HomeMy WebLinkAboutNORTH SLOPE #2 BLK 5 LT 18North Slope #2
Lot 18
Block 5
#050-511-35
N 0 v 19 18 10:,2 2 Archo,
go Weil & Pu rp s t 0 7 2 4'vQ7 4 2
Development Services beparttrwnt
Building 5afety bivisim
on -Site Water & Wastewatei- Prrat
47,X1 Elmore Road
P,C. RX 196650
44ark g;c, r ' Artchornge, A K 99507 c r
Mayw,
(9 07, 't S".3-7904
Pump Installation Log
VY'ell Drilling Permh Number: bate of Issue:
Parcel Identitkatior! _',�ujnber: 0-150 5- H -35
Legal Description propert-v Oviner N4kne rr__q&:
V�4 1 Vot—
Nor t� Slope- L 1,Y C&)L"x vjql A
Famp Iatsf:3ip:rti sr
Date:
Pump stake Depth. &-,ijw Top ofWzIll Casilig- feet
Pump Name:
Pump Model:
Pump Size lip
Pitless Ar it et
dapter Surfal Depth: i
Picless Adtpter Name.
!'.qiess Adapter hstfdlor.,
Well Dishifected Upon Camplerion? No
MV
ethod of Dis'nfectiori-
Comments: PIF R,
PURIP Installer Nn-,uc
Attention:
Municipality of Anchorage Page 1 of 5
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW000213 PID Number: 050--511--35
Name:ALLEN ROHDE Wastewater System: [] New · Upgrade
Address:
13155 OLD CLENN HWY. SUITE 207 ABSORPTION FIELD
No. of Bedrooms:
Ph°ne:[.907/¢ '~ 696-2960 DDeep Trench IIIShallow Trench DBed ·Mound DOther
LEGAL DESCRIPTION .o,, R.Ung: Total Depth from orynal grade:
5 aPb/Sq.
18 5 NORTHSLOPE #2 1.56 - 3.0 (ABOVE O.G.)r~ 0.52
- - - 5.6 - 5.5
~" Ol'~','ol w~dth: Number of lin.,:
WELL: [] New [] Upgrade 5
r~ ~ 150 so. ~ D 303'¥ F-S10
F~ WHITTER'S EXC. 7/14/2000
~ IPump set Ab ICa.lng HeightAbove Ground:
~,, ~ ,. TANK
SEPARATION DISTANCES [] Septic [] Holding · S.T.E.P.
From Tank Field Station Tank Sewer IJ.e~ ANCHORAGE TANK/ORENCO 1500
Well 100'+ 100'+ 100'+ - 25'+ STEEL 2
s.¢o=, lOO'+ lOO'+ lOO'+ - - LIFT STATION
Water
Line 1500 ANCHORAGE TANK/ORENCO
Foundation 5'+ 10'+ 5'+ -- -- TIMER ACTIVATED 46"
Drain N~NE KNOW~I #20 OSI 05 HHF ALCAN ELECTRIC
Remarks: ~[~~' ~¥~'r'¢..~ BENCH MARK
TOP OF SONOTUBE ON SOUTHEAST CORNER
' OF HOUSE.
107.00
inspections performed by:. AWWC, INC. Dates: 1st 7/1"/2000
2nd 7/14-/2ooo
,/../200o :
Department of Health and Human Services approval
Reviewed and approved b ~0,,///'_ .~ ./x,/'o 4~'*~'tc* Dote: ~ -2. -o o
PERMIT NUMBER: AS BUII~T DIe'WInG PARCEL ID NUMBER
SW000213 - 050-511-35
APPROXIMATE . ~
/
~ ~ ." ~ ~ / ' DESIGN D~WIN~
~ ~ f ST~ 48.5 57.7
~ ~ ~ / MH 58.5 67.0
~ ~N~ ~Na[bU C01 84.9 99.2
¢o' ~ MT 100.9 113.7
~-~ / C02 113.2 125.2
/
~S~ WATER & WASTEWATER ~.~.w. · "
............ ,~' ................ CONSULTANTS, INC,, .............. 1"
ALLEN ~ORDE (907) 696-2960 2 OF
NORTH SLOPE SUBDIVISION ~2; LOT 18, BLOCK 5
AS-BUILT OF SEPTIC SYSTEM UPGRADE (ADVANTEX)
PERUmT NUMBER: AS BUILT D~/~W~'~O PARCEL )O NUMBER:
SW00021 $ ' 050-511
AdvanTex Treatment 8) tem
~ Sehes - Mode la ~
T~ee (3) 34x48 Pods
~ FINAL O~E
m
I
2' INSULA~ON~
m~RT OF 9UNG~-- I~0~ I~1~ SCREENED
AT INL~ = 96.31 ~ 5,~,~,F,~K ~ ~ VAULT
EFFLUENT
PUMP
: :'~ D~WN7/24/2000Sy:~ 'TV'
~ ~' ......... CONSULTANTS; INC,, ................ s~:
EGAL DESCRIPTION: ~.~' --~95~
NORTH SLOPE ~2 SUmV~S~ON; LOT ~S, BLOCK 5 "~'... ........... .'~
WPE OF WORK:
AS-BUILT PROFILE OF TRENCH AND ADVANTEX SEPTIC TANK
Sent By: Alaska Water & Wastewater Consu; 907 338 3246; Jul-27-O0 12:13; Page 2/2
JUL. 27, 2000 II:ISAM ALCAN ELECTRIC NO. 8175 P, 2/2
alcan electrical & engineering, in".
p,o. box 91499
anchorage, alaska 99509
July 27, 2000
AllsR Rohds
30656 Kuparuk Avenue
Eagle River, Alaka 99577
Sewage Liit Station
Lot 18 Elock 5
North Slope Subdivision #2
In regards to the sewage lift station referenced above, all electrical
work performed by Alca~ Electric wes done to 1999 National Electrical ,6dda,
(NEC)~ Standards.
If you ha~e any quesCions~ please contact, me,
Sincerely,
Vice President o~ Operatio~G
Dept. o~ Labor Electrical Ce~ificate of Fitness No. 107758
cc: Jim Garness - Faxed 7-27-00
A.W,W .U,
(9079 563-3787 fax no. 562-6286
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 06, 2000
Expirafion Date: Jul 06, 200'1
Permit Number: SW000213
Legal Description: NORTH SLOPE #2 BLK 5 LT '18
Design Engineer: 0041 AK Water & Wastewater Consultant
Owner Name: Allen Rohde
Owner Address: 13135 Old Glenn Hwy, Suite 207
Eagle River, AK 99577-
ParcellD: 050-511-35
Site Address: 030656 KUPARUK AVE
Lot Size: 88813 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank L~ 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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.
THIS PERMIT IS ISSUED FOR THE CONSTRUCTION OF AN INNOVATIVE ADVANTEX TREATMENT SYSTEM.
AS A CONDITION OF THIS PERMIT THE OWNER SHALL MAKE ARRANGEMENTS FOR THE SYSTEM TO BE
SAMPLED ONCE A MONTH FOR A MINIMUM OF 12 CONSECUTIVE MONTHS AFTER BEING PUT IN USE. THE
ATTACHED PROPERTY OWNER AGREEMENTS BECOME A PART OF THIS PERMIT PACKAGE.
Issued By:
ALASKA WATER & WASTEWATER
June 19, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Reft Septic System Upgrade for Lot 18, Block 5, North Slope Subdivision #2
RECIRCULATING TRICKLING FILTER (Advantexm) SYSTEM
To whom it may concern:
1. GENERAL: The existing 3 bedroom home is served by a private well and septic system. The
existing septic system is surcharged and must be upgraded prior to the sale of the house. There
are numerous site constraints which are as follows:
· The slope contours
· The presence of shallow groundwater
· The location of the existing septic system
The primary concern is the presence of shallow groundwater and our abifity to maintain two feet
of accepting soils below the new dra'mfield. Consequently, we are reluctant to install the
proposed drainfield too far fi~om the only suitable site found. In order to maximize our chance for
success we have opted to utilize an alternative technology system that will allow for a reduced
TM
drainfield size, specifically the Oreneo Systems, Inc. Advantex treatment system. The
topography (roughly 20%) was such that an ISF system could not be installed. The MOA Onsite
Technical Review Board authorized the installation of three of Advantex systems on 6/14/00.
The proposed drainfield will have a 4'+ vertical separation to groundwater and a 6'+ vertical
separation to bedrock or impermeable soils. The soil application rate will be the same as was
approved for the Reaetex units. The follow'mg is a summary of the design:
2. SOIL CONDITIONS: Two test holes were excavated east of the existing septic system. In
TH#l, the soils below the organic layer is a ML/CL material to depth of 3 feet and then
transitions to a GC/SC/CL material to a depth of 9 feet (bottom of test hole). In TH#2, the soils
below the organic layer is a GC/SC material to depth of 9 feet (bottom of test hole). At the time
6901 Debarr Road, Suite 2B N Anchorage, AK 99504
Ph: (907)337-6179 ~ Fax: (907)338-3246 N Website: akwwe.com
of excavation of the test holes, groundwater was found to be at 3 feet in TH#l, and 5 feet in
TH#2. Nine days later, groundwater was found to be at 2 feet in TH#1 and at 4 feet in TH#2. No
percolation test was performed in TH#1 due to shallow groundwater. A percolation test was
performed in TH#2 between 1.5 feet to 2.0 feet and found the rate to be 10.9 minute/inch.
3. DRAINFIELD: The intent is to install a Recirculating Trickling Filter (Advantex) System
that will allow the use ora small drainfield in the area around a 30 foot radius of TH#2. The size
of the drainfield will be based upon an application rate of 3 GPD/FT2. We are proposing to install
a 5 foot wide drain_field that is 30 feet long and has an effective depth of 6"(remove all organics).
We propose that 2 feet minimum ofM. O.A. approved sand filter be added and leveled. Then, add
1 foot of clean, washed sewer drainrock below the distribution line. This corresponds to an
absorption area of 150 t52, or an application rate of 3 gpd/ft2 (assuming 450 gpd total flow).
4. ORENCO PACKAGE SYSTEM: The STEP tank with the trickling filter will be
manufactured by Anchorage Tank & Welding to meet the latest design criteria established by
Orenco Systems, Inc. The point of contact at Anchorage Tank is Lowell McNutt. As with their
standard STEP tank, it is equipped with a high water alarm per M.O.A requirements.
5. SURFACE WATER: There is no surface water within 100 feet of the proposed septic
system upgrade.
6. TOPOGRAPHY: The trench will be installed on a 20% slope. There are no slopes greater
than 25% within 50 feet of the drainfield site.
7. CLOSING: I am open to any suggestions from your department that would be an
improvement to the proposed system. I am unaware of any negative impacts that this installation
would impose on adjacen~wells, or septic systems. If you have any questions, please call us at
337-6179.
6901 Debarr Road, Suite 2B - Anchorage, AK 99504
Ph: (907)337-6179- Fax: (907)338-3246 N Website: akwwc.com
/ LOT IOA, BLOCK 4
~..~..~....~""~'~ \~ NORTH SLOPE #2 ~ LOT 11A, BLOCK
_~ ~ ,~ ~ ~ I~ ~ NOR~ SLOPE ~2
I LOT 17, BLOCK 3 /'/./' // ~ /N ~// /
,
-~ ~ -' ~ WALL
NORTH SLOPE
.... ~,~~ ,~, R ~'~
.... ,,~, ~' ..... , CONSULTANTS, lNG ........ ~ SOA~: ~
ALLEN ROHDE (907) 696-2960 1 OF 5 ~)r~ · '~
~*L DESOR~.T~O.= qd~ 4.. ~ ..'
NORTHSLOPE ~2 S/D; LOT 18, BLOCK 5 ~[,,~ .... [ ...... ·
SITE P~N FOr SEPTIC SYSTEM UPGRADE (ADVANTEX SYSTEM) ~,~
NOTE: THE CONT~CTOR MUST HAVE THE 100
FOOT WELL ~DIUS, AND THE 100 FOOT S~BACk
'~ "~ FROM THE NOTED SURFACE WATER OF THE
~ ~ REFERENCED LOT, F~GGED BY A REGISTERED
DATE:
~:~ ............ CONSULTANTS, INC,,~, 1"
LEGAL DESCRI~ION:
~PE OF WORK:
DESIGN Of SEPTIC SYSTEM UPGRADE (ADVANTEX SYSTEM)
AdvanTex Treatment SystemP.E."OTE=" J'M "ECROSS' -
AX Series- Mode la ~ ~w,~ ~ ~._ _
NSTA~ED OVER THE SEPTIC T~K & INLET ~. , -
THE ~V~ FILER. THIS WI~ ~LOW ~ ~ m
R[SE TO ~ FILTER ABOVE m 3' ~c NR DUCT ~ I I g
o~ cmwc SPACe.
CL[AN-OU~ ~ ~-~ ~ [~ RX-50 RLT[R OR
2" INSULA FOR TOOTER.
INLET ~ ' THE AX-lO PODS
~-- ~ SHALL BE PLUMBED
~ ~} SO THAT TH~ CAN
- PR~PI~ I~1~ SCREENED ~CH BE ISO~TED.
~ TRENCH T~T IS ONE FOOT BELOW
ORIGINAL G~DE, BY 5 FE~ WIDE,
,, BY 30 FE~ LONG. ADD ~0 FE~
' MINIMUM OF L~EUNG S~D, AND
~2 I~~ ONE FOOT OF CLAN, W~HEO
/ ....... ~ ~ 3 FOR LOCATION INSTALL TRENCH
6/19//2000
AI.ASI~ WATER & WASTEWATER K.D.W.
NORTH SLOPE ~2 SUBDIVISION; LOT 18, BLOCK 5
PROFILE VIEW OF PROPOSED TRENCH AND ADVANTEX SEPTIC TANK
' ALASKA WATER & WASTEWATER CONSULTANTS, INC.
LEGAL DESCRIPTION: NORTH SLOPE SUBDIVISION; LOT 18, BLOCK 5 "
PERFORMED FOR: ALLEN ROHDE ~,,.,~../~,, ,~,..~;~'%T:..,.,,.,:.,,,~
DATE PERFORMEB: 5/1/2000 (/0¢,¢/. '~. ~0~ -7955 ..".~,~
l [
I~PTH~ ORGANICS TEST HOLE #1 ~'~r - '
- GC '0~ xx
~ ~ . or CH
~c/sc/c~ ~,~} scSM oH
DEPTH TO DATE " - ''
GROUNDWATER '- ....... 1._..'
2' 5/3/2000
B.O.H. __.
1 O-- I
11 -- DATE READING CLOCK NET TIHE WATER LEVEE NET DROP
TIHE (HINUTES) READING (INCHES)
12--
1
6
17--
18~
19- PERCOLATION RATE ~ ,(NIN./INCH) /PERC. HOLE DIA. - (INCHES)
20-- TEST RUN BETWEEN - FT. ANF¢ [- FT,
co N.S: so. ON-.IT
DATE. DATE:
DEPTH TO DATE
GROUNDWATER
~' 5/1/2ooo
2' 5/~/2ooo
2' 5/10/2000
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
ISO,L LO0 - PERCOLATION TEST]
PERFORMED FOR: ALLEN ROHDE ~. , : ....
DATE PERFORMED: 5/1/2000
2--~ SOIL C~SSIFICATIONS
~ 5' 5/1/2000
8
~ ~' 5/~/2ooo
B.O.H. 4.S' S/~O/20oo
1~ -- DATE READING CLOCK NET TINE WATER LEVEL NET DROP
TINE (HINUTES) READING (INCHES)
2 1:57 30 5 1/4" 2 3/4"
4 2:27 30 3 1/4" 2 3/4"
5 2:27 6"
6 2:57 30 3 1/4" 2 3/4"
15~ ---,
18~
19~ PERCOLATION RATE. 10.9 .(HIN./INCH) ~ERC. HOLE DIA. ~ .(INCHES)
20-- TEST RUN BETWEEN. 1.5 FT~ ~ND ~ 2. FT.
PERFORMED BY A~SKA WATER · WASTEWATER I, g ~7[v ~ , CERTI~ THAT
THIS WAS PERFORM~ I~ ACCORDANCE WITH ALL STAT~/MU~ ClP~IDELINES IN EFFECT ON THIS
DATE. DATE: ~~ /
DEPTH TO DATE
GROUNDWATEE
5' 5/1/2000
4' 5/3/2000
4.6' 5/10/2000
Sent By.t Alaska WateP & WastewateP Consu; 907 338 3246; Jun-28-O0 16:21; Page 2/3
PROPERTY OWNER MAINTENANCE AGREEMENT
ON-SITE WASTEWATER DISPOSAL SYSTEM
This agreement, dated 7/ ~ ,200_0, is made between the Municipality of
Anchorage D.epartment of Hel/lth and Human Services (DHHS) and the property owner(s) of
· /~-h ~/a~# z Z,~ t~ z~/~ .~
!
This agreement is made for thc purpose of maintaining an on-site wastewater disposal system
on the subject property.
The property owner(s) agree to thc following:
The property owner(s) will have an annual inspection of the system performed by a registered
professional engineer. This inspection shall verify that all effluent and air pumps, timers, and
alarms ate functioning as designed. Any deficiencies shall be corrected and the engineer's
statement that the system is functioning as designed shall be filed annually with the DHHS.
Property Owner Name
Property Owner Name
State of ~4 aSlCO,.,
Judicial District '~a'rd,. SS.
on ~s §~' day of ~uL~ in the
ye~x ~.~ , before me, th~ ~mdersi~_ed no~ry
imblie, person~qy ~ppeazed:
~'~,h VI ~k'5. _'~¢~C0 _ known to me to be
the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged that he/she/they
executed the same for the purposes therein
contained.
In witness whereof, I hereunto set my hand and
offic, ial seal. A.~
Notar~'"~blic ~gnature~
(Notary's printed name)
My commission expires:
Sen~ B~ Alaska Water & Wastewaten Consu; 907 338 3246; Jun-28-00 16:22; Page 3/3
Municipality of 'Anchorage
Department of Health and Human Services
825 'L' Street
P.O. Box 198650 Anchorage, Alaska 99~ 19-6650
h~/vn~v, ti.an dn orage.ak.u$
Dear Homeowner/lS~ospecfive Buycr:
Thc oa-si~c wastcwatcr disposal system you are purchasing/installing is an "alterna~vc" wastcwater
disposal system. This system, known as an AdvanTcx Treatment System Septic System:, is
undcrgoing tcsfing wjthln the Mu~icipalJ.ty of Anchorage under the Alternative System section of thc
Wastcw~tcr Disposal Regulatious (AMC 15.65}. There arc certain risks involved with thc ownership
of one ofthcs~ systems:
1, The technology used in this system has been shown to bc effective ha other a~eas. The system
is curreafly uadergoing a two-year testing p~riod Ln Anchorage under thc guideace of the
Department of Health & Human 5ervice$ (DHHS) and the State of Alaska Dcpartment of
Environmental Consm~ation (ADEC) to detennine its cffectivencs~ ia a subarctic environment.
2. Thc system for this property rcccived a v~dcal separation distance waiver from both the Slate
of Alaska and Anchorage Municipal Code~ to ground water. This waiver wa~ granted duc to
thc system's expected pcfformonc, e w~thln the site conditions on this property.
I (we) ccrdfy that I (we) havc rcm thc ~ovc statements a~d am(arc) awarc of the risks outli~e. I (we)
also ce~ify that I (we) am (arc) in thc process o_fp .urc~z~ (property legal dcscriptkm):
/ (Pureh~er Na~e) (Purcha~ Name)
:BI' o~a~ize Below
5 ,20vt
~ who is ~aQy ~,~ to me
' ' whose i~ I pmvad on ~a b~is of
~ whose id~
a ~dible ~s
~ ~,* DE,,_ )tTMENT OF HEALTH AND HUMAN SER,,~/ES ~_~// ~'--~
~Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
Address
L~OALDE~Ca,PT,ON LOT LINEv'"J~' ~> /
I Lot /~ Block Subdiwsron
5 ,,ki'o~z'~ 5LoP~ Suez), --~'- FOUNDATION
'~"'¢'/~/t AS-BUILT DIAGRAM (Show Iocabof, of well, septic system, property hnes. foundabor
~ driveway, water bodies, etc.)
[] HOLmN
~atoba[ No. o~ Compartmonts ,
TYPE OF SYSTEM
E~] TRENCH [] BED [~'"~. DRAIN [] OTHER
Depth to pipe bottom lrom Total depth lrom original grade
or,ginal grade oJl~ FT / FT
-~ravei'iengm [ Gravel w,dth
Number of hnes Sod rating P~pe material
Inslaller Date Inslalled
WELLS C')~j~r__
~PRIVATE ~/~z/~ ~ OTHER (Identify)
Class~ncahon (A,B,C) Tolal Depth FT Cased to ~ ~ ~
Scale: ~ -' ENGINEER'S SEAL
I . ~ · ...... ~ ce~ily IhaUhis inspection was pedormed according to all~:,~ ..... ,
HeaJth Depadment Approval: ~ Date:
72 013 (3185)
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ~.~7,/,f'"~ /,.~J~' ~k. zfc,~p¢ ~¢/'~
8
9,
10
11
12
13
14
15
16
17
18,
19-
[ "~R~ 'S SEAL)
DATE
p E R F'e~- ~
Township, Range, Section: ~/
SLOPE SITE PLAN
WAS GROUND WATER
'1~
ENCOUNTERED?
S
IF YES, AT WHAT ~Z.I OL
DEPTH? p
E
Oepth to Water Alter
Moniloring? ~.~te..
/
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE _ (~tes/mch) PERC ,~OLE DIAMETER
~ ............ = ............ HAT T S TEST WAS PERFORMED IN
ACCORDANCE WITH.~'IL~I-I~-VE~f~I~L~O~'C~,~'GUIDELINE~S INL-~FFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13-
14
15
16
17
18
19
20
of Anchorage ~~~~.
DEPARTMENT OF HEALTH & HUMAN SERVICES ~~
825 "L" Street, Anchorage, Alaska 99502-0650 ~~~~~ '~
SOILS LOG -- PERCOLATION TEST / /~ ~<~'~ ~ ~,~5~.,
'%
DATE PEq~~
~o~.~& Township, Range, Section:'~ /2/~,
~ 13~. SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED:
IF YES, AT WHAT
DEPTH?
Depth to Water Alter
Monitoring? gale:
S
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION R E E DIAMETER __
TEST RUN BETW~ FT AND FT
PERFORMED BY: 17034 Eaule Riv~ L~ D~a ~ ~1 ~~CERTIFY THAT THIS TEST WAS PERFORMED
E~le River, Alaska ~7 ...... IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GU~DELI~CT ON THIS DATE. DATE:
72~008/Rev. 4/85)
.,'~0 '0 1'2
-T
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13-
14-
15
16
17
18
19
20
DATE PE
Township, Range, Section:
~ ~. SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
iF YES, AT WHAT ..~.l OL
DEPTH? p
E
Depth to Water Alter ._~' ,_,C//~/
Monitoring? __ Dote: .
Reading Date Gross Net Depth to Net
Time Time Water Drop
~ ~ ~ /~ ~ ~ ~//~ ~//~
PERCOLATION RATE / ~' (minutes/inch) PERC HOLE DIAMETER ~=,'~
TEST RUN BETWEEN (P' ~ FT AND /, ~' FT
PERFORMED BY: " [~ N~~OERTIF, THAT TMIS TES~ WAS PERFORMED
ACCORDANCE WI&"~[Z ~'¢~;~ ~'??"¢~J¢~ZL GUIDELI~FEOT~ ON THIS DATE. DATE: ~ ¢ ~ 7
/
72-008 (Rev. 4/85)
17034, E~i,qle Rive~ Loe, p Road No. ~: OMPUTATION SHEET
· E~gl~ Rive~'~ Alaska 995~ ~
SU~ECT:
DATE:
SHEET
BY
CKD
OF
WWD
Water Well Drilling
Phone 349-3809
Anchorage, AK,
Well Location Phone
Size Casing ~." /,:7,~'
Depth of Hole Cased to
Slatic Water Level "?~' ' feet Well Test _~' ,.";";";";";"~' ~ Gal per Minute Ior
Date .of Completion /.~.-~ ~"'~, ~ ~
feet
Hours
WELL LOG
,t? ~ .~Z~.~, ,
AUTHORIZATION TO DRILL
I hereby authorize W.W.D. Drilling'to proceed with the above work. Payment shall be made in the following manner:
Dale
Rig up Minimum (50% of anticipated depth) __feet. @ per foot
Balance due upon completion.
In the event it is necessary to institute legal proceedings to collect any amounts due on this contract, I agree to pay an additional
sum of Ten percent (10%) of the original contract price as attorney's tees, plus costs, for legal proceedings.
Name
Address
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
050-511-35
GENERAL INFORMATION
Complete legal description NORTHSLOPE SUBDIVISION ~2: LOT 18, BLOCK 8
Location (site address or directions) 30656 KUPARUK AVI~NUE
Property owner ALLEN ROHDE
Mailing address ,~0656 KUPARUK AVENUE.
Lending agency
Mailing address
Day phone
EAGLE RIVER. AK 99577
Day phone
(907~ 696--2960
Agent
Address
Day phone.
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE: If community well system, provide wdtten 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:
XXX
If community wastewater system, provide written confirmation from State ADEC
ing to the legality and status of system.
72~)25 (Rev. 1/91 ) Front MOA #21 Computer Vemion
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1400.00 at,
or prior to, closing for the engineering ser~4ces provided. J
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 Appreval 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 Municip,a. lity of
Anchorage fifes and from my investigation and inspectIon, the on-site water supply and/or wastewater
disposal system is in compliance with all Municip~l~r~ State codes, ordinances, and regulations in effE.ct
on the date of this inspection. ~)__~ ) ~,,~ ///~ f
Engineer's Signature[-.-, ,'/~ ~/~[J~/~/~ I Date
in conduoting this evaluation, AWWC, In¢l a~ /emt~/~d to pr~id~ thorough, con,,oientieus engineering analysis of the
system in accordance with ADEC and M~)A...I DHH~Guidellnes & Regulations. The reported results described the
performance of the system under the condit~ ~ns encountered at the time of the tE~st, and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend
on the local soils 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 tho control of
the svaluator of the system. Satisfactory test results do not guarantee future pedormance
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or parry is not authorized,
nor w/il it confer any legal right whatsoever.
6. DHHS SIGNATURE
~ Approved for ~ bedrooms
Disapproved
Conditional approval for bedrooms, with tile 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 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 s~ate requirements. Employees of
DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21 Computer Version
Legal Description:
A. WELL DATA
Well Type PRIVATE
Log present (Y/N)
Total depth 135'
Sanitary seal (Y/N)
Date of test
Static water level
Municipality of Anchorage . JUL
DEPARTMENT OF HEALTH & HUMAN SERVICES A~uk
Environmental Services Division ....
825~L'' Street, Rm 502 Anchorage, Alaska 99501 (907) 343-47~1
Health Authority Approval Checklist
NORTHSLOPE ~2; LOT 18, BLOCK 5 Parcel LD,:
050-511-35
IfA, B, or C, attach ADEC letter. ADEC water system number
YES
Date completed
Cased to 1.7,5'
YES
FROM WELL LOG
12/2/82
78'
12/2/82
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
3/15/2000
81'
N/A
1 2"+
YES
Well production
WATER SAMPLE RESULTSi
Coliform. 0
20 g.p.m.
7
g.p.m.
Nitrate
Date of sample: 7/18/2000 Collected by:
B. SEPTIC/HOLDING TANK DATA [ADVANTEX TREATMENT SYSTEMI
Date installed 7/14/2000
Foundation cleanout (Y/N).
Date of Pumping NEW
C. ABSORPTION FIELD DATA
Other bacteda
A.W.W.C., INC.
Tank size 1500 Number of Compartments 2 Cleanouts (Y/N) YES
YES Depression (Y/N) NO High water alarm (Y/N) YES
Pumper. -
l'BELOW FINAL GRADESI ~ ..~f ~ ~,~0
Date installed 7/14/2000 Soil rating (g.p.d./ft2 orfl2/bdrm) 5 System type TRENCH
Length 30' Width 5' Gravel thickness below pipe 0.52' Total depth *2.9'
Effective absorption area 150 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N). NO
Date of adequacy test NEW Results (Pass/Fail}. For ~
Fluid depth in absorption field before test (in.);~added (in.):
Fluid depth ~ Absorption rate = _
~t (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96) Computer Vemlon
D. LIFT STATION
Date installed ___
Manhole/Access (Y/N) YES
High water alarm level at*
Cycles tested NEW
7/14/2000
4'6"
Size in gallons. 1500
"Pump on" level at*. TIMER___"Pump off" level at*
· Datum_BO~q-OM OF TANK
I'IMER
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 100%
Absorption field on lot 100%
Public sewer main N/A
Sewer/septic service line 25%
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A __
Lift station 1 OO%
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+ __Absorption field
Water main/service line 10'+ Surface water/drafnage 100% Wells on adjacent lots
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10% Water main/service line
Surface water__ 100% Driveway, parking/vehicle storage area
Curtain drain. NO,~JE KNOWN
.
F, ENGINEER S CERTIIfI~/A ~ ~.3~/
I certify that I,~ '~te~/'mi~e~/fhr~ ~ /~/ field inspections and review
of MunicipaJ/reco lth~t. ~e~bov~ systems are in conformance
with MOA///AA g ~li~f~ i~/ effect on this date.
Signature[,,,,....,, ~ ~/~'~ "-'~
U
Engineer's Nam JEFFREY A. GARNESS
Date ~7/~.
/
100'+
10'+
10'+
Wells on adjacent lots 100%
f'f'/lt't-/'- 'k-':""}
%'%/'..v ~F-7953 ..' ~
..........
HM Fee $ ~-~ ~ ~"
Date of Payment.
Reoeipt Number_
72~26 (Rev. 3/96)* Oomputer Ve~lon
Waiver Fee $
Date of Payment
Receipt Number
Sent By: Alaska Water & Wastewater Consu; 907 338 3246; Jul-28-O0 13:30; Page 2/3
u¢-z~-§o 74:09 ,CRO~t-CTE ENV[RO~NTAI. 5615301
~d~t~__- CT&E £nvironmontal Servicea Inc.
Cr&~ Ref.~
Client Name
Project Name/#
Client Sample ID
Matrix
Ordcr~l By
PWS~
Samgle .~',emarks:
1003932001
AK Wa'~r & Was~ewa[¢r Coa~ulmms
Northslope #2 Lot l 8 Bk $
Northsiopc #2 Lei 18 B~c 5
Drinking Wa~er
Prillted Daw/Time 07/24/2000 14:48
CollectcdDa~e/Time 07/19~000 12:30
R~eeJved Da~e~e 07119~0~ 15:15
Technical Director Stephen C, Eae
Rel.~ed By
Lird~s
0.977 0,500 rog/I- EPA 3o0.fl I 0 max 07/iglOO SCL
To,al Cobtbrm 0 colllO0~L SMIg 9222B 07/19/00 K,a,P
MUNICIPALITY Of ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 995.19-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Lot 18; ~'Bi0c~ '5;"'Northslope'S~bdiuision ~
NHN Kuparuk Avenue
Location (site addreSs or directions) NO HOUSE NUMBER Kuparuk Avenue.
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Marty Smith Day phone 696-2954.,
HC83 Box 2421 Eagle River, AK 99577
Day phone
Day phone
¸4.
Unless otherwise requ.ested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If bommunity wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (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, t 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 s & ~ t;NGINEEP. ING ~ Phone
1~034 £a91. River L..O~R~a~I,
Address 2a~=~ ,~:~'~r, 51==~~....~ ~°~77 / ~ ~ ~ '
EngineeFs signature ~~ Date
DHHS SIGNATURE
~ Approved for _~ bedrooms.
Disapproved.
Conditional approval for 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 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 i~ issued. The Municipality of Anchorage is not
responsible for errors or omissions in the profession~-I engineer's work.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:~''d t~ ~'¢'¢~' J~°'~'~f'¢~\~ Parcel I.D.
A. WELL DATA
Well type ~,,L~
Log present (~/N)
Total depth
Sanitary seal (~)'N)
FROM WELL LOG
Date of test \
Static water level
Well flow
Pump level
If A, B, or C, attach ADEC letter.
Date completed
\'5~" ~ Casing height
Wires properly protected ~_~N)
g.p.m.
ADEC water system number ~'/~'
\ t:) - "/.-'Z--- - ~/2,--- Driller
AT INSPECTION
Cased to
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot \
Absorption field on lot
Public sewe.r main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cieanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform (~ c~ ~"1 ~o~ ,-'' '(L Nitrate
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed ~-~
Cleanouts (~N)
High water alarm (Y~
Date of pumping
Collected by:
Other bacteria t
S & S ENGINEERING
Eagle River, Alaska 99577
Tank size. \ c>c>c, Compartments
Foundation cleanout (~N) ~' D'epreSSion ('¢~)
V~ Alarm tested (¥/N~
~ %~ Pumper ~:::~'~ 0
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot \\~\ On adjacent lots \~(~
To property line \ o Absorption field
Surface water/drainage
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump on" level at ,------~ u~mp off' level at
High water alarm level .~ Cycles tested
Meets MOA electrical codes (Y~
SEPARATION~NCE FROM LIFT STATION TO:
W_C. Po~ lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed ~ ~
Length ~, \ "2--'\ Width
Total absorption area Lc'z~¢'~
Depression over field (Y~
Results ~ail)
Peroxide treatment (past 12 months) (Y~.~
Soil rating ~-'~, "~ t~ ~ F~¢--|
Gravel thickness \ ~
Cleanouts present
Date of adequacy test
for_ '~'¢~¢-E-.
~.'~ ¢¢-- Cd~c:~ If yes, give date
System type '~ ~ ~' ~, ¢. t..~ ¢
Total depth "~ ~' ~
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot
To building foundation
On adjacent lots
Surface water \ ~-~
Curtain drain
On adjacent lots \ oc~ Property line
To existing or abandoned system on lot
Cutbank ~ ,~. Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on t~.e. d~te of this insl~ection
S & S ENGINEERING
Signature 17034 EagleRIver Loop P. oa~INo. 204
Engineer's Name ~'
Date
HAAFee$ / ~E)/ ~O Waiver Fee:$
Date of Payment -~ ~ ~,-~ -- ~ Date of Payment
Receipt Number ~¢ ~ ¢ ~'~E'¢~ Receipt Number
72-026 (Rev. 3/91) Back MOA 21
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
.~ cLOW TEST
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
ROBERT SHAFER, P.E
ROGER SHAFER, P.E.
WELL FLOW TEST D/~TA
CIVIL ENGINEERS
(907) 694-2979
FAX 694 !211
CLOCK Dl~i TO DRAT~UX)WN PUMPING.
TIME W3tL'~K PATE (~PM)
HXSC. DATA: CASXNG HEIGHTz [ Z..,tt''~- SANITARY SEAL? ~ q WXRES IN CONDUIT?:.__~__ GI~ADING O..K.?zt
¥,
BACTERIA & NITRATE SAMPLES COLLECTED. ~
RESU~.TS~ W~.'r. [:U~,REN'JILY PRODUCES ~,~_) G-PM WXTH A ~.-~( DRAWDOWN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
~UA
8ampla
NIINAIE-H 0.38 ~/! ~Fk ~$3.2/300.0 10 0~/22/93 [~R
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcell.D.# ~¢-'~b(~' ~//-...~ HAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
LOT 18; Block 5; North Slope Subdivision~
Location (address or directions)
NHN Kuparuk
(b)?roperty owner
Mailing Address
(c) Lending Institution
Mailing Address
Carla S.' Had~e~
Telephone: (home) 694-2015 Business 563-4567
Ala4ka 99577
Telephone
HC 85 'Box 2421 Ea¢le River,
(d) Real Estate Company and Agent
Address
Telephone ' '
Mail the HAA to the following address: (or check here,~ if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING .
17034 Eagle Ri:vet Leep Read No, 2~4
Eagle River, Alaska 99577. .'.
(e)
2. TYPE OF RESIDENCE
Single-Family~ Number of bedrooms
3. WATER SUPPLY
Individual Well [~:]X Community [] . Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site .1~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page I of 2
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'ejes s~ melsXs leSOds!p jeleMejSeM Jo/puc Xlddns Ja~eM 8iis-uo emi jeq~ sMoq9 leAoJddv Xl!Joqinv qlteeH
.s!q~ jo ~o!~eSRseAu! ~m ~eql ~peA I 'MOleq UMOqS elep UO!~ep!leA eql ~o se pue o~eJeq pex!~ lees ~ ~q pe!j!~Jeo sV
NOI&Y~aOJNI aNY Y&YQ 'HO~Y3S ~11~ 'S&S~ 'SNOI&O~dSNI 9NlalAOMd ~alJ ONIM~aNIgN~ 'g
, ~i'"~i~,~ Health Authority Approval (HAA)
~,,3'o \~4/ · CHECKLIST - FEBRUARY 1984
~;~%0'~ ,.~ ~ ,~ Legal Description'
WELL DATA
Well Classification ~ ~[ I~ ~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present ~,)~ ~ DatelC~pleted ~ ~-~ ~Yield
~/~ ~
Total Depth [~ [ Cased to [~ Depth of Grouting ~ -
Static Water Level "7 ~ ~
Casing Height Above Ground
Electrical Wiring in ConduitS/N) ~
SEPARATION DISTANCES FROM WELL: ~ /
To Septic/Holding Tank on Lot I ~ ~ ; On Adjoining Lots
To Nearest Edge of Absorption Field o,n Lot ~,'7~"/ ' ; On Adjoining Lots
To Nearest Public Sewer Line rJ~1~
PumP Set At
Sanitary Seal on CasinC..C~N)
Depression Around Wellhead (Y/~
To Nearest Sewer Service Line on Lot
CTo Nearest Public Sewer Cleanout/Manhole I~,~
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANi~DATA
Date Installed (~-"5-81 Size
Standpipes~N) '"f
Depression over Tank
...-' Pumping/Maintenance Contact on File (Y/N)
Holding Tank' High-Water Alarm (Y/N)
1, c::~=,c:~ No. of Compartments
Air-tight Caps¢/N) '~' Foundation
e.J ,Date Last Pumped
~/./~ ; for
V~/~ Temporary Holding Tank Permit (Y/N)
SEpaRATION D'iS~FANCES FROM SEPTIC/HOLDING TANK:
To Wa{er-Supp y f ~" TO Building Foundation
To Pr(~per;[y;L[he' ':' ~ c> To Disposal Field
To Water Main/Service Line \
T0'Strea~, '';~
Pond, Lake or Major Drainage Course
Comments ,,~]---~__t~ C.~;;::¢~L.
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ~"' ~
Square Feet of Absortion Area
'~-~'Z-- ~,~,,~ Type of System Design ~ ~-~*:~-'~ ~--~..-J~¢
'/ Length of Field
'" Depth of Field
Gravel Bed Thickness J
Statndpipes Presentd~/N)
Depression over Field (Y/~j) ~ Date of Last Adequacy Test
Results of Last Adequacy Test
~- --
SEPARATION DISTANCE FROM ABSORPTION/FIELD:
To Water-Supply Well I "~-"'~ I .f .
~ t/ To Property Line
To BuildingFoundationj ~' ~'~ To Existing or Abandoned System on
Lot ~/~
; On:djoining Lots
To Water Main/Service Line ~ ~1'~ ~ To Cutback (if present),_
To Stream, Pond, Lake, or Major Drainage Course ~ ~
To Driveway, Parking Area, or Vehicle Storage Area ~ ~z~c::~t Jr'
Comments
D. LIFT STATION
Date Installed Dimensions
Size ink'G~ns Manhole/Access (Y/N)
On"
"Puml Leveq'"dh----,.~ "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** ~~
this'%
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of
inspection.
Signed
Company
Date
MOA No.
S & S ENG!NF~=RING
17034 Eagle Rivet' Loop Road No. 204
Rivet', Alaska g~,~Z~
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Ordex % 16892
Date Report Printed: SEP 25 89 8 18:36
Client Sample ID:LOT 18 BLK 5 NORTH SLOPE
PWSID :UA
Collected SEP 20 89 @ lO:D0 h~s.
Received SEP 20 89 @ 16:40 h~s.
Preserved with :AS REQUIRED
Client Name : S ~ S ENGR
Client Acct: SNSENOP
P.O.# NONE RECEIVED
Req ~
Ordered By :
Analysis Completed :SEP 22 89 Send Reporto to:
SuDervi~or,:STEPNEN_~._ C. EDE 1)S & S ENGR
Laboratory
ReLeased ~y :~ ~_~ 2)
Spooial
Instruct:
Chemlab Ref ~: 7637 Lab Smpl ID: 1 Matrix: WATER
Allowable
Parameter Tested Result/Units Method Limits
NITRATE-N 0.38 mg/1 EPA 353.2 10
Sample ROUTINE SAMPLE.
Remarks:
1 Tests Performed ' See Special Instructions Above UA=Unavailable
ND~ None Detected "See Sample Remarks Above
NA= Not Analyzed LT=Less Than, GT=Greater Than
