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HomeMy WebLinkAboutMINDYER MANORS BLK 1 LT 2Onsite File MUNICIPALITY OF AjNCHOII E / On -Site Water & Wastewater Program PO Box 196650 17u0Elmore Road Anchorage, Alaska 99519-6650 Phone: 343-7904 Fax: (907)343-7B97 Permit Number: (]Sp191228 Work Type: GephnTankUpgnnde Tax Code Number: 02009163000 Site Legal Address: K4\N8YERMANORS 8LN 1 L 2 {S:3336 Site K8e||ing Address: 4741 VIRGO AVE, Anchorage Owner: 8ARRGLEN A Design Engineer: GARNE8SENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: 2.03KIWO 6/1712020 M Disposal Field 0 Septic Tank 0Holding Tank 11 Privy 171 Private Well 17]Water Storage All construction shall be7naccordance 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 (18AACDD) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.GG.Provide notification bycalling (B07)343 -79O4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall baeither: o. Opened and Closed onthe same day, or b. Covered, sealed, and heated boprevent freezing CSpecial P,ovimions:ThewmUthathmnutinuwoohaUbedeonmniunionodper15.S5phorVoinypedionneport approval. Please submit decommissioning log. Received By: Date: -----___ -_ Issued By: Da te pl& iag. '' MUNICIPALITY OF ANCHORAGE Community Development DepartmentPhone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application r� For A Single Family Dwelling Parcel I.D. ORO- `-(p3 Property owner(s) NICK PLESS (BUYER - OWNER DECEASED) Day phone 350-3468 Mailing address 4741 VIRGO AVENUE, ANCHORAGE, AK 99503 Site address 4741 VIRGO AVENUE, ANCHORAGE, AK 99503 Legal description (Sub'd, Block & Lot) MINDYER MANOR S/D; BLOCK 1, LOT 2 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 1 (SEPTIC SIZED FOR 2) APPLICATION IS FOR: (®all that apply) Waiver Fees: Date of Payment: APPLICATION IS AN: TYPE OF DEWELLING: Absorption Field ❑ Initial ❑ Single Family (SF) Septic Tank ® Upgrade ® (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) E] Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: NONE Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd (Signature of property owner or authorized agent) Permit/Rush Fees: r� Date of Payment: �P�/d ��9 Waiver Fees: Date of Payment: Receipt Number: /� ���Q� Permit No. �g �` 9 `O� a� Receipt Number: Waiver No. (Rev. 01111) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191228, Rebecca Carroll, 06/18/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191228, Rebecca Carroll, 06/18/19 ZOTI N895 -9'30'E42797 L0T2, 8L0CKI MIND YERMANORSSUB. 49 TH �0 * 0 ANCHORAGE RECORDING DISTRICTALASKAAND THAT THE �- VISIBLE IMPROVEMENTS S , , ITUATED THEREON ARE WITHIN .D. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 29TH DAY OF MAY , 2019 IA SURVEY SHANE A. HOLT �a t �4 P LS -6914 CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 14244, FB 196-72 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol ~ GeophysicolSurveys Drilling Permit No. LOCATION OF WELL (Please complete either lo, lb or lc.) A.D.L. No. la.llBorough Subdivision Lot Block ib.ll I/4qtr$. Section No. Township N[~ Rcnge EF-~ Meridian Mindyer Manors 2 i -- of-- of--of -- S [] W[] ,c.Jl DISTANCE AND DIRECTION FROM ROAO INTERSECTIONS 5. OWNER OF WELL: Virgo Address: HUD Street Address and Area of Well Location Feet Below ~,. WELL DEPTH: (final) 5. DATE OF COMPLETION 2. WELL LOS Surface 307 ,,. 4 - 18 - 88 Material Type Top 8ottom ~Stick-up 0 2 e. ~co~,. too, ,o,~ Driven ;~velly silt 2 15 ~ Auger ~ detted ~ 8ored ~ Other: silty sandy water and ~vel 15 18 7. USE: ~ Domestic ~ Public Supply ~ Industry ~obbly 5~velly silt 18 23 ~ ,m~t,o. ~ ,,~,~re. ~ Co~m~,~, ssndy silt 23 25 ~ ~.,~ w.,, ~ 0th,~: bedrock 25 307 8. CASING: ~ Threaded ~ Welded ai~. 6 i.. ~o 28 ft. O~p,h W.iaht 28 ,b,./.. diam. in. to ft. Depth Stickup~ft. 9. FINISH OF WELL: Type: ope~ e~d Diameter: 6Il Slot/Mesh Size: Length: A s~ll portion of water ts ~ set between ft. ~,d ft. coming From the s~ce of bedrock~ Backfilling Gravel pack Approximately 4~ with re~sini~ ,o. ST*T,C W*T~, LEWL: 8 f,. 4/22/88 5~ co~*ing from 240-245. / ~ A~ow or ~ e~,o. ,~.a ~u~=c* ~'* / Equipment used: sounde~  i1. PUMPING LEVEL below land surface and YIELD 280 ,. ~,.~ -- ~r,. ,~,i~a ,25 ~.,.~. L~'~l~ ~/[~ ~ ~ ~ ~ ~ff' after hrs. pumping ~g'P'm- ~II~I~IPAII~ OF ANCHO~GE Material: ~ Neat Cement ~ Other: DEPT. OF HEALTH & 15. PUMP: (if available) HP ~NVI~g~ENJ~L F~IE~I~,~ Length of Drop Pipe ~ft. capacity __g.p.m. 14. REMARKS: ~e[[ ~s ~2e~ ~o 280 ~d ~ecove~e~ ~ ~ ~ ~ ! ~/~ ~ to 97'after 19 ho~s ~nd twenty min. ~ H~f~R for a flow ~te of .232 gpm '6. WATER WELL CONTRACTOR'S CERTIF'OAT[ON: ?4~__O~OZ '5. Water Temperature __o ~ F ~ C This well was drilled under my jurisdiction end ~s report is true to the best of my knowledge and belief; AIDf ~ ~rf 13 t ~ & ~n+.~wtses/ ~-q1_08 Registered B~iness Nome ~ ~ontrecl License Number A~u~: P.O. Box 11~96 Ancho~Me, ~ss~ 99511 Signed: Oaf e: Authorized Representalive Form O2-WWR (il/81) Copy Distribution: WHITE-State DGGS, PINK-Driller, CANARY-Customer T Municipality of Anchorage 825 L Street Anchorage, AK. 9950]. 4 ALASKA llUIROIlm I1TAL CONTROL $ RUIC B, [~nclinemncI ~ (~nuironmcntal Studies ~ay 5, 1988 inc. MUNICIPALITY OF ANCHORAGE DEPT. OF h'EALr~ & ENVIRONMENTAL PROTECTION MAY 6 1988 R[CEIVED Re: Mindyer Manors Subdivision, Block 1, Lot 2 Attacbed are calculations for a p~oposed chlorination system t,o be installed at the subject lot. The new well drilled 4/18/88 is 307 feet deep and cased to 28 feet. Static water level is 8 feet and well yield is 0.23 GPM with 40~ of the water coming from the.top of the bedrock at 26 feet and the remaining 60% from 240-245 foot depth. Water samples taken 4/i9/88 are satisfactory. We recommend an addition rate of 2 mg/1 and test for free chlorine residual at the taps to maintain 0.2 - 0.4 mg/1 residual. The mixture ratio can be adjusted -to maintain this. A minimum of 75 gallons of water storage will be needed. A 5 GPM flow restrictor will be installed off the well pump. The chemical feed pump will be wired so that when the pump control switch 'turns on the we!! pump, it also turns on the feed pump. Conversely, when the well pump is off, the feed pump is off. Also attached is catalog information for an example of properly sized feeder pure. p, solution tank and chlorine test kit. These or equivalents are to be used. The old wells production was calculated at 0.04 GPM. Total depth is 340 feet with a static level of 19 feet. Subsurface conditions may change to improve the welts production in the future. Therefore, we request approval -to temporarily abandon this well by welding a 1/4 iuch steel plate on top of the casing. The new well.currently shows no sign of con-Lamination. The chlorination system is proposed as a safety factor against the possibility of contaminants in the shal!ow water source. If you have any questions, please call. Sincerely, MINDYER~ MANORS SUBDIVISION LOT 2 BLOCK I G~j~L, ~R\VevJAY AS BUILT Pfl~PJ~ED BY; ,IEFF A. ~ASTALDI, N.L.S. ~OII IETTLW8 lAY LOOP ANCHORAgE,ALASKA 1950~ TEL. ~44- 4E72 ONAWN IY: Q.A.e. OArE~ 3-19-88 i HEREBY CERTIFY THAT I HAVE BURVEYED THE FOLLOWING DESCRIBED PROPERTY:LOt 2 BloCk i ~indyer Hanozs Subdivision ~?- AS INDICATED. IT IS THE RESPONSIBILITY w.,c. ~o .om ..~. o. m.~ .co.~ SHOULD ANY DATA HEREON BE USED FOR CON- STRUCTION OR FOR ESTASLISNINe BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA: ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. ~' OF OA~C.~A"ED"",4-,,1/~-,} .ATE CHECKED BY DATE SCALE "1 / Oi~l 0'00'1 o .LN:].I,N 03 H~)y2'I~ "lyeJ ~12d ~3.LY,~ $'I~'g - NOI.L~I'II~ H3Y3'1g I ' ~ ' ' ' ' ''if ', [ 3NI~O"IH3 "l/gl~ O0 dr13 - OI.LV~I x~lq NOI.LCI"IO$ _..~ _~.- _-.~ _~ _~ .L N 3.L 3 N I~IO"lH3 N OIA CI'I O~, 3NI'I .LO^Id DISINFECTION GUIDELINES A. Ground Water Sources (well 9rester than 30 ft. depth) Chlorination advisable, but not required. Suggested level and contact time: Contact time: 30 minuts~ Chlorine level= 0.2-0.5 sg/l fru chlorine residual at distant points of distribution system. £source: 1982 Ten Stats Standards] B. .Surface Water Sources 1. Full Treatment - £¢oegulation and filtration] Full treatment of surface water sources ia strongly recommended. Disinfection is considered that last line of defense against waterborne disease, and it le recosmended aa standard prsctic~ that all surface water systemm have full treatment prior to disinfection. The following information for treated waters ie baaed upon the presumption that the treatment process will sufficient percentage turbidity reduction through the plant, such that filtered water turbiditiee are below the drinking water standards with continuous chemical addition. A goal of 0.2 NTU should be considered. Suggested level and contact Contact time= 1~ minutes 30 minutes time: Chlorine level= 0.4 mg/1 free chlorine residual at distant points of the distribution 0.2 I~J/1 free chlorine residual at distant points of the distribution ,ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite ANCHORAGE ALASKA 99503 (907) 561-5040 CHECKED 8Y POSITIVE DISPLACEMENT/DIAPHRAGM TYPE BULLETIN S1681 4 CAPACITIES 7-15-24-30 GPD SERIES 100 Fo~; Hypochlorination Fluoridation, Chemical Treatment .-..: :.. and various other - Feeding and Removal Processes STA-RITE INDUSTRIES, Water Treatment Division DEERFIELD, WISCONSIN 53531 INC. FEATURES,,, Design features include lifetime lubrication... smooth, silent operation.., strong 30-$§% glass filled polystyrene pump housing ... minimum number of moving parts--means less wear.., sealed, maintenance free gear train... metal reinforced short-stroke diaphragm for long life.., easy-to-read calibration dial for capacity adjustment.., four position pump body.., fan cooled, continuous duty motor. STA-RITE Wall Mounting Position OPERATION Sta-Rite Series 100 Chemical Feed Pumps are adjustable feed, electrically operated diaphragm type pumps de- signed to handle a majority of treatment applications. These include domestic and municipal water systems, cooling towers, boiler water treatment, air con- ditioners, heat exchangers, swimming pools and sewage treatment. The Sta-Rite Series 100 Pump is ideal for jobs requiring feeding rates of 30 or less gallons per day. Chlorine, Fluorine, and other chemicals may be used for var- ious feeding and removal processes. Positive displacement operation pro- vides piston accuracy without piston packing: Note: To insure the best possible priming conditions and most re/iable pump operation it is recommended to oper- ate any chemical feed pump at or near its maximum output setting. SPECII:ICATIONS HEIGHT .................................. 3~'' LENGTH .................................. WIDTH ................................... $1/2" SHIPPING WEIGHT ........................ $ Lbs. 'MOTOR .............. Single Phase, 115V, 600, AC CAPACITY .... Adjustable from 0 to maximum rating MAXIMUM PRESSURE .................. 75 P.S.I. 'Available with 220 V motor also. EXAMPLE: If your maximum requirements are 7 G.P.D. or less, order Model 7. If your reqOirements are between 7 and 15 G.P.D. order the Model 015. If between 15 and 30 G.P.D., order either the Model 024 or 030. DISTRIBUTED BY: Printed in U.S.A. 6ZI ~ PARTS LIST SERIES 100 27~, jr~ CHEMICAL FEED PUMP L J 241 ~ 237 ~ 27~ STA-RITE INDUSTRIES~ INC, 0 PART NO. DESCRIPTION Water Treatment Division DEERRELD, WISCONSIN 53531 228 237 240 241 242 244 245 246 247 252 277 278 279 281 282 283 285 296 603 607 608 610 611 612 613 614 620 621 625 626 638 A-50 A-51 A-52 Diaphragm Gasket Coupling Nut Slip Ring Head - Valve Housing Injection Fitting Valve Seat Suction Valve Housing Diaphragm Return Spring Suction Tubing per foot Ball Check Discharge Tubing per foot Strainer Foot Valve Body Foot Valve Seat Anti-Siphon Spring Head P.V.C. Acid Feeder Housing Bracket Output Adjusting Knob Backing Plate Bearing Ball Needle Bearing (Not Shown) Cam (Not Shown) Motor and Reducer (Not Shown) Screw, slotted Head Mounting Bolts (Each) Motor Cover Diaphragm Shaft (Not Shown) Valve Seat (Hypalon) Foot Valve and Strainer Assembly Head Assembly (Lucite) Back .Check Valve Assemblv 900779 CHEMICAL SOLUTION TANKS 10 ST TANK 30 ST TANK SPECIFICATIONS Part Liquid Height Outside Shipping Wt. Number Model Capacity With Cover Diameter With Carton Color 720150 10 ST 10 gal. 17" 153/~'' 4% lbs. Gray 200352 30 ST 30 gal. 30W' 18" 7~5 lbs. Gray 10 ST solution tanks are manufactured with a tough, specially-formulated resin that resists acids and chemicals. These tanks will withstand steam cleaning and sub-zero temperatures. They won't leak, dent or rust and, because of their seamless construction, are virtually leakproof. These 10 ST tanks are NSF listed and feature tight-fitting snap-on lids that lock odors in. 30 STsolution tanks are constructed of a carefully balanced blend of tough polyethylene and reinforcing asbestos mineral blue rock fiber. The mixture produced a chemically inert, temperature-resistant product with an extremely high tensile strength. It will not corrode under the most adverse conditions and affords its user a reliable yet inexpensive chemical container requiring virtually no maintenance. ! 900790 (Rev. 7/77) L STA I::IlTE INDUSTRIES~ INC, ',MATI=R TRI=ATI~FMT rllVI.qlt~l~l · I-)FFRFH=I ~ WI RRF;.'~I ,, ~nR/7R4-.~462 CHLORINE TEST KIT DR 100 Colorimeter Direct-reading, hand-held photometer for free and total chlorine. Dual-range, EPA- approved. See page 5 for DR 100 Test Kit specifications. Range: 0-2, 0-3.5 mg/L as tree and total chlodne Sample: 10 mL Colorimelric Method: DPD Reagent Number of Tests: 100 each of free and total chlorine Case: 11 x 31 x 20 cm (4.25 x 12.25 x 8") Shipping Weight: 1.8 kg (4 lb) Order Cat. No. 41100-02 ... $195.00 DR 100 Colorimeter Chlorine Test Kit t] I chlorine measurement is part of Our swimming pool/spa monitoring I program, you'll find Hach multi- I parameter test kits are convenient land economical. See page 74 for our I newest Pool and Spa Kit containing ~ tests for chlorine, pH and total I bacterial count; Model 41100-22, DR I!00 Colorimeter Kit for chlorine and ~ pH; Model 41100-26, DR 100 Col- ~ orimeter Kit for chlorine, pH and ~ cYanuric acid; and Model CN-48B, Kit for chlorine pH. [Color Cube and 'HEXAVALENT CHROMIUM KIT ~d~! CH-14, Dual Range s F°ri:~l~her concentrations of chromate, such ~ ~'that ~und in diesel engine coolants and s c~o!ing tower waters, the Model CH-14 Test e Kit is particularly helpful The kit uses a'drop c%nt titration, with an end point color change 6~blUe to colorless. By varying the sample ~t si~,-either 5.83 or 0.583 mL, it is possible t0;analyze both high and low chromate con- cehtrations with the same kit. Raiige: 0-100 or 0-1000 mg/L ; ReadOut: 1 dr~p = 5 or 50 mg/L as chromate Analysis Method: Drop count titration ~a'rnple: 5.83 or 0.583 mL Nu~l~r of Tests: 100 ~': i9 x 12.7 x 12.7 cm (7.5 x 5 x 5") ) ~ipping Weight: 0.45 kg (1 lb) )0 Oider Cat. No. 2227-02 ..... $30.00 Don't miss Hach's newest test kits. Those for microbiological testing are on page 36 and other new kits are described on pages 41-43. Model CH-14 Hexavalent Chromium Test Kit Direct-reading, economical. See page 40 for complete cube kit description. Range: 0-2.5 mg/L as free or total chlorine Smallest Increment: 0.5 mg/L Sample: 5 mL Number of Tests: 50 of free or total chlorine Case: 4 × 9 x 9 cm (1.5 x 3.5 x 3.5") Shipping Weight: 0.23 kg (0.5 lb) Order Cat. Nos. 20604-00 Total Chlorine Kit .... 11.75 HEXAVALENT ~HROMIUM KIT Model CH-8, Diphenylcarbazide Method tn cooling towers, wastewater plants, plating operations, the tanning industry and other types of manufacturing, chromium usually exists in the hexavalent state. Analysts in these areas will find Model CH-8 Test Kit best suits their needs for measuring low con- centrations of this ion. The test procedure is based on the APHA diphenylcarbazide method; a pink color develops when the sam- ple reacts ~ith ChromaVer® 3 Chromium Reagent. Range: 0-1.5 mg/L as hexavalent chromium Smallest Increment: 0.1 mg/L Analysis Method: Colorimetric (color disc) Sample: 5 mL Number of Tests per Kit: 100 Case: 15.9 x 12.7 × 3.8 cm (6.25 x 5 × 1.5") Shipping Weight: 0.45 kg (1 lb) Order Cat. No. 1834-00 ..... $44.50 Chromium test kits contitttted ttextpttge 49 Color cube kits--complex col- orimetric chemistry combined into an economical, easy-to-use test system-- are perfect for classroom studies, monitoring aquariums and a variety of other uses. The cube is used to mix premeasured reagent with water sam- ple and for matching developed color with one of five calibrated color steps. Digital Titrator-Titrating Device for Field The Hach Digital Titrator is a compact, unbreakable titrating device, useable anywhere you want precise, quick titration.~.nalysis. Made of high-impact ABS plastic and metal, it comes with a lifetime warranty: Ha;ch-Company will repair or replace it free of charge, providing the Digital Titrator hasn't been abused. · Saves Time: It's quick and easy to use the Digital Titrator, both in the lab and field. No glassware cleanup · Saves Space: Bulky burets and stands are eliminated. · Accurate: Accuracy of + 1% is typical for most samples. · Easy: No calculation, no standardization needed with prestandardized titrants · Economical: No wasted titrant solutions · Sturdy: It carries a lifetime warranty. Hach will replace or repair free of charge unless it was abused. Interchangeable Titrant Cartridges _An important feature of Hach's patented* Digital Titrator is its use of titrants packaged in disposable plastic cartridges weighing less than 2 oz. In most cases, a single cartridge contains enough concentrated titrant for ap- proximately 100 tests. Are Prestandardized simply change cartridges. Several dif- ferent titrations can be performed on- the-spot with titrants you can carry in your pocket. Prestandardized, _ cartridge-packed titrants offer excellent stability and accuracy, and they save you preparation and cleanup time. Instead of reserving a separate buret for each titrant, Digital Titrator users *U.S. Patent 4,086,062 Cartridge Parameter Acid-Base Acidity Alkalinity Ca, Mg, Total Hardness Calciu~ Carbon Dioxide Chloride Titrants (See A-Z listing of chemicals for price information) Description Cat. No. HCI, 8.00N 14390-01 Chlorine PAO, 0.02256N 14395-01 H2804, 8.00N 14391-01 PAO, 0.00451N 22599-01 NaOH, 8.00N 14381-01 Na25203, 0.133N 22673-01 NaOH, 0.1600N 14377-01 Chromate Na25203, 0.2068N 22676-01 NaOH, 1.600N . ' 14379-01 Dissolved Na25203, 0.2000N 22675-01 H2504, O.1600N 14388-01 Oxygen Na2S203, 2.00N 14401-01 H2504, 1.600N 14389-01 EDTA MgCI2, 0.0800M 20625-01 CDTA, 0.0800M 14402-01 H202 in Ceric Standard 22707-01 CDTA, 0.800M 14403-01 Etch Baths Solution, 0.500N EDTA, 0.0800M 14364-01 Iron TitraVer®, 0.0716M 20817-01 EDTA, 0.800M 14399-01 Oxidants Na2S203, 2.00N 14401-01 EDT,~., 0.714M 14959-01 Ozone PAO, 0.02256N 14395-01 EDTA, 0.1428M 14960-01 Sulfite KIO3/KI, 0.39998N 14961-01 EDTA, 0.0499M 21253-01 Turbidity Formazin, 4000 NTU 2461-01 NaOH, 0.3636N 14378-01 Standard NaOH, 3.636N 14380-01 Volatile NaOH, 0.9274N 14842-01 AgNO3, 0.2256N 14396-01 Acids AgNO3, 1.128N 14397-01 Hg(NO3)2, 0.2256N 14393-01 Empty cartridges for your own reagents. Hg(NO3)2, 2.256N 921-01 Order Cat. No. 14495-01 ............ $3.00 4O Results are read directly. Cube kits are lightweight, compact enough to fit into a jacket pocket and are ideal compa- nions for back-packing ecologists. General Specifications Sample Size: 5 mL Analysis Method: Colorimetric (color cube) Case: 4 x 9 x 9 cm (1.5 x 3.5 x 3.5") Shipping Weight: 0.23 kg (0.5 lb) or Laboratory Each turn of the Digital Titrator dispenser knob delivers a precise amount of titrant--you read titration end-point concentration directly from the digital dispenser counter. Or~ter Cat. No. 16900-01 .... $85.00 ) ',._ / MUNICIPALITY OF ANCHORAGE '~. ~ DEPARTMENT OF HEALTH & ENVIRONMENTAl.. PROTECTION ENVIRONMENTAl. ENGINEERING DIVISION 825 L Street - Anchorage Alaska 99501 Telephooe 264-47;~0 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME [.PHONE LOCATION NO. OF BEDROOMS J Absorption area Dwelling PER~T~O.~ DISTANCE TO: ~ Z Sanufacture~ Sater~. ~ __ , No. of compartments ~ ~ ~,q~in gallons IF HOMEMADE: Inside length Width Liq pth ~ ~ Wall Dwelling PERMIT NO, DISTANCE TO: ~ Manufacturer Material Liquid capacity in gallons ~ Nearest lot ~ PERMIT~O. ~ DISTANCE TO;"-. Wel,/~/~ Foundat,ong 7__ / Distance ~tw~n lines ~ ~o. of I~nes ten,th ~a~i~ lota~]~ ~ lines lre~th ~' Topo[~iletofinishgrade ~r inches - ~ ~ ~ Material beneath tile ' *a inches Total Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot ~ine ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER APPROVED DATE LEGAL 72-013 (1~ . 3/78) { RF'F'L T - ¢ql'-,rr I','~ ~' ,'" .-~r.:¢::' 1:::, F... CiB T ~...:'c ~ ,. L C C:Fq" .'~ ON L E :'3FL L2E~:L H I F.!D'¢EF.: HF!;:.:;.;HUH '.~,,._HPF'F'_,_.. OF' E:EDF:;:IOI"I5 = ]: .......,~qnTi RFiT~NG ,:"...qK~ ?.f'/E:R ':' =. '~"!---'-~-~,. ,~_ ,.c'c"',_,.. .... Tr,:~.-r'..;_~ c'r2:E .... O;~:' 'I"F!E SOIL. RBSZr-~'PTiCN SVSTEi.! IS;: THE [..ENGTH [:,iNENS!ON iLS THE L. ENGTH ,:.'iN FEE¥) OF THE TRE?..!CH OR THE [:,E..PTH OF FI TF::ENC:H OF: F'['i" i:5 THE i;::,ZSTF!F,!CE BETHEE.N THE EURFF'ICE OFT'HE GROUND FINE:, THE BOTTOH OF THE E',:.:;C:Ffv'F'FF!ON (iN FEE¥). 'THEF?.E iS i'.,lO SET [,.I:~:£:,TH FOR TRENCHE:S. THE G.RR'v'EL [:,EPTH ~."S THE H!N):HUH DEPTH, OF' C:~F.:F%,'EL BETk!EFz'N THE OLITF'RLL. PIPE RND THE E:C','.TTOH OF THE E;:.:;CF!'v'FFi"iON (tN FEET). PERH I T F{PF'L ! CRNT HFrL:; 'THE F~,i::,z;pr'¢..p::: T R T ~ '*' T,,., TE * ~'~FE RH 'i'hl T S ..... ' F.'Z F.Z~".T' --- ,~. INSTF._L.RTZ]FI ZNSPECTZON5 OF F!N'¢ !-,~ELLq RC'JRCENT 'T'r] THiS F~ ~i'"4¢"~ ..... blt I ,-, ................ r,~.,~-~' OF RES i[:,EF,K::E5 THFtT THE bJE'Lt ,... .... ::,EFI'v'E. ,=. ,cc. ~=.,. ~_..~ ~: ~ .... ~' ~ E;FiCKFILL'r*'-i'''. .,., OF FIN'.¢ S'?'L:FT'Ehi kl'rTHr"ll T F'rt'i':l-, ,.,,; ......... iNS;PECTICd",I F~'.~F, .... pP¢'F:'"*' '~:. , ,_ ~:'""' DEF'RF.:TMEhFF i.,.! ] L [. ESL:: 5;L!B,TECT Tr; F'RO:SECUT I ON. H I N I MlJi"! L..,..: ~ rl t _.E E:ETP-!EEN R,.h._:'~':'~ ................ l:li'..i[, R?.,P? "±;:Z~;} FEET FOF.': FI PRiVRTE NEL. L. OR J 5~ T0 2'?!O FEE]" F'ROM *.q F'UE;L:[C P.!EL..L DEPENDING LIF'OF~ THE T'¢F'E (iF F'UE:I._:[C HE_ L. HINIHUH. [:,I:5TF!i'.,!CE FROH ,q r'l:..t ,h]~': NELL TO R Ti Ft COH. HUNIT"¢ 5SEHEF.". LINE: ~]5i; 7!5 FEET. OTHEF.: F.'F ':'...~. ................. T pFHFi'."r':' MR'-,.' RPF'L.':.'. SPECi,- z '-:Ft'r I ~i'-F-':;~'" FN[". CCiNqTF'I ........... c"'~ '" ,. ,.,.,r I dt.a,..r'fi',.:," "c,,-',- ,:"~,r*.c:""~:'"'"' !::i.:",'F~ I._RE _E TO ?. NS. L RE F'F' '" PEFe I N:BTFiLLFFf' i i C:ERT!F"r' TP'IRT ±: I RH FRHIL!FiR HI]"H THE REQUiREMENT:~; FOR Oh!-"S;ZTE SEP.IERS FINE:' NELL..5 RS; SET FORTH B'¢ THE HUNiE:iF'F![_IT'?' OF RNC:HORF!GE. 2: I F.!!L.L INSTRL..L TF!E S:?STE:H IN FiC:CORDRNCE P.!!q"FI THE CODES. ]:: Z LINDERSTRN[:, THFFr' THE ON-SITE SENER SYS;TEM t','tFW RE(;~UIRE ENLFiRGEHENT iF THE RESIDENCE i:S REMOE:,ELED TO iNCLUDE MORE THRN ]: BEDROOMS. U Z >- 0 0 0 © 0 0 0 © © © 0 0 0 © © 0 © 0 0 0 0 MUNICIPALITY OF AN qORAGE DEPT. OF HEA,LI & ENV!RON!~AENI,AL PR( ECTION. %?5 "l." S'I-,REE~ r',NCiI()IRAQ[~, ALASI<A 99!? i ~)OY) 2fifi-4 i! January 4, 1982 Michael Robinson P.O. Box 10-984 Anchorage, AK 99511 Permit ~ 810795 Subject: L2 Bi MINDYER MANORS S/D A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, Sewer and Water Program Enclosure: Copy of Permit PERMIT NO. RPPL!C.BNT MICH.BEL ROBINSON LOC.BTI ON VIRGO LEG.BL L2 Bi .~"IINDYER MFtNORS S,.'"D TYPE OF SOIL. RBSORPTtON S'¢STEM IS: TRENCH DEF'FIRTMENT,_,,_._ '.' HEFILTH FIN[:, Eh,f,,,' i RONMENT.BL"~,~ ,-,, ~ -~ ~ ::OTECT~ I ON ,:,.z,=[ "']~"z STREET., FINCHORF~G[:., nr .... ]]-L~-~i~ z. ( 8107~¢5 ) P.O. BO',,':', ~,E~-~84., .BNCH. °~q.%tl :~.:45-22:2]'.': LOT SIZE 55~bOE~ S6!U.BRE FEET M.BXIMUM NUMBER OF BEDROOMS = 3 SOIL. RWFING ':.'SQ FT,-"BR)= 225 THE RE64UIRED SIZE OF THE SOiL .BBSORPTION S'¢STEM tS: THE LENGTH [:,IMENSION IS THE LENGTH (IN FEE]') OF THE TRENCH OR DRRINFIELD. THE DEPTH OF .B "FRENCH OR PIT IS THE [.',ISTFINCE BETI.,.!EEN. THE SURFF!CE OF' )'HE GROUND RND THE BOTTOM OF THE E:,..'..'CFI',,,'.BT!ON '.'.'IN FEET:.". THERE IS Nfl SET kl!D'rH FOR TRENCHES. THE GRR',,,'EL [:,EF'TN IS THE MINIMUM DEPTH OF GRW,,,'EL BETWEEN THE OUTF'F~LL PIPE .BND THE BOTTOM OF ]'Hi.-] E',,.'-,'C.B',,,'.BTION ,:.'IN FEET). PERMIT RPPLICRNT HFIS THE RESPONSIBIL!T'.? TO INFORM THIS DEF'RRTMENT DURING THE INST.BLL.BTION INSPECTIONS OF .BN':,.' !.4EL. LS .BDJRCENT TO THIS PROPERT',-r' RND THE NUMBER OF RESIDENCES TH.BT THE !4ELL !.,.!ILL SERVE. BRCKFILLING OF RN'¢ S'?'STEM WITHOUT FtNRL INSPECTION RND .BPPRO~,,'RL B'¢ THIS DEF'.BRTMENT .[,.tIL. L. BE SUB.-rECT TO PROSECUTION. MINIMUM DISTBNCE E:ETWEEN .B WELL .BN[:'- RN'¢ ON-SITE SEI.4RGE DISF'OS.BL S'¢STEM IS; :t_E~E~ FEET FOR R F'RIVFtTE WELL OR ~.50 TO 2E~E~ FEET FROM R PUBLIC I.,.IELL [[.',EF'ENDING UPON THE T'¢PE OF' PUBLIC WELL MINIMUM DISTRNCE FROM .B PR I ',,,'RTE WELL TO R PRIVFITE SEWER LINE IS 25 FEE']' RN[:, TO R COMMUNIT"r' SEWER LINE IS 75 FEET. WELL LOGS .BF.'.E RE6!UIRE[-" RND MUST BE RETURNED TO ]'HE [.~EP.BRTMENT I.,.IiTHIN :]i:¢ [D.B"r'S OF ]'HE NELL COMPLETION. OTHER REL-]LIIREMENTS M.B~' RF'PL.'¢. SPECIFIC.BTIONS RN[." CONSTRUCTION DI.BGR.BMS RRE Rk".BIL.BBLE TO INSURE PROPER INSTFILLRTION. I CERTIF'?' THRT :~-: t BM FRMIL!RR WITH ]'HE RE6!U'rREMENTS FOR ON-SITE SEFtERS RND WELLS RS SET FORTH 8'-? THE MUNtCIPRLIT? OF RNCHORFIGE. 2: I HiLL INSTRLL THE S'¢STEM IN FICCORDRNCE WITH THE CODES. ]:: I UNDERSTRND TH.BT THE ON-SITE SE[4ER ~'¢STEM M~'¢ RE6~UIRE ENLRRGEMENT IF THE ~'ESIDENCE IS R. EMODELE[:, TO tNCLU[:,E MOR. E THRN 2: BEDROOMS. ~/~ ~ ~ I GNE[:,: _ - ................. RPPL. i CF!NT MICHREL ROBINSON 825 i "a, Tr,.:E I ~'r~C ~ RAGE, .~ , ~,0 ALASKA 99501 ,u0z~ 264-41il December 31, 1979 Michael Robinson Post Office Box 10-984 Anchorage, Alaska 99511 Permit ,% 790544 Subject: Lot 2 Block 1 Mindyer Manors Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer has inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, ~R.S. .~-- Senior Environmen=a! Speci%~_lst LNB/ljw enc: Copy of Permit F.F:'F'I. 3' i:F:It"t'T' H I f::HFIE:L F.:OE: ]: N'."~Cd',! LEf3f:IL. I_;?. E:::!. t"l!b![>'-r'EF~: .~FE CIF' '.iSOIL. FIF~,.:'~';CF:E:TICIi'-,I ::'~:::T[:II I::S' "I"F:E:NCH i"1f:]::':: I HLIH N! i"IE:EF'. OF t31E[::,F<CK)HS = 2: S.':.:!D ! L. 1:;;:!::!'I" I b! :ii ,:: Si;! F"!",.'"I::'?,F: ::, THE Fi:E'f::-.!U ..... I F:E:E:, 5.:; :1: ;:~E f"~F THE: SO I L. f::IE','f!;OF:<F'T :i: ON : ........., ~ .: I"'"'~.,', '~ I :E;: THE LENGTH [::' I I'"tEt',IS I ON I :':'i; 'r!'"lE I...Et',i:C~iTH < ! i",! FEi:lET ::, 0i:::' T!'"tE: '~"!~:E~FIC:~.'I ()Fit DF:F! I THE': DEPTH O1:: FI TI?.ENCH Oi:~'. F'IT IS THE: [::,t~?t"FINCI!_:: EL'rfTb.!E:!~:N "i'HE: SIJF?.F:FiCI~ii: OF:' GF..'.OLIN[::, FIND THE: E~OTTOH 01::: THE E:::.~;CFI',/FFI~'IOF,I ,:.'IN 'TFIE.:F~:E7 I S f'.,IC~ SET b.l I [::,'I"H t:::or4: 'I"I:~:EiNCHE!:S. THE: GI:;i~I::I'v'E!:L [::,E~:I::'TH 1:5 THE H ! 1'.,!): HUH E:,E:F:'TH 01::: I:!iF;'.Ft',/E:L 1:3L::Tb. IE:EN THE CILITF'F:IL.I.~ I:::' FIND THE E:O't"TOt,1 OF THE: E:F:',CI:::!'v'FITIOt'.,I <It'.,! F'E;ET). '""" :::~' :[ T? Ti::) ! NF'Oi:;;:H TH I ~::; I;:,E;F'F:!F:TH~:i:i',W .OU!;~: ! b!C:i F:'E:F~:H I T FfF'F'L )' r' FiNT HI:l:!5 THE: F:E;~i! F C N::: .l. E [1 i i'.,I~.:,Tf:iL.L.f:!T I O1'-.! I H':.SF'FD'":]" I OF,if!; CiF' f:ll'-4'.d t.,.!EL.L£~; Fi[::,..:ri::tC:FJiqT 'T ') "t"H !' ':~; t::'F:C~I::'E-::!:;~:'T"./ FINE:, THE: t',ll IHL: EF: O1::: F.:l~f..: ! E:,[ENCE:S THF!-t" 'TFIE I-,.IE!!~.L f.,.! ! I~L E:F~CI<I::' I EL :[ NQ OF:' Fll'.,l"r' :, ~, ::, t E.I I I.,.!:1: THOL.IT t::: I Nf::lL t i'-t'j: i:::'E'C T I i H F:IlqE:, F:IF:'I:::'t::i:CP,/F!L. l::~Fr* ']"!"11 ri!; [::'E:F'FII:;~:THE:i",IT I.'.II LL E E '.:::;LIE:JE:CT TO F'I~:tD~!;[~:CUT I HINIHLIP1 .F.:,ISTFIt".!C[::: E:E'TI,tE[/N FI I.,.IE:.:LL f:lN.[::' FIb,!"t' Obi-SITE: SEI.,if::!G[i~: [::'I.":i;F'O':'};FII~. :~.~;~ FEET F'OF". F! F'FitI',,,'F'ITE: !.,!EL.L.; :Lt'~eJ TCI 2~..:.'~,':3 FEi:E:T F'lROhl Fa F'LtEd.._IC I,.IEL. L [::,E:F'I!~I',![>:t:NG UF'ON THE T'~"PE: C!F' .r'::'LIE:L!C b.lE!..J. .... !.,.IELL LOGS F:IF:E I:~t[D.::!Ltlf,:'tE~[.':, FINE:' HLIST [i':IF: F.'.E:TI..IIRN['!D TO TH[~. D,I:~:':[::'F:IF~'."I'P1E:!",!'!' H!THt,N OF' THE !.,.tE:L.L COHI::'L.E:T ! O1",1. OTHEF;: R[~(;!I. JlI:~:E:hlli~:NT:.::: HF:!"r' FIPPL'¥'. SF'E:CIF!CFfF!ObI:!5 FIND FI'v'FI I I....£aDL.E TO I I',I~;UF.:E PF~:C~F:'E':Fi: i N'.:'~;TPILLf:!T ! ON. I CEF;:TIF:'"? THf:!T :!.: ! RP1 F'F:ih'I!!....T..FIR 14ITH THE' [;;:E(..:!LIII:~:EHENT.':7; F'OF;: Cd',!'-"':BITE %I!EI.qE!RS FIN[> t.,!li~:!..L.:~: F:i:'.5 SE:T FOF;:TFt [~',W THE HUNI C Z PFIL. !'l""d OF F'II",tC:HOf4:F~GE:. ?: I FI Z LL, I N:~,:,Tf:ILL THE: ~";"r'k];"f'Ef"l I i",t 2i:: t UNDE[?.'Z,'I"FIN[::, THFIT THE: Ot",!-SITI'~; SE:HI:~:F: ':5?fE;T'E:H h'!Fl"r' I:?.[~L::!I...II~:~'.E ENL. FIF~:GE:H!:3",H" !F:' THE: F;:[::%;IDENC:E I::!i; I:;i:E:h!O[::'EJ....EE:' ,TO~ :[t",I(:::L. LLOE': HOF:E THFI?',I ::i: E;[E[>F-:OOI"'!'.:~i;. FIF'F'L., I C:f:ll'.,t2 1"11CHFIE::L I: ~::SUE:[::, . ........................ . ~ ~/, MUNICIPALITY OF ANCHORAGE ~ /~'41~1(,~) L~EPARTMENT OF HEALTH & HUMAN SERVICES MUN~Ci~;^LITY O~AL~C Division of Environmental Services ENVIgONMENTAL SERVICES DWIS',CN On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 SEP 05 !997 343-4744 CERTIFICATE OF HEALTH AUTHORITY V ~\L t. I ED APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# (~),--'--'~("}-~ \-/~.,~% HAA~ ~~,~- 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Don L4"~-T~Iy Day phone - ( ~ %¢¢e ~// ~ner) Day phone Address Unless otherWise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: -~ TYPE OF WATER SUPPLY: Individual well ~ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest-' lng' 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 ~rom State AD£C" ~ttestin~ to the legality and status o~ system. 72~25 (Rev. 1/91) Front MOA #21 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. NameofFirm ~::/cx~Lr~? 7-~¢,~n~¢~/ -¢~ Phone Address I~ff ~ ~Ad ~/, ~c4o~¢~, ~ 9~1~ Engineer's signature %~ ~ ~ Date ¢~/¢ /*¢7 DHHS SIGNATURE '~J Approved for /H~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 ab?ve 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 ()missions in the professional engineer's work. 72q325 (Rev. 1/91) Back MOA f¢21 Legal Description: Municipality of Anchorage ~U~c~a~L DEPARTMENT OF HEALTH & HUMAN SER~I~E~! Environmental Services Division S~v/'~°~,~~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)~-zj3-,,~7_44 -"' ~'o 1997 Health Authority Approval Checklist ~'CE/V~FD ~.~ ~/'C,C/c ~ /~,~¢.,~',y¢,,~ /¥~'nc, ad' Parcel l.D.: A. WELL DATA Well type IfA, B, Or C, attach ADEC letter. ADEC water system number Log present (WN) Date completed ¥ / /,~ / ,~ Total depth ~' 7 Sanitary seal (Y/N) Cased to S~',~,ce) Casing height (above ground) / z" Wires proPerly protected (Y/N) ~' FROM WELL LOG AT INSPECTION Date of test Static water level Well production- I~' g.p.m. O',~.~ g.p.m. WATER SAMPLE RESULTS: Coliform C~co/i/loo~ Nitrate ~o. -~ate of sample: ~ / ~/? 7 Collected by: ~/~xf/~p %'~cA _CL, c B. SEPTIC/HOLDING TANK DATA Date installed 7/d'/~ Tanksize (Oc~¢~5, Number of Compartments ~ Cleanouts(Y/N) Y Foundation cleanout (Y/N) ~ e~ ~ Depression (Y/N) N High water alarm (Y/N) ~. ~. Date of Pumping ~ / ~//?'7 Pumper C. ABSORPTION FIELD DATA Date installed 7t/o/ /,~ Z Soil rating (g.p.d./fF or fF/bdrm) 2L~C ~_~ System type -7-,'-e,~c4 3' Length 6'7'' Width Gravel thickness below pipe 45' r Total depth ,~;-.?~"r~,~u- Effective absorption area ,~O ¥ Monitoring Tube present (Y/N) ~ Depression over field (Y/N) Date of adequacy test ~) / ZI ~ 7 Results (Pass/Fail) ?a_~ For 3 bedrooms Fluid depth in absorption field before test (in.); g'.5' Immediately after '7'// gal. water added (in.): 14' '~/o~ Fluid depth I$'- (ins) Minutes later: 5'O Absorption rate = ~. ¥5-~ g.p.d. Peroxide treatment (past 12 months) (Y/N) None. ~,,~c~,,~ If yes, give date fi/, ,~. 72-026 (Rev. 3/96)* LIFT STATION ~. ~. Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E, SEPARATION DISTANCES SEPARATION DISTANCES I--ROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Size in gallons "Pump on" level at*. *Datum On adjacent lots :> ~oo ' On adjacent lots ~> ,,(.,o ' Public sewer manhole/cleanout Lift station M. ,,¢. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 8 c~' Property line ~Y~ J Absorption field Water main/service line "~ t¢, ' Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ~o' Building foundation Surface water .~ Curtain drain ~onC. _~; ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature .~7'~ ~. ~ .~; Engineer's Name '7~/~,,~'~,"~ F. Wells on adjacent lots HAA Fee $ ~'00 Date of Payment 72-02~ (Rev. @/~)* "Pump off" level at* Water main/service line ';> lC' Driveway, parking/vehicle storage area Wells on adjacent lots Waiver Fee $ Date of Payment Receipt Number are MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot ~ Block ~ of ~[~6i~F- ~6{~5 Subdivision, the well's k) . 0 productivity was determzned t be ~.~,~ gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a ~ bedroom residence is ~SIZ gallons 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 non-critical 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. SEP-04-1997 17:37 CT&E ESI ANCHORAGE CT&E Environmental Services Inc. ., ~ ]T&E Ref,# ];lent Name 'roject Name/# ]lient Snmplc ID ]rdered By ?WSID ~_~ple Remark: Toter CoLiform 975140001 Flattop Technical Srv. Lot 2,Blk l.Miadyer Maaors S/D Lt 2,Bk 1,Mindyer Manors S/D Drinkiag Water ResuL:$ PQL' UmJ~5 0.100 u 0.100 mg/L 0.00 cot/lOOmL Client POff Printed Date/Time 09/04197 16:23 Collected Date/Time 09/0'2t97 13:45 Received Date/Time 09/02/97 14:30 T_~-hnlcal Director: ,~ephen C. Ede Attouabte Prep A~atysis Hethod Limits Do:e _Date init SM16 4500-NO3F 10 max 09/03/97 JBL S~18 9R2~S 09/02/97 T~ MUNICIPALITY OF ANCHORAGE · DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Prope~y Owner--/~ ~ Telephone: Home Business " Mailing Address . Mailing Address (d). Real Estate Company and Agent ~57~ Address ~/~ Telephone (e) Telephone Mail the HAA to the followin(~ address: or; Check here ,4~ifhold for pick up, List cont~c.~p~rson and.day.phone qu~ber below. TYPE OF RESIDENCE Single-Family'}~ Number of Bedrooms WATER SUPPLY Individual Well~ Community[] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~,. Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page I of 2 72-025 (Rev 81861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date DHHS APPROVAL Approved for 7~J'~¢ L.,.<~bedrooms by Approved r,,~ Disapproved Conditional Date Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-o25 IRev 8/86~ 8ack EHVIP, ON "R~,LTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 J U N 1 ? 1988 RE[EIVED WELL DATA Well Classification 264-4744 Legal Description: /~7~ ,Z~ /~/_._~/ ////.~J~¢~,~ ]/¢~//~,~J: Well Log PresentCN) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in ConduitCN) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) ¢-/~-(~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing~N) Depression Around Wellhead (Y~ Date Completed Cased to /4~-O ,-/--- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /)/?q ; On Adjoining Lots To Nearest Public Sewer ~i//4 TO Nearest Sewer Service Line on Lot /~--d~ loc. i,W£t.'/ ;Date Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes~)N) Air-tight Caps Depression over Tank (Y~.~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /co To Property Line' /~ "/- To Water Main/Service Line ',, Course Size /0"~3 NO. of Compartments Foundation Cleanout~N) //' Date Last Pumped /-5--E'~' ~/~4- ;for Temporary Holding Tank Permit (Y/N) / To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments ..... ;' Pageiof2 '- : 72-026 fRev 8/86~ Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design/ Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~N) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y~.~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / 37 To Building Foundation Lot To Water Main/Service Line ,/¢' ~'¢-- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~/'''f'- To Cutbank (if present) /")/ ! Comments D. LIFT STATION '~Pi~ ~n ~aOt~i ~:~'matLevel at F ~~. Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~'Ru~..g Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha~e.,,chec~ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~----~"/'t~/~"'"--'- Date Company /~¢ '~ MOA NO. Receipt No. 72-026 fRev 8/861 Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~ ~_ ~(_..~L-~ OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date /"~' GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Property Owner /'/bfq) Telephone: Home Business (b) (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent ~-fT~w ~',~2zS~'~r5 Address ~'//~ ~f~ Telephone ~ ~/7/? (e) Mail the HAA to the followine address: or; Check here ~ if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms WATER SUPPLY Individual Well~, Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Depa~'tment of Environmental Conservation attesting to the legality; and status. Page 1 of 2 72-025 ~Rev 8/861 Front ENGINEERING FIRMPROVIDINL ~SPECTIONS, TESTS, FILE SEARCH, DA',. AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm '~)"~'~-"~ Telephone Address /,~"¢/~ //J ~ /~/~, $/~/7"~' ~ ,,~. Date DHHS APPROVAL Approved for ~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Date Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-o25 IRev 8/86/ WELL DATA ,, \11 0 ~,~IJ~I[~,LITY OF ANCHORAGE (MOA) ~\G\?~'~',.¢,t.%~/\U~iEALTH AUTHORITY APPROVAL (HAA) ,~O~ ~),n CHECKLIST - FEBRUARY 1984 ~ ' ~ ~ ~o~ 264-4744 Legal Description: J-¢~',~-~ ~'/ /~/,¢/~t¢~'/¢ Well Classification Well Log Present/~) ! Total Depth ~,~//O Cased to Static Water Level /~"~2 Casing Height Above Ground / Electrical Wiring in Conduit~/,~l) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To' Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed td - ~'¢~'// Yield Depth of Grouting .~J'//'J- Pump Set At .w~/,,~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y~) /¢~) ¢' ; On Adjoining Lots /~'~ ~ ; On Adjoining Lots ./~/-~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~'~' ~" B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (~N) Air-tight Caps~'4) Depression over Tank (Y~__~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To PropettyLi,ne "' ' To W~ier M'aih2SerVice Eih~; :: / ~'Course ,, :, ,'.:'/¢0 7 Comments .... ~ '~ ~' ¢~¢'~"' Size /¢'"~¢~ No. of Compartments ~-~ Foundation Cleanout~N) /,~/ Date Last Pumped j-5'-~'~' ,~.J/A ;for Temporary Holding Tank Permit (Y/N) ,,~//~ To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page i'0f 2 72-026 trey 81861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (YU Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~ '~ Depth of Field Gravel Bed Thickness Standpipes Present'N) Date of Last Adequacy Test /-/~'~'~'~'~' To Property Line /~' To Existing or Abandoned System on ; On Adjoining Lots ~"~ To Cutbank (if present) Comments LIFT STATION Size in Gallons ~ "Pump On" Level at ~ High Water Alarm Level at Tested for Eiectrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~ Vent (Y/N) equacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h_ay¢ ch.¢j~ked, v,~r_ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~/~ ~, ,~Z,~---- Date /'- ~ "~'~/ Company /4'Z:=~-.,~ MOA No. ~ ¢~ Receipt No. ~- ~ ~ ./~ O O ~ 0 Date of Payment /- ~ ~ ~ ~' , ou.t: /F ¢ Page 2 of 2 72-026 fRev 8/861 Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. Dat~ gepo~ Printed: JUSt 15 88 ~ 12:55 Client 3ample ID:L2, PWSiD :U~ Collected JUN 14 88 0 09:10 hrs. Received JUN 14 Preserved with :REFRIGERATION C!ie~ Name : AECS Client kcct P.O.$ NONE ~eq $ Ordered By : Laboratory Supervise[ :STEPHEN Q. EDE i)AECS f Spoc~al Instruct: Chemlab Ref $: 1395 Lab Smpi ID: 1 ,~atrix: ,qate.. Allowabl~ Paral~et ez Tested Result/Units ~,fet hod [ir~it s NITRATE-N ND(O. JO) n~/1 EPA 353.2 10 Sampla ROUTINE 1. Tests Periormsd * See Special Instructions lboYe UA=UnsYailabia ND~ Nons Detoctad '* See Sampla Remarks Abow }~A~ Not AnaIyzed LT-Less Than, gT-Gzoater Than Iv MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY · Application Date 1. GENERAL INFORMATION (a) (b) Legal Description (include lot, block, subdivision, section, township, ran,g~e.~.~ Location (address or direc~ons) Applicant Name ~'~ ~'~¢~ Telephone: Home ~-Z~-- lU~ Business Applicant Address (c) Applicant is (check one): Lending Institution~'; Owner/builder []; Buyer []; Other [] (explain); (d) Lending InstJtution~ Address (e) Real Estate Company and Agent Address (f) Telephone Telephone Mail th.~e ~AA to the follq_wing add~ss:~. TYPE )F RESIDENCE single-Family~ Multi-Family [] Number of Bedrooms ~ ~ ? . attesting to the legality and status. :: · 4. SEWAGE DISPOSAL Other " WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation [ '- Onsite,,~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation. ' attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDI~.~iNSPECTIONS, TESTS, FILE SEARCH, D~=~A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained' from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with alt Municipal and State codes, ordinances, and regulations in effect.on the date of this inspection. Engineer's Seal D.a.A..ROVAL Approved ~ Disapproved , ~-~~ -A~ate ' Condition~- Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 { 11/84) MUNICIPALITY OF ANCHORAGE (MOAT' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGE DF-PT, OF HEALTH & ENViI~ONMENTAL PROTECTION . AN 1 7 WELL DATA Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Well Classification ~'¢-~'~ ,( A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~ 0.~ Date Completed ! ? ~ / Yield Total Depth _~ _,~-..t~ ! Cased to ~'~-~cJ'c~C~Depth of Grouting //~/1.~., Static Water Level /~g:::> ~' Pump Set At ~"~/~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) //(~" ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot J ~" ; On Adjoining Lots / O0 '/ /" To Nearest Public Sewer Line ~ To Nearest Public Sewer Cleanout/Manhole J~/~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~1;,-~ - -~. ' - g'4~' C"-..~O','r ~ ;Date Water Sample Test Results J I' ~.£ /3 ' 1~ B. SEPTIC/HOLDING TANK DATA Date Installed "'~/~ ~., - Standpipes (Y/N) ~ Depression over Tank (Y/N) Size ~OOC> NO. of Compartments ~ Air-tight Caps (Y/N) ~"'~------~ Foundation Cleanout (Y/N) A.,//~=~ Date Last Pumped ,,) / Pumping/Maintenance Contract on File (Y/N) /'[~/,~ ;for Holding Tank High-Water Alarm (Y/N) /t///~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well il/ To Property Line ~.~) ¢''~ To Water Main/Service Line :rCourse ,,¢'1~ Comr. e.ts " To Building Foundation ,~,~"/ To Disposal Field 5 ff To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7/~ Width of Field ~/ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test It! /~/~'~ Square Feet of Absorption Area Depression over Field (Y/N) /V Results of Last Adequacy 'rest ' ,~'"/ .... '~.. Separation Distance from Absorption Fiel;d: TO Water-Supply Well /~_.~, It _fL.. To Building Foundation Lot /C/tO ~v, ~__ To Water Main/Service L'ine . To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~¢~ [ ~ To Existing or Abandoned System on ; On Adjoining Lots ~/~;;~ ~, ~' "~ To Cutbank (if present) "~ O'/' Comments LIFT Date Installed ~ Dimensions Size in Gallons ~ Manhole/Access (Y/lq) "Pump On" Level at ~-~ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) . Tested for Pu~o~g Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Sign e~a.*-~,~.~~l certify that I have checked, verifiec[, or conformedDate to all MOA~/~/~/I~ ~and HA& guidelines in effect on the date of this inspection. Date of Payment Amount:$ (o~~ . Engi e.r' S , Page2of2 v~% ~- .,, ~-~0 W. Benson Blvd. Suite 206 PENINSULA ENGINEERING Anchorage, Alaska 90503 (~o7) January 16, 1986 Mr. Michael Robinson 4741 Virgo Anchorage, Alaska RE: Lot 2 Block 1 Mindyer Manors Subdivision Septic Adequacy Test 86-E-103 Dear Mr. Robinson: At your request we have performed an adequacy test on the sewage disposal system on the above referenced lot. The system consists of a 1000 gallon septic tank and 67 feet of drainage trench. The system was tested by adding 450 gallons of water to the absorption trench and monitoring the levels in the field and septic tank for 3 consecutive days. The test results are tabulated herein: END DATE TIME TANK TRENCH FLOW QUANTITY 1/13/86 0 10 2O 26 5O 60 8O " 90 2.75" 10.5" 0 0 2.75 10.5 5 gpm 50 2.75 10.5 5 100 2.75 10.5 0 130 2.75 16 5 250 2.75 18 5 300 2.75 20 5 400 2.75 20 5 450 1/14/86 0 10.5 17 0 0 " 10 10.5 18 5 50 " 30 10.5 20 5 150 " 40 10.5 22 5 200 " 65 10.5 25 0 305 " 80 10.5 26 4 365 " 100 10.5 27.5 4 445 1/15/86 0 15 12 0 0 gals Well supply chgd - to creek supply Well supply chgd - to creek supply The test results indicate that the system may have been slightly clogged after the initial day of testing and didn't respond as well as it should, but after the second day of surcharging with an addition 450 gallons the system fully recovered within a 24 hour period. Therefore the septic system is considered adequate for a 3 bedroom single family home. The well was tested during the adequacy test and was found to have a rather slow delivery. The well test indicated that the well has a delivery rate of 300 gallons per day or 0.21 gpm. This delivery is satisfactory for a two bedroom residence only. If I can be of any further assistance, please call. Sincerely, WH:js P~roper t y Owner f~ailing Address APPLIC~ ~T FILLS OUT UPPER HA! 'ONLY zip Code ~?/ '? ~'// Buyer Address Lending Institution Address Realty Co. & Agent Address Legal Description Street Locatic~ Zip Code Type of Residence  in gle Family ultiple Family No. of Bedrooms [] Other Zip Code rPhone Phone Phone Water Supply "~.~ndividual [] Community [] Public Utility ATTACH WELL LOG. A weft log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). Sewer Disposal udiVidual bile Utility [] Holding Tank Year Individual Installed: ~¢ /'ti /~ '7~ When Connected to Public Utility: ' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector InsOor · , ,![.~.~ Field Notes: ~ ~ DEPT. OF HEALTH ~ ~0 ~ ENVIRONM2NTAL PROTECTION , ~ MAY 2 RECEIVED ( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAP~OVED Soils Rating Date ~wer Installed Well To ~sorption Area Well Log Received '~ ~ ~ ~, ~o ~n~ S~..o r~ S~ze