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CONTOUR ACRES #4 BLK 4 LT 7
MUNICIPALITY OF ANCHORAGE DI' RTMENT OF HEALTH AND HUMAN SEF ;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 ~' ~ Tn SEPTIC ABSORPTION ^ddressFRO M -"'-..~.~ TANK FIELD WELL Phone(s) - ' Permit No. INo. of Bedrooms WELL LEGAL DESCRIPTION Lot I Block Subdiwsion Township, Range, Section ' AS-BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, ' ' TANK~ N ~'~nulactur~r Capacdy in gallons Material No. of CompaAments TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER ,~ ~epth to p~po bottom kom ~otal Ooplh from original OraOe ~ original grade ~* OFT [ ~, ~ FT ~' Fdl added above original grade Gravel depth beneath pipe ~ ~ ~i Gravet length Gravel w~dth Total absorpt,on area I [~SQFT Distance between lines ~0,~ FT In~e~ D~le Ins~lled ~RIVATE g OTHER Ildentitv) Classification (A,B,C) Total Depth J Cased to ~1 J ~ ,~ ~' InstalJeJ Date installed: REMARKS: InspectiOns Pedormed by: I ~ R IOAY ce~ily that this inspection Was pedormed according 1o all 72-013 (3/85) ?ERMIT NO: PROTECTION 9'.5 01 AP?L.ICANT: ADDRESS: CO~TACT ~L CROSS ANCHORAGE. AK ~9516 345-0657 LEGAL DESC~tP: SUbDIViSION: CONTOUR ACRES LOT: '7 FLOCK: 4 SECTIGN: Z? TOWNSHIP: I~N i~AX LIST~O ~ELOW ARE THE OPTIONS AVAILABLE TO YOU IN D~ESIGNING YOUR SEPTIC S¥STE~. CHOOSE THE OPTION THAl 3EST FITS YOUR ~E?TH TO PZPi! ~OTTO~ TOTAL DEPIH (FT.) f~ R.AV:!L ~I~TH G~qAVEL LENGI'H (~ GRAVZ. L VOLUFiL (CU. YDJ.) TANK SIZ~Z (GALS) GRAVE:_ LEN~JTH > 75 F'T. REL~UIRES I~ULTIPLE RU?~S (4OT EXCE~ZDiN~'~ 7~, FT. kAC,t) TANK ~;US~ HAVE A1 LEAST l;,.~O COMPARTMENTS CERTIFY 'THAT: fOrTH E-Y TH~ ~qUNiCiPALiTY OF ANCHO~R~E (MOA) AND THE STAT~! OF ALASKA. E. i ~iLL iNSTALL THE SYSIEM i~ ACCORDANCE ~ITH ALL ~OA CODES AND RE~iULA'TJONS~ AND I~ COMPLIANCE WITH TH~J OESIf~N CRITERIA OF THIS PERMIT. ,~. I WiLL ADHERE TO ALL ~IO,A A~Jg STATE OF ALASKA ~E':~UIREN',ENTS FUN ~HE SET DISTANCES FRO~ ANY EXISTI'oG ~ELL~ ~ASTEWAT~q DISPOSAL SYSTE!q OR PUBLT~C SEWERAGE SYST~F~ ON THIS OR ANY ADJACENT Oq NEAR,bY LOT. 4. I UNDER,STAND THAT THIS P~Re}IT IS VALID FOR A MAXI~(UM OF 3 ~5L~DF<O0~/~S AND A~Y EdLARSE~}ENT ~ILL ~(~:iUZR~L AN ADD.~TIONAL PER~i'ZT. iF A LIFT STATI':)N iS iNSTALLing iN AN AREA CO'VE!~Eg 5Y ~OA ,~,UILDIN,~ COJ)ES. TH~N (1) A~ SLECTRICAL PE~;~IIT AND INSPECTION MOST 9E O(STAiNED; (2) AS-::~F:UILTS ~ILL NOT ~E AP~ROV~D WITHOUT A~ ELECTRICAL INSPECTION ~IEPORT; ELECTRICAL WJR~ MUST ~E DO~E bY A LICE~ISED ELECTRICIAN. APPLICANT: CRRL CROSS PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PEF LEGAL DESCRIPTION: Lq 1 2 3 4 § 6 7 8 9 ~.~'~"DOfL-- /~Z..~°wnship, Range, Section: -'~,~ . ~.~ .... SLOPE SITI~ PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS '"~:=~,"~' ~"O~,,..q~ PERFORMED BY: WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT O ~-----.--------"-'" DEPTH? p Depth to Water .After Monitoring? $ & S ENGINEERING SRB 196X It):r,e A EAGLE RIVER, AK 9957~EROOLATiON RATE 'Z.~ m (minutes/inch) PERC HOLE DIAMETER /~:/~A ~/~.'~' ~/~/~ TEST RUN BETWEEN ~ FT AND ~ FT Reading Date Gross Net Depth to Net Time Time Water Drop ~ ~t:~5 ~ /o ~/N. ~'//~" I't,/l~ " ~ ~A ~o ~/~. ~//~" / 'h~" ~/e" CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) DEF'AF'C'f'MI{:N'I" HEAL..'I"H AND EI',.IV I RONME:I',ITAI_ ¢OT'EC]T I ON 8;25 I .... S"I"F;,'Ii.::]::.!:T' :, AIxlCHC)R(~GE, AK 9950 :L ,..~I;~.P.~----'t' t I1'",,.1t ........ Ei.:.; :]:: '"'fi'"' E:: Sj'::~ E:Z I~,,1t E:: IF~: F::" i:: R IMt ][ ']t .... ADDF~ES:S: 13 10 :[ BA I I',IBF~ I DGE AI',ICHOI::~AGFZ, AK 99t516 CONTACT' I:::'HC)Ix~Ei:: %63-.37'73 L..EGAI ....Dli!i:SCR:I:P',: SUBDIVIBION: CONTOUR ACRES LOT: 7 ~ BL. OCK: 4 SEC'I"IC:)N." ,"P. 7 'I"OWNSHIP: 12N RAN[:)~ 3W ~ / L..OT SIZIE:, 2..2.5A (SD.F'I". OR ACRES) · I ce,"t:i, fy t.l",at: ' ~'~,~t.~.., ~:,v .~...h~, ,~,,~.~:~p~,] ~t~, ,:,~' ~':~/~'.~t ~9A> "'"'~ ~ st..,~:~ ~,~' ~:,.,~,.::~.. dis'Lances I'd-om any exist, lng ~ell,J ~a~.e~t.~ disposal ~y~:,m o,'1 publ:i.c sewe,.,age syst..em c,n .Lhis or..any ad,ac~r,'L c~r~ 'fF: A I...II::'"l'- S"I"AT]:Olkl IS [NSTALLE:D [N':'f~N A EA COVERED BY MO~ [U~L.~[N?~ ~ODES, THEN (1) AN EL.I~]:CTRICAI .... F::'ER~I"I" AND ~1:' TION HUS'T' BE OB~]NED~ (~/ AS-.BUIL..'T'S WII_I ....NOT BE APPROVED ~["I'HOU'I" AN IEL. EC~ ~hl.~ INSF'ECTION I::RE~ ~~];) THE: EI_tEJ]TRICAI_ WORK MUS'T' BE DONE: BY A L. IC~ ~D AI:::'I::~I_ I CANT ." CARl .... A,, CR(]SC.3 I ~:~S U E D B Y o') ~) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: (ENGINE ~ ,~..L) LEGAL DESCRIPTION: ~--~¢1"~~' ~¢~'$ 8'~ L,'~'- Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED7 s L IF YES, AT WHAT O DEPTH? p E Depth to Waler After Monitorin0? Date: Gross Net Depth to Net Reading Date Time Time Water Drop //~z - ~o !1~ /o .~ . o~ u~ lO '5'~ ,Ol PERCOLATION RATE ,~/~/~ {minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FT AND__~ It~-'FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT O~HIS DATE. DATE: THAT THIS TEST WAS PERFORMED IN J,..,.., /z'o% 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: j'~?e '~' Township, Range, Section: (ENGIN~I~S SEAL) t?8~ Te~t 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? . S L IF YES, AT WHAT O DEPTH? p E ~ -'-'-- -'"" Depth to Water Alter $?V/I Monitoring? ~t-~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop ~-/i-8~ /o sq _ .~o - // De ~o ,5¥ /~/ ~' zO .~,~ ,03 l/ lq - ,~o - PERCOLATION RATE ~ -- (minutes/inch) PERG HOLE D~AI~ETER TEST RUN BETWEEN ET AND FT ,~ PERFORMEDB : CERT,. THAT TH,S TEST WAS PERFO.MEO IN /o ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC N THIS DATE. DATE: 72-008 (Rev. 4/85) ! Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~,~--,,-[ (ENGIN~,~EAL) DATE PERFORMED: ! I78~ LEGAL DESCRIPTION: 3 4 5 6 I 7 8 9 10 11 12 13 14 15 16 ¢ 17 18 19 2O COMMENTS Township, Range, Section: ~.. ~_~ ~'/z ~'A ~" Te~l' SLOPE SITE PLAN ENCOUNTERED? S L IF YES, AT WHAT 0 DEPTH? p E Depth to Water After Moniloring? Date: PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~'"~'- FT AND__~ FT Reading Date Gross Net Depth to Net Time Time Water Drop lib s' / o ,~'o 'oo /I I~ ~ .~ - tt~ r ~ ~0 - 11~~ /o '~0 .0o /1~ ~ ,~o - //~ /~ ,,~ -oo PERFORMED BY: ~'~'~--~ ~' i~1~- ,.~'-l~"~ 0 'Z.~//' I ~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: 72-008 (Rev. 4/85) ALASKA t~r.'",ROilmfllTAL COllTROL $t~RL"'~$, IFIC. CLIENT ADDRESS PERCOLATION TEST DATA SHEET to, IqrJo ZIP CODE LEGAL LOCATION TOTAL DEPTH OF ROLE ZONE TESTED ~,0 ~. I..5 TO '~.0 ft TEST HOLE DTAMETER ~.0II READING # CLOCK TINE NET TINE DEPTH TO NET DROP RATE (min/in) DATUM .... ~:~o~.Oflz~ . ~ o~ _ ~,~o- ~O~ · o~ ,~ FINAL PERCOLATION RATE -~*~' ',~ i "~ SQUARE FOOT/BEDROOM MOA STS}-O2Zt (mtn/tn) ALASKA enulRonmenTAL CODTI~OL Sel~UlCeS, Inc. i~nqinerdnq G ljnuironmcntal Stuclle~ ADDRESS'~'' PER_COLATION .TEST DATA SHEET ..... .~: __ ~l~t z~P cODE ............. LEaL LOCAT~O..Coa-r'o~'k kc~gs 'g ~,Y-.~ TOTAL DEPTH OF HOLE ,a:,O ft. ZONE TESTED _ /' 5 ft TO (::~. 0 ft READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (mtn/tn) ': DATUM FINAL PERCOLATION RATE 1200 LUest 33rd Aucm,, ~ui,,to~. Rn~:J~raqe, rRlaska 99503 · (gO7) 276-1361 ALASKA erlUll:JorlmeriTAL COnTFJOL Sel~UlCeS, Irtc. ~cjinm'i~cl $ i~ui~om~ml $~cli~ · PER~COLATION TEST DATA SHEET ADDRESS'~i'' READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in) · DATUM ~ '.H~,o I ~:'*" .~ · 30 _ FINAL PERCOLATION RATE Il P~RFOR.~, B~ "g_~;~,_C_V ; I (mln/in) i~'/; 12oo UJest ALASKA fflUIROlllTI~IITAL COIllROL 51~RUICt~5, Inc.' CLIENT PER_COLAT! ON,T,EST DATA SHEET ADDRESS ..... , ..... ZIP CODE TOTAL ~P~ OF roLE ,. ~'R II TH ~ TESl MOLE DIAMETER READING # CLOCK TIME gET TINE DEPTH TO NET DROP PATE (mtn/tn) IJATUM y2o Itm~ ,~o . Yao ',~'/~ tom~a :~ .15 FINAL PERCOLATION RATE [ 2-S " {' ::~ '~ . SaUAR~f FOOT/BEDRODM MOA STB3-02,~ (min/tn) '"'~ 276-1)61 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 82§ "L' Street, Anchorage, Alaska 99502-06§0 SOILS LOG -- PERCOLATION TEST ! F (ENG'NEER'SSE^~ DA~E PER~OR~ED: 7-- I~-- ~0 LEGAL DESCRIPT,ON: C0~"~0[/~ J0(d,~ ~,~L'7 Township, Range, Section: -~C 4,~-~ -r"/~ AJ R~/' 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 -- 0L. 0~:9~,vzc-s 3 4 SLOPE SITE PLAN UIO WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? Date: S L O P E' Reading Date Gross Net Depth to Net Time Time Water Drop , ~ ., "1.11,,-01, II:q-q. ~.11^ _ I/.S/~ ~^ ,,~.,.,~ ~ ----- R~(J I,~:0~ [u rw.,',,.5'0 · t5' [1-~,0 left:lOr iur~.,.,',..,~0 · 15' %i,~ /,-'3:lq- r[0~) IA:3!: ~u,'t-" .5~ ..// PERFORMED BY: ..... CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ALASKA ENVIRONMENTAL CONTROL SERVIC[ INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561.5040 SHEET NO. ,, CALCULATED CHECKED BY SCALE OF ~ DATE ..... ALASKA ENVIRONMENTAL CONTROL SER¥1C INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 SHEET NO. OF CALCULATED CHECKED BY DATE SCALE ALASKA ENVIRONMENTAL CONTROL SERVIC[ INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 8HEET NO OF , , CALCULATED BY 'Z~t 7 DATE CHECKED BY DATE SCALE .................................................. ~ X -' .... ~..~,~ ,~ ~-~,~ . ~ ...~:i..°.'./~...:. i~:~ ~/~. . ~.~- ? ~ ~ /~V 7 ~.~,.~ ..... ~.. ........................ ~ ........... ~....o.~.~.~.~ ........ ~..~ .:.....~,-/ .... ~ /. ~ ~ ~...4.~.~ ..... ~r~ ~ f.,-~,.~...~ ........ ~r..~.,.......~.~.~.~ .~...~<~..~.......,~ ~ ~ ~ ~'~ ~ 7 ~ ..... ~:,~ .~.~ , .................................. L~:~...L....~.,:~..~ .,:.~. ~ ~- : ~ .~....~ ....... :~= M~*-~· ~,~U~ . ~ ~ I~ ~ ~ ~ .~ ~% ;+ ~, ~ ~o:. .~.io~ .......... ~ ....... 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ALASKA ENVIRONMENTAL CONTROL SERVIC , INC. ! 200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 SHEET NO, CALCULATED BY~"~~''¢ 7 CHECKED BY OF DATE DATE ALASKA ENVIRONMENTAL CONTROL SERVIC, INC. ! 200 west 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 SHEET NO. CHECKED BY SCALE DATE CONTROL SERVICES, INC. ! 200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO._ CALCULATED BY CHECKED BY sc^~E ~%"~ DATE Filoer~,-ss Lid w/ a' FoG~ o, nd r`e'tcdnlng mech(znlsm NEN~ 4X Junc-tlon box 1' P V C ]~ii V0~tve P4' x 4' 6' Cutver"t No, nhoLe 1° FLexible Pr'essur-e Hose l' P V C F~pe Typ Ur-e'tho. ne ~oo.n (shop ~ppLlecl) wrth Tnemec 'top coc~'t Adjus't:oJ0te Flo~'l: Swl'tch Assembly .- See, t wi'th RAH-NEK or. Equ(~l. --rubber' Gr'o~me't or wetctec/ steel, I 1/4' pipe 4'pvc FLor Inducer' 1 3/8' holes 6' nC iA HDLE I l/::)* check v~,tve 1/8' r~esh poLye'thylene 15' dig x 39' hlCt~ h.p. Tell pump scr'een ALASKA ENVIRONMENTAL CONTROL SERVICF~, INC. '1200 West 33rd Avenu Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 JOB SHEET NO / CALCULATEDSY ~'~ "'1 CHECKED BY SCALE DATE . ALASKA ENVIRONMENTAL CONTROL SERVI¢ ', INC. ].200 west 33rd Avenu~ Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 CALCULATED BY ~),~- r,~ DATE '~ ~/~ "~' , / CHECKED BY DATE. ALASKA ENVIRONMENTAL CONTROL SERVIr '~, INC. 12OO West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 SHEET NO 3 OF CALCULATED BY ~:)~¢1 ~ DATE CHECKED BY DATE SCALE ~ T~ · R~rve ~p~c~ty c~ove ~rn Reserve Cat:~cl~y Gbove punp on C~p~cJty ]~e'~een Pump on & Pump ~Loot Level. 113 GAL~131 ~ 147 ~ P. O00 5~ G~L ~4 G~C~L I 44 [/~" . 39' [ 40 tiE" ~ LIFT STAT~I~ DATA d Emttons per TYPICAL PUMP PERFI:]RMANCE CURVE Sl'ZE 11500 ,~ [ EO00 (4 BE]~RI:DM) (5 & 6 SIZE CHART NnTE. - LTFT STATZDN TANK~ MUST ,lie P.50 GALL1DNS LARGER THAN STANgAR.D TANKS FOR ,~ME /~)PL.TCATZDN .',IDTE- . SEE ATTACHE~ SPEC~J:~CATI*I:INS Fl:iR EGUT. J:~MENT SHDVN HERE i~ MUNICIPALITY OF ANCHORA~_ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE MAILING ADDRESS LEGAL DESO~IPTION ~ DISTANCE *O: /00 + 0OO~ ~ ~ Manufacturer ~j Material No. of compartments kiq. capaciW in ~allons ~nside length ~iOth Eiquid depth / ~ 0 IF HOMEMADE: ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer Materia~ Liquid capacity in gallons O Well Foundation Nearest lot tine PERMIT NO. ~ ~ DISTANCE TO: ~ ~ Z No. of lines Length of each line Total length of lines ¢ Trench width Distance between lines ~ ~ ~ ~ ~ ~ inches ~ ~ ~ Top of tile to finish grade ff Material beneath tile ¢ ~ Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Welt Building foundation Nearest lot line m DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS / APPROVED ~ ) DATE LEGAL 72-013 (Rev. 3/78) RECEIPT Date~, / ~" 19 ~ 4353 Received From ~T. OF CASH ~T. PAID CHECK ~ ~ ~ DUE ORDER RECEIPT Date~, ~ 19 (? 6363 Received From (l~-nJ~ ~ ~ ~_ ~~~~/~ ~ ,,'_Dollars $~,~ ~T. OF CASH ~ /f I ' ACCOUNT ~ DEPARTMENT OF HEALTH AND EN¥IRONMENTAL PROTECTION / /j~~..S 825 'L' STREET., ANCHORAGE, ~LL ~N~ 0~~ · T~ / 8F'PLICANT CARL C:RO~S SR8 BX 15~l-R OC T ON ...... Z -' LEG.L . . L~ SIZE 90~0 SQIJRRE FEET s ~ Y~T M I~ TRENCH TYPE OF SOIL 8B_ORPTION S _ E :: · MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING <SQ FT?BR)= 1~5 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 8 LENGTH= 54 GRA%~EL DEPTH= 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCRYRTION (IN FEET). R~'EC4LI I RED SEPT I C TANK S I ZE= 1250 GRLLOf~S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO ( 2 ) INSPECT I O~S ARE REQLI I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR R PRIVATE WELL OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T E×P I RES DECEMBER I CERTIFY THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2~ I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~ I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. APPLICANT CARL CROS~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2224 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 SOILS LOG - PERCOLATION TEST 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DATE PERFORMED: SLOPE SOILS LOG [] PERCOLATION TEST SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Net o Net Time Time Drop ~_~ ~, o~ ~ PERCOLATION RATE TEST RUN BETWEEN COMMENTS PERFORMED BY~ CERTIFIED BY: 72-008 (7/76) RETURN TO: Division of Geologic id G ,slcal Surveys (DGGS~ 3OO1 Porcupine Drive ~Tele~ e: 277-6615) Anchorage, Alaska 9950t WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES Drflllng Company Nan ~w~ .~ yeI i&w~~ U.S.G.S. Local )lo. ...... Drilling Permit No, LOCATION OF WELL Please complete either la, lb, or lc. A.U.L. NO. la. Borough Subdivision Lot Block lb. Fraction Sectlon No. Township Range Herldlan lC. Dlstance and Direction from Road Intersections 3. OWNER OF WELL: 0~"/ Add ress: Street Address and Area of Well Location 2. WELL LOG Feet Below ~. WELL DEPTH: (completed) Surface Elevation Date of Surface Comp1 et ion ~aterial Type Top Bottom .~,~ ~ ft. ~g~ /il/ 0 ,~g ~. ~Cable t~' ~ Rotary ~ Oriven ~Dug ~/~~ 8/ ~ ~Oo~st lc ~Publ lc Supply ~ industry / " 8. FINISH OF ~ELL: ~. STATIC ~ATER LEVEL: ~ ft. ~A~ve ~Below land surface Type of ~easure~nt: ~ ~ e 10. PU~PING LEVEL below land surface ~ ft. after ~ hrs. pumping ~ g.p.m. , , ~ ft. after ~ hfs, pumping ~ g.p.m. ~IINICIPALi~ OF ANCHORAGE th ~ELL H~D COHPLETION: ~ In Approved Pit ENVIRONMEN~ AL ~ ....... 12. GROUTING: Well Grouted: ~ Yes ~ 6 ~980 Materlal: ~,eat Ce~nt ~Other: 13. PUMP: (If available) HP ncCClklF[) Length of Drop PIpe ~ f~. ca.clty Type: ~ Sub~rslble ~Rec lProcat tng ~ Jet ~Other: t5. ~ATER ~ELL :ONTRA~TOR"5 CERTIFICATION: Thls wet1 was drilled under my jurisdlctlon and this re~r: Is true :o the best of my knowledge and belief: Register&3 B~&s~ Contra~t License ~umber .... Author i ~ed' R~presenta(i ve Form 02-~R gopy Distrlbutlon: ~HITE - State DGGS, PINK - Orilter, CANARY - Customer 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 1. GENERAL INFORMATION Complete legal description Location (site address or directions) i'.13 t.o~' G'~o/~'i,~'~f~- rfc..2 Property owner Mailing address Lending agency Mailing address Day phone Day phone Day phone Agent Address ~_6'o0 Corc/o~,~ 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- ing 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 '~JOM s,Jeeu!§ue leUO!SSe~oJd eql u! SUO!SS!LUO ,Jo sJoJJe Jo~. elq!suodseJ jou s! e§eJoqouv ~o Xl!l~d!o!unl~l eqj. 'penss! s! eleo!~!lJeO e eJoieq m~P ezXl~U~ Jo suo!loedsu! lonpuoo 1ou op SHHQ ~o seeXOldLU~ 's3ueLueJ!nbeJ elels pu~ I~Jepe~ u!mJeo/~s!les ol JepJo u! suo!lnl!jsu! 5u!puel J!eq~ pu~ setuoq ~o sJes~qoJnd o1Xsela noo e s~ s!q1 seop SHHQ eq.L 'mtSelV ~o elms eql u! peJels!§ej Jeeu!§ue i~uo!sseloJd 1uepuedepu! ue Xq eAoq~ g qd~J§~J~d u! ue^!§ suo!l~lueseJdeJ eq1 uodn ~lUO peseq seleo!l!ueo le^oJdd¥ Xlpoqln¥ qil~eH senss! (SHHC]) seo!/ues u~tunH pue qil~eH ~o lueLulJ~deQ e§~Joqou¥ ~o X1!l~d!o!un~ eq.L s~ueujLUoo leUO!l.!pp¥ :suo!lelnd!ls §U!MOIIOJ eql Lp,!M 'SLUOOJpeq Jo~. I'~AoJdde leUO!l.!puoo 'sLuooJpeq 'peAoJddes!a al:lnlVNOlS SHHO · uop, oedsu! s!q], ].o elep eq~, uo ~,oe,ge u! suo!lsln6eJ pus 'seousu!pJo 'sepoo elelS pus Isd!o!unR I1~ ql!~ eous!ldLuoo u! s! LUelSXS Issods!p ~e~e~elss~ ~o/pu~ Xlddns Jels~ e1!s-uo eql 'uogoedsu! pus uo!l~,6!lse^u!/~LU LUOJ,t pue sel!~ e6sJoqou¥ to X1!lsd!o!unl~ eq~, woJ,t peu!~lqo uo!ll~tuJo~u! eq~, uo pes~q 1~ql ~!Je^ Jeqlan~ I 'u!eJeq pm,~o!pu! eJnlonJls ~o edXl pu~ swoo~peq ~o Jeqwnu eq~, Jot m,~nbep~ pu~ leUO!loun~ 'e~s s! wm, s~s I~sods!p Je~,~els~ Jo/pu~ ~lddns Je],la~ el!s-uo eql ~q~, s~oqs uop,~o!ldd~ I~^oJdd¥/{),!JOLI],nv q~,l~eH s!q~, ~to uo!l~§p, se^u! ,~w ~q~, ~pe^ I '~oleq u~oqs el~p uo!~p!l~^ eql to s~ pu~ oleJeq pex!t~ I~es ,~w/~q pe!~!lJeo sv "9 1:I~I:3NI~DN:! Aa NOI10~]dSNI JO IN~i~:II~fIS '~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /.- '7/ ~ ~ .('o~/o~.r- /~:n,./, Parcel I.D. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. )" Date completed ;~ 2. ~' Cased to / ~f ¥ Date of test Static water level 1.3 Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ! ~, ~ Absorption field on lot I ~ ~' Public sewer main /N,/F Sewer service line ~lOo FROM WELL LOG ii ~'~ / ,6'0 ADEC water system number II / 3/80 Driller Casing height .2 Wires properly protected (Y/N) AT INSPECT'~UNICIPALITY OF ANCHORAGE / / ~{~RONMENTALSERVICES DIVISION ~/~' ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform o col /I o O ~,~ Z Nitrate Date of sample: q J t(~/~7- Collected by: Other bacteria FL,4"[TOP B. SEPTIC/HOLDING TANK DATA Date installed ~ / ~O / ~'~ :4~' r% ' 5 ' '~.. Tank size i ~-o ~,~/ Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Compartments Depression (Y/N) Alarm tested (Y/N) /~, ~. Pumper ..~_~',~ ~ c..r NONE - \ SEPARATION DISTANCES ~FROM'SEPTIC/HOLDING TANK TO: Well(s) on lot /~, ? ,' .... On".adj~centots ~/°O~ To propertyline ~ ~ ' Absorption f eld ~ , ~ ~ ! Foundation I~' Water main/service line '7/0 Surface water/drainage 72-026 (Rev, 7/91) Front CONTINUED ON BACK PAGE c. LIFT STATIC. (", Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Width Date installed Length '7? ' Total absorption area I ! O d' Depression over field (Y/N) ~o~¢ Results (pass/fail) ~A SS Peroxide treatment (past 12 mo~ths) (Y/N) Soil rating 'Z¢~ ~/~r,~r,~ System type Gravel thickness 7, o Total depth Cleanouts present (Y/N) Y (_.~4o4 Date of adequacy test q ]17/~ z for ~ If yes, give date N' .,~ , bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I :~ ~) To building foundation On adjacent lots ~ 20 Surface water ~ / ~ ' Curtain drain ~/~o On adjacent lots '7/co' Property line '~' To existing or abandoned system on lot Cutbank N.A, Water main/service line ~/o' 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 the date of this inspection. Engineer's Name Date HAAFeeS /'7~ o.~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Rack MOA 21 CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 April 24, 1992 ANCHORAGE, ALASKA 99516 Mike Williams 13101 Bainbridge Road Anchorage, AK 99516 Dear Mr. Williams: Per the request of Karen Largeant at ReMax Properties on April 17 we conducted adequacy tests of the water supply and wastewater disposal systems serving your residence on Lot 7, Block 4, C°ntour AcreS Subdivision. Copies of relevant backup documents are enclosed. I will deliver the Health Authority Approval (HAA) certificate to Karen Largeant after it has been signed by the Municipality. According to the driller's log, the well was completed in November of 1980 and has a total depth of 226 feet and a yield of 2.5 gpm. The water supply system includes an aboveground storage tank of approximately 400 gallons capacity, from which a booster pump draws water for the pressure tank. At the start of our test the static water level stood at 190 below the top of the casing. During the course of our test we pumped a total of 454 gallons of water from the system at the maximum pump output of 6.2 gpm. During this period the water level in the well was drawn down to the pump intake at 212 feet numerous times after which the "Coyote" pump protector turned the pump off and allowed the well to recover for approximately 35 minutes between cycles. Based on our recovery rate measurements we determined that the yield of the well is 0.47 gpm, which is slightly greater than the Municipal criteria of 0.42 gpm for approval of 4 bedroom single family residence. It should be noted that the yield of some wells fluctuates significantly over the course of a year. Well yields are often at their lowest in late winter, due to the effect of a reduced recharge during the preceding cold weather. Water samples collected on April 16 were satisfactory, showing 0 coliform or other bacteria per 100 ml., and 0.64 mg/l of nitrate-N. According to the as-built inspection report on file at the Municipal Health Department the wastewater disposal system consists of a 1250 gallon septic tank installed in 1980 followed by 79 lineal feet of soil absorption trenc.h containing 7 feet of sewer gravel which was installed in 1986. To assess the adequacy of the system we ran a total of 454 gallons of water into the system through the cleanout pipe downstream of the septic tank while monitoring fluid levels in the soil absorption trench standpipes before, during and after the flow of water was stopped. The initial fluid depth in the monitor tube at the south end of the trench was 17" and the maximum rise was 9.5". Once the flow of water was stopped the fluid level in this monitor tube receded at an adequate rate for a 4 bedroom residence. In conducting an adequacy test we attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the system's performance under the conditions encountered at the time of the test, and the reported separation distances are measured to readily identifiable features. Satisfactory test results do not guarantee future performance of the system under different conditions, nor do they guarantee there are no hidden defects or encroachments. Please feel free to give me a call if you have any questions on this report. Sincerely, Ted Moore, P.E. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D. # ~/' PRIVATE WATER SYSTEM ~'L ATTO.P Name Mailing Address City State Zip C,o~le s,,,,,,,,~o^~-~: ~, ~ I I I la, ~ z Mo. Day Year SAMPLE TYPE: R outine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water ;Z' Untreated Water SAMPLE No. LOCATION ~ I LT,. 3u~ CO~'TOu~ AC,e~x' l 2 J uo~"r~ s~ ,~ose ~tB J J Time Collected Collected By 1:3o TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [ Satisfactory [] Unsatisfactory [] Sample 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. Date Received Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* 92,1579 I A.O.E.C. ~ ~//~/~ READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LSB (:~ Coliform/100 mi Fecal Coliform Confirmation BGB Final Membrane Filter Resulta /~ ReportedBy ~'~ ~,' / TNTC = Too Numerous To Count OB = Other Bacteria Date PART ONE OF TWO REHAINDER TO FOLLOW Coliform/lO0 mi CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALISIS RESULTS fox IH¥OICE t 52864 Che~ab gef.t 92.1579 Sample t 7 Matrix: FAX: (907) 561-5301 Client Sample ID : L? B4 CONTOUR ACRES NURTHSIDE HOSE ?WSID : UA Collected : APR 16 92 ~ 13:30 h~s. Received : APR 16 92 ~ 15:00 hxs. Pzeeezved with : A~ REQUIRED Client Name :PLATTOP TECHNICAL SRV Client Acct :~LATTOT BPOt : POt :NONE RECEIVED ~eq$ : Ordered By :C~IS Analysis Completed : APR 17 92 Laboratory Supervisor :JTE?HRN C. EDE Released By : Send Reports to: I)FLATTOP TECHNICAL SRV Parameter Results Unite Mathod Allowable Limits NITRATE-N 0.64 ~g/1 EPA 353.2 lO Sample ROUTINE SAMPLE COLLECTED BY: CHRIS. I Tests Performed * See Special Inst~uctiom Above UA-Unavailable ND= None Detected "See Sample Remarke Above NA- Not Analyzed LT-Less Than, ST-G=eater Than Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Lot 7, Block 4, Contour Acr~6 Location (address or directions) 13101 Bainbridg~ (b) Property owner .Carl (]ros~ Telephone · (home) Mailing Address' '13'101 Bain6ridg~,.'; Anchorage.: Ak. 995~6 345-0057 Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent ?~b Address =;~_r~! o.- -qt-, A,~/~n~_nge; Telephone 56_~-5500 (e) Mail the HAA to the following address: (or check here l~f hold for pick up.) List contact person and day phone number below: At~. qq5n.~ s & s ENGINEERING ~_7n~4 ~:gl~ Ri~er Loop Road Eagle River, Alaska 9~2577 2. TYPE OF RESIDENCE Single-Familyj~ Number of bedrooms 4 3. WATER SUPPLY Individual Well [~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site ,~ 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 1 of 2 · 5. 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 S & S ENGINEERING Eagle River, Alaska 99577 Telephone Approved for 4:~ bedrooms by / ~,- _ _ ate Approved ./~,. . Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 cor~duct 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) A. WELL DATA {'~(~'~'~'~-~- Well Classification I Well Log Present~/N) ~ Date Completed Total Depth'~-''Z-I~ l , C.ased to ~''ar'l Depth of Grouting Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~ "7 t~L..,I~-.. ,~' If A, B, C, D.E.C. Approved (Y/N) '/~ Yield '~.-~'" ~ ~' ~ ~ Static Water Level ,"- ~, Casing Height Above Ground ~ ~Z- ~'.~ Electrical Wiring in Conduit~;;~N) "~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot' Pump Set At Sanitary Seal on Casin;j::~YN) Depression Around Wellhead (YX~J' ; On Adjoining Lots { ~-~"'-~ ; On Adjoining Lots ~ ~ ~ To Nearest Edge of Absorption Field on Lot ~ "~ ~' TO Nearest Public Sewer Line I~ /./~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Se'r'{dCe Line on Lot '7...~:.:.; Water Sample Collected by '~J~'~'~ ~:::~-~=~l~~ ;Date Water Sample Test Results ~ .c~ ~ ..- ~-~~. ~ ~ ~.~ Comments A~~-~ o-~=>~ ~.,,.I..~.~.,~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed ~ ~ O--l~O Size Standpipes ({~'N) y Air-tight Caps (3~/N) Depression over Tank (Y~I:~ Pumping/Maintenance Contact on File (Y/N) Hold["ng~;~i~k"Hi'gh-Water Alarm (Y/N) ., SI~PARATt. ON DISTANCES FROM SEPTIC/HOLDING TANK: ... ~.o. Wat.e~ii~Su pP!y' Well- \ ...:,;To-Property Lin~ .~ ,. TO Wai',e.r.,~.l~air~/~rvid~ Line 'l'~.stteam,. Pond, Lak~ or Major Drainage Course [ ~"~'-~ No. of Compartments Foundation Cleanout (YXI~) Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata '~l,~ ~ ~,/~r,.,~ . Type of System Design Date Installed ~'~ ~ ~--~= Length of Field "1 ~ J Width of Field "~ ~'- ~ Square Feet of Absortion Area Depression over Field Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: Depth of Field tv Gravel Bed Thickness ~ Statndpipes Present<[~/N) Date of Last Adequacy Test ,./ 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 ~ ~ "~ \'"~::~ To Property Line · ?._.t,' To Existing or Abandoned System on ; On Adjoining Lots ~. ~ t't- To Cutback (if present) Comments D. LIFT STATION Date Installed Dimensions Size in Gal, l, ofls, "Pump On Lev,I ~t~"'"'-~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "pump Off" Level at Vent (Y/N) '~P~,~umping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect inspection.. Signed S & S ENGINEERING 17034 Eagle Company ~_-_.=!e River, Alaska 99577 Date ,/'4~ /~/~' MOA No. C_.. ~ / -(~'~"(-;7~ _.~ Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# ~-.-ERIVATE WATER SYSTEM Name Phone No. $ & $ ENGINEERING 1707~_ ~_~_~!e ~_~. er t_~t,_~ R~_~-:_ H=. 2~ Mailing Ad(E~e River, Alaska 99577 City State · Day Year SAMPLE TYPE: ~-..Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose Zip Code [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 31 4 I Time Collected I ~___j~ J~Collected / TO BE COM.~LETED BY LABORATORY Date Received Time Received Analytical Method: /~sYSiS shows this Water SAMPLE to be: atisfactory [] Unsatisfactory [] Sample 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. Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* I I FT-1 I FT-I Analyst READ INSTRUCTIONS BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count (~ Collform/lOOml BEFORE COLLECTING SAMPLE Verification: LTB BGB Final Membrane Filter Results ~) Reported By ~ Date Time: Collform/lOOml a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 17148 Date Report Printed: OCT 4 89 @ 21:06 Client Sample ID:LOT 7 BLOCK 4 CONTOUR ACRES PWSID :UA Collected ~ ~s. Received SEP 29 89 @ 17:00 hrs. Preserved with :AS REQUIRED Client Name ; S & S ENGR Client Acct : SNSENGP P.O.$ NONE RECEIVED Req ~ Ordered By : Analysis Completed :OCT 2 89 Send Reports to: Laboratory Supe%yi;or, :S~EPHEN ~ 1)S & S ENGR Released By : ~~'~. 2) Special Instruct: Chemlab Ref ~: 7805 Lab Smpl ID: 5 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 0.45 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: i Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than 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 264-4720 GENERAL INFORMATION (a) (b) (c) Application Date ~'- I~ -~1,~, Legal Description (include lot, block, subdivision, section, township, range) ~.' Location (address or directions) Applicant Name ~ ~-"¢,~ , Telephone: Home '~- Oc:~7 Business 5~'Z- Applicant Address I ~ ~c~ I '~_~l:~j'Z.-', 1~4..,~. -'- ~..-3C_-~ , / ~'~-- '~ ~ ~'1 Applicant is (check one): Lending Institution []; Owner/builderl~~-, Buyer I-1; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent ,, I~C>~ Address Telephone (f) Mail the HAA to t~e~cl~(~j~~NG TYPE OF RESIDENCE Single-Family.J~- M ulti-Fam~..I-I Number of Bedrooms Other 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 Onsitel~ Public [] Community [] Holding Tank rrl~ 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 PROVIDh...~ 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 all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & $ ENGINEERING Telephone ~'/-//"~ ~ ~' SRB 196X ' .... * Address Date EAGLE RIVER, AK 99577 AUE I I DHEP 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) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA} CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Legal Description: ~ E D Well Classification , '~"~,~. If A, B, C, D.E,C. Approved (Y/N) Well Log Presentd~l~/N) Date Completed ~ - ~,.. ~,O Total Depth "4.."4-(~' Case/d t© ~ ~.[~t Depth of Grouting "-- Static Water Level J '"~'J..-- .., Pump Set At Casing .Height Above Ground Electrical Wiring in Conduit~N) Separation Distances from Well: Sanitary Seal on Casin~N) Depression Around Wellhead (Y~ To Septic/J;b3tdifrg Tank on Lot [ I...~t ' ; On Adjoining Lots To Nearest Edge of Absorption Field on I~ot ~ '~ ' ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Man hole Water Sample Collected by Water Sample Test 'Results Comments ~ ~.~ {;~-- rt L+ t ¢>~:~ /...ir" -, To Nearest Public Sewer To Nearest Sewer Service Line on Lot , ; Date ~ -- ~'"'~ SEPTIC/CI"~TANK DATA Date Installed ~=~ -1 O- ~ Size t ~ No. of Compartments '~' ~ Standpipes~:~N) Air-tight Caps ~N) , Foundation Cleanout Depression over Tank (Y~J;~) Date Last Pumped '~- ~- ~' Pumping/Maintenance Contract on File (Y/N)~/' Teml'~/l~ porary Ho ; for -- , / Holding Tank High-Water Alarm (Y/N) / j~ : i ', :ld~n:'l g Tank Permit (Y/N) Se paration Distances from Septic~Tank: To Water-Supply Well , t,~ ' . To Building Foundation 1. ~ ' To Property Line ~::)~ t ~ To Disposal Field ! To WatercourseMain/Service Line-1'31 jk I.e.~ ~ ,, To Stream, Pond, Lake, or Major Drainage Comments'~' J,l~J~'te-'x ~ '~.'rl.C, ~d... ~ ,-l--te,.~_. ~ Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date I nstalted Width of Field '2.., Square Feet of Absorption Area j Depression over Field (Y/{~) Results of Last Adequacy Test Separation Distance from Absorption Field: ! Jl~,~r'~ Type of System Design ~.~ Length of Field "7~ f Depth of Field Gravel Bed Thickness Standpipes Present (~/N) D~l;f Last Adequacy Test To Water-Supply Well To Building Foundation . Lot ~1 ~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area I To Property Line '~--~ To Existing o~System on ; On Adjoining Lots To Cu~k (if present) -/./~ Comments D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for I~lanhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** ,certify t~a~ or conformed to~lf~O~tt~l~;~A~;~,i nes in effect on the date of this inspection. Signed ~ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) ~IME- ' ' - TIME- [~ '()' _ TIME ~ ',: { ~ ~ INSPECTOR INSPECTOR ~ . INSPECTOR ...... ............ . . ~IEONMENT~ PEOTE~I~b . MUNICIPALITY OF ANCHORAGE . ' - ~ Telephone 2~-4720 REQUEST FOR APPROVAL OFtNDIVi~UAL WATERAND SEWER FACILITIES - DIRECTIONS= Complete all parts on page 1. Incomplete reqU~ ~1/not be proc~, Please allow ~en (~ 0) days fo~processing. 1; PR ~PER TY OWNER . r ...... -- ...... ~ PHONE ~ MAI~IN~ADDRESS -- PROPERTY R ESI DENT (If different fromabove) - ' PHONE 2- BUYER MAi LING A~DR ESS MA/LIN~ ADDRESS ' 4, REALTOR/AGENT_ ] PHONE "MAILING ADDR E~S 72-0~O (Rev. 6/79) [] .One [] Two [] MULTIPLE FAMILY FI- Three 7. WATER~SOPRL~' ' ' ' _-! _ ' ~. - ~ INDIVIDUAL. ATTACH WELL LOG. Awell log ~s required fo all wells drdled ' [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] puBLIc UTILITY depth (attach log-if available.) ~ ~_SEWAGE DIsPOSALB¥STEM- . - _ ' . ' · NDIV DUAL/ON-StaTE** ON-S TE SYSTEM WAS NST LL;D ~ PUBLIC UTI LITY' , NOTE: THE INSPECTION FEEMUST ACCOMPANYEACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2; W~ER suPPL¥~' [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY · ~Conni~cti~o~ Verified 3, SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank THIS SIDE FOR. OFFICIAL USE ONLY . .. NUMBER OFBEDROOMS [] ONE r-I THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER [] OTHER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER Size: 1-3-~'° If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line- SOILS RATING Sewer Line J Nearest L~t Lin~ MANUFACTURER ~ MATERIAL Septic/Holding Tank ~Absorption Area 5. COMMENTS DATE [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) ALASKA ,,UIROIlmI FITAL COrlTROL Se.,.,JICI S, IFIC. ~n§in¢¢rin§ & ~nuironmcnlal Sluclics CARl, CROSS 13101 BAINBRIDGE ROAD ANCHORAGE ALASKA 99516 SELLER-SAME 6/19/86 CARL CROSS 13101 BAINBRIDGE ROAD ANCHORAGE ALASKA 99516 60219 LEGAL:CONTOUR ACRES BLOCK 4 LOT ? ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-5/12/86 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 517 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 100 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 50 GALLONS. THE SYSTEM IS UNACCEPTABLE BECAUSE THE SURGE CAPACITY IS LESS THAN 75 GALLONS. TIlE SYSTEM IS NOT CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 9/6/85 THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE-5/12/86 A FLOW TEST WAS PERFORMED ON THE WELL· 365 PUMPED AT A RATE OF 6 GPM OVER A DURATION OF 1 THE DRAWDOWN WAS 12.8 ' WITH A RECOVERY TIME OF GALLONS OF WATER WAS HOURS. 60 MINUTES AND THE STATIC WATER LEVEL WAS 187 FEET. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME m.~ ,, ~ ,, ~v~ ~*'*.,,..,' 1200 ~est 33rd ~uenue, Suile B, ~nchoraqe, ~laska 99503,(907) 561-5040 ALASKA ,,UIROFImI FITAL COFITIROL Se:l dlCl $, IFIC. (~n§ineerinq 6 ~nuironmenlal Studies SPECIFICATIONS FOR BED WASTEWATER TREATMENT SYSTEM - LOT ?, BLOCK 4, CONTOUR ACRES SUBDIVISION 1.0 GENERAL 1.1 THE DRAWINGS, SHEETS 1 THRU 7, SHALL BE PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, DEPARTMENT OF HEALTH & HUMAN SERVICES (DHHS), THE CONDITIONS OF THE PERMIT, AND ALL APPLICABLE RULES AND REGULATIONS CURRENTLY IN EFFECT. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY, AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY A DHHS APPROVED INSPECTOR. 1.4 IT IS THE RESPONSIBILITY OF THE INSTALLER TO ADHERE TO APPROVED DESIGNS FOR INSTALLATION, TO MAINTAIN THE SPECIFIED SEPARATION DISTANCES, AND TO HAVE THE APPROPRIATE INSPECTIONS. 1.5 IF THE INSTALLATION IS NOT INSPECTED BY AN AECS ENGINEER, AECS WILL NOT BE RESPONSIBLE FOR THE DESIGN. AN ENGINEER AT AECS SHOULD BE CONSULTED PRIOR TO CONSTRUCTION, TO DETERMINE THE NUMBER OF INSPECTIONS THAT WILL BE REQUIRED AND TO EXPLAIN WHAT THESE INSPECTIONS WILL INVOLVE. 2.0 SEPTIC SYSTEM 2.1 THE EXISTING SEPTIC TANK MAY BE USED, IF IT MEETS THE CAPACITY REQUIREMENTS FOR THE RESIDENCE AND THE APPROVAL OF DHHS. IF NOT, THEN SPECIFICATIONS 2.2 THROUGH 2.6 APPLY. 2.2 THE SEPTIC TANK SHALL BE A UPC-APPROVED TWO-COMPARTMENT TANK, CONSTRUCTED OF 12-GAUGE STEEL WITH BITUMASTIC COATING, SET LEVEL ON UNDISTURBED SOIL, AND INSULATED WITH AN OVERLYING LAYER OF 2 INCH BURIAL TYPE POLYSTYRENE. 2.3 THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM THE HOUSE FOUNDATION, AND A MINIMUM OF 5 FEET FROM THE ABSORPTION AREA. 2.4 THE SEPTIC TANK AND BED SHALL BE A MINIMUM OF 100 FT. FROM ANY PRIVATE WELL OR BODY OF WATER, 150 FEET FROM CLASS C WELLS, AND 200 FEET FROM CLASS A OR B WELLS, UNLESS OTHERWISE SPECIFIED. LESS THAN THE REQUIRED SEPARATION DISTANCE MUST HAVE PRIOR APPROVAL OR WAIVER BY ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION (ADEC). 2.5 PIPING SHALL BE FITTED WITH A MECHANICAL WATERTIGHT CALDER COUPLING ON THE OUTLET AND INLET OF THE SEPTIC TANK. PIPING SHALL BE 4-INCH SOLID PVC ASTM D3034 OR CAST IRON, SLOPED A MINIMUM OF 1/4" PER FOOT WITH A MINIMUM OF 4 FEET OF COVER. 2.6 CLEANOUTS SHALL BE INSTALLED AS DESIGNATED AND CAPPED WITH AIR-TIGHT RAIN CAPS (JIM CAPS OR EQUIVALENT), AND EXTEND A MINIMUM OF 2 FEET ABOVE GROUND LEVEL. 1200 We$I 33rci Auenue, Suite B., Anchor'aqe, Alaska 99503.,(907) 561-5040 3.0 SEEPAGE BED 3.1 THE SAND SHALL HAVE AN EFFECTIVE SIZE OF 0.4 TO 0.6 MM AND A UNIFORMITY COEFFICIENT OF NOT MORE THAN 4. 3.2 THE GRAVEL FOR THE BED SHALL BE 0.5 TO 2.5 INCH, SCREENED ROCK WITH LESS THAN 3% PASSING #200 SIEVE RESIDUAL. ALL SUBSTITUTES MUST HAVE PRIOR DHEP APPROVAL. 3.3 THE BOTTOM OF THE EXCAVATION SHALL BE LEVEL AND RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. 3.4 THE DISTRIBUTION PIPE SHALL BE 4-INCH RIGID PVC WITH A MINIMUM CRUSH STRENGTH OF 1500 LBS. ALL PIPES SHALL BE LAID LEVEL, AND SPACED ACCORDING TO THE DRAWINGS. 3.5 MONITOR STANDPIPES SHALL BE PLACED AS SHOWN IN THE DRAWINGS. THEY SHALL BE RIGID PVC ASTM D-3034, OR OR 4 INCH DIAMETER CAST IRON. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5 INCH HOLES ON THE 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE, OR A SECTION OF REGULAR PERFORATED SEWER PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO-HUB COUPLING OR SOLVENT JOINT. A RUBBER RAINCAP (JIM CAP OR EQUIVALENT) SHALL BE PLACED OVER THE TOP OF THE PIPE. 3.6 IF THE FINAL GRADE OVER THE BED IS LESS THAN 4 FEET ABOVE THE GRAVEL, INSULATION IS REQUIRED, USING DOW EXTRUDED BLUE STYROFOAM BOARD. THERE SHALL BE 1 INCH OF INSULATION FOR EVERY FOOT OF SOIL LESS THAN THE REQUIRED 4 FEET OF COVER, BUT THERE MUST BE AT LEAST 18 INCHES OF SOIL EVEN THOUGH INSULATION IS USED. THE SOLID PIPE EXTENDING FROM THE SEPTIC TANK TO THE DRAINFIELD SHALL ALSO HAVE 4 FEET OF COVER OR AN EQUIVALENT LAYER OF INSULATION COMBINED WITH SOIL TO PREVENT FREEZING OF THE LINE. 3.7 IF INSULATION IS NOT NECESSARY, THEN THE GRAVEL MUST BE COVERED WITH A LAYER OF A NONWOVEN FABRIC (SUCH AS MIRAFAI, FIBRETEX 200 GRADE, POLY-FILTER X, OR EQUIVALENT). 3.8 THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX OR BLUE GRASS. 4.0 INSPECTIONS 4.1 THIS BED WILL REQUIRE THREE INSPECTIONS. THE FIRST INSPECTION WILL BE 'OF'THE OPEN EXCAVATION, TO ASSURE THAT THE SYSTEM IS INSTALLED IN PROPER STRATA AND DEPTH. 4.2 THE SECOND INSPECTION WILL BE PERFORMED AFTER SAND FILL IS INSTALLED, BUT PRIOR TO PLACEMENT OF GRAVEL AND DISTRIBUTION PIPES. THIS INSPECTION WILL VERIFY THAT THE FILLER IS PROPERLY INSTALLED, THAT IT MEETS SPECIFICATIONS AND THAT IT FULFILLS THE INTENTION OF THE DESIGN. 4.3 THE THIRD INSPECTION WILL BE PRIOR TO BACKFILL AND VERIFY THAT DISTRIBUTION PIPES ARE POSITIONED PROPERLY, SUFFICIENT GRAVEL IS PLACED, AND THE SPECIFICATIONS OF THE DESIGN. 5.0 5.1 5.2 5.3 THE LIFT STATION REFER TO ANCHORAGE TANK 500 GALLON LIFT STATION SPECIFICATION. PROVIDE A CALDER COUPLING AT THE CONNECTION OF THE 4" SOLID PVC INFLUENT PIPE AND 4" STEEL NIPPLE. MOA BUILDING CODES: WHEN LIFT STATIONS ARE INSTALLED WITHIN THE MUNICIPALITY, AN ELECTRICAL PERMIT AND INSPECTION ARE REQUIRED. IN AREAS NOT COVERED BY MOA BUILDING CODES, THE SYSTEM SHALL BE INSPECTED BY A LICENSED ELECTRICIAN TO INSURE THAT THE ELECTRICAL INSTALLATION IS IN ACCORDANCE WITH APPLICABLE CODES AND REGULATIONS. CHEMICAL & oEOLOGICAL 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 BYWATER SUPPLIER TO BE COMPLETED BY LABORATORY [] PUBLIC WATER SYSTEM I.D.# ~[ PRIVATE WATER SYSTEM ~c~ Name /zoo w 3 3 ~,~ hOE. Mailing Address City sAMPLE DATE: Phone NO. State Mo. Day Year zip code SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water '~Untreated Water Analysis shows this Water SAMPLE to be: ~atisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to Indicate reliable results. Pleas~ send new sample via special delivery mail. Date Received '~' .//~ *~Y~ Time Received //~ ~ Analytical Method: Membrane Filter * No. of colonies/100 mi. SAMPLE NO. LOCATION ~I ~Is~,~o , I 31 4 I I Time Collected Collected , By Lab Ref. No. Result* I ~ I I ~ I BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count Coilformll00ml BEFORE COLLECTING SAMPLE Verification: LTB Final Membrane Filter R~,~/..pF TNTC = Too Numberous To Count OB = Other Bacteria BGB i Co~&mll00ml p.m. ~,L. ~CHEMICAL & GIz,~LOGICAL LABORATORIES ~:; ALASKA, INC.~ Drinking Water nalysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: Water System Name Mailing Address I.D. NO. City State Mo. Day Year Phone No. Zip Code SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpoee [] Treated Water [] Untreated Water SAMPLE NO. I LOCATION Time COl~yted Collected An~Jysis shows this Water SAMPLE to be: ~ Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new.sam ple Date Received Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst *No, of colonies/100 mi or No, of Positive gort~ons. 06-1220 Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Date Collected] Source Data Received Time Recalv~l p.m.I, at). No. Presumptlva 10mi 10mi 10mi 10mi 10mi 1,0mi 0.1mi 24 Hours 46 Hours ~onflrmltory 24 Hours 46 Hours EMB Broth 24 hours: Broth 46 hours: Multiple Tube Ret)ort: 10mi Tut)es Positive/Total 10mi Portions Membrane Filter: Direct Count '- Collform/[00ml Verification: LTB BQB Final Memt)rana Filter Results Collform/100ml . RaPorted BY ~' ' ' · ''''''~': "< ',.' "~' Data Time= a,m, Anchorage Tank & Welding, inc. ~ ~'.~~ ' ':~OO Porcubine Dr. ' , k~v~ ~ --~iChora~e,/d'aSka egsot TANK F'OR LIFT SYSTEMS ' SEPTIC TANK 'SHALL BE A MODIFIED ANCHORAGE TANK S'[EEI. TANK. THE DESIGN OR ANALYSIS SHALL BE IN ACCORDANCE WITH ACCEPTED ENGINEERING PRACTICE AND LOCAL REGUt,ATORY AGENCIES, THE TANKS SHALL B~' DESIGNED FOR LOADING CONDITIONS AS REQUIRED BY MUNICIPAl. AND STATE REGULATIONS, AL, I,,, "WELDING SHALL BE IN ACCORDANCE WITH APPLICABLE CODES AND STANDARDS, COATING SHALL BE TNEMEC ~&-..~65 HI-BUILD TANK COATING AND APPLIED AS .... .., .,_ ~ . :' 0R oTH'~_R-i'hEA'NB .AS ,:NECESSARY ,+c:,' . ~ :": ~' . ": ;~';?' ;'".:~'~PLIC~Io~, ' ' :SHALL: BE'AiRLESs ~ :.... ,.. WITH BRUSH GR.'ROLLER, . .... )~{~PPRov'~ 'H~'T~:"~I'AL AND WILL NOT ::~'~}~'EE'g';~'~ '~?~;" .SURFACE '~E. HPERATURE BHALL NOT -~/:'f:?":-~'OR 5 ~gOu"7~'E~' POINT WHICH INI'FRIOR SHALL"BE COATED TWO TIMES AND SHALL' BE A MINIMUM OF 20 DRY MILLS EXTERIOR'~SHAi~L BE COATED ONE TIME AND SHALL BE A MINIMUM 01::' 10 I)RY MILLS, RISERS .~HAL, I.. BE GALVANIZED :~NI:f':'$HAL, t...,~BE 5~+ INCHES (MINIHUM) .HIGH, SH~ HI~IHUM~:~OMI~L DIA~ETE:R OF 2~ INCHES~' (NEMA?~X) ~OX OR EQUAL,' " ~¢ LISTED E'LECTRICAL CORI:I GR:rPS, .~<~;:: . '..BE ~$[)NSTRUCTED OF -FIBERGLASS OR'~ [ BONDED INSTAI..,I. ~ ' SYSTEM~ / OF' inc. WITH I.RY FIJOATI~ ON'~ TO VAUI..T, ONE .