The URL can be used to link to this page

Home My WebLink AboutSPERSTAD #2 BLK 5 LT 10 MUNICIPALITY OF ANCHORAGE DEPAR'FMENT 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 MAILING ADDRESS LEGAL DESCRIPTION L OCA T, ON WeN DISTANCE TO: Manufacturer capacitv in IF HOMEMADE: DISTANCE TO: Well DISTANCE TO: [Well No. of lines I Length of each I~]e / Top of tile to finish grade~,~.~/~ ¢/~- ____ Width Length Absorption area .z;z' Dwelling ,, _ ,47,47 - erial ,~.~, ,,~ / [Inside length Total length of lines Materia~ benead~ tile Depth NO. OF BEDROOMS PERMIT NO. - No. of compartments, Liquid depth PERMIT NO. Material Liquid capacity in gallons Nearest lot line z Trench width ~i~' inches 5~ inches PERMIT NO, ~'~)0&'7¢ Distance between lines Total effective absorp,~ion area PERMIT NO, Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Sewer line CJass Depth Driller Distance to lot Jine DISTANCE TO: Building foundation Septic tank OTHER PIPE MATERIALS SOl L T~S-( RATING .......... INSTALLER REMARKS '~ APPROVED DATE LEGAL so~ption area(s) 72-013 (Rev. 3/78) PERMIT IqO. [:,EF'FIRTMEN]" L HEFIL'TI-.I FIN() EN',/' I RONI',IEN"f'FIL . .O'¥'EC]" I ON 825 "'L'" STREET., RNC:HORFIGE., FIK. 9950:l. 264-472.0 [.,-! [e: L.. I~ .... If:It IP-,41 I-i:, CH ['4 -- LS Z -T E .".E; IE !..,.! lEE [-~;:-.': F' EE [~: i"d :[. 'T FIPF'I_I CFINT LOCFITI ON JONN CLFIRK BRCK RORD FINCH LOT ~LO B5 SPER-C;,TFID SRFI BO'X :1.4:t4 LOT SIZE ]:44-69:1..5 20000 S[;)L.IRRE FEET TYPE OF SOIL RBSORPTION S~'rlS]"EM IS: TRE~4CN f'IR2:IMUM flI..li'IE, E.R OF E:EDRO0 "- -' . ..... '1"HE RE)Z..,UIREI} SIZE OF THE SOIL FIBSORPTION SYSTEM IS: THE I_ENGTH E:,IMENSlIDN IS THE LENGTFI (IN FEET) OF ]"HE TRENCN OR DRRINFIEI..[:,. TNE [)EPTH OF R TRENCH OR PIT IS THE DISTFINCE BE'f'I.4EEN THE SLIRFRCE OF TI-.IE GROUN[:, RN[:, TNE BOTTOM OF THE EXCFIVRTION (IN FEET). THERE: IfS NO SET I.,.IIDTH FOR TRENCHES. TFIE 13RR',,,'EL DEF'TH IS 'THE MINIMUM DEPTN OF GRFt',,,'EL BETNEEI'.,I THE OUTFRL. L PIPE FIND THE BC. ITTOM OF TPIE E::':',CFIVFITION (IN FEET). REC ,..:..:.~ t.J I R E.'-: E:, .'._=.; E F-" -It- ][: C '"It" R l'-,! K :S I Z ES == J_. ;2:-5 ¢.Z~ ~'.'3 K-~ L_ L. (2"~ l'..,~ "_.SS; I:::'EF.':MIT flPPL..IC:F~NT PIRS THE RESPONSIBILITY TO INP"ORM 'FFIIS I]:'EPFIRTMENT DURING THE: I N2F, TFILLFI"rION INSPECTIONS OF FIN'-r' WELLS FIE:,JFICENT TO THIS PROPERT'¢ FINE:.., TNE NUMBER OF RESIDENCES THFIT THE I.,.IELL. !4ILL ~.SER'¢E. ............ -T l..,dt C} ,C. ;:Z '.':, Il: II"-.l S F" E~; C: 'T I E.) 1-41 fL-; II::~ F-'". [~ F~.". E~. ~.]:! LIt Z II~.". ES E~FICKFiLI..IIqG OF FINY SYSTEM WITNOUT FINRL. INSF'ECTION RN[:, FIPPRO',,,'FtL B'¢ THIS DEPF~RTMENT I.,IIL..L BE' SUBJECT TO PROSECI..ITION. MINIHUI'd DISTFINCE BE]"14EEN R WELL. FIND, RNV ON-SITE SEWFIGE I.".,ISF'OSlaL. SYSTEM IS ::L00 FEET FOR FI PRIVIR'rE [4ELL OR :L50 TO 200 FEE]' FROM R PUDL. IC 14ELL DEPENE:,INC:i LIPON THE T'¢PE OF PUBL. IC I.,.IELL. MINIMUM [)ISTRNCE FROM FI PRIVRTE !-,.IELL TO Fi PF.~I',,,'FITE SEI.,.IER LINE IS 25 FEET FIN(:, ]"0 FI C':OMMIJNIT'¢ SEI.4ER LINE IS 75 FEE]'. P.IEI...L LOGS RRE RE6!UIRE[:, FIND MUST BE RETURNED 'FO THE DEPFIRTMENT I.,.IITHIN ]:0 DR'.r'S OF THE NELL COI',IPLETION. OTHER RE~UIREMEN]"S MFI'¢ RPPL'¢. SPEC:IFICFITIONS RND C:ONSTRUL';'FION DIFIGRlat',lS FIRE FIVRILFIBLE TO INSURE PROPER INSTRLLFITION. I CER'rlFY THFIT :i..: I FtM FRMILIFIR P.II'TH TI4E REQUIREMENTS FOR ON-SITE SEWERS RND NELLS RS SE]" FORTH B'-r' THE MUNICIPFILITY OF FINC:HORRGE. 2: I I.,.IILL. INSTRI...L THE SYSTEM IN FICCORDRNCE 1.4ITH THE CODES. ]:":: I UNDERSTRND THRT THE ON-SITE SEI.,.IER S'¢S'T'EM MRY RE(:]UIRE ENLFIRGEMENT Il:'": "f'HE RES I[:,Ef',tCE: ~f~EMODELE[:, TO I I'iIC:LU[~IORE THRN 4 BE[:,F.:OOMS. ,t~'¢'i~L. ICFIN'I'.., JOHN C:LI=IF.:K , / J; SSIJE[:, B" . .......... [:,FITE ............. V4. 0 J~/';OI LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchora§e, Alaska 99502 276-222'~ SOILS LOG- PERCOLATION TEST [] PERCOLATION TEST LEGAL DESOR,PT,ON: 6 7 8 9 10 11 ...... 12 13 14 15 16 17 18 19 20- COMMENTS PERFORMED BY: DATE PERPO MED: 2J SLOPE SITE PLAN WASENcOUNTERED?GROUND WATER · SL : O- IF YES, AT WHAT DEPTH? : Gross Net Depth to Net Reading Date Time Time Water Drop ~ERCOLAT~ON RATE (minutes/inch) TEST RUN BETWEEN FT AND __ FT 72-008 (7/76) M-W DRILLING, Inc. P.O, Box4-1224 · 1310CInternationalAirport Road (907) 274-461 ] ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner John Clarl: Use of Well Domes tic Location (address of: Township, Range, Section, if known; or distance main road LOt 10 Blk 5 Sperstad #2 Size of casing, C:' Depth of Hole Static water level 25 ft, · Screen ( ); Perforated ( Describe screen or perforation N/.~: Well pumping test at ~ 9 gallons per (1i5ti~.) 5f drawdown from static level. ~te Of completio, ~. J./4 / ~0 99 feet Cased to 65.4 feet (below) land surface, Finish of well (check one) open end ( :n: ); (mihute) for 1 hours with_ 1007 MUNICIPALITY OF ANCHOP. A(~ DEPT. OF HEALTH & WELL LOG ENVIRONMENTAL PROTECTION Depth in feet from . ground surface Give details of formations penetrated, size of materml, col~n~ liar~s TO TO TO /4£ .TO ~ .TO. --TO ~? TO __TO __TO TO. TO TO 2 5?. 9 9 Ca$~B~ Sticku~ $~l~dy gr~ve? 'Sand~ ~ray _ . .B-~ 1 ry 'Silty wo.t .r, raw?l Si].t¥ sa:od NWWA Certified Contractor C~ Li£~uuL~ ......... 3 2 -- STATE 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 AU'FHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description /..oT 1o BLk' s~ 5P~'S'T/}b t4'2 $ Location (site address or directions) 13oq/ ~CK p. oAb , Property owner Mailing address Lending agency Mailing address Agent $/~IP Address F'.~. 13oq/ BDcK Re>. ,~Ncfl, Al< , EST, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Day phone Day phone Day phon'e, 3~5- ~llO TYPE OF WATER SUPPLY: 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: 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) From MOA #21 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my inves.tigation 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 F//~TT'oP TEc~I, 5l,'C5 Phone Address }~b~3O ECHo ~T ~NC/~. AK ~/~ Engineer's signature ~'J"'~- ~ ~'~ Date DHHS SIGHATURE '7,, Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 4OVP,'4. ,~'¢t"O,q-- Date I1[0/ct4- 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 (Roy. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: LoT JO, ~LK2, SPE~£'T',~b ParcelI.D. A. Well Data Well type Log present (Y/N) 'Y' Total depth c~ c/ / Sanitary seal (Y/N) 7 If A, B, or C, attach ADEC letter. ADEC water system number Date completed ]1/~/~)0 Driller Cased to ~5" Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level1 I o g.p.m. ._3. '~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / I c) Absorption field on lot I .3~ Public sewer main ~ 1oo Sewer service line ~ c~ O' ; On adjacent lots ~ /oo ; On adjacent lots ~ /oc~ Public sewer manhole/cleanout .> / o o Petroleum tank NONE Ol~5ERv~ L¥ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate o. / m~/./-_ Other bacteria 0 ¢0/ /roe, ,~ Z Collected by: F~ATToP 'F£dI.) ~/~ . B. SEPTIC/HOLDING TANK DATA Date installed /O / Cleanouts (Y/N) High water alarm (Y/N) hi ,,A. Date of pumping Tank size 1 2 5O Foundation cleanout (Y/N) d; ,q L Compartments "/ Depression (Y/N) Alarm tested (Y/N) ~, A, Pumper ~EN /~ z_( SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot }10 On adjacent lots >-/oo To property line 3~ Absorption field 2. 2 Sudace water/drainage ~ / oo Foundation 2~ ¢~0r~ C.o. Water main/service line ~ /oO~ 72-026 (3/93). Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed I¢/%0 Length 2 ~ Width .3 o Total absorption area 35-o Ft~ Date of adequacy test i:z/~s / fl3 Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) 1.9 CpD/ Gravel thickness Cleanout present (Y/N) Results (pass/fail) System type Total depth Depression over field (Y/N) for After test 2 ' If yes, give date N. Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: f i / Well on lot I ~0 On adjacent lots ~ /oo Property line %0 To building foundation ~' To existing or abandoned system on lot fl,/~, On adjacent lots ~ ~u' Cutbank hl,/~. Water main/service line ~ ~'$ / / Sudace water '~ 1oo Driveway, parking/vehicle storage area ~0 Curtain drain HoN~ o~s~ev~'b ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signature Engineer's Name Date ~-~,,~ ~. c~,.-? ..~.. HAA Fee $ Date cf Payment Receipt Number 72-026 (3~93)° Back ';,;":"% C~-3587 ..' 2~:;'?¢ Waiver Fee $ Date of Payment Receipt Number COMMERCIAL TESTING & ENGINEERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY ~_..-- TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER' SYSTEM I.D. # "~ PRIVATE WATER sYSTEM Name l~5'3o Ed~o Mailing Addr~s c~y Mo. Day SAMPLE TYPE: %~ Ftoutine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose Pho~o No. Year Zip Code [] Treated Water '~' Untreated Water SAMPLE No. LOCATION Time Collected Collected By [ Iz:oo TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: '~i Satisfactory [] Unsatisfactory E] 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: Membrane Filter No. of colonies/100 mi. Lab Ref. No. Result* I yst · D.~ .C. i'~-~-j~"~%~- BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count (~ Coliform/100 mi BEFORE COLLECTING SAMPLE TNTC = Too Numerous To Count Verification: LSD BGB Fecal Coliform Confirmation Final Membrane Filter Results Reported By Time: Collforrrdl00 mi OB = Other Bacteria Member of the SGS Group (Soci, pART ONE OF TWO: REtlAINDER TO FOLLOW ENVIRONMENTAL LABORATORY SERVICES 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 ~"~SGS Member of the SOS Group (Soci~t~ G~n~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include [0t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~/~ ~¢~¢~/ TelChone: (home)~¢=-/¢' 7 Business Mailing Address Z¢¢¢/ ~¢~ ~ (c) Lending Institution ~¢~¢ ~M/~% Telephone Mailing Address (d) (e) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well,~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~2~ 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, 72-025 (Rev, 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of thevalidationdateshown below, l verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, funct ona .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 Address Date 6. DHHS APPROVAL Approved for ~ Approved ---/~'7' --- Disapproved Terms of Conditional Approval rooms Conditional Engineer's Seal The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 DHHSdonotconductinspections 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: ~,¢7' ,,,Cz. A. WELL DATA Well Crassification r~i~-)l/~T'~ IfA B C D.E:C~i'Approved (Y/N) Well Log Present (Y/N) t _Date Completed ///~D TotalDepth ¢¢ Casedto&.-¢,¢' Depth of Grouting //~r~',C~//T/,'./6' Static Water Level ,:~¢ t ,~.~ ,, Casing Height Above Ground ,j-,-7¢; '/ Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot //7 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ~¢~t,/. Water Sample Test Results Comments ~ .~E/.& /~' Pump Set At 4/'¢ ;~ Sanitary Seal on Casing (Y/N) y Depression Around Wellhead (Y/N) ; On Adjoining Lots /,¢/ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date F,~,X!¢/¢ ,4 B. SEPTIC/HOLDING TANK DcATA oate,n,t ,, d Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~¢'~' No. of Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) AJ Date Last Pumped I ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To P'roperty Line To Water Main/Service Line //7 To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course /,./,¢x.~ ix/ Comments ~-7~/~ 7'~'/~- ?--,.RA/,~' /5' ,/~Z~-.L~¢)~4~;~,/~ 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Az' Results of Last Adequacy Test /::~-~-~'¢'~ '/ SEPARATION DISTANCE FROM ABSORPTION FIELD: / To Water-Supply Well To Building Foundation --.~z/'/ / Lot /~/¢~£ ~ ~7' To Water Main/Service Line ;?¢ ' / To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /'/zF~,c/~/4~,~-/,~x/' Z",g'z¢-/,/(,,,,~t Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line --¢~" [ / To Existing or Abandoned System on ; On Adjoining Lots /¢¢ ";~ To Cutback (if present) ~ STATION Date ns~'C~d~ Dimensions Size in Gallons % Manhole/Access (Y/N) "Pump On" Level at ~.~ "Pump Off" Level at THiegsthedWfa~r Alarm Level at -'~'""'~"----_~(Y/pNu)m'~ing Cycles during Adequacy Test. ~l;rentr~eMntOsA Electrical Codes (Y/N) -'"'---~~~ **Check Permitted Bedroom Rating Against HAA Request** · . ,-:' ~ .~.,~,%. ~ I certify that I have checked, verified, or conformed to all MOA and H,~'~.deJ, ir~t~l~r~ effect on the date of this inspectio~ l. ~ ~' '~ '~" '"~ Date ~ ]~ ~ ~%";~~ Engineer's Seal Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 ISAACS PUMPING SERVICE (Norm Tibbetts, Owner) 6218 Quinhagak Street ANCHORAGE, ALASKA 99507 Phone 563-3300 ~ CUSTOMER'8ORDER"O' I PHONE ~/~ ,^---~ 1 I : ~ ' . : '~ 7:, :.'~" I I J TAX '6815 ~'"~'"' .... dret .... d goods ML)ST be accompanied by thi~ bill, CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 14558 Date Report Prlt~ed: JUL 4 89 @ 14:35 Client Sample ID:W~LL TAP 1304i BACK ROAD PWSID :UA Collected JUL 2 89 ~ i2:00 Received JUL 3 89 ~ 11:45 Preserved with :AS Client Hame : MCFADDEN, WAYNE Client Acct: MCFAWC P.O.$ NONE REC'D Req ~ Ordered By : Analysis Completed :JUL 3 89 8end Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)MCFADDEN, WAYNE Released By : /~t--//~ 2) .................. ................................................................................... Special Instruct: Chemlab Ref ~: 6079 Lab Smpl ID: 1 Matrix: WATER Allowable Paramate~ Teated Result/Units Method Limits NITRATE-N ND(O.1) m~/1 EPA 353.2 10 Sample ROgTINE SAMPLE Remarks: SAMPLE COLLECTED BY W.M. 1 Tests Performed * See Special Imtruetlons Above UA-Unavailable ND- None Detected *' See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-Ormator Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASK-AT-tNC. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM I.D.# I I '1 I' I I I .~PRIVATE WATER SYSTEM Name_ ~ / ~ ' - ~' Phone .o, City State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose ) [] Treated Water [] Untreated Water SAMPLE NO, , I LOCATION Time Collected TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,J~ Satisfactory [] Unsatisfactory [] Sample too long in transit; sa,,mple 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: Membrane Filter No. of colonies/100 mi. Collec'ted Lab Ref, No, By , Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD~~q Membrane FIIten Direct Count Verification: LTE_ Final Membrane ~r R/~..ul:s ';~¢Z.. Reported By ~w .~/,/....~ Colllorm/100ml BGB_ Date Time: Colltorm/100ml TNTC = Too Numberous To Count OB = Other Bacteria MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner .2g~E. Mailing Address I~¢ql /~.Ac~ I'E¢A~ ,4~¢.~,1c~A~ /4//. (c) Lending Institution Mailing Address ?~ ~,2X 70¢5' /) /dC /-/a~,~ (; ~'/ .4/,' (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here [;i~df-hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family'[~ Number of bedrooms 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community we!l system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [~ 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. 72-025 (Rev. 7/88) Page 1 of 2 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, Iverifythat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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 /~JJ(~$O~J ~'-~Oz~/c., -~.~,hJ(~ Telephone Address Date / 6. DHHS APPROVAL Approved for /~/ bedrooms by Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Aul!~ority Approval (HAA) ·CHECK, EI'~'T- FEBRUARY 1984 ~ 'i" "'"i' 'i i~ ~]: ]','i .~:~ 0iV~2i§-4744 A. WELL DATA Well Classification Well Log Present (Y/N) ~/ Date Completed _ Total Depth ~o~' Cased to_b~.q' Static Water Level 4Z '?' ~." Casing Height Above Ground _ Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Flolding Tank on Lot 10.5' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments /,t/~LC /5 Legal Description: . Depth of Grouting if A, B, C, D.E.C. Approved (Y/N) ~/,¢ Yield Pump Set At ~J¢T lpgT~/~/~u~'z~ Sanitary Seal on Casing (Y/N) y' · Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ~ '/?/ '41'' ; Date ti- ~ B. SEPTIC/HOLDING TANK DATA Date Installed ~Size Standpipes (Y/N) ~/ _Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) )/ Holding Tank High-Water Alarm (Y/N) No. of Compartments ~' y Foundation Cleanout (Y/N) y Date Last Pumped 5'-- IB-SB ; for ~ ?~¢~ Temporary Holding Tank Permit (Y/N) /w/~4 SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot /qo ~'r~F::~ ~ 5¢' To Water Main/Service Line 7¢' To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field ~.B' Depth of Field /Z ' Gravel Bed Thickness ? Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line 3 15" To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) I~.' "Pump On" Level at ~ High Water Alarm Level at ~ Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA'.a'nd' inspection. MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ~ffect on the date of this ineer's Seal ANCHORAGE CESSPOOL PUMPING · ALASKA PUMPING '~SUPERIOR STEAM THAWING P.O. Box 110232 ANCHORAGE, ALASKA 99511 (907) 344.2632 344-2453 344-7732 3353 PWSID :UA Collected NOV 90 88 ~ 12:00 hfs, ReoeiYed NOV ~0 88 ~ 1S:00 hfs, Preseryed with :4 DEG, C LAB INSTRLICTIONS"fo) We~k :;¢~],~) ;~ [26 ¥, Date [t,,?i,: P,[~-;tc,~d: O~,t'J ~ ;S .~ I2:05 Client Name : MCF~tDDEN, WAYNE Client tcct : ~4CFIWC P.O.~ NONE REC'D Req ~ Ordered By : ChemLab Ref, ~ :3S96 Analysis Completed :~-~' /~-/-Rg Laboratory Supervisor :STEPHEN C, EDE Released By : Send Reports to: I)MCEADDEN, WAYNE 2) Special HOLD FOR PICK UP AND PAYMENT. Instruct: ~ Chemlab Client Parameter Sample ~ Sample Description Matrix To Test )~ethod Units Result I MCCARRELL 1 201S3-NITRATE-~ EPA 3S3.2 ms/1 JJ4;~o]O) ACHEMICAL & GEOLOGICAL LABORATORIES OF ALASIfA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ~1~ PRIVATE WATER SYSTEM Name Phone No. Mailing Address ~ City State SAMPLE DATE: ~ 17P: 17F-I Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (tot routine sample with lab ref, no. ,~_ Special Purpose SAMPLE NO. LOCATION 2 I 3 I 5 I Zip Code Treated Water Untreated Water Time Collected Collected By Iz :oofl ")*l,~e_ TO BE COMPLETED BY LABORATORY :fysis shows this Water SAMPLE to be: atisfactory nsatisfactory [] 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 /f/_ ~ Z~ -- f~ Time Received /.--~*~'~ Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* I I I Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count ~') Verification: LTB~_ Reported By~~ fV~ , TNTC = Too Numberous To Count OB = Other Bacteria BACTERIOLOGICALWATERANALYSIS RECORD l~ Coiltorm/100ml BGB Coilform/100ml Time: /(~'~-~ a.m. p.m.