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HomeMy WebLinkAboutMCKINLEY HEIGHTS #1 BLK 6 LT 3McKinley 'D Heights #1 Block 6 Lot 3 #051-213-04 ,BILL a. COLE OC CO aba 0110ULLIVAN9,akWATER WELLS P.O. Box 670269,, AK 99567 688-2759 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Legal Description McKinley Heights #1 Block 6 Lot 3 Pump Installation Date: 6-2-16 ®5/-2c3.0 Pump Intake Depth Below Top of Well Casing: 310 Pump manufacturer's Name: Grundfos Pump Model: SSQE15-450 Pump Size: 1.5 Pitless Adapter Burial Depth: 10 Pitless Adapter Installer: Unknown Disinfected Upon Completion? ® yes Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Unknown Pump Installers Name: Sullivan Water Wells ❑ no Date of Issue Property Owner Name & Address Maria Rentz 18317 Amonson Chugiak, AK 99567 feet hp feet Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage '° Development Services Department Building Safety Division OnS@a Water and Wastewater Program. 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 Page 1 of 2 www.ci.anchorage.sk.us (907) 343.7904 ON-STrE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO50157 PID Number: 051.213-04 R""' ED MARIA RENTZ Wastewater System: ❑ New ® Upgrade Aao.ss P. - BOX 672384 CHUGIAK ABSORPTION FIELD n D pp Tr*tt"t ® Snerlo" Trend) D Bed D M"nd o onr Ptane A~ of 11*"00,m LEGAL DESCRIPTION ��a Tal" Depth train �0•ede 1.2 GPDM? 8.6 Ft. OwdL L" Ubdmiem Depth npipe boe"natm*,V "vele Gnv"dspme"rempro. 6 3 MCKINLEY HEIGHTSt1 5.2 Ft. 3.4 Ft TOW" Reny* sedan. Fa added eppre"p pede Grev"L"pth: 15N 11W 16 0.5 Ft. 16 Ft. Upgrade Well: [INew ElUpg Grev"rtan. 5 rn,tro«"wa 1 Dwonce bet~%even, 0 Ft. Ft cusParwaa Ipnvete. A B. ck Td" Depth Geed n T" aoe"gan "w Pipe M""ul EXISTING PRIVATE I Ft. Ft 80 FP I ASTM 3035 Dr Dole DWW Suterw""L"/el it " Dai*Instew Ft GREEN GENERAL 6115/2005 Y.a PtaT s"" Gwq °°�" tt«y* "c+n"td TANK GPM Ft. Ft SEPARATION DISTANCES ® septic ❑ Holding ❑ S.T.E.P. ❑ Other. To From Septic Tank Absorption Field LM Station Holding Tank btk/Prlvate Sewer Line ' *,'r ANCHORAGETANK 1250 c" w« +100' +100' — — +25' Mel" STEEL rw.ro«"cwtpa "e. 2 wfataw"*v +100' +100' — — LIFT STATION Lune +5' +10' — — We NO LIFT Ge, wa w +5' +10' — — 'Ptenp W* Wel" -PWV otr IM" NO win" ""n ". iaenetan h n m ��t +50' +JV����tt ' — — PUT MW* & Modw Eumral Yrpeoeor" p"t"aed M Cwt.D. EXISTING ABSORPTION FIELD EXTENDED TO MEET FOUR BENCH MARK, Lcmetw and Dee"roa"i BEDROOM ABSORPTKW SYSTEM REQUIREMENTS CORNER OF DECK AT HOUSE SOIL TYPE VERIFIED AS SLIGHTLY SILTY GWISP DURING 100 FL, INSTRUCTION. eq, Inspections performed by: CHRISTOPHER WOOD Dates: 1" 6113/2005 2n4 611512005 Development Services Department Approval Conditional Approval Date: CHRISTOPHER R. WOOD CF -10387 Reviewed and approved by: Date: ///7 nt" eaeel l Permit No. SW050157 Page 2 of 2 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT ON—SITE WATER & WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: MCKINLEY HEIGHTS#1 LOT3, BLOCK6 051-213-04 a SWING TIES Z D 1 13.4 1 13.0 B 1 7.5 I 4 O - SEPTIC PIPE • - MONITOR TUBE 00" WELL+ LOT 3 LOT 2 gd O roo a o \'o 09 V M. �.Y1e. EXISTING u c",m ma cx ' HOUSE ELEVATI❑NS (NOT TO SCALE) RN i 1AT HOUSE ASSUMED ELEVATION • 100' 0.5' ORIGINAL GROUND LEVEL AT, 93.6 MT -I 121AN00;' • o 0 . 915 GAL 3.4.GRAVED ?o 86.9 86.988.4 85.1 85.0_ SHED SCALE 1"=50' LOT 4 /13 ENGINEER'S SEAL 00000Opp�O F, OF AG 4 x-88.4 Q 0 ............................... •o �° •. CHRISTOPHER R. NVOD CE -10387 : MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 02, 2005 Expiration Date: Jun 02, 2006 Permit Number. SWO50157 Parcel ID: 051-213-04 Legal Description: MCKINLEY HEIGHTS #1 BLK 6 LT 3 Design Engineer: 0848 Eagle River Engineering Services Site Address: 018317 AMONSON RD Owner Name: RALPH & MARIA RENTZ Lot Size: 42689 SO. FT. Owner Address: PO BOX 672384 Total Bedrooms: 4 Permit Bedrooms: 4 CHUGIAK , AK 99567-2384 This permit is for the construction of: ❑v Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. -A SUBSURFACE DISPOSAL FIELD MAY NOT BE INSTALLED IN AN ACCEPTING SOIL STRATUM HAVING A PERCOLATION RATE FASTER THAN ONE INCH PER MINUTE WITHOUT INSTALLING A FILTRATION LAYER IN ACCORDANCE WITH AMC 15.65.060 SUBSECTION D. NEED TO VERIFY SOIL TYPE AND IF NECESSARY CONDUCT A FIELD PERCOLATION TEST AND SUBMIT WITH THE INSPECTION REPORT. Received By. /A'' �.c— Date: G,G lOS Issued By _�f�— Date: v z vJ' Municipality of Anchorage • -� Development Services Department Building Safety Division �. On -Site Water and Wastewater Program $ ^ 9*a 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us. (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. OS/ 02/.? O'/ Permit Number SW Property owner(s)_ t Dayphone = (,fZ Mailing address (1)i�0 Bcx 6-7-2-974�i1u�,Z.r k� K Q%57o'� �aikl geddmss (2)_1$314 AmanscvN (2d Zip Code g9SG7 �a38�f U Legal description (Lot, Block & Sub'd.) L:tV cet;iZjV f%l Va r Z#- / p Ll B Legal description (Section, Township & Range) Lot Size q.2, 09 Acres q:Z THIS APPLICATION IS FOR: Number of Bedrooms _ U Sewer Only ❑ Well Only ❑ Sewer and Well El E Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application Is being made for a Single FamilyjWeliing and 13.i cordancywith applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: 1/ 6 o Waiver Fees: Date of Payment: 3 — 3 / — 0-6� Date of Payment: Receipt Number: 96 G Receipt Number: (Rev. 12(00) / Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW RD. Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax May 31, 2005 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: I%IcKlnley Ilts. #1 L3 B6 Narrative & Permit Application Dear Mr. Roth: Eagle River Engineering Services (ERES) was contracted to design a septic system upgrade at the above referenced property. The homeowner wishes to upgrade from 3 bedrooms, to 4 bedrooms. The septic tank will be upgraded from 1,000 gallon to 1,250 gallon. The existing leachfield is dry, and in good GW material. Neighboring septic systems are also founded in free - draining soils. The existing trench is installed within 50' of a slope greater than 25%. However, the trench was installed prior to 1986. We are requesting to waive the 50' setback requirements for the following reasons: 1) The existing system was installed prior to 1986 2) A lift station would be required to install the additional 13' of trench in any other area on the property 3) No effluent has ever daylighted on the slope below the leachfield. 4) The 13' of additional trench for the extra bedroom will be installed as close to 90 -degrees as possible off of the existing trench, away from the slope greater than 25%. We are also requesting to proceed without a soils percolation test, given the free -draining nature of the soil on this lot, and neighboring lots (soil logs included for your reference). ERES will visually verify soil type at time of installation, and if necessary, conduct a field percolation test. We will also determine the need, if required, for a 2' sand liner at time of construction. The proposed 4 bedroom septic system upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are already developed, so there is room for wells, septic systems and alternate sites. 2. Immediate neighboring septic systems are all +10' distance, and no private (or community) wells within 100' of the proposed septic system. 4. Drainage will not be affected and is not a major consideration in our design. V003\05-054MCKINLEYSEPTICNARRATI VE Installation of this 3 to 4 bedroom upgrade trench will not adversely affect the wells or septic systems or reserve areas on adjacent lots. If you have any questions please call our office at 694-5195. Sincerely, Sincerely, d, P.E. Principal \2003\05-054MCKINLEYSEPTICNARRATI VE f ROg�N WELL too' N 6. SEPTIC +30 / 1 I I I I I I 2 � WELL too' SEPTIC +30 LOT 2 i i i i SHED 5'.13' ADDITION TO LEACHFIELD ® - TEST HOLE • - MONITOR TUBE 0 - SEWER CLEAN OUT + - WELL — — - EASEMENT PROPOSED LEACH FIELD EXISTING LEACH FIELD WELL +too' ©- DRIVEWAY 1. NO SURFACE WATER +100'. 2. NO KNOWN CURTAIN DRAINS 3. SEE SITE PLAN FOR ADJACENT SYSTEM INFOrMATION E sl::' t EW ,tomIr EXISTING IC TANK I HOUSE s I6G10 N PN`ONS� '4Q WELL/SEPTIC SITE LEGAL: LOT 3, BLOCK 6, MCKINLEY HEIGHTS OWNER: RALPH RENTZ CONTRACTOR: HALEYQUEST JOB# 05-054WS I DATE: 05/31/05 SCALE EAGLE RIVER ENGINEERING P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX.' (907) PLAN #1. SUED. 1 "_ SERVICES �� WELL 100' SEPTIC +30 LOT 4 r 0 0 O 00 r 3 PUMP AND REMOVE OLD SEPTIC TANK —NEW FCO FILL EXCAVATION WITH TYP II GRAVE` 1 AND COM ACT IN t§' LIFTS WELL 100' SEPTIC +30 H 63 ss �SbO w OF or i' '.CHRISTOPHER R. WOOD.' �I CE -10387 J 1 ... • ' c4v '4k� 694-3297 1 ���� Eagle River Engineering Services Christopher R Wood, P.E. rog2t VFW Rd. Suite 2or (907) 694-595 tel Eagle River, AK 99577 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: I%IcYJnley [its, L3 R6 May 31, 2005 A. GENERAL 1. The septic plan is for a 4 bedroom single family home septic upgrade only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open lest hole excavations shall be filled and monitor tube removed. 9. It is the responsibility of the contractor to obtain any lot line staking or well radius staking, etc... by a licensed surveyor prior to installation of any component of the septic system. Although not required, it is highly recommended, and is purely the responsibility of the contractor if any component of the wastewater system is installed too close to any lot line, house foundation, well radius, surface water, or any other object which the MOA requires specific setback requirements. B. SEPTIC TANK 1. The sewer piping from the house shall be 4" PVC 3034 laid at 2% grade minimum, and insulated with 2" of burial foam if shallower than 3 R., with 2 ft. minimum. A foundation cleanout shall be installed within 4' of the house foundation. 2. The septic tank shall be an Anchorage Tank 1,250 gallon 2 chambered septic tank. Contractor may submit alternate tank and for approval, as long as it meets MOA requirements. Two opposing after - tank cleanouts shall be Installed. C. TRENCH 1. The trench upgrade is to be located as shown on the site plan. 2. The total depth of the initial trench excavation is to be 6' max. relative to existing ground elevation at existing leachfield location. The bottom of the trench shall be level, plus or minus 1.5". 3. A 4 foot layer of sewer rock is to be placed over the native sand and gravel. The 4" effluent piping is to be laid on top of the gravel layer with, with 6" additional gravel added as follows: 4" along sides of effluent pipe, and 2" of gravel cover over the piping. 4. The completed trench gravel and piping is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of +3' or equivalent is to be placed over the leachficld. Soil shall be contoured over the trench to prevent runoff from ponding. Continued on next page \\Eres\docs\WPDOCS\2005\05-054MeKinfcyu=ch- specAm Eagle River Engineering Services Christopher R Wood, P.E. 10421 VFW Rd. Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (9o7) 694-3297 fax Continued: C. SAND LINER 1. A 2' sand liner shall be utilized beneath the sewer rock if it is determined that the existing native soil is less than 50% sand. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH= 6' GRAVEL DEPTH = 4' under effluent pipe, 2" over pipe TRENCH LENGTII - 13' TRENCH WIDTII = 5' SOIL RATING= 1.2 GPD/fl1 BEDROOM CAPACITY= 4 SEPTIC TANK= 1,250 gallons EFFLUENT PIPE= 4" diameter of Muni and Engineer approved materials and construction Twenty-four (24) hours notice required for all Inspections. \\Ercs\docs\WPDOCS\2005\05-054McKinlcytrench- etxc.doc DATE: April 7, 2004 MUNICIPALITY OF ANCHORAGE Building Safety Division MEMORANDUM TO: On - Site Services Program FR s oss, P.E. ger, On -Site Water Wastewater Program SUBJ: Slope setbacks from >25% In situations where slope conditions will not allow a wastewater disposal field to be located 50 feet horizontally up gradient from a change In slope to greater than 25%, as required In AMC 15.65.060.A.1.b the following requirements apply: (As allowed by AMC 15.65.030.G) 1. A point shall be determined two and one half feet above the Invert of the distribution piping of the septic field at the field's closest point to the slope greater than 25%. 2. A line shall be drawn from this point and perpendicular to the distribution piping at a down slope of 25% in the direction towards the slope greater than 25%. 3. The intersection of this hypothetical line and the actual slope shall be a minimum of 35 feet horizontally from the point established In #1. 4. This 35 foot horizontal separation shall be the minimum allowed between a disposal field and a slope of greater than 25%. If a property has a wastewater disposal system that was constructed prior to 1986 and the absorption field encroaches a change in slope greater than 25%, an upgrade of the failed system may be approved in the same location if the following applies: 1. No other location exists on the property to construct an upgrade drain field with proper separations. 2. The engineer field verifies that no effluent ever surfaced on the slope surface. 3. The engineer maximizes the separation from the field to the slope as much as possible. '^ M r 0 J u y i 4 o J �=1 M N ti S F4M14 Pw «'a' .^iii' r. �Oaa�k.fa L V 7 9 0 J v M RUC Y N. .�,.%�. R �u SOILS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 828 L. Stmt, Anchorege, Alaska 99501 2844720 TEST SOILS LO�G,-�— PERCOLATION TEST / PERFORMED FOR: % � r DATE ./ PERFORMED: c 'A LEGAL DESCRIPTION: —� L� C! rt��, �( /�/% /(eL� fw-s IEEE e) 1 (f 2- 3- 4- 7- 10- 11 34 13 14 15 16 17 19 19 20 8eben A. 1140. 14 4(6"h , WAS GROUND WATER A)2 1/ S ENCOUNTERED? L P IF YES,ATWHAT E DEPTH? Reeding Date Grose Time Net Time Depth to Water Net Drop °r of +J I PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: -S & S Englela•titteT CERTI 72-008 (6/79) MUNICIPALITY OF ANCHORAGE O DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTF.CfION ENVIRONMENTAL ENGINEERING DIVISION 826 L Street • Anchorage, Alaska 99601 Telephone 2G IA720 ON SITE SEWAGE DISPOSAL SYSTEM AND/Oil WELL INSPECTION REPORT NAME{ I' (ILS Cc, �k NEW C D/c+rs % / UPGRADE MAILING ADDRESS _ 13 iE� U LEGAL OESCRIPTIy / ` 0 LOCATION --ff-- NO. OF BEDROOMS., UX DISTANCE TO: Well I,7/ Arno rpt p= Dwelling ,�„ PER 4PT20 � Z W2 W, Manufacturer /ni-e` C� M( No.��oJJI U c tartments 7. G LI cyuPrity,lp gnllom IF HOMEMADE: Inside length Width Liquid deeds d sc �0$ DISTANCE TO: W011 Dsaeil1e9 PERMIT NO. = Z Manufacturer Material Liquid capacity In gallons W DISTANCE TO: Well /� oundution .�. Ne ne PE Np, (/l j Y. z ~ No. of lines / Length a lin( ( Total 1 t al II(er Trench w' ) Distance Ll/ Inches bn nn n ¢ H D els os ule to in}Rr �de , j� Zn : ci� �'f Irsrises Total alfs;ctlynu o2tlion Va NO. W Length Width th PERMITT u S Type of vlb Crib diem Gib depth Total affective absorytlon area w TO: WeII Building foundation Urlllor Nearest lot line J tDISTANCE .^ Dep Distancotolotlim PERMIT NO. ANCE TO: Building foundation Sewer line Septic took Absorption arealsl OTHER PIPE MATERIALS G SOIL TEST RATING 9 INSTALLER A /Ar rs REMARKS 0 OF A „4 - is -e c • -N•r• _ P • �' Robert A. It o" t an i ! sA {. -Hd+ A P 710 VED DATE LEGAL S.& S Engin".ring f� 7 � lieu. 7!781 EAGLE RIVER ENGINEERING SERVICES 10421 VFW RD Suite 201 Eagle River, Alaska 99577 (907)694-5195 ERES Project No.: 05-054 Calculated By: CW Date: 5/31/2005 Legal: McKinley Hts. #1 L3 BO TEST HOLE 1 Single Family 1 Bedroom Dwelling Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom - 150 gallons Percolation rate - 1 minutes per Inch Wastewater application rate = 1.2 gallons per day per square foot Required absorption area = 125 square feet Trench width (W) = 5 feet Gravel depth (D) = 4 feet Required length = Shallow trench factor • Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor = 0.50 C,.O Total Excavation Depth = S'15,feet Required length = 13 feet 05-054_4brupradedrainfieldCalc 2:02 PM5/31/2005 u a .r MLmlct Wty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825'L' Street, Anchorage. Alaska 99502.0650 SOILS LOG — PERCOLATION TEST I�KiNJ PERFORMED FOR: �s DATE JA.rJi Lifu/ .... ... LEGAL 15 16 17 18 19 oIzGMV IGS Township. Range. Section: S L I 1-7/m.5 ''1 Em WASGROUNO WI ENCOUNTERED? IF YES. AT WHAT DEPTH? Oto Y Mae Met Reading Date Gras Net 090th 16 Net Time Time Witte. Drop 21 r ePt. S? • v y, 20 U PERCOLATION RATE 4 1 (mmule IW4")�PERC HOLE DIAMETER TEST PUN BETWEEN t" FT AND -%FT COMMENTS ;;4k; VlXKIIVV /'�J -��r PERFORMEDBY: f/j�1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WIVAL( iTilfEC WITVAt. GUIDELINES IN EFFECT ON TNS DATE. DATE 72-00E (Rev. 485) MD ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8', X•nnetCE 71'. SOILS PERCOLATION TEST ff;��••.._ Performed for. Richard Mount Date Project: McKinley Hts Add Al, B6, L2 TEST IIOLE N 200M Depth 15- 16- 17- 18- 19- 20 - SEE ATTACHED SITE PLAN OIVORC FOR HOLE LOCATION CP/SP —brown/gray, sandy gravel w/ occ. cobbles to 1 c6arse sand and moisture Increasing w/ depth SWISM — moist gray sand w/ trace of silt- increasing w/depth B.O.H. Insitu material suitable as filter HOLE PRESOAKED PRIOR TO TEST Was Croundwater encountered? NO What depth? NA Depth to water after monitoring? 12S' Date? 08/26/03 Reading Date Gross Time Net Time Depth to Water Net Drop 1 8/19103 1:00 6" 2 1:05 5 min dry 6- 3 • 1:06 •6" 4 1:11. 5 min dry 6" 5 1:12 6" 6 1:17 5 min dry 6- 7 • 1:18 6- 8 1.23 5 min dry 6" 9 1:24 6" - 10 129 5 min dry 6- 11 • 130 6" - 12 1•.35 5 min dry 6" • Water Added Percolation Rate _.q_1(min/In) Perc Hole Diameter 6" Test Run Between 4 feet and _5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. MUNICIPAll-11 Y OF ANCHORAGE DEPARTMENT OF HEALTH & F.NV I ROINIll MOTEC'll r I ENVIRONMENTAL ENGINEERING DIVISION 825 L. Street - AnGhcuragL, Alaska 99901 Telephone 264 .4720 ON-SITE SEWAGE FASPOSAL SYSTEM AND/OR VVELL INSPECT ION REPORT NAME N EVV UPGRADE MAILING ADDRESS /9 004 LEGAL DESCRIPTIO z LOCATION J NO. OF BEDROOMS Well �, Absorption pare Dwelling {/J DISTANCE TO: 4- PE NT 0 Manufacturer N, D P 6attments UJ (n Liqsca y& llons IF HOMEMADE: Inside length Width Liquiddepth DISTANCE TO: Wal Dwelling PERMIT NO. 0 < 1: F- Manufacturer Material Liquid capacity in gallons w Foundation l;Yiie Ine DISTANCE FO: uj 7w No.oflines LengthAea)i linf notal I th,of lit'" Trench vvl�ot inches Distance b Yen ine f- Top of tile to funigh grgde �apertal pen6th t�10 Total effect abso 4 on aA.a ove—inches zll� 1 T � '-7" -.1 9 Lt Lengih Width Depth PERMIT NO. h- --Fyp—eof Crib depth ------I—Total effective absorpLion area Crib diam a lu W Well Building foundation Nearest lot line Us DISTANCE TO: Class e!57 Depth Driller Distance to 10L line PERMIT NO. w Building foundation Sewer line Septic tank Absorption areas) DISTANCE TO: OTHER PIPE MATER — S CCT --- C�Fj RATING INS-FAILLERN —4. 4. REMARKS Q 41 ftb Rrt A. Sh Cf PPF3OVED r —'T5ATr LEGAL 7 2k0n 3 ,/Rev. 3/78) MUNN I K2 V TV 1-1 W FV*,:ON� DEPHRTMENT OF HEHLTH GND ENYIROMMENTHL PROTECTI�6111,��r� TYPE OF SOIL HBSORPTIGN 5YSTEM IP MENCH MHXIMUM NUMBM OF BEDRQQMS SOIL RHTING (SQ FT/BR)85 THE REQUIRED SIZE OF THE SOIL HBS RPT M I5� 7/ �W�W0� � ������� ����� � .� THE LNGTH DIMENSION IS THE LENGTH (IH FEET> OF THE TRENCH GR DRHINMIFLD. THE DEPTH OF H TRENCH QR PIT IS THE DISTRNCE BETWEEN THE 5URFHC£ OF THE GR3UND HND THE BOTTOM OF THE EXCHVHTION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES, THE GRAVE -1. [SPM IS F1INIMU1,.1 OF GRAVEL TFHLL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET), 1�. I lot EEV" X 17 - 1- TOP 1% d N.': ST 1: K MAE J. G) 121 Fly 151 1=1 R— U 121 RV 0 VE; PERMIT FPPLICHNT HAS THE RESPNSIBILITY TO INFORM 01I5 DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELL5 HDJHCENT TD THIS PROPERTY HND THE NUMBER 8F RESIDENCES THHT THE HELL WILL SERVE, F U3ITY ::il-: T% 90" Eli��������� BHCKFILLI�G OF MY 5YSTEM WITHOUT FINAL IMSPECTION HND HPP8OVHL BY THIS DEP9RTMENT WILL BE SUBJECT TO PROSECUTIQN MINJMUM DISTRNCE BETWEEN H WELL HND HOW ON~SITE SEWHGE DISPQSHL SYSTEM IS 100 FEET F8R H PRIVHTE 44ML OR 150 TO 200 FEET FROM 9 PUBLIC WELL DEPEWDING UPON TIE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM A PRIVHTE HELL TO H PRIVHTE SEWER LINE IS 25 FEET 1940f TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MW HPPL? SPEMFICHTIONS RKD COMSTRUCTION DIHGRHMS HRE HYHILHBLE TO INSURE PROPER INST9LLHTION V& M owl X W HE 1-1 to, 1. to? OAR top lot FEE 10 FEE XWT IS Eli F11 1. vim Q IL I CERTIFY THHT J. I #M FHTULIGT 100; THE REQUIREMENTS FOR ON~SITE SENERS HW) WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2: I MILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES 3� I UNDERSTHND THHT THE 010-5ITE SEWER SYSTEM tqHY REQUHRE ENLHRGMENT Hi TH� RESIDEMCE IS REMODELED TG INCLUDE MORE THAN I BEDROOMS MAIL 10017 NORTH SAW CONS& CO, ` �� SOILS LOG MUNICIPALITY OF ANCHORAGE •� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST \\ 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �p .i</ (.t��s d'!'DATE PERFORMED LEGAL DESCRIPTION: DEP SLOPE SITE PLAN 13 14 9 16 17 TH (FEET) Ro� 1 Depth to )k(t Ai 54' 4:f � 2 k9 • s� Ne t % 3 ff— �:`."' fir(` �ryS, V, 4- ��1 � �n wm �.a s •.:A R'f+tPiSCt'r a 5- 6 N 7- 8 9 10- 11 ag e 12 A-- c 13 14 9 16 17 Date Ro� Net Depth to )k(t Ai 54' 4:f � • s� Ne t % 18 ff— �:`."' fir(` �ryS, V, 4Vlt;A ��1 � �n wm �.a s •.:A R'f+tPiSCt'r a 19 20 COMMENTS WAS GROUND WATER l„� S ENCOUNTERED? L O P IF YES, AT WHAT E�``� DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop 4Vlt;A i. N ag C. c f U(� V WAS GROUND WATER l„� S ENCOUNTERED? L O P IF YES, AT WHAT E�``� DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop i. ag PERCOLATION RATE TEST RUN BETWEEN Te_ FT AND PERFORMED BY: CERTIFIED 72-008 (6/79) (minutes/inch) __ FT DATE: CHUGIAK ALASK{ "' pct w KODIAK, ALASKA . im 1688-3199 � � t x, 486 4826 g J� WE SERVE ALL ALASKA ' = :.POST OFFICE BOX 42 - CHUGIAK, ALASKA 99567 - - PerrV=Colter 345 OWNER OF LAND ............ ..................................... ..:..... DEPTH OF--WELL .... ........ ADDRESS,.... >� �7 V..� ........ .: S� r.� ..:. }, STATIC LEVEL OF WATER FT .....................................�� � WELL - SITE ..t a,'s..a �..,..!` :.:....... l ......, DRAW DOWN FT ��'.C�... lz....... _ DATE -STARTED ...... .8�'.... ........ GALS PER fiR3Dll� �.... . DATE -ENDED' 6-8-81,I KINA OF CASING (u SCh I:0/ •........ .... ....... .........• ........ ........y,yffiF ....... ......... KIND OF FORMATION FROM ......... ........ FT. TO .:� G ............ FT...SH,dd... ..CrY'�rVPli i FROM FT. TO . FT«...; `. FROM ........'. FT. TO ..: 16 ?IF FT..Clay FROM. FT. TO F ..(�......C.,.n........��. FROM :..2��.....'.. .. FT. TO :2 ............., FT...Fracttzred IR6c� FROM ....... ........... FT. TO .. F7"p?..;c ... 2% 304 Bedrock 1 FROM.... Z........ ..... FT. TO ... ......... FT .................... . << FROM ........................ FT. TO ......................... F -,! �.. FROM 304 ......... FT. TO 33? FT. }'racturad Rocs FROM FT. TO ...:.... ..: ... .......... .. ........................ - 7:...................... . F z FROM ... 35......... FT. TO 24?�... Sind ?)tonP W ..... FT.... ........ FROM FT. TO .. FT ................................ FROM...................... FT. TO ...................... FT.................................... ; FROM .................. FT. TO ........................ FT................................. FROM ........ ......... FT. TO .................`!.... FT..... .... ...... FROM .................... FT. TO ....... FT................................. ... FT.... ....... FROM FT. TO FROM .......:......... FT. TO ...................,. ......::...: .................. ....... ........... FT. FROM ' ................................... FROM FT. TO ..... FT. FROM ... FT. TO FT.... i FROM .................. FT. TO . FT. FROM .................. FT. TO FROM ..................... FT. TO ..............� ... FT........................ �� ........................ FT................................. MISCL. INFORMATION: ,QLD " rt 7mz,I)e"z2L DRILLER'S NAME ....................................... . ...... .......... ........ ..................... MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343'4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL 'FOR `A SINGLE FAMILY DWELLING Parcel l.D.# 6)— Q I --Q0 HAA# LkQ'� 1. GENERAL INFORMATION Complete legal description Lot,.3; ,13.2ock..6, .MeKi;itey Heights 01 Location (site addressor directions) 21830 Amon3on Chr�k AK Property owner Steve and Cheny2 Remme Day phone (w) 257-4259 Chen.yt 846-1446 Sieve Mailing address P.O. Sox 671094 Chugiak, AK '99567 (w) Lending agency Day phone Mailing address Agent Ethann Otdham DON�MCKENZIE REAL 'ESTATE Day phone 694-9035 Address 13135 02d Glenn Hwy Eagle Riven, -AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 1`' 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, providewritten confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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 #21 S. 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 oft is ins ection. Name of Firm Address Engineer's signature 17034 Eagle River Eagle faverr, Alairc 6. DHHS SIGNATURE - Approved for bedrooms. __— Disapproved. �— Conditional approval for Phone 69�rZ�79 _ Date bedrooms, with the following stipulations: Additional Comments —S_ E 6172�chtiD GyAIM W&u. ADV['60L 7� By: k)a(s( GM('n4 Date 3 Lz,q ■ •, 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 orderto 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. WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. PA C491.zd During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot _.3 _�_ of -v PTS Subdivision, the well's productivity was determi ed to be Oo LS'� gallons per minute. The minimum well productivity required by this department (AMC 15.55) for a � bedroom residence is 0,10gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of noncritical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. Municipality of Anchorage .� Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: U® -c '2-) '5 uv-- l,' WCL 14-14 o q &t I Parcel LD A. Well Data r� Well type \��Pv��th��'co If A, B, or C, attach ADEC letter. ADEC water system number_ � Log present &/N) Date completed Driller Total depth 3 5 Cased to t -\'r'6 Pa ( o a s c v-- Casing height 1 -z. - Sanitary seal O/N) Wires properly protected WN) Date of test Static water level Well flow Pump levell FROM WELL LOG U-0-lb1 min® AT INSPECTION -g-Ak -I,4�7 5- 1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ( o ®t ; On adjacent lots Absorption field on lot 1 0 cD ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line ? 1 Petroleum tank WATER SAMPLE RESULTS: W Coliform Nitrate 01/0 Other bacteria d 3- I- Collected b 5& S ENGINEERING Date of sample: y170TTEagle River Loofa Road No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed t" ' `b I Tank size 1 ®cbo Compartments ?-- Cleanouts&N) _Foundation cleanout/N) Depression (Y1 _ High water alarm (YC* t�Alarm tested (Y/N) Date of pumping \ � s - i Pumper --S: i�' LAS s P a �— SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot \ o C On adjacent lots � C.-> C) To property line \� t k Absorption field Surface water/drainage \ c> z' Foundation _Water main/service line S`" ` CONTINUED ON BACK PAGE 72-026 (3/93)* Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DIST, D. ABSORPTION FIELD DATA Date installed t `i—G.-,A t LIFT STATION TO: On adjacent lots Manufacturer Manhole/Access (Y/N) _ "Pump off" Surface water _Soil rating (GPD/Ft2) f3 S __System type Length _ Width S Gravel thickness _Total depth __ 9 Total absorption area '%(oo. Cleanout present &N) _moi Depression over field (Yo Date of adequacy test_ -4 ` `t `f _ _ Results sari-s7fail) for ( Bedrooms s U Water level in absorption field before test . 3 After test _ ! a - Peroxide treatment (past 12 months) (YM, ti6 r �, �� \—k J If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: 0, \A -- Well on lot \ y U On adjacent lots \ a Property line To building foundation _ 'Z k__ Tq existing or abandoned system on lot __ On adjacent lots \ Cutbank �� Water main/service line Surface water _ 1 G' \ ___Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or Signature a ENGINE"ri7 C 17034 kagl:. i op gad No. 204 Engineer's Name, Date HAA Fee $ 00 <c JO c- Date of Payment U)- l� - Receipt Number 72-026 (3/93)" Back r V and HAA guidelines in effect on the date of this inspection. Waiver Fee $ Date of Payment Receipt Number_ 0 \1 ------- ---- COMMERCIAL TESTING J& ENGINEERING CO. : NVIRONWEI,JT't'L. LARCIRATORY SE.RVIO,FS 5F?� =TWEET 5 S- Drinkin". Nater Analwis R(�i-JoT-t for Total Colitbr.m. Bactcriu AN,-HcDF-"ZE. AX�95.513 READ 1N,5TPL/CYY(,/`S ONRETT,'TRSE Ell)], TEL: (9'W) -.,52-2343 FAX: (907) 551-830t BF, COM -PL, TED RY LARORATOrRY Amelvsi: s-ows thusWatc- SiMAPLE to be: 0 PtT)3LTC WATER SYSTEM L D. V. PRIVATE NVATER 5VSTENT 0 11fp-'or' over 30 hours old, rc��Ls may L - ----------- b��. wi—lliable I it , m. er Sample too long in trans it; sample should r❑ not be ovcr 48 hours old at examination to indmeit 1-thable, resL�ts Please send neW smiple via Eqp�-M' dG,] IN. rYX1-11 '1. TY Tin -le Received 0 VandRay.Lts Analysts Began L 0 Number ofNj zrJ Lab Ref, No, Result, ii'pak'st Routinc r("at""d 'ItN'ater 0 Repeat Sample (foe VoutInc samt,0�, with lab re;. no. CntreaI`ed Water c Special Purpose Sjnt!,).AJ).R.c, (-"ArtchRiles Timecolle"red 4 S,-OITU LOCATION Collected By Client riolifo-d ofunsat!31-actciry rcsa)ts: 0 Number ofNj zrJ Lab Ref, No, Result, ii'pak'st 2- -T�j Sjnt!,).AJ).R.c, (-"ArtchRiles El Client riolifo-d ofunsat!31-actciry rcsa)ts: J Phoned $pokVith F it x cd Timc: BACTER101,C)GIC,4-L WATFR ANALYSIS RECORD NT-,N10-',1U,GRe5u1t: TtltBl CcPf.,,-m F-, coli A.Mernbrgnelilter: ml N-Wi5raficia: 1,7B BGR CG};FkI7� HI 7,N% - TcoYk.134'011 Final Membrane Filter Resulf,; Collfcj=ulof) ml Reported By61�z- Date III's Comments: Fres.hst3s SERVICES P4 A' ASK�, I, -CIB -Otho 3=�. a PART ONE OF TWO: REMAINDER TO FOLLOW ;A L� CT&I', Ref -4 Cliurt Srnnp I e TD Matrix Commercial Testing & Engineering Co. Environmental Laboratory ServiCes LA IC)RATQRY ANALYSIS i REPORT 044.9'7 iH-1 L:?B() M4cKTN':F,,'FEES ft, l IVA CEIL Chen(Nninc SL, SENO*Ih'TERIN(', wokk Order 76338 Clydcr(xi P} R. SUAF'ER Printed Dain ()3/)9/94 (u), 13:19 hrs. Pr jectNarr:e Collccdccllyate 03/07/94 ci 0 9: 10 hrs, Prnj< ciSf ; r 'd "p?:`;:: b3/(i7l94 (ci; 12;30 lu:a. P4WSIIJ 11A 1'rtdtzttC?) STFFHEN C.11lL' ( --__-------------- S Ile Rema) s ---_. — — _._ — --._ ...,_ ROti'rTNE 6?,i IPLLC'01 I.1 C'T)'l) } Y, PLAY. ------- --------�----�---..M,---- _ (1C Allowahle. Ext, Ancil Partunetcr Itcsults Qual Liui# Metllnd T.imits Date DaI.c Lnit Ni#rt1te-N 10 L- mS/l, I?PA 353.2/300.0 IU 03007/94 LLFI 9 See Special tnst!'LtlonsAbove UA=Unavailable *" See SanipleReinarksAhove NA Not Analyzed TJWUnl-Loctc:d,RrTortcdvalucislhegntcti:algw!Ltiiication hinit, LT=Lcs3Than . D = S ccon&&ry (Lh0 io;i. t . I = Cb u4ter 11) an 5633 6 Street, Anchorage, AK 99618-1600 — Tet: (907) 562-2343 Fax; (907) 561.5301 ENVIRONMENTAL FACILITIES INF ASKA, COLORADO, FLORIDA, ILLINOIS. MARYLAND, NEW JERSEY, OHIO, UTAH, WEST .' RGINIA q HEALTH AUTHORITY APPROVALS SEWER d WATER MAIN EXTENSIONS SEWER d WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST S.TE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER. P E ROGER SHAFER, P.E CIVIL ENGINEERS WELL RECOVERY TEST DATA 19071694 2979 FAX 694 121' 11 CLIENT: e,'CA t< t4, Zvi kP � WELL LOCATION (legal): t-or3 3 Le TEST DATE: 3 . a -1A� TESTED BY: � WELL DEPTH: 3 A S ` WELL DRILLER: �SW.,j L u -A kvus CASING DEPTH: DATE DRILLED: u - e -C61 TEST PROCEDURE: 1) Draw water down to pump. 2) Shut pump off 15-60 min. -record time -record meter reading 3) Turn pump on. Drawdown. 4) Shut pump off. -record time -record meter reading 5) Calculate gal./min. recovery. TEST DATA: START TIME: cA,o— MISC. DATA': 11J - Casing Height: 12 Sanitary Seal?: Wires in Conduit.: Grading O.K.?: Pump Depth: 3�NS Samples Taken?: — Date: 3 --1 -`ty STATIC WATER LEVEL: CAI TRIAL PUMP TIME METER GAL./MIN. 1 OFF \ �', 1 S Tan�f� ON OFF �J 2 OFF O ', fl n 2- ON OFF 3 OFF o 0 1 S, S 1 2 .6 y ti- C, C1. is M4t ON -- OFF Cl `1 ', � y -2- 4 OFF Lo ON OFF 5 OFF ON OFF RESULTS: WELL CURRENTLY PRODUCES: 1.5- i AK" --OAS P6� NQ FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR! 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Time Time ne Date Date Date Inspector Inspector Inspector Comments Conditional Approval 1 Date Sewer Installed Permit No. Septic Tank Size AD50 Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank`��� f APPLICANT FILLS OUT LOWER HALF ONLY Property Owner%�lZ_"� t C� —�7 Phone • � P •'y p -rte J J C Mailing Addre *t < &'7 Buyer Address Lending Institution' (� 1,!/� a i1� I �.(- (<! _ r( Phone Address Realty Co. & Agent Phone Address Legal Description Lo i Cle Street L cation TypeResidence Single Family ❑ Multiple Family No. of Bedrooms _ ther qru Watpplydividual ATTACH WELL LOG. A well log is required for all wells drilled since June Ll Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available.)____ SewaG6 Disposal Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ HoldingTank NOTE: THL INSPECTION PEE MUST" ACCOMPANY EACH REQUEST BE -FORE PROCESSING CAN DE INITIATED. CHEMICAL & G_ LOGICAL LABORATORIES . 2 ALASKA, INC. OJ F tNpEPF/y�f NT. TELEPHONE (907)-2794014 ANCHORAGE INDUSTRIAL CENTER '$ of -ee 274-3364 5633 B Street z #r n 4eOR^roR1eS Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER: TO BE COMPLETED BY LABORATORY WATER SYSTEM: Analysis shows this Water SAMPLE to be: I.D. NO. ❑ Satisfactory ❑ Unsatisfactory Water System Name Phone No. El Sample too long in transit; sample should -b 48 hours old at examination Mailing Address City State -. Zip Code L I SAMPLE DATE: m I Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose El Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 1 2 3 4 5 064220 (b) Rev. 1978 Date Collected _ READ INSTRUCTIONS Date Received_ Presumptive 24 Hours BEFORE COLLECTING SAMPLE not e over ou to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: • Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result" Analyst l I m M FTI M +Noof colonies/100 ml. or No of Positive portions. BACTtRIVLUG ICAL WAI CH ANALYWI n4l.vRu Multiple Tube Report: Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results - Reported By _Time Received _ 10ml 10ml Source a.m. -p.m. Lab. No. l.Oml I 0.2ml Broth 24 hours: Broth 48 hours: 10ml Tubes Positive/Total 10ml Portions Date coliform/100ml p.m. CHEMICAL & G. LOGICAL LABORATORIES F ALASKA, INC. r.NOE o TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER �` 90 J i.4 274-3364 5633 B Street ueoaarowiee Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER -` TO BE COMPLETED BY LABORATORY WATER SYSTEM: Analysis shows this Water SAMPLE to be: I.D. NO. EJ Satisfactory ❑ Unsatisfactory Water System Name Phone No. ❑ Sample too long in transit; sample should not be over 48 hours old at examination Mailing Address to indicate reliable results. Please send new sample. City State Zip Code m Date Received SAMPLE DATE: W Mo. Day Year Time Received SAMPLE TYPE: Analytical Method: ❑ Routine ❑ Check Sample (for routine sample El Fermentation Tube With lab ref. no. ) ❑ Treated Water ❑ Membrane Filter ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected Lab Ref. No. Result' Analyst NO. LOCATION Collected By i m 2 I I ED 3 I l m 4 I t i I m 5 I I i I m *Noof colonies/100 ml. or No. of Positive portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source READ INSTRUCTIONS a.m. Date Received Time Received P.M. Lab. No. Presumptive l oml l oml l om l l oml I l oml 1.0ml 0.1 ml 24 Hours BEFORE - 48 Hours fl confirmatory 24 Hours 48 Hours EMB Broth 24 hours: Broth 48 hours: COLLECTING SAMPLE Multiple Tube Report: 10ml Tubes Positive/Total 10ml Portions Membrane Filter: Direct Count Coliform/100m1 Verification: LTB BGB Final Membrane Filter Results Coliform/100m1 Reported By Date p.m. CHEMICAL & GL LOGICAL LABORATORIES ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER J — 274-3364 5633 B Street Se� .. 't. 4 �t ueO ..... Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: Analysis shows this Water SAMPLE to be: I.D. NO. ❑ Satisfactory ❑ Unsatisfactory water System Name Phone No. ❑ Sample too long in transit; sample should not be over 48 hours old at examination Mailing Address to indicate reliable results. Please send new sample. City State , Zip Code C E= SAMPLE DATE: tom- Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By Y 2 3 4 5 Date Received Time Received Analytical Method: Fermentation Tube El Membrane Filter Lab Ref. No. Result' Analyst � l m � � m m *No. of colonies/ 100 ml. or No. of Positive portions. 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source READ INSTRUCTIONS a.m. Date Received Time Received p.m. Lab. No. Presumptive loml I l Oml I l oml I l oml 1 l Oml 1 l.Oml BEFORE �o ;81 EMB Broth 24 hours: Broth 48 hours: COLLECTING SAMPLE Multiple Tube Report: 10ml Tubes Positive/Total 10ml Portions Membrane Filter: Direct Count Collform/100rn1 Verification: LTB BGB Final Membrane Filter Results Collform/100m1 Reported By Date p.m. 6 FAUNICIPAI_ITV OF ANCHORAGE DLPAR'9'MENT OF HEALTH AND ENVIRONMENTAL PAOTI CTIOW6 LMVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON SI'r E SEWI._R AND WATER FACILITY 264-4720 Application Dater -- 1. GENERAL INFORMATION (a) Legal Descrption (include lot, bloc,lc, subdivision, section, township, range) Location (address or directions). / (b) Applicant Nam!�� Telephone: Borne f� f ' Business — Applicant Address (c) Applicant is (check one): Lending Institution El ; Owner/builder ; Buyer ; Other 0 (explain); (d) Lending Institution Telephone Address----------�===-=--�----------- - -- -------- (e) Heal Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF F.E sIDENC E Single -Family Multi -Family D Other Number of Bedrooms __----_.'-------_.--- 3. WATER SUPPLY Individual Well ,,J Community E.7 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 Public 0 Community U Holding Tank D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72 025 (11/84) Page 1 of 2 5. ENGINEERW). FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, IATA AND 1NFOnMATION 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 Telephone Address------------------— -------------- ------- Date DHEP APPROVAL bedrooms b Dc� G Approved for --.--..--bedrooms y r-=------ e Approved _____.--__.._ Disapproved°_--__—_— Conditional Terms of Conditional Approval The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based salely 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 72-025 (11/84) 1•'i.RNi0i1,Li i ( OF .,NIQ R )RAGc MUNICIPALITY OF ANCHORAGE (MOA) [)LPT. OF i ii:/,i 51 & HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: f A. WELL DATA N rI Well Classification �If A, B, C, D.E.C. Approved (Y/N) d Q Well Log Present6qDN) Date Complete , Yield Total Depth �'� + Cased t Depth of Grouting Static Water Level Pump Set At J 4 Casing Height Above Ground Electrical Wiring in ConduitdY/N) Separation Distances from Well 1 e>" Sanitary Seal on CasingQ.'irN) Depression Around Wellhead (Y/kQ To Septic/UDW rM Tank on Lot On Adjoining Lots ti To Nearest Edge of Absorption Field ontot t ��' On Adjoining Lots 1 Ort 4 To Nearest Public Sewer Line A, To Nearest Public Sewer } Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by �� ; Date Water Sample Test Results Comments A q1��,•p P, N B. SEPTIC/ TANK DATA Date Installed LO Size t No. of Compartments Standpipes CV/N) Air -tight Caps®/N) Foundation CleanouteL?YN) Depression over Tank (V4Q Date Last Pumped 10 — I e:N Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) ® Temporary Holding Tank Permit (Y/N) — Separation Distances from Septic4Hakti4>- Tank: t To Water -Supply Well 1aC:) To Building Foundation t, To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) To Disposal Field 1t4 t 10 -Y- To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata —__. I� Type of System Design Date Installed b -f46_ Length of Field _ -.7- n , Width of Field — Loz:) Depth of Field - ---- N Gravel Bed Thickness Square Feet of Absorption Area _—__ 2(�rCS`�' Standpipes Present/N) Depression over Field ✓ fJ�______ Date of Last Adequacy Test -Z- Results ZResults of Last Adequacy Test Separation Distance from Absorption Field: to Water -Supply Well _ l `aptt +_ _ To Property Line Jo Building Foundation Lot __ rJ /A ---- --- i "I o Water Main/Service Line_L-c-_> _ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. (LIFT STATION Date Installed _ To Existing or Abandoned System on On Adjoining Lots 3 C�:, I'r" To �utbank (if present) —_ Aa N /A I� Dimensions 11 Size in Gallons __-- Manhole/Access (Y/N) "Pump On" Level at ___ _ "Pump Off' Level at High Water Alarm Level at ___ - _ Vent (Y/N) Tested for — _ - - — Pumping Cycles during Adequacy Test, Meets MOA Electrical Codes (Y/N)__- Comments "" Check Permitted Bedroom Rating Against HAA Request "" I certify that I have checked, verified, or conformed to al I MOA and HAA guidelines in effect on the date of this inspection. Signed ___--- Date Company, MOA No. U� Receipt No. -- 6t' "9 6'21- DateofPayment—_1%47_i/F5 Amount: $ - -" - ng e r' Se ll Page 2 of 2 72-U26 X11/84) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street uwowwrow¢e Drinking Water Analysis Report for Total Coliform Bacteria " TORY TO BE COMPLETED BY WATER SUPPLIER (•) See h on back WATER SYSTEM: I.D. NO. J � Phone No. Water System Name � j � rj Mailina Address &/In City State Zip Code =1- SAMPLE DATE: % [ Mo. Day Year SAMPLE TYPE: Routine ❑ Check Sample (for routine sample t ❑ Treated Water with lab ref. no. Untreated Water ❑ Special Purpose SAMPLE Time Collected NO. LOCATION Collected By �.i-17 3 6Ilt6-, %l�`J����J; �I'/fi7�s cm1) m g 2 I 3 4 5 TO BE COMPLETED BY LABORA Analysis shows this Water SAMPLE to be: 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. Date Received _ Time Received _ Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result' Analy t I m I m j m •Noof colonies/100 ml or No of Positive pomons 061220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1983 READ INSTRUCTIONS Membrane Filter. Direct Count Coilforml100ml Verification: LTB l BGB Final Membrane Filters es / C�ollform1100m1 BEFOREReported By ✓�_Date� Time: a.m. p.m. COLLECTING SAMPLE TNTC = Too Numerous To Count