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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 12 LT 1AMountain Park Estates Block 12 Lot 1 A #017-441-49 GRE ER ANCHORAGE AREA BOr UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON—SITE SEWAGE DISPOSAL SYSTEM _ NAME l��e//UG LO'79Jj/,P1-1e11I��M &I NG ADDRESS �n /CJ GJ. PHONE LOCATION LEGAL_ DESCRIPTION Xf.S SEPTIC TANK: DISTANCE / FROM WELL 7 MANUFACTURER /i/ M J/(/ MATERIAL NUMBER OF COMPARTMENTS_ INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /SSG GALLONS. SEEPAGE PIT: .01 9 G2/)" " / /Y X / Z J; a Jr /oC /S X / NUMBER OF PITS _. DIAMETER OR WIDTH LENGTH=, DEPTH 1 / LINING MATERIAL�N� s. �� �U RIB SIZE: DIAMETER—/DEPTH--2—DISTANCE FROM: WELL GG / / TOTAL EFFECTIVE BUILDING FOUNDATION Z0 NEAREST LOT LINE G _ . ABSORPTION AREA (WALL AREA) d �� y — SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE CONSTRUCTION d DEPTH DISTANCE FROM: BUILDINGNEAREST NEAREST n FOUNDATION �� LOT LINE 1 SEWER LINE /Z!/F SEPTIC / TANK L/ / n 7/ SEEPAGE SYSTEM CESSPOOL_ w OTHER SOURCES APPROVED DISAPPROVED_ REMARKS,�ST��'<Ie,7-/z�/J Gf(,UPl<C AO ��f//�i�cr�diOJ DISTANCES: S111)wy _ DIAGRAM OF SYSTEM INSTALLED BY: Oil/f/c/2 PIPE MATERIAL: Ct9STr�O�� _ LOT SLOPE: Sl_ REMARKS: /0/ ////Z --,i :/de -7 iU Form No. EQ -031 /ON VI J/NG.Gc fvrr/,c% � 7/ ,-'a ,-'Qr i11t16 .211 DATE ZZ73APPROVED a G.A.A.B. M mW DRILLING, Inc. P. O. Box 4-1728 ® 2811 Dawson A C 907-279-1741 ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner... — _ .v,..., _._ _ hf� 044/0 Use of We1L ,-,T Location (address of: Township, Range, Section, if known; or distance main road Y r De Size of casing p th of Hole r^2 feet.. Cased to feet —�—_ Static water level r• ft. (above) (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( ). Describe screen or perforation_ Ione Well pumping test at_—} -__gallons per (hour) (minute) for 1 hours with i rnd ft. _• of drawdown from static level. Date of completion ? WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO�- -—To, r . —TO-- --TO- -TO- -TO- -TO- -TO- --TO- ---.TO- -TO- --TO- clay O—TOTOTOTOTOTO__TOTOTO o' r'lo r•nn�il An rl. r* -n,1 Y•�Pn ^�c a(14rt n"��. ��, 1,""tly C�flVR�,_ 3 — Contractor GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO, % ILJ 3330 "C" STREET ANCHORAGE, ALASKA 99503 Ir7I IIII'n(/\)) TELEPHONE 274-4561 ell 1I ✓ eiF a YYY II �MI310 IAM,'0 SEWAGE DISPOSAL SYSTEM d-- APPLICATION AND PERMIT NAME OF APPLICANT 1._3l_!l_//_%P71/7 //% ?��^" 10A I.- Al INSTALLATION LOCATION LEGAL. DESCRIPTION INSTALLATION OF: SEPTIC TANK _ ✓- SEEPAGE PIT __� DRAIN FIELD _._., OTHER TYPE AND SIZE OF FACILITY TO BE SERVED ' 1 J- <-/ FINANCED THROUGH — � ����� ���_4 -------___ TO BE INSTALLED BY �_�e_Z44_ SOIL TEST RESII LTS �!_.iJl..yr�lC.NOTE; 'I'I^IIS PERMIT 1> NOT 1/j�l�jY) VJI Y'HOAJ'r ,OIL, YE;Si ,1 COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTkM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, Nb.�YG ` ms's /---1_ _— SEPTIC: TANK SIZE _ /L/U TYPE SEEPAGE SEEPAGE AREA SIZE: _— TYPE .✓_�o—o1_7 MINIMUM ETIs-fAi',jcEs, Ru.ouIREmEN'rs FOUNDATION l'O SEPTIC TANK_ FOUNDATION TO SEEPAGE Ply DRAIN FIELD _/0 TANK TO SEEFAGE PIT WALL J / � SEPTIC; TANK __ ti SEEPAGE PIT if v DRAIN FIELD 16 TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD _— WATER MAIN TO SEPTIC TANK { DRAIN FIELD --/�_I_ SEEPAGE PI7 _L 0 ALSO CONSIDER AREA WELLS. l SEEPAGE PIT 11 , SEPTIC TANK, _00 SEEPAGE PIT DRAIN FIELD I'D RIVER, LAKE, STREAM. CASTIRON 'NTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL 13AOKrILL CONFORM l'O BOROUGH REGULATIONS REGARDING INSTALLATION. f 1 OR /- LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT i AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. I, DATE v sem'--!) '._ APPLICANT'S SIGNATURE FORM NO. EQ -016 1101 now"Is 8 (WISTIon 1 . (7 (� , 1 229 EASI 5h.i. AV��. P.OUO} 6(;�) - AN'Cl 10U1,G[;, /,,I Civi), NIA1 CC)LfitP- JM,A�,'� M!�, u, s It 2 L :1.973 R & Nc) , 36649 hl A)"AhOnW, Pacific 15 1 7 Saward HighwEly 19) (3 99!; Quc i>EPT. L�� V arm! ].C)gf R(:PorL Eor S'a1i.11..&r)' c S, I at At 2 12, blourilmin Per], immmij, Owar Sjon-, a --r-0 SlIjbiltitting herc�vj.jjj tjjc! Le, hor -3 ] -'-j L. j- ing re� L' -i:s c111( -z Olt]: Liorn.ji encolinLececj at 'Lhe subject - jj si L e This invest-iga"Aon \as _,.yiP ,-tco \:,j. L j-, of 15, 1973, ancl j--j'OE;c! )-)rOC--dU:ueS aalclirird ifl a IcLto-:r da Led 1-3, 1971. by Mc. Rolf H-Ic1 G7eaLer Ancho I-E'cj(' Area Elorollyh D,parLmFant- (-)i C)Ll;.-Al d. Ly '. c: -,L hole vasa u o 11 wd 2 of Jc'.' 'J ccl J. '�jel-cnczll sill )SUMOICE! I 1111culd cr sysWon, SM TACOWARM Ci 11 1_Aws Qw- c ". JQS ;A(;C;Cpgp:l '.Si]. C). Q ttj ' Line Lost 110Ae OL of 13 , Cwb 1,21cm1-inal ir)Qj Cc Fr)j- Lh in Drwing w, -0j_ l-iaS JACK MCOLIMerEwl irl jf1p LCIE3p, IjCq' z A. 1ACCID yon, 1111culd YOU.11avo sej:vi Lc) L11c P 6-0 DO L 1-10A (' D E. z A. 1ACCID O!"G"�NriC Sl[,T �j 6 0 0 VT D,' C,flAVI'j-, G J yll) I p. o. R&M EN( 4EERING & GEOLOGK tL CONSULTANTS 229 EAST 51st. AVE, — 13.0. BOX 6087 — ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 TELEX 090-35419 Civil Engineers Geologists Land Surveyors JAMES W. ROONEY, P. E. RALPH R. MIGLIACCIO MALCOLM A. MENZIES, P,E., L.S. Engineering Geologist JAMES H. WELLMAN, P.E. September 17, 1973 Mr. Ray Mizer Northwest Pacific Construction Company 4517 Seward Highway Anchorage, AK 99503 R & M No. 36628 SEP 197J ASA Re: Lots 1 and 2, Block 12, Mountain Park Estates Dear Mr. Mizer: GREATER ANC1-IbRAGt ARLA 9t)R0Uf;W DEPT. OF ENVIRONMENTAL QUALITY In response to your request, we are submitting our comments on the probability of encountering a ground water table within a depth of 17 feet below ground surface at subject site. During excavation and logging of test holes, there was no indication of gound water below the immediate base of the hole which was termi- nated at a depth of 13 feet. Since the soil was relatively dry, we do not feel that the water table was located within the upper few feet below the test hole base. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS William E. Duncan /J7amesW. Rooney Laboratory Manager tner WED:JWR:ph xc: GAAB - Attn: Mr. Ronni L. Kinneenl ANCHORAGE FAIRBANKS JUNEAU Parcel I.D. 017-441-49 Municipality of Anchorage On -Site Water and Wastewater Program (907)'343-7904 Certificate of On -Site Systems Approval Expiration Date: 1. GENERAL INFORMATION Complete legal description Mountain Park Estates, Block 12, Lot 1A Location (site address) 6130 Nenana Place Current Property owner(s) Ekuk Alaska Salmon Day phone Mailing address 6130 Nenana Place Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual F Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNanance request for: Received by: 1 / U/w Lu kA Date: d ?d S COSA to be released to the en ne , unless otherwise requested by the engineer. COSA Fee $ 45? -%o Waiver Fee $ �l i Date of Payment 64115- i Date of Payment Receipt Number 63(0 Receipt Number COSA # cerci 5 Waiver # 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, based on procedures outlined in the Certificate of on -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being. served by the system. These conditions are outside the control of the evaluator of this system. All systemseventually fait and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole. benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 04(10/15 #: 49 6. DSD SIGNATURE System #1 Approved for bedrooms $/evert 1f.'Pa r Y PP — J— tf CE -8149 System #2 Approved for _ bedrooms Disapproved h�h� Conditional approval for bedrooms, with the following stipulations: By: n Original Certificate Date: L -5 The Municipality of Anchorage D4elopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_: [- c If more than 1 septic system is on the lot: COSA Checklist # + of Structure served by this system 1 'Certificate of On -Site Systems Approval -Checklist Legal Description: Mountain Park Estates, Block 12, Lot 1A Parcel 10:017-441-49 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 10/24/1973- Sanitary seal (Y/N) Y Wires properly protected (YM) Y Total depth 302, ft. Cased to 135 ft. Casing Height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of teat . 10/24/1973 04/08/2015 Static water level 145 ft 140 ft Well production 1 g.p.m. 1 g.p.m. WATER SAMPLE RESULTS: Coliformcolonies/100 mL Nitrate 111.6 mg/L Arsenic l uglL Date of sample: i Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Mate0al Septic/ concrete Tank size 1250 gal. Number of Compartments 1_ Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 04/01/15 Pumper Isaacs Pumping Service Date installed 10/26/1973 C. ABSORPTION FIELD DATA Date installed 10/26/1973 Soil rating (g.p.d./fta orftz/bdrm) 225 sf/br System 4ypeCrib Length 27 ft. Width 21 ft. Gravel below pipe 9 ft. Total depth 11.4ft. Eff. absorption area 864 fe Monitoring tube Y Depression over field N Date of adequacy test 04/08/2015 Results (Pass/Fail) PASS For 4_bedrooms Fluid depth in absorption field before test 26 in. Water added 615 gal. New depth 26 in. Elapsed Time: 220 min. Final fluid depth 26 in. Absorption rate >=600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum 111 Size in gallons _ "Pump off"level at Cycles tested _ Manhole/Access(Y/N) in. High water alarm level %it Meets alarm & circuit requirements?' E. SEPARATION DISTANCES WELL - ON -LOT TO: Septic tanktlift station on -lot 100+ On adjacent lots 100+ Absorption -field on tot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ONLOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surfacewater 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Its an odd shaped crib. See inspection report. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 04/10/2015 COSA canary sheet_2-6-15.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ in. i NOTE: 1. Dimensions are measured to the wood trim. 2. Offsets are measured to the foundation corners. I hereby certify that an accurate survey of the following described property: MOUNTAIN PARK ESTATES SUBDIVISION (79-258) LOT 1A, BLOCK 12 was made on August 27, 2015 and that the improvement: situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Easements other than those shown on the record plat may not appear on this drawing. Anchorage Alaska, this 31st day of August 2015. Aonument SCALE : 1" = 30' 0' 15' 30' 60' PREPARED FOR: PANNONE ENGINEERING POST IN A CONSPICUOUS PLACE ALL WORK MUST BE INSPECTED Field Inspection Request required 2 working days in advance of starting work and 2 working days in advance for final inspection. Cali (907) 343-8206 (voice recorder) for scheduling. Permit is not valid without the call-in and also must include the one -call ticket (utility locate) number. MUNICIPALITY OF ANCHORAGE RIGHT OF WAY DIVISION RIGHT OF lWT R152339 Type Enctmnt- - X12838 `,Date Fsed: 9/9/2015 ., Construction Start= =.w: Last Update I PWDEW Last Updated. `69109/2015 Contact 61 SALMON Legal0escilption: MOUNTAIN PARK ESTATE�K A O"rl9I I Work gqg ©esCriptron Encf Oment of an absor t l ; " <:I See reverse for requirements/remarks. I have read and understand both sides of this permit. I agree to the terms and conditions; and I certify that all work will comply with federal, state, and nicipal codes and regulations and the provisions of this permit. Signature: e� r 9 ( Date: Zy /S (+£.L - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES ON I 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 i 7 I `I l- �I I HAA # Parcel I.D. fY 1, GENERAL INFORMATION t 1 1� l3 K 1'2_ Complete legal description+ l I Location (site address or directions) I e t C� Day phone 3 y - o�.� Property owner Mailing address Day phone Lending agency Mailing address Agent — Address — Unless otherwise requested, HAA will be held for pickup. -5 �l 2. NUMBER OF BEDROOMS: — 3, TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site —— Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 021 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm `; Y l<_I c Phone Address r= Engineer's signature �l ��'C, �_J Date6­//A— ---___ 6. DHHS SIGNATURE 1L Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments - -�-—�N..L1J1UjjL U1 neaitn 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 riot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1N1) Back MOA 1121 Municipality of Anchorage *04- Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: r i' Parcel I.D. �� I.-� . L4 IN , I A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Date completed Log present(Y/N)— t' �r'/ �' Driller Total depth j «' . Cased to I `= ` Casing height Sanitary seal (Y/N) _Wires properly protected (Y/N)— Date of test Static water level Well flow Pump levell FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: AT INSPECTION t/ g•p•m< r` -+i Q:7 M < 3 70 c o z � n 3 7 D Lbw A O Tz' J: o c x �c m Z Septic/holding tank on lot 112 ; On adjacent lots Z / C2, Absorption field on lot 1 t ; On adjacent lots ! Public sewer manhole/cleanout I / A, Public sewer main "; Sewer service line r) Petroleum tank WATER SAMPLE RESULTS: Nitrate Other bacteria — Coliform Date of sample: ) "' ` ' Collected by: — 13, SEPTIC/HOLDING TANK DATA I o , /-`1 ;; , Compartments I Date installed Tank size _ Cleanouts (Y/N) `% Foundation cleanout (Y/N) / Depression (Y/N) High water alarm (Y/N) t:'>>• Alarm tested (Y/N) Pumper Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots ' r' Well(s) on lot i I T', -- Foundation I t -- To property line _Absorption field j �, Water main/service line Surface water/drainage i<,1 () CONTINUED ON BACK PAGE 72-026 (3/93)` Front C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: "Pump off" Level at Cycles tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed , /t2) rating (GPD/Ft2) Length ? I Width Gravel thickness Total absorption area L,'' Cleanout present (Y/N) Date of adequacy test ' Results (pass/fail) System type r ,30r�,r-r" , t_J Total depth Depression over field (Y/N) T-1 for Water level in absorption field before test '15' j After test 1"i 1 Peroxide treatment (past 12 months) (Y/N) )NJ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot i t.% On adjacent lots > /0-0 Property line To building foundation ": t To existing or abandoned system on lot e), ? " On adjacent lots t:' Cutbank 1 r I Water main/service line Surface water1 % ' ?r' Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION Bedrooms l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in egfe -,on1hp date of this inspection. Signature rJr e r 4� �,• Engineer's Name �> Date %i ql t p 9 :cy HAA Fee $ Waiver Fee $ Date r of Payment Date of Payment Receipt Number C2,S 0 6 / Receipt Number 72-026 (3/93)' Back CT&F Ref.N Client Sample ID Matrix Client Name Ordered By Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.2588-3 LlA BLK12 MPE V WATER TOBBEN SPURICLAND, P.E. UA Sample Remarks: ROUTINE SAMPLECOLLECTED BY: T.S. QC Parameter Results Qual ihtits Nitrate -N WORK Order 78891 Printed Date 06/01/94 cD 16:11 Ins. Collected Date 05/27/94 @16:30 Ins. Received Date 05/27/94 @ 16:45 Ins. Technical Director STEPHEN C. EDE Released By:3' Method 0.78 mg/L EPA 353.2/300.0 Allowable Fxt. Limits Date 10 ------------------- * See Special InstntctionsAbove UA=Unavailable ** See Sample Remarks Above NA=Not Analyzed U = Undetected, Reported value is the practical quwiti tication limit. LT= Less Titan 1) = Secondary dilution. GT = Greater Than Anal Date Init 05/31/94 CMR 5633 8 Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA COVIMERCIALTESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Drinking Water analysis Report for Total Coliform Bacteria REA-D INSTRUCTIONS O. ' REpc PSE SIDS BEFORE COLLECTING SAMPLc sc%I ss< zs FF,X: ;3371 55755.1 \.UST BE COMPi LE17ED BY NVATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. ❑ PRIVATE WATER SYSTEM ❑ Send Resins G Send Invoice ❑ Send Invoice � v svz::. Result' none: un.ocr ; az; umor. Gr: I Routine ❑ Send Resnls ❑ Send Invoice � > Result' M• q he.' s Day Year Gr: caSLEDaiE: � > Result' Month Day Year S A UDLE TYPE: Routine .'enc =bks ❑ Treated Water / ❑ Repeat Sample (for routine sample ( Untreated Water with lab ref. no. ) r Special Purpose Time Collected LOOCATION Collected By iSAINIPLE TO BE COMPLETED BY LABORA LABOR"T ORY A fa osis shows this Nater S-3 LHE to be: 'Scrllactory / ❑ UasatisfactorJ ❑ SamDle over 30 hoilrs old, resu1 is may beunreliable ❑ Sa; role too lone in transit sa ...-!e shoLd not be over 43 hours old at to indicate reliable res._i`. ierst send new sample iia <_peci l Date Received S Z G1 Time Received is Analysis Began MAY 2 7 1924 Anal}'tical -Method: _ Nurnber of colonies/100 r:1. Lab Ref. 4o. Result' Analyst _� Sentto.4D.E.C. .'enc =bks �c^: Fzscd D.ae: n -:e: Client notified of unsatisfactory results: ❑ -I Phoned Spoke eirh ...sec Date: Time: BACTERIOLOGICALWA-TER ANA -LYSIS RECORD Lti10--ILiGResult: Total Cchfcrm Membrane Filter: Direct Count Verification: LTB Fec21 Coliform Confirmation E. Coli 6 Coionies/100 ml -C=- rcC�_:: BGB COLEM- G3 = 0:�, 3-c.'c Fina! Membnne 'ter Resells Colifarm/100 ml Reported Bs' D2te {;;{(('J 4 199A Time hrs Ce�._�eats: PART ONE OF TWO: _ REMAINDER TO FOLLOW INSPECTION APPOINTME=NTS I DA INSPECTOR INSPECTOR / / l INSPECTOR Or Al,�-_' r MUNICIPALITY OF ANCHORAGE I — DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION " t -HON 0 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL- SANITATION DIVISION Telephone 264.4720i1sE REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts oil page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER r PHONE VIAILINGAnnnFc-� cam— "�" {�-- �— n 34/ LI MAILING A 4._REALTO MAILING ADDRESS LEGAL DESCRIPTI STREET LOCATION L dp,wa ai 4?cp 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ MULTIPLE FAMILY ❑ Two ❑ Five 7. WATER SUPPLY' Three ❑ Six _ INDIVIDUAL.* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well _ ❑ PUBLIC UTILITY _ depth (attach 109 if available.) B. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** �`3_YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 5. COMMENTS Lj?APPROVED FOR —3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED n _„ —. Ioe a/791 ❑ OTHER THIS SIDE FOR OFFICIAL USE ONLNO NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE ❑ ONE ❑ THREE ❑ FIVE ❑ SINGLE FAMILY ❑ SIX El MULTIPLE FAMILY EJ TWO ❑ FOUR PERMIT NUMBER 2. WATER SUPPLY ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE DATE INSTALLED ❑PUBLIC UTILITY Connection Verified INSTALLER ❑Septic Tank or ❑ Holding Tank Size: ��� If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL C. l Septic/Holding Tank Absorption Area Sewer Line 4. DISTANCES WELL TO: Ahcnrotion Area to nearest Lot Line 5. COMMENTS Lj?APPROVED FOR —3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED n _„ —. Ioe a/791 ❑ OTHER ALASKA CnUIROMPTRL COnTROL SMUS, InC. Engineering & Enuironmental Studies 1220 West 25th Ruenue • Anchorage, Alaska 99503 • (907) 276-1361 is 1220 West 25th Ruenue • Anchorage, Alaska 99503 • (907) 276-1361