lots Al n To Nearest Edge of Absorption Field on Lot t Cn Adjoining Lots fl To Nearest Public Sewer Line Pis !-IL To Nearest Public Sewer !f Cleancut/Manhole 00 -f To Nearest Sewer Service Line on Lot 25 Water Sample Collected By S'� �/.l�G�� J Date 3111s - p ' Water Sample Test Results Comments h10 A-Je- B. SEPTIC/HOLDING TANK D= �U /9 L! S-;F�fj Data Installed Size No. of Compartments Standpipes (Y/N) Air -tight Caps Y } Foundation Cleanout (YIN) Depression over Tank (YM) Date Last Plmmping/Maintenence Contract on File Y ) t for Holding Tank High -Water Alarm Y ) Te Holding Tank Permit (YM) Separation Distances fran Septic/Ho1JW Tank To Water -Supply M1.1 Vt'7 To property Line To bispodal Field To Water Kain/Service Line To Stream, Pond, Course Comments [Page 1 of 21 Lake, cc Major Drainage Receipt #'249Za- Date Paid: ' Amount: 010 2-15-84 Soils � t,tting in Absorption Strata Date Insta1w Width of Field Square Feet of Absorption a _ Depression over Field (YIN) Results of Inst Adequacy Test 4 Separation Distance frac Absorption To Water -Supply Wall To Building Foundation Lot t On Adj To Water Main/Service Line To Strema/Pcnd/Iake/a• Major ina To Driveway, Parking Area, Thig D. LIFT STATICN Date Installed Sine in Gallons _ "Pump On" Level at High Water 7S(Y Tested for Electrical Type of System Design Length of Field _ Depth of Field .Gravel Bed Thickness Standpipes Prese (YM) Date of Last Adaauacv st To*, ist nng or Abandoned System on Dimensions Manhole/Access (Y/N) "Pump Off" Level at at Vent (YIN) Pumping Cycles during Adequacy Test. Meets MDA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or cmformed to all MDA HAA Guidelines in effect on the date of this inspection. 8 a 4 49 9 $1y Aa Signed . Dateff—I Z:: r�F > Canpany "WbQM MDA No. F C D 3 K81/d5/9 1 (Page 2 of 21 �, f •• Nn, 115?{ •• �. 2-15-84 _ w>LLpr .r �• ° CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER �`: .-•� •` 5633 B Street y% �4 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: l•) See h on back I.D. NO. Water sysle��tl.me _ /� PhIfe No. Mailing Address / �J /il(-v, l�` {i��CCiJJf j /�l� / / J-/7 city state Zq Code SAMPLE DATE: gT31 r -/ S Mo. Day Yew SAMPLE TYPE: O Routine ❑ Check Sample (for routine sample 1 Treated Water with lab ref. Untreated Water ,2�Speeisl Purposea SAMPLE Time Collected NO. LOCATION Collected By Z211 G3 s �� ✓ s J / l�1 /vl 3 4 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: I?�satisfactory 0 Unsatisfactory 0 Sample too long in transit; sample should not be over 30 hours old at examination to Indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: O Fermentation Tube i7 Membrane Filter Lab Ref; No. Result' Analyst ry I I � m .Mo alW .1100M M Ne a ro44H Wr1.W. W12"M BACTERIOLOGICAL WATER ANALYSIS RECORD Ru. 1997 Membrane Filter. Direct Count Collform1100ml Verification: LTB /) BGB Final Membrane Filter Results v Collforml100ml Reported By ��/; ^ "�r��''.+;- Date .�� f Time: a.m. P.M. TNTC= Too Numerous To Count