HomeMy WebLinkAboutCOLONIAL PARK BLK 2 LT 5
"'~' MUNICIPALITY OF ANCHORAGE
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
MAILING ADDRESS
f~.o. ~ -/-/OTU~,
LEGAL DESCRIPTION
LOCATION
IPHONE ~UPGRADE ~
NO. OFBEDROOMS ~
' r~J Well / . AbsorPtion area ~)1 IDwelling PERMIT
DISTANCE TO:
I C~ "'" '7.'~' No. ~504'Z7
Manufacturer I Materi~j.._~_./INo. of compartments~.
gallon-s -IF HO~EMADE: I Inside length Width Liquid depth
D,STANCETO: ~e,, ~t I. IDwe'''ng PE,M,TNO.
Manufacturer '~'! R IMaterial Liquid capacity in gallons
Foundation
DISTANCE TO: Well ~ Nearestlotline I
' Length of each Total length of
No. of hnes
lin~t lin~I~ Trench wid~h.~ inches
~ grade ~ I Material beneath tile _ ' Total effective ~sorp~are~
Top of tile to finish ~ inches
Length Width Depth ~ PERMIT NO.
Type of crib Crib~ Crib depth Total effective absorption area
DISTANCE TO: Well '' - Building foundation Nearest lot line
Driller Distance to lot line PERMIT NO.
c,~.~ ~.,t~lI ~
DISTANCE TO: BuildCng~o~n~on Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
lOVED ~'
DATE LEGAL
2-013 (Rev. 3/78)
· ~ 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
I PHON E [] NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION ' ' NO. OF BEDROOMS
~ ~z Manufacturer ~ ~] ~ ~J' 'T~ [ Material~~l,~ t No. of compartments~
Liq' cT%~. gall°~s I IF ,O~DE: Inside length Wid,h Liquid depth
~ DISTANCE TO: Well N'/A Dwelling PERMIT NO. _-.
~ -- ~ Manufacturer Material Liquid capacity in gallons
~ Well I Foundation I Nearest lot line I~ ~ PERMITNO
~ DISTANCE TO: +t~ ~
~ No. oflinos ~ Length of each lin~i T°tallength°fli~81- TrenchwiOi~ inches Distancebotw~enl'nes
P ~ ~ Top of die to finish grade ~ I Material beneath tile To~al effective cbsorp~Qn area
Length Width Depth PERMIT NO.
Tgpe of crib Cfi Crib depth Total effective absorption area
m Well Buildino foundation Nearest lot line
¢ DISTANCE TO:
~ Class Depth~ / Driller Distance to lot line PERMIT NO.
~ Buildfng ~o on Sewer line 5eptic tank Absorption area(s)
~ DISTANCE TO:
OTHER ' - --
PIPE MATERIALS - ~
SOl L TEST~ATI NG ~
1N8~ALLER
REMARKS I ,~ "
'2-013 (Rev. 3/78) ~'"
"~M'LJ~ I C ii F' "~L_ I -r'Y OF' A~l[]tH[- :~AGE
DEPARTMENT OF~EALTH AND ENVIRONMENTAL P~TECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
SEWER F'ERM I T
~0: 8~04~7
,SUED: U7 / 19/8~
3ANT:
£SS:
,~TACT PHONE:
RASMUSSEN ENTER.
P.O. BOX 770766
EAGLE RIVER, AK
688-~110
99577
~GAL DESCRIP: SUBDIVISION: COLONIAL PARK LOT: 5
SECTION: 7 TOWNSHIP: 14N RANGE: 1W
LO]' SIZE: 1.25A (SQ.FT. OR ACRES)
MAX BEDROOMS: 3
BLOCK:-~ ~
Listed below a~e the options available to you in designing your septic
system. Choose the option that best ~its your site.
DEF'TH TO F'IF'E BOTTOM (FT.)
GRAVEL.. DEPTH (F'l".)
TOTAL. DEPTH (FT.)
GRAVEL. WIDTH (F'T.)
GRAVEL LENGTH (FT.)
GRAVEL VOLUME (CU.YDS.)
TANK SIZE (GALS)
SOIL RATING (SQ. FT. /BR)
'TRENCH (BED\ W. DRAIN
4.0 5.0 4.0
8.0 0.5 2.5
12.0 5.5 6.5
2.5 14.0~ 5.0
25.0 28.0 ~g' 33.0
18.2 14.6 18.4
1,000.0 ** 1,000.0 ** 1,000.0 **
122 85~ 85
** 'TANk-:: MUST HAVE AT' LEAST TWO COMPARTMENTS
I certi[y that.:
1. I am £amiliar with the requirements ~or on-site sewers and wells as set
[orth by the Municipality o[ Anchorage (MQA) and the State o£ Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria o~ this permit.
3.. I will adhere to all MOA and State o~ Alaska requirements ~or the set. back
distances [rom any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid (or a maximum o~ 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFl" STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN EL. ECTRICAL INSPECTION REPORT; AND (5) 'THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
..............
APPLICANT: RASMUSSEN ENTER.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
· ECA~.DESCR,PT,ON: LOT 5, /qLr'X'J4 ?~: _/'~/-C~L p~50.gDl~J~tl3M
1
3
4
5
6
7
8
9
SLOPE SITE PLAN
SOILS LOG
NOIJ. DgJ. O~d 31V.j.N~iNNO~iAN=3
~ H&lV:~H =tO
10
11
12
13
14
15
16
17
18
2O
,57, was GRO N WATER
ENCOUNTERED?
~[~ ~'~' ' ~PTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN
COMMENTS _~, ._~_, ~(7 r~'~ 4'' ~ ~ ~' ~a~
PERFORMED BY: ~ ~~.
72-008 (6/79}
FT AND ~ FT
& associates,inc.
Consulting Engineers
4790 Business Park Blvd. · Bldg. D · Suite One · Anchorage, Alaska 99503 · (907) 561-6151
August 30, 1985
Municipality of Anchorage
Department of Health and
Environmental Protection
825 L Street
Anchorage, Alaska 99501
SUBJECT: Lot 5, Block 2, Colonial Park Subdivision
Gentlemen:
This letter is to verify that the original crib system on the above ref-
erenced property was abandoned when the new system was constructed.
Should you have any questions, please let us know.
Very truly yours?
COR~N~& ASSOCIA~, INC.
Presider~t
MUNICIPALITY OF ANCHOI~AGI~
DEPT. OF HEALTH &
ENVIROINMENTAL PROTECTION
RECEIVED
MATANUSKA ELECTRIC ASSOCIATION, INC.
P.O. BOX 1148
PALMER, ALASKA 99646
TELEPHONE
(907) 745-3231
July 12, 1985
Richard & Sharon Kreps
P. O. Box 603
Eagle River, AK 99577
RE: Leach Field Encroachment
Matanuska Electric Association, Inc.
T.RACH FIELD / SEWER SYSTEM
has no objection to:
Encroaching into:
20 FOOT UTILITY EASEMENT MIDDLE OF LOt 5, BLOCK 2
COLONIAL PARK SUBDIVISION, T14N, R1W, Section 7
This non-objection is conditioned by the following stipulation:
MEA IS NOT RESPONSIBLE FOR DAMAGES TO SEWER SYSTEM OR ANY
ABOVE GROUND VENTS/PIPES ~
Matanuska Electric Association, Inc. will be held harmless from any and all
damages that may result from the existing and future use of said easement.
If you require additional assistance, please contact our office.
Sincerely,
Rebecca L. Bidasolo
Right of Way Agent
ALASKA'S FIRST REC--INCORPORATED 1941--ENERGIZED 1942
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE 688.2759
OWNER OF LAND
ADDRESS /C;~'. 0~.,~ ?
LEGAL DESCRIPTI ON/OT'.?
DATE - Started
PERMIT NUMBER
Ended
DEPTH OF WELL 3~, f 3- ~
sTAnc LeveL OF wAter FT. ~PO
DRAW DOWN FT.
GALS. PER HR , ~::ZO 0
K~nl) OF cAsING ~'~DO
KIND OF FORMATION:
From O 'Ft. to ,d.
From c~ Ft. to '~
From /-~ Ft. to ! o~
From / ~,. Ft. to a)-.~
F,,m ~ 3 Ft. to 6'~-'
From :~"~"'" Ft. to ~.~"
'From.~et''' Ft. to '70
From 7'0 Ft. to / ~
From /~/_.d Ft. to ! 70
Ft. ~Jr'°G ~CT"tC-~,J~D From
. Ft. _,OOc"~/'J0~gf~:~'J From
From ]70 Ft. to~et. ~'-,'~,~o~ ~,4~/~:(.. ,~- ~~ From~
From ~1~ Ft. toC~-]O Ft. /!i~,~t~l From
From ~Ft. to~~ Ft. . From
e,om ~t. to~ ~t. ' Tt e~7~ ~om
F,om ~Ft. to~O~ n. ~~ ae~ From
~,om 2~n. to.~aCFt.~~,-~ From~
F~om 3 9~ Ft. to 33 ~ Ft. Y~ ~ ~ Z~ ~ ? ~tom
~,om ~ n. ~o n. ~ ~ ~ ~,om
Ft. to .... Ft.,
Ft. to Ft.
Ft. to Ft.
Ft. to Fl,
Ft. lo Fl_
Ft. to Ft.
Ft. to Ft.
Ft. to__Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to, Ft
F,.to__ .EC E lVED
FL to F~Ay
Ft. to Ft.
' Municipaliiy of Anchorage
__Ft. to---l:~ot,~4ea!th & Human Services
Ft. to Ft.
MISCL. INFORMATION:
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 SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910041
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:KREPS RICHARD D &
OWNER ADDRESS:19829 SECOND STREET
EAGLE RIVER, ALASKA
99577
DATE ISSUED: 3/27/91
EXPIRATION DATE: 3/27/92
PARCEL ID:05030205
LEGAL DESCRIPTION: COLONIAL PARK BLK 2 LT 5
LOT SIZE: 30240 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT:
THIS PERMIT IS FOR THE CONTRUCTION OF:
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 (iSAACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
RECEIVED BY: , r _
ISSUED BY: ~--~-~
DATE:
SOILS LOG
:{OTECTION [] PERCOLATION
TEST
~TE PERFORMED:
/
8
9
10
11
12
13
14
15
16
17
18
19
2O
SITE PLAN
ENCOUNTERED?
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(r~inutes/inch)
72-008 [6/79)
TEST RUN BETWEEN
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
GENERAL INFORMATION
Complete legal description
Lot 5; Block 2; Colonial Park Subdivision;
Location (site address or directions) 19829 Second Str6~:
Property owner
Mailing address
Lending agency
Mailing address
Richard & Sharon Kr6ps
Day phone 594-9189
198.29 S~eond Str~t, Eagle River, Ak. 99577
Day phone
Agent Audrey M~znn R~./Mr~ cJf
Address 16600 Ccnt~rfi~ld Dr.
Eag£_¢_ ~'.uCJ~ Day phone .:'~94-4200
#201 Eagl~ River, A~. 99577
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well Y,X
NOTE:
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
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
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority 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
Address
~gle River, Alaska 99577_
Phone
Date
Engineer's signature
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA 1~21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~'~ ~:~-~--~-- ~...o~-~.~-. ~),~-~-=.Parcel I.D.
A. WELL DATA
Well type
Log present~'N) '~
Total depth ~7..-~ '~'*
Sanitary seal ~N)
Date of test
Static water level
Well flow
Pump level
If A, B, or C, attach ADEC letter.
Date completed
Cased to ~ ~'
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Public sewer service line
ADEC water system number
~5- c~t I Driller
Casing height
Wires properly protected(~VN)
g.p.m.
T~.INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
g.p.n~ 3>
WATER SAMPLE RESULTS:
Coliform
Date of sample: ~" 7--°1" ~ I ~
Nitrate
~' ~ I Ix -'~ I Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed ~' ~- '~ ~
Cleanouts (~/N) ~
High water alarm (Y~
Date of pumping
Tank size ~.7..~ ~"0 Compartments
Foundation cleanout ~N) ~ Depression (Y~
~ Alarm tested (-WI~) ~[J~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~,c)o ~ On adjacent lots ~,~ ~ ~' Foundation
To property line ~, ~ ~ ~'- Absorption field ~ ~ Water main/service line
Surface water/drainage
72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size l~Tt1'~a~ons ,, Manhole/Access (Y/N)
Vent(Y~N)~velat~'" ~~
High water alarm level ~ .~ Cycles tested
Meets MOA electr~ ~
~TANCE FROM LI F~nS~Oe~t ~o~~ Surface wa~
D. ABSORPTION FIELD DATA
Date installed ~;5 - 'Z. -
Length ~ Width
Total absorption area
Depression over field (Y~i~
Results~:~::~ail)
Soil rating ~ ~///~-- · System type ~'~--.-J:>
/~' ° Gravel thickness ~, ~" · ,
, Total depth ~. -~'
Cleanouts present ~/N) y
Date of adequacy test 2. o ;Z, ~- '~ !
Peroxide treatment (past 12 months) (Y~
for
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot t~¢3 ~ 4--
To building foundation
On adjacent lots
Surface water % ~=~
Curtain drain
On adjacent lots ~,C>o ~ Property line
~.~'~' ' To existing or abandoned system on lot
Cutbank ~ /~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
, agle River, Alaska 99577
Engineer s Nam~
.~ ~ee ~
~e o~ ,a~en~ ~ ' ~ - ~ ~ ~a~e o~ ,a~en~ .
.~c~ .u~r '~~ ~ .ece~,~ .u~er
72-026 (Rev. 3/91) Back MOA 21
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING
5633 B STREET
ANCHORAGE, ALASKA99518 TELEPHONE (907) 562-2343
ANALYSIS REPORT BY SAMPLE £or WORKordert 33396
Date Report Printed: APR 20 91 @ 19:15
FAX:(907)561~5301
Client Sample ID:L5 B2 COLONIAL PARK
PWSID :UA
Collected APR 16 91 ~ 14:15 hrs.
Received APR 17 91 ~ 12:50 hrs.
Preserved with :AS REQUIRED
Client Name :S & S ENGINEERING
Client Acct :SNSENGP
BPO I PO I NONE RECEIVED
Req t
Ordered By :R. SHiFER
Analysis Completed :APR 19 91 Send Reports to:
Laboratory Supe~vi~EN C. EDE 1)S & S ENGINEERING
Chemlab Ref t: 911492 Lab Smpl ID: 1 Matrix: WATER
Allowable
Parameter Tested Result Units Nethod Limits
NITRATE-N ND(O.IO) mE/1 EPA 353.2 10
Sample ROUTINE SAMPLE COLLECTED BY: RAY
Remarks:
1 Tests ?erformed * See Special Instructions Above UA-Unavailable
ND- None Detected '* See Sample Re~arks Above
NA- Not Analyzed LT=Less Than, GT-Greater Than
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 10t, block, subdivision, section, township, range)
Lot 5; Block 2; Colonial Park Subdivision;
Location (address or directions)
19829 Second Street
Richard ~ Sharon Kreps
(b) Property owner
Mailing Address 19829 Second S.~¢~::
(c) Lending Institution
Telephone'(home) 694-9189
Ea~le River, Alaska 99577
Telephone
Business
862-9123
Mailing Address
(d) Real Estate Company and Agent
Address
RE/Max of Eagle River ATTN: Audrey Mason
Telephone
(e) Mail the HAA to the following address: (or check here [~if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17034 Eagle R~ver Loop Road No. 294
Eagle River, Alaska ~57'/
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms $ '~
3. WATER SUPPLY
Individual Well r~x. Community [] Public []
Note: If community wel! system, must have written confirmation from the State Department 0f Environmental
Conservation attesting t° th legality and status.
4. 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.
Telephone ---~q~~7I
Name of Fir~& $
'Ii 7034 Eagle River Loop Road No. 20_4
Address p_.agie F, iw~',,~.-o~-~ ~"['~ ooc??. .... _
Date
Second cl~anout on s~ptic tank, cleanout after
septic tank and one monitoring tube to be repaired
in SPRING 1991.
6. DHHS APPROVAL
Approved for '-~
Approved Disapproved Conditional
Terms of Conditional Approval ,,~,n~$ ~,-~,'$,,~ ,~c ~-~'c:~'O~z/
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 conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
Well Log Present (Y,(~). /'-/ Date Completed ~{Z.t. oL ~;'
Total Depth t.)t~-., Cased to~)t't' Depth of Grouting
Static Water Level
Casing Height Above Ground ~.,
Electrical Wiring in Conduit {~N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results %~--~t '~ ¢ ~-~'-~ ~-~ -
Comments --/Yr' [., j~ t~,
If A, B, C, D.E.C. Approved (Y/N)
Yield
Pump Set At
Sanitary Seal on Casing~l
DepressiOn A~ound Wellheac
; On Adjoining Lots _
~.~C~~4'- ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
;Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ~-"~--'~'~'Size
Standpipes ~ '~ , 1~
Depression over Tank (Y~)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) '~"~ ~-
\7~'~'c) No. of Compartments '~-
Air-tight Caps {~/N)~ ~ Foundation Cleanout ~)/N)
Date Last Pumped ~-'- -Z...~.~ ' % ~
, for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ~, ~c~ ~ ~'- To Building Foundation ~ ~ e-
~ C) ~ ~ To Disposal Field ~'c:~
To Property Line
To Water Main/Service Line
72-026 (Rev. 7/88) Front Page 1 of 2
To Stream, Pond, Lake or Major Drainage Course
Comments ~ ~-~(~'-~, ~
C. ABSORPTION ~IELD DATA
Soils Rating~ Absorption Strata
Date Inst0~l~d ~_~%
{;t~luare P~t o,~_. ortion Area ~i'D L0'~
Depression ~ Field (Y~)
Resu Its of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
Type of System Design
Length of Field 7-'~~
Depth of Field
Gravel Bed Thickness
Statndpipes Present
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
Comments -~' i~t~..-
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots "~
To Cutback (if present)
D. LIFT STATION
Date Installed
Dimensions
Size in...Gallons Manhole/Access (Y/N)
"Pump On" Level at ~ "Pump~Off" Level at -.-----
High Water Alarm Level at
Tested for ~ ~ycles during Adequacy Test.
Meets MOA Electrical Codes
Comments ~
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on
inspection. $ & 5 ENGINEERING
Signed
Company
Date
MOA No.
17034 Eagle River Leop Road No. 204
Eagle River, Alaska
Receipt NO. ~ ~ ~' 3%~ -
Date of Payment ~- '~- q/
Amount: $ / "~0 o?~,'
72-026 (Rev, 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING
__----- ~---- ------__---------
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
ANALISIS REPORT B! SANPLE for Work Order ! 32134
Date Report Printed: FEB 26 91 ~ 16:50
FAX: (907) 561-5301
Client Sample ID:L5, B2, COLONIAL PA~K S/D
PWSID :UA
Collected FEB 21 91 e 14:30 l~s.
Received FEB 22 91 ~ 15:10 hxs.
Preserved with :AS REQUIRED
Client Name : S & S ENGINEERING
Client Acct: SNSENGP
BPO t PO t
Req !
Ordered By : R. SHAPER
Analysis Completed :~EI~ 25 91 Send Reports to:
Laboratory Supe[vls. or.~![TEP~N C. EDE I)S & S ENGINEERING
R.l....d
Chemlab Ref t: 910633 Lab S~pl ID: 1 %atrix: WATER
Allowable
Parameter Tested Result Units Method Limits
NITRATE-N 6.2 mg/1 EPA 353.2 10
Sample ROUTINE SAMPLE COLLECTED
Re~arks:
1 Tests Performed ' See Special Instructions Above UA-Unavailable
ND- None Detected '* See Sample ~eaarks Above
NA- Not Analyzed LT-Less Than, GT-Greater Than
March 6, 1991
ROBERT SHAFER, P.E.
ROGER SHAFER
CIVIL ENGINEERS
(9O7) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
$OILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Richard ~ Sharon Krep~
19829 S~cond S~re~
Eagl~ River, Al~k~ 99577
REFERENCE: Lot 5~ Block 21 Colonial ?ark Su§divi~ion;
D~arMr. ~ Mr6. Kr~p6,
At your r~qu~t a flow tut wa6 p~rform~d on thc w~l ~rving th~
r~f~nc~ prop~ty on F~br~ry 28, 1991. Th~ ~c wat~ l~v~ w~
m~ur~d witch th~ w~ ~ 19 ft. 5~ow ~ top of th~ ~ing. A
m~ ~ conn~ ~ ~ ~t~ ~y~t~ a~ ~ flow ~rn~ on f~.
Aft~ appro~at~ 300 g~o~ w~ ~p~d, th~ ~ l~v~ ~ ~ ~
p~p a~ ~ flow ~¢n~d off. Aft~, th& w~ w~ ~owed to r~cov~
for approx~y 30 mi~. Th~ flow ~ ~¢n~d on and thC ~t~r
l~v~ dr~n down ~ th~ p~p ag~n w~& th~ q~y of ~ w~
m~d. T~a proc¢~r¢ ~ reputed fiv~ ~ w~h co~i~
r~. From ~ t~t w& fou~ th~ w~ ~ produ~ approx~at~y 24
g~o~ p~ ho~r (GPH). T~ flo~ rat~ i~ no.t g~ra~d to r~n
co~, ~ub~qu~ va~o~ ~n oc~.
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577