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Home My WebLink AboutHOLLY HILL BLK 2 LT 5 , Municipality of Anchorage Page t of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report ,~"~ ..... , ~I~I-D~I- Permit Number: --~W c~-,O(::~c~ PID Number: ~' Name: ~0~ ~~ Wastewater System:~~ ~ Upgrade ~ddre~: ~l&{ ~~[~ ~ ~ ABSORPTION FIELD Phone: , of Bedrooms: ~ Deep~ D Shallow Trench ~ Bed D M~ Other ~ _ ~ }No. ~ Soil Rating: ~ Total Depth~riginal grade: LEGAL DESCRIPTION wo/sq. ,,. Lot~ B~k: ~// Subdivision'. Depth to pipe bottom from 9riginal~ ~epth beneath p,pe Ft. ~/ ~/~ ~ Fill added above original grade: ~ ~ngth: Township: Range: Section: ~ Ft. Ft. WELL: ~t~l~ew ~ Upgrade G~w, depth: ~ Numb~o~ Ft.~ Ft. Classificatio~ivate, A,B,C): Total Depth: Cased To: Total abso~ea: Pipe materiah Driller: Date Drilled: Static Water Level:Ft. ,~ Date installed: Yield: GPM Pump Set at: Ft. Casing Height AboveGround:Ft. ' TANK -- SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. TO Septic Absorption Lift Holding Public/Priva,6 M~~ ~, Capacity ,~ns~ From Tank Field Station Tank Sewer Lines ~ Well /0~I ~ ~ ~A ~ Material: ~~ Number of ~rtments: Surface Water /06'~ -- - -- -- ~ LIFT STATION Lot t size in gallons: M~~ U,e I~ -- - ~ -- Foundatio~ ,~ _ - ~ ~ "Pump on" level at: ~le~water alarm at: Curtain Drain ~ ~ ~ ~ ~ Electrical Inspections pedormed by: ~ Remarks: ~1~ ~l~ ~ BENCH MARK ~~. ~ ~ T~{~ L°cati°n and Descripti°n: T0P 0~ ~ I Assumed Elevation: /~ Ft. ENGINEER'S SEAL ~ e® ~ Inspections performed by: s & 5 ENGINEERING Dates: lst~' ~.~.~~:,, .......-... Eagle River, Alaska Department of He nd Human Services approval ~:~... Reviewed and approved by: ~~ ~ ~ Date:/%~- ~ '~OFES~:~ 72-013 ~1/911 MOA 25 f !~ 'Permit No. Page e~ of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519~6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: /"/OLd? ~JU- .~a~C~ ! ~J.F-. ~,! Lo3' PtD NO.: TOP o~ F~.o~q ~ EEl=.· El, l~lJ -" I0oG PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920096 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MENDES JOHN S & LYNN E OWNER ADDRESS:7141 HENDERSON LP ANCHORAGE,AK 99503 DATE ISSUED: 5/21/92 EXPIRATION DATE: 5/21/93 PARCEL ID:01408111 LEGAL DESCRIPTION: HOLLY HILL BLK 2 LT 5 LOT SIZE: 20000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM 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 (18AACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: . HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTtON & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. May 20, 1992 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 MuniciPality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 5; Block 2; Holly Hills Subdivision We request you issue a permit for the installation of a new 1000 gallon septic tank for the septic system serving the referenced property. The existing septic tank has collapsed and needs to be replaced. We do not anticipate any adverse effects to neighboring properties by instaling a new septic tank. If you have any question or require additional information, please contact US. ~~ _~/~cerely, JAMES P. WILLIAMS Civil Engineer ROGER J. SHAF~R, P.E. JPW/tv 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 r'= 30' SCALE WA/p lO0' WELL RADIUS ~" ' ' 'ty ., lun c pah o! Anchorage Department et Health and Human ~erv~.es S25"L' p.O. Box 19~0 Anchorage. ~ 9~51 e"e65° Nie~ ineering ~echnician . - ~ervicee, Xnc- ~a~ 99503 ~aive~ ~e~es~ ~o~ ~ S Bl~k 2 Holl~ well on ~ · _,~ ~ +~= te~ lo~ ~1 ~__~ ..~ ~': :.,~ fl~ teat P ~ i~lXi Andreaa, P.E., Xanager On-Side Services/Water nicipality of Anchorage P.O. Box lg6650 ~i6; xg88 Depadment ot Heath and Human Set, cee 825 'L" S~eet Ancho~g~ A~Ikl 99519~650 have been taken from you~ tt~e water sa~plee_ _ _ the eeepage ~aniel ~. Roth Enqineer Services !c-. x~re.., On-Site Servxcee/~acer GREATER ANCHORAGE AREA Department of Environmental Qualit 3500 T~>dor Road -- POuch 6-650 . ~ Anchoraqe, Alaska 99502 -- ANCHORAGE AREA BORO~,~H ...... -------'- N°. 853 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: ADDRESS LIQUID CAPACITY GALLONS. .--S'"~r~----,~)~, ~z~ NUMBER OF MATERIAL COMPARTMENTS INSIDE LENG}H "~//z'z~"~ ..... INSIDE'WIDTH LIQUID DEPTH__ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER / ,' 4 LINING -: . NEAREST LOT LINE ~ / 7gO :~'' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) J OR WIDTH z/ '~) , LENGTH ~']2 , DEPTH ~-~/~' , DISTANCE FROM WELL ,/'(":C' /./'~?;~':Z.2~ , BUILDING FOUNDATION~-)'~'~/~ ...~ ~7(~'~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL ,/~"'~: FOUN~"'~D'A~J,QN , NEAREST LOT LINE NUMBER OF UNES /"' DISTANCE BETWEENLjN ES~'''~ TRENCH WIDTH ABSORPTION AR SQ. FT. LENGTH OF EACH ' M~~I DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER TOTAL LENGTH , OF LINES IN. TOTAL EFFECTIVE ~1 ~AS~OVETILE__ ~ .~ -. "-- DISTANCE FROM -- WATER WELL: TypF:~,~,?{~/c, , DEPTH .,BUILDING FOUNDATION SAMPLE , NEAREST ~ NEAREST ~ SEPTIC -'~ SEEPAGE ~ OTHER LOT LINE , SEWER LINE . TANK , SYSTEM , CESSPOOl , SOURCES DISTANCES: ?..~:.~ ..... D AGRAM OF SYSTEM GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL DUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION //g~ LEGAL DESC.,PTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY T(3 BE SERVED SOIL TEST RESULTS COMPLETION DATE ANTICIPATED PERMIT NO. ~ , OTHER SEEPAGE PIT ~ ~ DRAIN FIELD TO BE INSTALLED BY · NOTE~ THIS PERMIT I$ NOT VALID WITHOUT ~OIL TEST pFEMTT VAITB flNF YFAR FINAL INSPECTIONs 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INEPECTION BY THr. MINIMUM DISTANCES, REQUIREMENTS /~ · . 5 ft. /] . , . FOUNDATION TO SEPTIC TANK / SEPTIC TANK, 25 ftc, SEEPAGE PIT 100 ft. , DRAIN FIELD TO LAKE, ./~crr8 ~ GEAYCL ~AC~FZLL "One test is worth a thousand opinions" Performed For C~r/~ ~./tt/~ ' Date Performed 4:~--/-7~-' Leaat Description: Lot ~ Block ~Subdivision ~0((~ ~/f~ This Vorm Re~orts Soils Lo~ ~ Percolation T~st - Qepth Feet 7 8 Was Ground Water Encountered? I~ Yes, At what Depth? ' i Reading Date Gross Time Net Time Depth to H20 I Net Drop I ,:Test Performed By ~/~...~'/x.~-~. /~.. ~~ ercolation Rate Hinute Proposed Installation: Seepage Pit Drain Field Deoth of Inlet Depth To Bottom Of Pit Or Trench M,.,NIC,PA,TY OF A,C.ORAGE 0 DEPARTMENT OF HEALTH & HUMAN SERVICES ~,v,s,o. OF E.V, RONMENTAL SERV, CES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL o~ o.-S,T~ s~w~...~ W*T~. ~*C,.,T* 264-4744 Application Date ~" ~ ~ - GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot block, subdivision, section, township, range) Locati6n (address or direbtions) (b) Property Owner Mailing AddreSs: ;Z3~- ~'. ~'.z~ (c) Lending Institution '~./ /~. Telephone Mailing Address.. (d) Real Estate Company and Agent Address -~/ ~ ,~/~~ ~/~ Telephone ~5~' ~o~ Telephone: Home Business (e) Mail the HAA to the followina address: or: Check here ,~if hold for pick up. List contact,~per o~y ~']'~--~Y/~/d/ph°ne'n~ber ,belo/w. ~.~¢¢2 TYPE OF RESIDENCE Single-Family'~ Number of Bedrooms WATER SUPPLY Well~. Community [] Public [] Individual 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 Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRay 8/861 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 /~ -~'~/~" Telephone 2:5~/- ~0~/0/ Address /.~-'¢'~ ~/ .~/,~ ,c,/~ ,~¢C- _~'~]"~ ~L~ /~/~t/. /~. "~ "~ ' DHHS APPROVAL Approved for ./~ bedrooms by Approved .~' Disapproved Terms of Conditional Approval 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 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 72-025 fRev 8/86) Back MUNICIPALITY OF ANCHORAGE (MO~l HEALTH AUTHORITY APPROVAL (HAA) k~UNICI?ALI~' Ol: ANCH~:'~KLIST - FEBRUARY 1984 i~HVI~ONM~-N~*AL $~p,¥,CES DIVISION 264-4720 t'~IAY 3 tSS~ Legal Description: ~¢~'~''-5'~ -/'~r'~ ;~ ~f WELL DATA , /~, Well Classification ~/~'~" If A, B, C, D.E.C. Approved (Y/N) Well Log Present (y/~/h Date Completed ~ /¢"Z~' Yield Total Depth ~ Cased to ~".~ / ,~d/~+ __ Depth of Grouting . Static Water Level (~ --~'~?" Pump Set At ~t.)/,-~ Casing Height Above Ground / ~ Sanitary Seal on Casing ) Electrical Wiring in Conduit~ ¢~'~'~ Depression Around Wellhead (Y/~ Separation Distances from Well: To Septic/Holding Tank on Lot (~ ~/ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot (~) /~ ~ ; On Adjoining Lots To Nearest Public Sewer Line ~,Y/~ To Nearest Public Sewer Cleanout/Manhole .,d?.~ To Nearest Sewer Service Line on Lot Water Sample Collected by //Czar-~; ~ ~'~/ ; Date Water Sample Test Results /~/'~ '?'~ J/~-~/P7~-5' ~-~ Comments /~ ~d~2z~ '"" ~ SEPTIC/HOLDING TANK DATA Date Install~Size _/~'~ r'TJ NO. of Compartments ~- Standpipes~Y~/~l) -- Air-tight Caps~'~) Foundation Cleanou~'~ Depression over Tank (YO Date Last Pumped ~'~>'~-~? Pumping/Maintenance Contract on File(Y/N) ~r~ ; for Holding Tank High-Water Alarm (Y/N) xJ~//-t- TemPorary Holding Tank Permit (Y/N) Separation Distances f~ank: To Water-Supply Well ~/ To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'-~' Width of Field / 7 Square Feet of Absorption Area Depression over Field (y(~l Results of Last Adequacy Test Type of System Design Length of Field ~ ! Depth of Field /~ Gravel Bed Thickness ~' / Standpipes Present {~N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well C) 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 Comments ~_~)/tCg/~ ~_~¢ To Property Line To Existing or Abandoned System on ; On Adjoining Lots /,d To Cutbank (if present) LIFT STATION D a'~'e"~tall ed t/ Dimensions Size in G~~__///A Manhole/Access (Y/N) "Pump On" Level at '"'"~_ "Pump Off" Level at ~ Vent (Y/N) . High Water Alarm Level at % · . Tested for _ ~cles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~~ Comments ~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav_e ¢jCqeck¢~, verifi~ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~"'~///" ~,~t///~/"~"'-'~ Date ¢~ 2'~---~' Company /'¢"~ ~ MOA No. ~"~-~ ~'~'/' Receipt No /¢¢'~/~/ -~ Date of PaYment /'~'~'/,-~/ ' .- Amount: $ / ~' .~~ .... Page 2 of 2 72~026 (11/84) Tom Fink, Mayor unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 May 6, 1988 Alan C. Wien Engineering Technician Alaska Environmental Control Services, Inc. 1200 West 33rd Avenue, Suite B Anchorage, Alaska 99503 Subject: Waiver Request For Lo~ 5 Block 2 Holly Hills Subd. Waiver Request Number~wR88-016 .~ Dear Mr. Wien: Your request for waiver of the required 100 foot separation of a private well on Lot 4 Block 2 Holly Hills Subd. and on the subject lot to a seepage pit on the subject lot has been approved. The approved separation to both wells is 97 feet. A well flow test performed on the subject lots well showed the maximum drawdown was 18 feet and then stabilized. This indicates the well is supplied with water from a confined aquifer that is under pressure. A well log belonging to the well directly across the,street from the subject lot also indicates there are silt barriers between possible surface contamination and the confined aquifer supplying well water. This waiver approval applies to the existing wells to seepage pit only. Any future upgrade to this pit will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-Site Services cc: Gus Andress, P.E., Manager On-Site Services/Water Quality Programs Tom Fink, Mayor unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 May 6, 1988 Robert Madsen 7131 Henderson Loop Anchorage, Alaska 99507-2542 Subject: Separation Distance Waiver of the Well on Lot 4 Block 2 Holly Hills Subd.,.Recorded Owner, Robert Maden, to the Seepage Crib on the Neighboring Lot 5 Block 2 Holly Hills Subd. Dear Mr. Madsen: The Health Department is entertaining a request from your neighbor on Lot 5 Block 2 Holly Hills Subd. for waiver of the required 100 foot separation from the well on your lot to the seepage crib on their lot. The requested waiver distance under consideration is 97 feet. At this time, water samples have been taken from your neighbor's well which also has a separation from the seepage crib in question of 97 feet. The results from this water sample indicate that there are no contaminants in the well. The engineer hired by your neighbor and the Health Department believe that the chance for contamination to enter either well at a future time is unlikely. If you have any questions regarding this matter feel free to call me at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Services cc: Gus Andress, P.E., Manager On-Site Services/Water Quality Programs ALASKA EI1UIROIIMEnTAL CONTROL SERUICE$, InC. April 20, 1988 Municipality of Anchorage Department of Health & Human Services 825 L Street Anchorage, Ak. 99501 Re: Lot 5, Block 2, Holly Hills Subdivision Waiver Request From the HAA inspection and referencing the sewer inspection report, we find that the ~ub:jec~ Crib :~is~?app~oxima~elY 97 feet from the sub~ec't~ well, and ~he: Th~ ins~{~0n ~epo~t stateS'the 'pit to be ~ f~e~ from the neighbor well and was approved by the inspector. The subject well was not in at the time, There are no well logs available for either well. On 7/29/87, a well flow test showed static level at 58.9 feet, a flew of 4.3 GPM with a maximum drawdown of 18 feet. A previous HAA dated 3/30/84 states the depth of the subject well to be 83 feet. The lot is on level ground. Water samples are satisfactory. We request that you grant a waiver of the required 100 foot separation distance to 97 feet. We feel that this 3 percent reduction of the required distance will not pose a threat of contamination to the wells. If you have any questions, please call. Sincerely, Alan C. Wien Engineering Technician Approved by: //'/4 Y " WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling Permit No, A.D.L. No. ,a.lJeorough Subdivision Lot Block ih. Il '/4qtre. Section No. TownshlPN~] Range ED Meridian ~p~'h4}-aoe ioliv ~1. lO i _of_of__of -- s~ Ic.]iDtSTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL; ~ ~t:[~md Street Address and Area of Well Locatlo~ WELL LOG Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION Material Type Top Bottom S~J].C~. ~' ~!~T~TC~ 1,;/~cr~Dk.~ C)f~.e~ ..... C~%: 0 ].~ 6, ~ Cable tool ~ Rotary ~ Driven ~ Dug ~tr~"~k of '~{~3]': ~;r.e]" ~>~ KO ~ irrigation ~ Recharge ~ Commerical ' *~ ('~ ~'~Threaded [~ Welded ~,~[tl~'~~ g~O ~;~$ ~?~l[ 7, ~',f, 8. CASING: diam. ~ in. to~ ft, Depth Weight ~7 lbs./ft. diam. in. to.~ fl, Depth Stickup ft. 9. FINISH OF WELL: Type: O~X~. ~t[~ Diameter: Slot/Mesh Size:. Length: Set between ft. and ft. Backfilling Gravel pock '0. STATIC WATER LEVEL ..... ft. 8/26/ Dote ~ Above or ~ Below land surface Equipment used: ~2 ~ ].e~ [I. PUMPING LEVEL below land surface and YIELD ft. after bra. pumping g.p.m. ft. after hrs. pumping I~,GROUTING WeE Grouted: ~ Yes ~ No Material: ~ Neat Cement ~ Other: i5, PUMP: (if available) HP Length of Drop Pipe ft. capacity ~g'P'm' u,, D O,h.. ,.,.~.~s: ~:}~[ for % l-~ ~ ~5 ;~}~ ',~i~ to ~6. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Woter Temperoture ° ~ F ~ C Signed: ~ , ~ ~ ' '~'~ Date: ~, ,_ .~.,~.;/ _ CHEMICAl. & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~'~X 5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (007)562-2343 ~"~o~% FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 6224 Date Report Printed: APR 25 88 @ 11:49 Cliant Sample ID:LS, B2 HOLLY HILLS. PWSID :UA Collected APR 20 88 @ 12:20 h~s. Received APR 20 88 @ 12:35 hrs. Preserved with :NONE Client Name : AECS Client Acer : AKECSRP P.O.~ NONE REC'D Req ~ Ordered By : CINDY LOVELACE Analysis Completed :APR 22 88 Send Reports to: Laboratory Supflrv%so~ :STEPHEN C~[DEj 1)AECS Released By : .~~.~ 2) Special Instruct: Chemlab Ref ~: 9758 Lab Smpl ID: 1 Matrix: Water Allowable Parameter Tested Result/Units Method Limits NITRATE-N ND(O.iO) ms/1 EPa 353.2 MUNICIPALITY OF ANCHORAo~ ENVIRONMENTAL SERVICEs DIVISION l~A¥ ~ 1988 RECEIVED Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY A. WIEN. i Tests Performed ND= None Detected NA~ Not Analyzed See Special Instructions Above UA=Unavailable See Sample Remarks Above LT=ness Than, GT=Greater Than ACHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water'Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PRIVATE WATER SYSTEM Name /z-~ o 33'J Mailing Address Phone No. City State SAMPLE DATE: 7-741 [¢-71 Mo. Day Year Zip Code SAMPLE TYPE: ~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose .) [] Treated Water ~ Untreated Water SAMPLE NO. LOCATION 4 I MUNICIPALITY OF ANcHO,~AOE i:NVIR(JHIVieHIAL SERVICES DIVISION 1988 Time Collected RECEIVED READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: Analysis shows this Water SAMPLE to be: [~ Satisfactory [] Unsatisfactory [] S~mple too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. /,23 Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* ? 75w-~. I 1-71 I I FT-] I I-~ I IT1 BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count ~erification: LTB. Final Mere bra ne ,~~.~ Reported By v . . Analyst TNTC = Too Numberous To Count( ....... OB = Other Bacteria "j PART ! OF 2 '1 O Coilformll00ml BGB 0 Date Time: Coilform/100ml IREt4/~ [NDER TO FOLLOW /~L~SKA ENVIRONMENTAL . CONTROL SERVICES, INC. 1200 West 33rd Avenue. Suite B ANCHORAGE ALASKA 99503 (907) 561-5040 SHEET NO CALCULATED 8Y CHECKED BY SCALE OF DATE ~-~z-~7 DATE -- MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL IiEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~//~ /~'~/~J/_-.~ ..... Legal Description (include lot, block, s~bdivision, section, township, range) Applicants Address '---~ / ~/ / ~tr:~t~%~....a L~'~(~ f ~-',xl~ it ~-~- cl~J-2~? Applicant is (check one) Lending Institution ~-~ ; Owner/butlder~ ; Buyer ~ ; 0that ~ (explain); Lending Institution Telephone (a) (b) (c) (d) Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAL to the following address: 2. T~e of Residence Single-Family ~: Multi-Family~ Number of Bedrooms Other (describe) 3. Water Suppl_L 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. 4. S_ewa~e Disp0sa_! 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] Engineering Firm Providin$ 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 regula- tions in effect on the date of this inspection. Name of Firm / Address t / . Date ~, DHEP Approval Approved for Approved X bedrooms Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF A~CHORAGE DEPARTMENT OF HEALTH AND ENVIROP~NTAL PROTECTI0~: (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON Tt~ REPrESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSI0~L ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO Pg~C~%SERS OF HOMES ~ND THEIR LENDING INSTITUTIONS IN ORDER~TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. ~[PLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ~CHORAGE IS NOT RESPONSIBLE FOR E2RORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUqi~ORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 1984 .RECEIVED Well Classification ~:~%\~_~ If. A, B, o~ C, D.E.C. Approved(Y/N) -'-----' Well Log P~esent (Y/N) ~x%~ Date Completed ~F~.~-~ 1~7'~_ Yield Total ~p~ ~ ~ Card to ~,~- ~..~ ~pth of G~outin~ ~-- Static Water Level ~-7 Pump Set At Casing Height Above Ground j ~ '~ Elect~ical Wiring in Conduit (Y/N) ~:~_' Separation Distances f~om Well: ~_~ To Septic/Holding Tank on Lot ( To Nearest Edge of Absorption Field on Lot ~ ~Q~]- To Nearest Public Sewer Line N~/~. Sanitary 'seal on Casing (Y/N)~{f~ Depression A~ound Wellhead (Y/N) ~3~ ; On Adjoining Lots ~ ; On Adjoining Lots To Nearest Public Sewere Cleanout/Manhole ~/~%- To Nearest Sewer Service Line on LOt Water Sample Test Results ~ ~7--] ~ J'~z:~/~-:~-,~-7 CQ~,~ents B. SEPTIC/HOLDING TANK DATA Date Installed _~}-~iQ~;~ j 9 7'?~ Size / C)~.'~ (¢,~_. No. of CQ,~nts Standpi~s (Y~) ~ Ai~-tight Caps (Y~)~i~ Foundation Cleanout ~pression ove~ Ta~ (Y~) ~O ~ ~te ~st P~d ~ ~ j I~ P~ing~intenan~ Con~a~ on File (Y~) ~ ; for " Holding Ta~ High-Wate~ ~a~ (Y~) ~/~ Te~rary Holdi~ Tank ~rmit (Y~) Sep~ation Distan~s ~~~ding Tank: TO Water-Supply ~11 ~~ To ~ilding Foundation ~t~q~- To ~o~rty Li~ "~7 / To Dis~sal Field ~ ~' To ~ter Maip~vi~ Line ~ To S~e~, Pond, ~e, ~ Major ~aina~ [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed i $7 Z~ Width of Field . 17 ' Square Feet of Absorption A~ea Depression over Field (Y/N) J~CD Date of Last Adequacy Test Results of Last Adequacy Test J'Z:-)-C) Separation Distance from Absorption Field: To Water-Supply Well !~)1 { To P~operty Line ~/Z~,///~lz~ype of System Design C~'(,- '~l~"j-' .... Length of Field '~__~0 '" Depth of Field Gravel Bed Thickness Standpipes ?£esent (Y/N) f To Building Foundatlon.-~q~¥<%%, ~ To Existing or Abandoned Syst~,m cn Lot ~JA ; O~ Adjoining Lots I. ~:) ~ To Water Main/Service Line b4/~ To Cutbank(if present) To Stream/Pond/Lake/or Major D~ainage Course To Dmiveway, Parking Area, or Vehicle Storage Area ~ Cc~m~nts J J ' 'J=F-,..~,,,,.- C.~%z..,~_ ,,~ -V'I~¢I-, D. LIFT STATION Date Znstalled ~ Dime r~ ions Size in Gallons , ' ~.,~ Manhole/Access (Y~ "Pump On" Level at "Pump Of~at High Water Alarm Level at ~ 'gent (Y/N) Tested for ~ng Cy~Adequacy Test. Electrical Codes (Y/N) ~~-~ ~ Co~nts ' ~ ~ets MOA ** Check Permitted Bedatoom Rating Against }L~A Request I certify that I have checked, verified, o~ conforme~d to all MOA HAA GuideLines in effect on the date of th~s-±nspe~ction. Company "---'j--~ro I,.,~ c.% KSt/d5/s [Page 2 of 2] IIX' , "'"' "~! ~'% " /c~~, TELEPHONE (907)562-2343 ANCHORAGE INDUSTRIAL CEN~R ~ Drinking Wa~r Analysis Report for Total Colifor~ Bacteria -i TO BE COMPLETED BY WATER SLI~,'PEJ~R ,-- 'V -" :;'. Water S~tem Name ~on~ Nb. c~ SAMPLE DATE: SAMPLE TYPE: · Sta Mo. Day Year .,~ cOUtlne ~ heck Sample (for routine samph ~ with lab ref. no. ,). [3 Treated Water · [] Untreated Water [] Special Purpose SAMPLE NO. LOCATION :~ Collected Time ' ~' Collected B ' I TO B~ iOMPLETED BY LABORATORY Analy,~is shows this Water SAMPLE to be: .~ati~factory * ' [] Unsatisfactory [] Sar~ple too long in transit; sample should not'~e over 30 hours old at examination to indibate reliable results. Please send new sample via special delivery mail. Date~Recelved ,- ,~ Time'Received ~ b .~- ~ I ical Method: "~ Fermentation Tube ~;,Membrane Filter Lab Ref. No. Analyst I I ;: I Result* *~0 ot colonies/lO0 mi or NO of Positive por1~on$. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE. [8.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD ~ev. 1983 J ' e. embrane Filten Direct Count rification: LTB BGB r Final Membrane F:~esu{t:.._~"~ i ~epo,ed By ~..~. C"--~'~-~,{'>',~'~-- Date~_ Time: 'NTC = Too Numerous To Count Coilformll00ml Coilformll00ml a.m. TECTOI IICS INCORPORATED DATE SEPTIC SYSTEM ADEQUACY TEST CLIENT: Name Address LEGAL DESCRIPTION: SEPTIC TANK: Telephone LEACH PIT: DRAIN FIELD: Material Type .Size Number Bedrooms Surcharge Test Rate of perEol at ion Required Tank Size ( ~o~.~ ~'~'~- gal. water; 0.80 (150 x No. bedrooms) min. gal./day Sludge condition in tank: Remarks: Enaineerina · Civil · Structural ° Mechanical · Electrical ° Surveying DATE SIGNED ~rm ~ 4S 469 Po~y Pak (50 sets) 4P469 SEND PARTS I AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY