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Home My WebLink AboutCONIFER HEIGHTS BLK 3 LT 19 Development Services Department Building Safety Division E 8 O -Site Water & Wastewater Program o 4700 Elmore Road aZ z. P.O. Box 196650 Mark Begich Anchorage, AK 99507 s n E T Y Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: 01 _ �`� 3� 0 'Tc -P j,3 ?1 Legal Description Property Owner Name & Address: L A q rol✓ qq so Pump Installation Date: ! _ /'V //16 Pump Intake Depth Below Top of Well Casing: Z-00 feet Pump Manufacturer's Name:�(��'� Pump Model: 100613q -95Z-1 Pump Size / hp Pitless Adapter Burial Depth: 1'7-- feet Pitless Adapter Manufacturer's Name: AIA-- L:b X -%- Pitless Adapter Installer: Well Disinfected Upon Completion? VYes ❑ No Method of Disinfection: Comments: ANCHORAGE WELL & PUMP SERV. Pump Installer Name: Y 330 EAST 76TH AVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Page / 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 Permit Number: .~'(,x/' ~/O~, PID Number: N~--~ei ~ it ~ t~~ ~ ~~,~astewater System: ~New Q Upgrade [,h~ ~~ ~o~ ~% ABSORPTION FIELD Phone: I N°' of Bedrooms: ~Ut~ ~ Deep Trench ~ Shallow Trench ed ~ Mound ~.Other L E G A L D E S C R I PTI O N so~ Rating: -~ GPD/Sq. Ft. Total Depth from origi~,~nal grade: -- Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneat~ pipe Township: ~ Range: ~ Section: Fill added above original,grade: Gravel length: I I Numbe~lines: l Distance between lines: WELL:. ~ew O Upgrade Gravel width: ~ Ft.Z I ~';'~ Ft.l Classification (Pri~ate. A,B,C): Total Depth: Cased To: Total absorption area: Pipe materiah~ ~~ ~ ~,. ~ ~. I~ se.~. ~hff t~ V~X~ Date ,,stalled: , Driller:/,,,~d:,/' "P~m~/~1~ ~d//~ p Set Date Drilled:,,/~/~ Static Water Levek~F,; Ins . :~ SEPARATION DISTANCES ~Ptic D Holding ~ S.T.E.P. To Septic Absorption Lift Holding ~/Private, Manufacturer: Capacity in gallons: From Tank Field Station Tank SewerLines ~~~ ~ , / Surface Water >/~ ~/~/~ ~ ~ ~/r~' L~FT STATION Line Remarks: ~~' ~, ~ k~~ BENCH MARK ~ Location and Description:I _ Inspections performed by: , ~ Dates: ls~~,~ 2nd~ Department of Healt~and Human Services approval ,*"~ ,eviewed approved b,: / /- 72-013 (Rev. 9/91) MOA 25 Permit No. Page 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: ,/ PID No.: C~--- O~3 "Oq ,A Michoet E, Anderson Permit No. Page 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 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD LOCATION OF WELL BOROUGH SUBI)IVISION / 2LOT BLOCK SECTION QTRS SECTION TOWNSHIP RANGE MERIDIAN ~/.~c~ UN nE tq .~ os uw LOCATION/SKETCH: WELL OWNER: Depth of hole: ~-./-//~ ft BO.E.OLE DATA: Depth Oepth of caBing:~ Material Type and Color From To ~~ ~ ~ ~ ' ~. _ =~ ~,~. , ~e,ow ~ c.,.~ ~ orou~ ~u,ace ~;~ .¢¢ M.HO. OF DRILLING: Cai, rotaw ~ cable tool /,~ /~ USE OF WELL: ~'domestic ~ irrigation ~ monitor ~,/~ CASING STICK-UP:. ~. ft. Diem: ~ in. to~ft ~' ,~..~ ~ ~' / ~ .~ Casing ~pe: ~~ ~ in. to ' WELL. INTAKE OPTING TYPE: ~ open end ~ screened &~.,,~Z% ~/ /~ ~ /¢/ ~pedorated U open hole '' / ¢// ~z~..~; ~~' /~/ ~ ~ Depths of openings: ~ ~ to ~ ~ ft ~ / SCRE~ TYPE: Diem: in. ~~~ ~~ ~ ¢0 ~,~ ~ Slot/Mesh Size= Length: ,t ~ ~ ~ ~ Volume used: Depth to top: / . GROUT TYPE: Volume: ~ De.th: ~rom ~t to - .~o.~m~ M~,o.= ~:2_~ =~/ ~ ~ftafte, ~ hrspumping ~ gpm ~U~ INTAEE DEVTH~ ft Horsepower: WELL DISINFECTED U~ON COtiLlION7 ~ YES ~ NO CONTRACTOR INFORMATION: REMARKS: "[~,.¢~__ ]_ / /~ ,~ ,n (. PLEASE MAIL WHITE COPY OF LOG:TO: Signature of AuthBrized Respresen~i'~e Date PO BOX 772116 " EAGLE RIVER AK 99577-2116 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 December 17, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Onsite Services Engineer Subject: Lot 19, Block 3, Conifer Heights Health Authority Approval Certification Well Abandonment Dear Reviewer: The first well placed on the subject property encroached within the 100' separation radius from the septic system. This well was subsequently abandoned and replaced by the well shown on the system as-built. The well abandonment was completed in accordance with A.D.E.C. regulations. The casing was removed 4' below the ground surface, filled with sand and concrete and a 3/8" steel plate welded atop the casing. The abandoned well was then backfilled to existing ground level. Sincerely, Michael E. Anderson, P.E. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 January 9, 1994 Municipality of Anchorage Department of Health & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Dan Roth Subject: Lot 19, Block 3, Conifer Heights Health Authority Approval Certification Dear Dan: Four testholes were dug at nearly the same original ground elevation on the subject lot during the preliminary site investigation for the onsite septic system. The attached drawing identifies the locations of these holes. Testholes No. 1, 2 and 3 were dug on April 28, 1993, and monitored through May 4, 1993. Testhole No. 5 was dug September 10, 1993, and monitored through September 23, 1993. During the site investigation in late April substantial snowmelt was occurring on and above this lot. Several unmelted snowbanks were located upgrade from the testhole locations. In addition, the 1' peat/organic layer was saturated and runoff water was seen between this layer and the underlying sand layer. On May 4, we measured water at an elevation of 6.5' below ground in Testhole No. 1, 4' in Testhole No. 2 and no water in Testhole No. 3. Since these testholes are located at nearly the same ground elevation it did not appear that the groundwater table had been breached. The lack of groundwater in Testhole No. 3 at depths of 8.5t appears to bear this out. The water in the testholes was probably caused by an accumulation of runoff water. Discussions with the owner of the lot and craftsman involved with the construction of the home on the lot indicate that once the ground surface dried up and breakup was completed the subsurface water also disappeared. We have no way to verify this information but assume water in the testholes disappeared around June 1. D.H.H.S. Lot 19, Block 3, Conifer Heights January 9, 1994 Page Two Testhole No. 5 was dug to a depth of 19.5' which equates to a depth of 17' below the absorption bed. No water was found during excavation of the testhole or during the two week monitoring period immediately thereafter. This further verifies our assumption that water found in the testholes was caused by surface runoff. We were unable to locate the monitor tubes for Testholes No. 2, 3 and 5 due to the heavy snowcover. If these tubes are still in place we will monitor the subsurface water levels and report them to you during breakup of 1994 to further verify the bottom of the absorption bed is at least 4' above the seasonal groundwater level. The rough grading of the area atop the absorption bed was discussed with the developer of the lot, Designs in Wood. They intend to regrade the entire area when weather allows. The attached letter from Sam Hill reiterates their intentions. Please review the aforementioned information and advise if you have further questions. The levels of water encountered during the onsite investigation were considered and discussed during the design of the system and issuance of the permit. We feel the system will perform adequately as designed and constructed. Sincerely, Michael E. Anderson, P.E. ,i~~~'.!~~ Mummpal~ty of Anchorage · a~~-'~ DE-~ARTMENT OF HEALTH'~AND~HUMAN SERVICES ~~'~ ENVIRONMENTAL SERVICES DIVISION'~;~ ~~6650 · Anchorage,-~Alaska 99519-6650 · Telephone: 343-47~ ~st~Water D~sp~sai~ Syste~'and/or'W~ll InSpection Repo~ :' -'~:~ Legal Description: ~T I~ ~K ~ ~1~ ~¢~ ~/~ PID No- ~,:. ; ' I r '~ ' 'f '1 I I t Michael E. Anderson 4381 - E ,,: .: Municipality' ot~ ~nchorage Department; of. Environmen.~al..$..e~Vtqe~ ' ' RE= Lot lg elo, ck 3 Conil~er Height,s . , '....h :-i.; , . ,. .: ~ . Please be advised that due t~ ',t;he' Ni.~,~ ~eathe~ conditions, Z am unable to grade'ti~e~.~:ound in the ~ield. ~s such, an appropri~e.emo~:~.~.':~ ~unds Nill be escrowed at closing to cover these: ¢~;~.;~13en the No~k .,;. . >.....~; .. ~:... ..~ , .. .., ~ .... . '~.. ...'~:';. i "~.~: h . ';'"" '' ...... ;,~ ,. ..'~ ..: ,.....,. , , .' '.~ ;. ~ ~ I' ' '. , . . ,~ .,,.,..,,,.,;,.... ~ . ~'.r'*.,;!~%v :. '~ ,.,~. · ,:'.~. .;~... , .. '"~:. ,~*.~ .,.' ~ ..... ~ .... ;' ~., .1~.'~ '~ ." ~ :, ,~ ,:~.,.. ~,,/..,. :. ,..,::,., ~ ..",? -: ~:~:~..': .."~',,~,. .... '; ,'." ~. '.~ '..~ F... $' . .,.,:,. t~', .~ .... JOB SHEET NO. CALCULATED BY CHECKED BY SCALE DATE R"EC"E I V'ED': P~001JCT 20,`1-! ($iql~ Shills} 205-1 (P:10ded}/~-----7~ Inc., '~ro!0n, ~ss 01,1;'1. "o Ot~er P'~0NE TOLL FREE !*~00-225.~.180 ROCKFORD CORPORATION P,O, Box 111706 ANCHORAGE, ALASKA 99,511 (907) 344-4551 FAX (907) 344-2130 CALCULATED BY '~ //~' '~ ~ DATE SCALE / ~ /o0 · PROOUCT 204.1 (Single Shssls) 205.1 (Padded) ~® Inc., Grolon, Mass. 05471. TO Order PHONE TOLL FREE 1-800-22~-6380 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~¢"r'/~ /~c~ L ~O~J"~z'"cr~- Township, Range, Section: 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE WAS GROUND WATER ENCOUNTERED? s L IF YES, AT WHAT ~ O DEPTH? p E Depth t° Water A, Iterz~ ~ f~?2 !~32 Monitoring? ~ ' Date: . _ . Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (m,nutes/inch) PERC HOLE'~iAMET'£R ~ FT AND , FT TE ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DA : . ~ WAS PERFORMED IN 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: ~7-' /~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 8 9 10 11 12 13 14 15 16 17 18 19 20 DATE PERFO Township, Range, Section: SLOPE SITE PLAN PERCOLATION RATE ~. (minutes/inch) PERC HOLE DIAMETER IESTRUNBETWEEN~'~ FTAND ~-/'FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/~0/~ 7~-008 (Rev. 4185) WAS GROUND WATER ENCOUNTERED? s L IF YES, AT WHAT J O DEPTH? ~ ~ )epth to Water Alter ~ i ,~,: , '.. Reading Date Gross Net Dep~hqto " Net Time Time : Water Drop Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:. LEGAL DESCRIPTION: 10 11 12 13 14 15 16 17 18 19 2O COMMENTS 3 DATE PERFORMED: ~.~0~J ~,.-~_.Township, Range, Section: WAS GROUND WATER ENCOUNTERED? PE S IF YES, AT WHAT f L DEPTH? E Oeplh to Water AIterJ d~ L,, Monitoring? ~" Date:,,l'~' SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop , ' ~ t I1~/~ ~ Jl.~,: , ~ · , ?.. ~:' ,,~ . PERCOLATION RATE . . TEST RUN BETWEEN ~ (minutes/inch) PERC HOLEDIAMEiT,~R ~ FT AND FI ) ' ,? ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: <:~/~' 72~008 (Rev. 4/85) I-- 0 / H / / / \ 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 WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930102 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:ALASKA INDUSTRIAL DEVELOPMENT OWNER ADDRESS:480 WEST TUDOR ROAD ANCHORAGE, ALASKA 99516 DATE ISSUED: 5/13/93 EXPIRATION DATE: 5/13/94 PARCEL ID:01509304 LEGAL DESCRIPTION: CONIFER HEIGHTS BLK 3 LT 19 LOT SIZE: 39364 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 2. 30'. RECEIVED ISSUED BY: MAXIMUM DEPTH OF SYSTEM 2.5'. DISTANCE FROM EDGE OF BED TO CUTBANK AT DITCH WAIVED TO DATE: ANDERSON ENGINEERING May 4, 1993 Municipality of Anchorage Department of Heath & Human Services Subject: Design Impacts to Adjacent Properties Dear On Site Services Engineer: system. Since this is the last lot in the area to be developed, placement of the well is critical to provide the 100' separation distance. The location shown on the attached plans meets 'the separati°n requirements. The lot slopes toward the road and drainage will not pond at or near the proposed septic system. If the system is constructed as designed the. following conditions -will result: 2. The system, if constructed as designed, wilI have no adverse impact on existing septic systems in the area or those to be 'constructed in the future. Sincerely, Michael E. Anderson, P.E. SCALE PRODUCT ~-t [S~ng~ S~) 2~.1 {Pad~4) ~e I~. Gto~, ~. 01471. TO PER F,~RMED FOR: LEGAL DE~CRIPTION:~ ~hip. Range, Section: SLOPE DEPARTMENT OF H~LTH & HUMAN SERVICES 825 "L" Strut, Anchorage, ~a ~2~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SITE PLAN 'WAS G"OUND WATE. ENCOUNTERED~ V~'~ IF YES, AT WHAT 7 ~ DEPTH? r E R~i~ ~te Gr~ Net T~ TI~ Wat~ ' ' ~ I~ I~ F~ ~q I~,ss I,~ (nanuter~ln~,h) PERC HOLE DIAMETER ,, TEST RUN BETW~ ~ FT AND + FT COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: DATE: .. ~..~/q..~ W~ PERJ=ORI~ ~1 72-008 (Rev. 4/85) Munlr..lpallly ol Anr, h~age DEPARTMENT OF HEALTH & HUMAN SERVICES 825 %" Street, Anchorage, Alaska 99502.4)650 SOILS LOG -- PERCOLATION TEST Township, Range, 2 3 4 5 6 7 8 g 10 11 12 OL-- 'WAS GROUND WATER ENCOUNTERED? _ ~/'~ IF YES, AT WHAT t L 0 DEPTH? ~ 'r~ P E Reading Oett Grot? Net Depth to Net Time Time Wat~ Drop PERCOLATION RATE , Immuter,~mchj PERC HOLE DIAMETER · 13 14 15 16 17 18 19 2O COMMENTS TEST RUN BETWEEN . ?2-008 (Rev. rd¸ DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, AlaSka 99502~ SOILS LOG -- PERCOLATION TEST I 5 6 8 10 11 12 13 14 15 16 Township, Range, ~on: SLOPE SITE PLAN ,WA~ GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? R~ding D~te I Gro~ Time Time Waler Dr~ 17 18 20¸ PERCOLATION RATE COMMENTS TEST RUN BETWEEN (n~nu~el~,nr.~) PERG HOLE DIAMETER . FT AND .. FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. OAT;' ,, 72-OO~ (Rev. N Michael E. ~,nderson ~ 4381 - E D~TE £. Anders~n ~ ;¢381L E SHEET NO.. CALCULATED BY CHECKED BY. sc,,LE DATE DATE PRODUdT 204.1 (S~Ola ~} 2~1 (Pa~e,~) ~® Inc., Gr~, M~. 01471. TO 0r~r I~'~E TOU. FREE MUNICIPALITY OF ANCHORAGE · DEPARTMENT OF HEALTH & HUMAN SERVICES · Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Ol~---O~- O~J NAA# 776 GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address phone Lending agency Mailing address. Day phone Agent Address Day phone 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 Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~4~J/) ~""A~'o ~ ~'~ ~/rJ -6'"¢'/'~ Al/_, Phone Address Engineer's signature ~ ~'- ~ Date DHHS SIGNATURE X Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments '~he M~Jci~lity of Ar~c:h°rage Department of Health and Human Services (DHHS)issues Health Authority .A. Pproval CertificateS-based only upon the representations given in paragraph 5 above by an independent prdfessional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and tl~eir 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 p.rofessional engineer's work. . · 72-025(Rev. 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Y~ Date completed II/~_5'/~$ Driller Z ~-' / Cased to ~ 5(/ Casing height Y Wires properly protected (Y/N) '"1/ Date of test Static water level Well flow Pump level1 FROM WELL LOG Z.07~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main IOI I Sewer service line g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~) Nitrate Date of sample: ///~ ~'/~/ ~/5/' Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) "~ High water alarm (Y/N) Date of pumping Tank size Foundation cleanout (Y/N) Y Compartments Depression (Y/N) Alarm tested (Y/N) /~//,/~ Pumper ,~//4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~)/ On adjacent lots To property line ~,Z. / Absorption field Surface water/drainage ~ iD0 / Foundation Water main/service line 75' 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Su trace water D. ABSORPTION FIELD DATA Date installed /O/'zl, Zz~/q..~ Soil rating (GPD/FF) Length ~-/~ Width Z Gravel thickness Total absorption area /Z~O ~ z. Cleanout present (Y/N) Date of adequacy test /,~-t,,J ~,0~$~ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) /J' system type "~- Total depth Y~ Depression over field (Y/N) "~P' $ 5 for r~ dfL. After test O If yes, give date /~)/~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain ~'100 I On adjacent lots 0/0 ~) Property line ' To existing or abandoned system on lot Cutbank /~0 ,J ,E Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effect or~,~a~,¢f this inspection. Signature ~ Engineer's Name Date HAA Fee $ ~ ~ ' ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back CtlEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAl_, TESTING & ENGINEERING CO. TO BE COMPLETED BY WATER SUPPLIER L-J PUBUC WATER SYSTEM I.D. # ~ I I .... ['..."~ PRIVATE WATER SYSTEM ............ ~k- ......................... m~'~ .... TELEPHONE (907) 56~-2345 B633 8 $1reet Anchorage, Alaska 99518 Drinking Wator Analysis Roport !or Total Coliform Bacteda SAMPLE DATE: SAMPLE TYPE: Mo. ' Day Year ,/~Routlne Check Sample (for routine sample with lab reft no, [] Special Purpose [] Treated Water ~3 Untreated Water TO BE COMPLETED BY LABORAFORY Analysis shows this Water SAMPLE Io be: "'¢' Satlsfact?y E] UnsatJslactory L--J Sa, mple too long in transit; sample Should not be over 30 hours old at examinati()tl to indicate reliable results, Ptease ~end new sample via special delivery moji, pate .a~¥e~ [ I_/2.~' Thne Received ·,} ~<~0 Analytical Method: Membrane Filter · No, of colonies/100 mi, SAMPLE No. LOCATION Time Collected Collected By Lab Ret. No. Result* Ana,!y:~t ......................... '~.~-~,~ ~[Z.J .............. I ~7-.:..: ,,:? .... ,...-,., ! ......... ...: .I.~ LZI'.Z] .....:.:.~.,...:.::,?-z ...... I FT-] _ TNTC OB : BACTERIOLOGICAL WATER ANALYSIS RECORD .D.~.C. ~ ~ c~ READ INSTRUCTIONS Membrane Filter: Direct Cou,! ...... i Verification: LSB BEFORE I Fecal Coliform Confirmation COLLECTING SAMPLE Final Membrane F[I. ler~_: ~ReaytI" ~ T = Too Numerous To CoUnt PART ONE OF TWO: Other Bacteria REUAINDER TO FOLLOW Collferm/I00 Coliform/tOO /,5-"><,, ~0,-I Nd ET :~0 £661:'~'0 'o~ C~0 S~£ 2..06 -I-1I~dG =tNtd']~ : uJo,-t..zl Cl. ient Sample ID ~19~.3 Ma I: ~: Ix : WA~F.,R 5833 B ,1 ANCHORAGE, AK TEL: (907) FAX; (907} 581 Client Name ;ALPINE DRI[,[.,I~NG WORK ()rde~.' :73624 - Or,:te~ed By : .Rr:po~'t Compl. eted : 12/03/9] Project Name : Co].l~c ted P.c"o;Ject~ : Rec,?ived ~ l.L/29/93 ~ t. 6~,~ :",'..'~. PWS ID : I]A 'l'r}chn ic;J J. O irecto [': ........................................................................................................................................................................................................... ~amp.Le Remarks: ROUTINE SAHPC,~: COl.,LId',CT[t) BY~ ALP'[N~] DRILl, See Sper. lat Inst[uc'tJ. ons Above [iA See Sample3 Remarks Above NA = Not Undetm(::ted, Reported value t~ th~ pr.a~:t[,,.al, quat'~'tification ktmi't. LT = Less Than 8ecojlt::J~w:'y dt].utLon. GT .= Gr',:~atet;