HomeMy WebLinkAboutDEBORA BLK A LT 3��,(,�hLl �uC�t!�,
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MUNICIPALITY OF ANCHORAGE �,•
el
DEPARTMENT OF HEALTH & ENVIRONMENTAL
PROTECTION
ENVIRONMENTAL ENGINEERING
DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
P��HyyONEIEW
P'
Jtp,— QZ, ❑UPGRADE
MAILING ADDRESS
S-10/ 5u17 -r 3 - 1ANcEE. <C
LEGAL DESCRIPTION
LOCATION
Llt✓�Nb7e/isrr.3
NO. OF BEDROOMS
DISTANCE TO: Well4?,3 Absorption area/
Dwelling PERMIT
U y 67 �
qa
1—Z
G
Ma � %.. No. of compartm ntr—s
q,cWaturer
Liq c achy in gallons Inside len th
IF HOMEMADE: ��
Width Liquid dept
.��
-10
DISTANCE TO: Well w/ Dwelling
(
PERMIT NO.
i? F
Manufacturer
Material Liquid capacity In gallons
w=
Well Foundation
DISTANCE TO: r"
PEH
NearestEw�id�
„Wj LL 2
? W¢
No. of lines Length of ink Total le h of I les
/
Trench Distance between lines
2 f
Top of tile to finish grace / Material beneath lila
inches Total effective absorpttipa
O
efr-ea
inches NN''
W
Length Width Depth
PERMIT O
U
Wo
Type of crib Crib diameter ri ih
Total effective absorption area
W
w
DISTANCE TO:
Well
Building foundation
Nearest lot line
JClass
J
Depth
I
Driller
Distance to lot line
PERMIT NO.
W
i
-/
DISTANCE T0:
Sewer line
Septic tank
Absorption areas)
w dmg fountlation
OTHER
O A
15-1
PIPE MATERIALS
Vc
SOIL TEST RATIN
INSTALLER
0
Lam+ -0719
REMARKS
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TYtW,,< 93"
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OW
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r
.i l 4cbad A. Shofar : W
OLe
APVHO
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LEGAL
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f,c:aLE
VER,
SIVE
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72 ev.3/781
.. , (fie cfi�e�d �xillin aEug
by.
DOC Co. EGa
SULLIVAN WATER WELLS
P.O. BOX 272, CHLIGIAK, ALASKA 99567 • TELEPHONE 688-2759
• //
OWNER OF LAND F ,-? Y DEPTH OF WELL �d
ADDRESS _r4O/ G'd[OnuA Soli a03 ?95-40?T,TICLEVELOF WATER FT.
LEGAL DESCRIPTION z o T S x7c ll A 00F, a x /P
DATE -Started :�hf7ZId'Z Ended
PERMIT NUMBER
KIND OF FORMATION:
From 0 Ft. to_�2_Ft. a ui=-e fr14 X7J- „i
FromQl Ft.to_J_PFt.
%f/4^/'0 / ,(I✓.IGG
From Z r Ft. to--.L—Ft.
a .1 x7:"- is A;,/64
FromFc to_Z_-_!��_Ft.
S.4 --V d t9,.�
From
Ft. to Ft.
From 1i n Ft. to 7 7 Ft.-
J42J ZI
From17Ft.to L—/ Ft.:tA-+4
64rNv"G t
From Ft. to _,j Ft.
go 7—,E x
From Ft. to Ft.
From
From Ft.
From Ft.
From Ft. to—Ft.—
From
o Ft._
From Ft. to' Ft. —
From Ft. to—Ft.—
From—Ft.
o Ft._
From Ft.
From Ft.
From Ft. to Ft.
From Ft. to Ft:
MISCL. INFORMATION f' 4.1 '.''�
DRAW DOWN FT.
GALS. PER HR Id d O
KIND OF CASING G -s d0
From
Ft. to Ft.
From
Ft. to Ft.
f
From
From
Ft. to Ft.
KNCJPFrom . OF iEALTi1tOF ANC7tA0RA0E
From
EWIRONMENTAL PROTECTION
From
Ft. Ft
From
'toA �:
FfMMY i 0 F.
From
-'RECEIVED-
From—Ft.
to Ft.
From
Ft. to Ft.
From
Ft. to Ft.'
Ft
/
From
Ft. to Ft.
DRILLER'S NAME
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to —"'Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft
DRILLER'S NAME
PlUN I C I f-,faL I -rV 90 11= nN0110Rf�03E
DEPARTt1ENT OF HEALTH AND ENVIRONPiENYAL PROTECTION
B2.S 'L' STREET] ANCHORAGE. AK. 99501 r
264-4729
WEI-t_ nt4f> ON—S I T'F S3CEW1rR F?ERt•1 I T
PEP.NIT NO. C 830531 )
''I'IPPLICANT LAKOTA CORP. 5401 CORDOVA SUITE 293 561-1021
UJCATION
LEGAL LOT3 BLK A DEBORA SUB LOT SIZE 399999 SQUARE FI:
TYPE OF SOIL ABSORPTION SYSTEM I5: TRENCH
tiflXIMUM NUMBER OF BEDROOMS - 3 S)IL RATINJl <SO FT/SR)- 335
THE REQUIRED 512E OF THE SOIL ABSORPTION SYSTEM IS:
QEF' Tl -i= E 3_E!'30T7-1= s2 13Rflvfzt_ DEFT"= 4
THE LEN+3TH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND ANO THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET,WLOTH FOR TRENCHES.
THE ORAYEL-DEPTH IS THE -MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF 7HE EXCAVATION CIN FEET).
r?E� fJ I !?EO SEPTI TfaIVK S Z ?Fm ZG3f33G3 C3F4t_L_'0N
PERMIT APPLICANT HAS THE IkESPONSIOILITY TO INFORM •THIS DEPARTMENT DURING—.TH6'
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO -THIS PROPERTY AND THE
1•UJI.ISER OF RESIDENCES THAT THE 61ELL WILL 5ER'IE
--- Ttjo C 2> I taSP'EE~T I f3iVS nmr_= F2E6flj I JREO --1
EACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL. BY THIS �
DEPARTvENT WILL BE SIJBJEI;T TO PF.OSEcurioN. j
41ININUM DISTANCE SETWEEN A 14ELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE HELL OR 130 TO 200 FEET FROt4 A PUBLIC WELL DEPENDING j
UPON THE TYPE OF PUBLIC WELL !
11ININ1.111 DISTANCE FRO19 A PRIVATE WELL TO A:PRIVATE SEWER LIKE IS 25 FEET AMID E
TO A COMPUJNITY SEWER LINE IS 75 FEET.
WELL L0135 ARE R02UIPED ANO MUST BE RETURNED TO THE DEPARTtJENT'WITHIN 39 DAY:;
OF THE HELL COMPLETION.
..OTHER.REQUIRD-1ENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
•nVAILASLE TO INSURE PROPER INSTALLATION.
P•EF21-i I T CSCE` I FZI 0ECEt+H3EfZ 3.1., O`�k3: Z
I CERTIFY THAT
1: I All FAMILIAR I41TH THE REoUIREMENJTS FOR ON-SITE SaJERS A/JD I -JELLS AS SET
FORTH BY THE 14UNICIPALITY OF RNCHORAOE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE JJITH THE CODES.
3; I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY Rfi1)UIRE ENLAROENENT IF THE
RESIDENCE ;15"ODELED T ' INCL DF MORE THAN 3 SEDR001.15.
-------*it{ LAKOTA CORP.
ISSUED
MUFJ I C� I F AL I TY OF F1t�ICHt. Fir iGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET, ANCHORAGE, AK. 99501
264-4720
WELL A t4E> CDt4-SITE SEtJEFQ PERM I T
PERMIT NO. ( 830581 )
APPLICANT LAKOTA CORP. 5401 CORDOVA SUITE 203 561-1026
LOCATION
LEGAL LOTS ELK A DEBORA SUB LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
6EPTH= LEt-.FGTH= C3:2 GFSAk•EIL F?EPTH= 4
THE LE14GTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
FSEC-!U I FREFJ SEPTIC TAt4K SIZE= 1000 GALLOt-75
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TWO <;2 ] I t-JSPECT 10i AFZE FSEQU I FREFJ ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER, INSTALLATION.
PEFRt7 I T EXP I FZES F>ECTEtlEDEwFZ ZT11 nLEDED
I CERTIFY THAT
1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED
ISSUED
V4. 0
P ---SOILS LOG
i MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
I
� 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: L Ax o m ,QGOr `/ DATE PERFORMED: 6' "Z 3 - 8-3
LEGAL DESCRIPTION:- G J %jam 7C13D1Z4
DEPTH SLOPE
(FEET)
1
2 1-Z Srl%
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMM
rr
tae
t!
r "b 'AC
Gross
Time
MtiMewNeeaea •e1
NIX
it
Joe 1% IP60 ��ii
e�NMNaje�i
PERFORMEDBY:_ LQn
72008 (6/79)
WASGROUNDWATER +
ENCOUNTERED? _aO
IF YES, AT WHAT
DEPTH?
�k7
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
CERTIFIED
DATE:6 L3-�
GARB HPI GRS:ATER ANCHORAGE AREA BOROUGH
i HEALTH DEPARTMENT r
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING U�
NAME ADDRESS'e5 X :2 iF' /PHONE�1-
f �. r. l
SEPTIC TANK:
�7i9N.1' a vitT Bi
DISTANCE FROM FROM WEU( �� V/�27'�MATERIAL �� , OX
,_-72—,_r NUMBER OF
COMPARTMENTS
LIQUID CAPACITY �QGALLONS. INSIDE LENGTH Z INSIDE WIDTH u � 'DEEO
PTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETE / /
Cpci/LT dJ' /b?C//aL OR�WIDTH /!�LENGTH, DEPTH'/_
LINING MATERIAL .DISTANCE FROM WELL` A .�"-^4�V/ 2��UILDING FOUNDATIONSS__?�_
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 'i/.32- SO. FT.
TILE DRAIN FIELD:
DISTANCE FROM
NUMBER OF
FOUNDATION
BETWEEN LINES
ABSOPi MON AREA SO. FT. LENGTH OF EACH LINE
TOTAL LENGTH
LOT LINE , OF LINES
TRENCH WIDTH
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL. TYPEDISTANCE FROM WATER
DEPTH A— ,BUILDNG FOUNDATION. SAMPLE—. NEAREST
NEAREST _� SEPTIC SEEPAGEOTHER
LOT LINE , SEWER LINE , TANK SYSTEM—, CESSPOOL,SOURCES—
DISTANCES:
OURCES—
DISTANCES:
71
DIAGRAM OF SYSTEM
DATE2
T
b
�
4
DATE2
T
:
DATE2
T
GAAB-11D-2 GREATEh ANCHORAGE AREA'`OROUGH Case No.
IIEALTII DEPARTb1ENT
327 Eagle St. Anchorage, Alaska 99501 279.2511 4 (L//� U
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
20l i� / c�N L — GS
NAME OF APPLICANT MAILING ADDRES 0 �/ PHONE N0.
RESIDENCE ADDRESS LOCATION OF INSTALLATION 1�[iA/d;^-.rn//J/lA) 6U2
LEGAL DESCRIPTION7- 3 /%t� �� 'L9,F— t'�c'-,iji
APPLICATION TO INSTALL: SEPTIC TANK ✓ , SEEPAGE PIT_ t/ , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY 5 6C- e- l%lty 1f/Oyil!^
FINA CED THROUGH_ c��f=1-F
TO BE INSTALLED BY�5cFl-=
-PER ON TEST RESULTS ANTICIPATED DATE OF COMPLETION,2yh%e iL�T/C
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
, PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED t{!
SEPTIC TANK SIZE 1. o,_ _� TYP�nSEEPAGE AREA" Cyt
DIAGRAM OF SYSTEM
DISTANCES(/f'/%//&/,/)
r(r/,FLL Td
�T 7-o
HEALTH AUTHORITY
OR
UCENSEO DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area BoroughOrd}nance No. 28-68 and that the
above described system is in accordance with said code. 4/07-
DATE_ =/E�Z�I Z APPLICANTSSIGNATURE_,f
I GREATER ANCHORAGE AREA BOROU;Hr`
HEALTH DEPARTMENT
327 EAGLE STREET
ANCHORAGE, ALASKA -99501
JCASE d
Performed For Wl,- H,; /ele Date Performed ///yp� lel
Legal Description: Lot --Oz j /a Subdivision ,r��
This Ferr. Reports a: Soils Log, t/ rercolation Lest
Depth
Feet Soil Characteristics Location Sketch
C4, viva -ivi
fA" tote, litA
ea h Warr
i 11t c, verb
ccnfenf,
?X iten,e
061orn t,
Was Ground Water Encountered?—
At What Depth
Proposed Instal ation:—Seepage Pit
Depth Of Inlet .Drain Field
COMMENTS: �, Deptn To bottom Of Pit Or Trenc
Test Performed By:�,r,c
Data Certified By:���
Date:v
U
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
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot block, subdivision, section, township, range)
_ 3 B 64 i7�o,e is s4
Location (address or directions)
(b) Applicant Name A ZZ�/6°6 Telephone: Home b 2'72�y0/ d
Busines�
(c)
(d)
Applicant Address
Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Othe® (explain);
Lending Institution �S��T��S Telephone
Address
(e) Real Estate Company and Agent
Address
Te, lephone
tnJ
(p the I the HAA to the following address:
2. TYPE OF RESIDENCE
Single-Familyiy Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual WeIX 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,o Public ❑ Community ❑ Holding Tank ❑
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 72-025(11.84)
S. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION r 0
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 o1 this inspection.
Name of Firm Telephone
AddressSRQ 19G;C _ �j� Q
',iN4 CCH G�JiI C
tt
Date PH. 0 W U70
Q
DHEP APPROVAL
Approved for _Sbedrooms by
Approved Disapproved Con )nal _
Terms of Conclitionlil Approval
1N j
CAUTION
Date
r.
ine
.. ..
Wo. 1437-0 r.P-
4,
The Muncipality of Anchorage Department of Health and Environmental Protection (OHEP) 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 not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAG,
DEPT. OF HEALTH !!��
ENVIRONMENTAL PROTEf.TION -.
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) 1,:AY 0 togs,
CHECKLIST - FEBRUARY 1984 !{�� �` E J
2644720 40-r �' 4� 1, 1.,E y O ID
Legal Description: LAEB
A. WELL DATA
Well Classification �L�V aTE 11 A, B, C, D.E.C. Approved (Y/N) �''
Well Log Present&.Ny Date Completed q -415 -S3 Yield rfevo O.S E,�M
Total Depth g O r� 1r A r
P Cased to Depth of Grouting
Static Water Level tot 4 Pump Set At U �-
Casing Height Above Ground A1 �� ~ Sanitary Seal on Casing/H)'
Electrical Wiring in Conduit Lla .
Depression Around Wellhead,(Y&
Separation Distances from Well: 4,
To Septic/Holding Tank on Lot - C/? / ; On Adjoining Lots /p0 /
To Nearest Edge of Absorption Field on Lot /04 1 ; On Adjoining Lots /00' r
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole Nta To Nearest Sewer Service Line on Lot Asor oD SI r
Water Sample Collected by C; -4L-% E^Jf. rN ca_ IU& ; Date i - sr -
Water
Water Sample Test Results s/9 T/ STAG TrJ.G y _
Commentsllc C G E�Tr P G✓ Ai i�F ij /� 7 ?AC
B. SEPTIC/HOLDING TANK DATA
Date Installed g 3 "S 5 Size /o u o No. of Compartments
-2
Standpipes 1' l} Air -tight CapsiO/Wr Foundation Cleanout0#4-
Depression over Tank Date Last Pumped
Pumping/Maintenance Contract on Fite (Y/N) NVQ ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Nt'A'
Separation Distances from Septic/Holding Tank:
i
To Water -Supply Well
To Property Line
To Building Foundation /a
i
To Disposal Field S
/ f
To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage
Course
Comments y%Lr /.✓.S) /L/ Eit .q 7?�1�/��l�j
Page 1 of 2
72-026(11164)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Ss �,l Type of System Design
Date Installed 6-1-81 Length of Field �a
B r
Width of Field /Ut/►-- Depth of Field
Square Feet of Absorption Area
Depression over Field (YO
Results of Last Adequacy Test
Gravel Bed Thickness
a SS Standpipes Present Y m
Date of Last Adequacy Test NEW
N/_4
Separation Distance from Absorption Field:
To Water -Supply Well SPD f
To Building Foundation ZO
Lot
To Water Main/Service Line
t
To Property Line /D
To Existing or Abandoned System on
�„ , 0 --
;On
;On Adjoining Lots
To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
liOit
Comments
D. LIFT STATION
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
•• Check Permitted Bedroom Rating Against HAA Request ••
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
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 C
Company
Receipt No. `6`6-6b
a 81 Q E.`IQINEER(I\'a � _ a a _� 5
Date of PayQ, SEil3 =
c ,uLG RIVER AIASKA 7577 N
Amount: $ PH_ W4,MZ8
Page 2 of 2
A
Mb.n A. Sherr �;
No. I457•E0-0
'
�� Vv
72-026 111,841 -% `"
r
r , sCHEMICAL & G�LOCICAL LABORATORIEJF ALASKA °"'•
INC. • " erg ,;
TELEPHONE (907) 5622343 ANCHORAGE INDUSTRIAL CENTER ��` ��•(
5633 B Street,
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM: 1 1771 (') Ses h on back
es
t I.D. NO. cry �j
_ /l« lhlCr` I
Water System Name
/ yL� Phone No.
Madrtq Address,
Cm -
SAMPLE DATE: IUB I s__I
Mo. 77 Day
State
Zis code
TO BE COMPLETED BY LABORATORY
t� Analysis shows this Water SAMPLE to be:
CF Satisfactory
❑ Unsatisfactory
❑ 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.
rTF1
II Date Received �� 6 ' 0 J
Year Time Received
SAMPLE TYPE:
"utine
❑ Check Sample (for routine sample
With lab ref.
❑ Spacial Purpose —
❑ Treated Water
�lntreated Water
SAMPLE
NO, LOCATION
2
4 I I
5 f
READ INSTRUCTIONS
BEFORE
Timis Collected
Cot acted
Analytical Method:
❑ Fermentation Tube
V Membrane Filter
Lab Ref. No. Result' Analyst
112
I I m
I I m
I - m
U l2]
•rb a eaary 100 m a No a PorrM so.rw.s
061220 tel BACTERIOLOGICAL WATER ANALYSIS RECORD
Mr. leel
Membrane Filter. Direct Count
Verification:
Final Membrane Filter
Reported By !2 1:
COLLECTING SAMPLE TNTC= Too Numerous To Count
Colllormllooml
Colllorml/looml
Date— �. �_ �g
Time: / Vn n a.m.
P.M.
UuF ALASKA BILI SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/HESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501 274-2533
May 17, 1985
Mr. Robert A. Shafer, P.E.
S&S Engineering
SRB 196X
Eagle River, Alaska 99577
SUBJECT: llaiver Horizontal Separation between Well and Septic
Tank, Lot 3, Block A, Debora Subdivision, Eagle River, Alaska
(8521 -HA -161)
Dear Sir:
The Department has reviewed the subject waiver request and hereby waives
the horizontal separation between the well and septic tank to 93 feet
on the subject property for a 3 bedroom single family residence only.
Sincerely,
Steven 11. Eng.e
District Engineer
SHE/msm