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HomeMy WebLinkAboutALDERWOOD PLACE LT 2Aiderwood Place Lot 2 #050-281-66 January 10, 1986 TO: Permit Applicant R.O. BOX 6600 ANCHORAGE, ALASKA 99502-1.6:,0 (907)264-4111 11v KNOWLkA10✓VL v C P DEPARTMENT OF HEALTH 3 HUMAN SERVICES Subject: Permit # 850635 Lot 2 Alderwood Place Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as -built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit ~ PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: o~xwow4C.. �o-;-I I.. I. n v to v - no V, k.^*L5 ON 10 Li kL-,. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~125 L STREET, ANCHORAGE, �-- 99501 264-472O C3 t%J__E3 1-��� W I_ F=' FEZ 1---Z 1�1 T 850635 09/30/85 ca���"�BODA' ��,MILLER CONS 129 TOAKOANA EAGLE RIVER, AK 99577 694-9302 SUBDIVISION: ALDERWOOD PL LOT: 2 BLOCK: NA SECTION: 12 TOWNSHIP: 14N RANGE: 2W .5A (SQ.FT. OR ACRES) I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulation and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set bac distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. SIGNED DATE: APPLICANT SV ISSUED BY DATE: � ____ ____ �� /_�- �---�-------------7�-- - �---��- - WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys c w G) W r v 2 0 Drilling Permit No. LOCATION OF WELL (Please complete either la, Ib or Ic.) A.D.L. No. lo. Borough Subdivision Lot Bloek Ib. V4gtrs. Section No. Township Np Range EC] Meridian Aneh Aldervood 2—of—of—of — sp WO Ic. DISTANCE 4ft DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Paul. Miller Address: 129 Toekoama Eagle River Street Address and Area of Well Location Feet Below 2. WELL LOG 4. WELL DEPTHY(final) 5. DATE OF COMPLETION Surface 119 ft. 10 — in Material Type Top Bottom "1 g. 0 Cable tool [3Rotary Q Driven E3 Dug 0 Auger E]Jetted C]Bored C] Other: Sand & Gravel 4 20 Snrldy r ria 20 7. USE: g Domestic []Public Supply []Industry 85 100 C] Irrigation O Recharge C] Commerical Sand Graim3 B0111 diarn 100 11q9 Test Well Other: Sand Gravel WAter 107., 119 e. CASING: 0 Threaded Q Welded diom—L_in. to 119 ft. Depth Weight 17 diam. in. to ft. Depth Stickup 1t. 9. FINISH OF WELL: 61 Type: [)nen Hole Diameter: Slot/Mesh Size: Length: Set between ft. and It. Backfilling Gravel pock 10. STATIC WATER LEVEL: 80 ft. 10 C3Above or ® Below land surface Dote Equipment used: ICIPALITY OF ANCHORAGE DEPT. OF HEA TH I I . PUMPING LEVEL below land surface and YIELD 115 ft. after ___,J_hrs. pumping 1”) O.P.M. DEC I 919a8— it. atter hrs. pumping g.p.m. 12.GROUTING Well Grouted: El Yes © No Material: 0 Neat Cement [] Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. Subm. [3 Jet 0 Centrifical Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature a C] F El C This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; Bart r:ullock ?Jail Drilling - Registered Business Name Contract License Number Address: 1)90. Box 87 272.Wasilla AR Signed : Dote: uthorized Representative Form 02-WWR (11/131) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY- Customer c w G) W r v 2 0 111lIScA£ 8 • Municipality of Anchorage = On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL Parcell.D. 050-281-66 1. GENERAL INFORMATION Complete legal description ALDERWOOD PLACE LOT 2 Expiration Date: S-14-13 Location (site address) 10126 LEE STREET EAGLE RIVER AK 99577 Current Property owner(s) RONALD MOHR Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 10126 LEE STREET EAGLE RIVER AK 99577 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Communitv Class _ Well ❑ Public Water System ❑ WaiverNariance request for: Day phone TYPE OF WASTEWATER DISPOSAL: Individual ❑ Holding Tank ❑ Community _-1 Public Sewer Received by: �r�=`1 i('�,c �� Date: ,. COSA to be released to the engineer, unless other mjs requested by the engineer. COSA Fee $ ` cl Date of Payment 611 3'13 Receipt Number o; Jc61-0 COSA #��I'st 1%1 Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4/30/2013 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen '"' !„W A if +S encroachments, deficiencies or discrepancies exist. A R1s 6. DSD SIGNATURE V System #1 Approved for bedrooms. y3js System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: The Original Certificate Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheel_10.1P12.d.. X Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: ALDERWOOD PLACE LOT 2 Parcel ID: 050.281.66 A. WELL DATA Well type PRVi If A, B. or C provide PWSID # _ Date completed 1011985 Sanitary seal (Y/N) Y Total depth 119 ft. Cased to 119 ft. FROM WELL LOG Date of test 1011985 Static water level 76 ft. Well production 3 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 4.89 mg/L Arsenic: ND ug/L Date of sample: 412312013 B. SEPTIC/HOLDING TANK DATA — PUBLIC SEWER Tank Type/Material Tank size _ gal. Number of Compartments Foundation cleanout (Y/N) Depression over tank (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA — PUBLIC SEWER Date installed _ Soil rating (g.p.d./ft' or fiz/bdrm) _ Length ft. Width Total depth ft. ft. Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) 18+ in. AT INSPECTION 412312013 ft. g.p.m. Collected by: ARCTERRA Date installed Cleanouts(Y/N) High water alarm (Y/N) System type Gravel below pipe Eff. absorption area ft2 Monitoring tube Depression over field ft. Date of adequacy test Results (Pass/Fail) _ For bedrooms Fluid depth in absorption field before test _ in. Water added_gal. New depth_ in. Elapsed Time: _min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION — PUBLIC SEWER Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at —in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot NA Absorption field on lot NA Public sewer main 751+ Sewer /septic service line 254 Animal containment areas 504 SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Wells on adjacent lots Property line Water service line ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line _ Water Service line Curtain drain F. COMMENTS G. ENGINEER'S CERTIFICATION Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots NA On adjacent lots NA Public sewer manhole/cleanout 100'+ Holding tank NA Manure/animal excrete storage areas 1004 Absorption field Surface water Building foundation Water main Surface water Wells on adjacent lots Driveway, parking/vehicle storage 1 certify that I have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are in Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOA COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 0413012013 COSA brown sheet 10-10-12.doc in. a.ED M9'ID rt00n (AfSUFD) (�j eON�FA K esNci I i 9UlN:. YIBIA( 9MI.N SE1B.7( ARd11G 419N]( 3 33' 7 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE UNES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABIUTY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. Lor suRVi:x SURVEY IYHL FOUNDATION AS -BUILT ❑ DNAL STRUCTURE AS -BUILT ❑ PLOT PLAN ... AS -BUILT ... LOT SURVEY ... TOPOGRAPHY ® AS-eWLT NO CORt1ERS SET ❑ PECERTIDCATION AS -BUILT ... NO CORNERS SET PLOT PLANS & LOT SURVEYS IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CERTIFICATION ...fir&%F%I"'k PLOT PLAN �.• �� •..; I!✓Q •�♦ N FOUNDATION AS -BUILT"• "" ""_' WELL . o � ....... ..... : `ROBERT E, ' N o . A ; I FINAL STRUCTURE AS -BUILT � y .• • .♦ Ae '•.• L Renal c .IdaA..H.. AYaAY vINY Mat I ml. RerNRnRd a AR -9u11 wmy o1 M ,.•' . e ••............• D o LU + Pr Loo + ofeasion_d_ � �1� 0 56.0' ..._........ " _ _......_ o _ ._. o ... �— 6.0' EXISTING o w I HOUSE b W CANr W z U 40.0' W W � J I I oND N89° 58'38"W 263.76' 7 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE UNES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABIUTY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. Lor suRVi:x SURVEY IYHL FOUNDATION AS -BUILT ❑ DNAL STRUCTURE AS -BUILT ❑ PLOT PLAN ... AS -BUILT ... LOT SURVEY ... TOPOGRAPHY ® AS-eWLT NO CORt1ERS SET ❑ PECERTIDCATION AS -BUILT ... NO CORNERS SET PLOT PLANS & LOT SURVEYS IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CERTIFICATION ...fir&%F%I"'k PLOT PLAN �.• �� •..; I!✓Q •�♦ N FOUNDATION AS -BUILT"• "" ""_' 4 RM. L AM4 ./.. IInOI a�a1fY Mal . w,e.um a al. a eas M.e a a. eh.n�.n. ak ewmaam as Maw n..cw ....... ..... : `ROBERT E, ' N iie.,�ouwwa �vasam.,4 rYl Wr . A ; 21— FINAL STRUCTURE AS -BUILT � y .• • .♦ Ae '•.• L Renal c .IdaA..H.. AYaAY vINY Mat I ml. RerNRnRd a AR -9u11 wmy o1 M ,.•' . e ••............• D o ww.nn an ala eR aW Ma a nM sna.I.l. ar aamrxa e. Mo.n n..m + Pr Loo + ofeasion_d_ � �1� bw a,E m mawlma4 PYL uY _ SET R£BAR rm W DRAINAGE 0 ASPHALT O FOUND REBAR 0 8 6 WOOD FENCE CONCRETE 00 a ASSUMED ELEV. „--)4 x METAL FENCE ® WOOD DECK ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WALL BE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE. ALASKA 99504 Scde� 11. = 401 Rec. Lot S.F. Rec. Plot File No. DOfe SUfVej e 04/23/13 Drawn by REJ Checked bjMK Date Drawn: 04/23/13 Grid: NW53 WD' 13-143 LOT 2 ALDERWOOD PLACE • MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # HAA # {moi iz 9Q� 0 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Alderwood Place Subdv. Lot 2, T14N, R2W, Sec. 12 Location (address or directions) 10126 Lee St. (b) Property owner Ron Mohr -Telephone :.(home) 696-1604 Business269-1103 Mailing Address 10126 Lee Street, Eagle River, Ak. 99577 (c) Lending Institution NBA Mailing Address P.O. Box 6127 (d) Real Estate Company and Agent Address Telephone Telephone. 694-5373 Eaale River. Ak. 99577 (e) Mail the HAA to the following address: (or check heren, if hold for pick up.) List contact person and day phone number below: Pickup by Engineer 2. TYPE OF RESIDENCE Single -Family ® Number of bedrooms — 3 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. 4. SEWAGE DISPOSA i On-site ❑ Publi Community ® Id Tank ❑ Note: If communit well system, mus ave written confirmation from the State Department of Environmental Conservation attesting to the legailty 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 Eagle River Engineering Services Telephone ( 907) 694-5195 Address P.O. Box 773294, Eagle River, Ak. 99577 Date 6. DHHS APPROVAL Approved for bedrooms by 6 Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION 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 �o_rs�a�an �i 6. DHHS APPROVAL Approved for bedrooms by 6 Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION 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 an 343-4744 Legal Description: l' 74-2 L�/fie•�� /% 2,/zlov 2 a Szc 11 A. WELL DATA Well Classification 4. -C -Fl -e_ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth— �Cased to Depth of Grouting r fir.-: Static Water Level 76 �/.�..� 1?7- 1 Pump Set At Casing Height Above Ground 12 ".1 Sanitary Seal on Casing (Y/N) X Electrical Wiring in Conduit (Y/N) ,Y Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Alm' olo"lu ; On Adjoining Lots J`^'e' To Nearest Edge of Absorption Field on Lot " 14- ; On Adjoining Lots rw�' To Nearest Public Sewer Line 94'/ To Nearest Public Sewer Cleanout/Man hole To Nearest Sewer Service Line on Lot +25' Water Sample Collected by C ; Date 5/-2 y'/90 Water Sample Test Results /, ,.... _ /�' k ;J /-'7 Comments B. SEPTIC/HOLDING TANK DATA 04.0 A---, 6//�' 1G-•�� Date Installed Standpipes (Y/N) Size No. of Compartments Depression over Tank (Y/N) Air -tight Caps (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High -Water Alarm (Y/N) Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field 72-026 (Rev. 7/68) Front Page 1 Of 2 C. ABSORPTION FIELD DATA 1/_�/ Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line _ Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on On Adjoining Lots To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) . "Pump Off" Level at Vent (Y/N) Pumping 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 guideliWs' t-6ff tpn the date of this inspection. �;'➢� s +; ,` Signed. be3 Company�P . r. o ► �� "; 4y 4 Seal Date S� �� 9� MOA No. ��–,2 y Fa ............... .. �a c `�a Leis °" CE -6736 ® ", �t����'�•o... v//^ ///' ! Receipt No 4. a� u.a^���� may, r Date of Payment o Amount: $ ��. 06 Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 HA`i' 31 '90 10: 2FJ r 1TL-AN1:_ H(-)RPGE 907 274-13645 P.2/2 NORTHERN TESTING LABORATORIES, INC. f. 0 2505 FAIfMANKS STREET ANcrtOHAGE, ALASKA 99503 907.2778378 • FAX 274.96,15 600 UN1VER!Wy PLAZA WEST, StjlrE A r FAIR'AANKS, ALASKA 99709 007-479.3115 + FAX 479.0547 Eagle River Engineering PD. Box 77329+4 Eagle River AK 99577 Attn: Louis Butera our Lab #: Location/Project: Your Sample ID. Sample Matrix: Comments: A100921 Alderwood, Lot 2 Water Report Date: 05/30/90 Date Arrived: 45/25/90 Date Sampled: 05/24/90 Time Sampled&* 0837 Collected By: LB Flag Definitions U - Below Detection Limit DL Stated in Result B = Below Regulatory Limit H - Above Regulatory Limit E = Below Detection Limit Estimated Value Metbod Parameter Units Result Flag —.+.r,.. — "'----------- nom" ----------------win--------------' ----------------- EPA � Atrate-N mg/1 1.3 pl- Reported By: Francois Rodigari. Anchorage operations Manager TI- 30 '90 12.46- NTL -ANCHORAGE 90; 274-964 NORTHERN TESTING LABORATORIES, INC. 2508 FAIRBANKS STREET 1 ANCHORA04E. ALASKA 99503 907.277-8378 + FAX 274-8645 600 UNIVERSITY PLAZA WE$T, SUITE A FAIRBANKS, ALASKA 99709 $07-47"115 + FAX 479-0547 Drinking Water Analysis Report for Total Coliform Bacteria. TO BE COMPLETED BY CLIENT ❑ PUBLIC WATER SYSTEM I.D. 1A PRIVATE WATER SYSTEM NAME Maiiinp revs City Stilts 7io Coda SAMPLE DATE: Q'2` .. 2' Phone) �7 Mo. Day Year Purchase Order No. SAMPLE TYPE: i Routine ❑ Treated Water ❑ Special Purpose ra Untreated Water ❑ Check Sample (for original contaminated . sample with lab reference no. semWe Time No. LOGetlon Collected Colimed by L41beratary Rol. NO. MIA tf&N Z. 7 — 8 8 10 t Signature of Representative2":",) } r FOR LABORATORY USE ONLY CHANGE PREPAID TRTAL I SPECIAL INVAUCTIONS MAR HOW' FOR PICKUP TO BE COMPLETED BY LABORATORY Deceived at:�Aneh.. ❑ Fbks. Date Receiued� -� Time Received -5 Next Sample Due COMMENTS: SATISFACTORY UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT OirOet VerNfeptign Count L$B 040 -Finer ROluk+ Cemmanta *No. of Total Coliform Colonies per 100 m' Reported by {^y Rate ri Time MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services ` DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 62� o 291 HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2- Alderwood Place Location (address or directions) Lee Street jj1tR5lr, Rtv�Rt O A1/ttlr}!� .FNc. (b) Property owner Mike Quinn Telephone: (home) 694-4955 Business Mailing Address P O Box 91 17 #189 Faql P Ri vPr, Al a. -,kA (c) Lending Institution Alliance Bank of Anchorage Telephone Mailing Address (d) Real Estate Company and Agent Address 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 River Loop Road Na -904 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family KI 3. WATER SUPPLY Individual Well Number of bedrooms 3 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ❑ Public M Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty 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 S & 9 ENGINEERING Telephone 2� 17034 Eagle River Loop Road No, 204 Address —nin River, Alas" 909577 Date 6. DHHS APPROVAL Approved for 3 21/ bedrooms by 9"";/ —&Zv Date LZ Approved X Disapproved Terms of Conditional Approval Conditional CAUTION 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 orderto 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 forerrors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 NICIPALITY OF , Cl4ea th Authority Approval (HAA) OA) D' CHECKLIST - FEBRUARY 1984 343-4744 1 '4` Legal Description: Lor Z A. WELL DATA 1r Well Classification J�>Gi If A, B, C, D.E.C. Approved (Y/N) N Well Log Present OI) — Date Completed t Q-10- 0� Yield Total Depth )I Cased to Depth of Grouting Static Water Level Pump Set At �I � Casing Height Above Ground �% 4- Sanitary Seal on CasingON) —� Electrical Wiring in ConduitON) Depression Around Wellhead (Y(1P Z ELLToSEPARATION DISTANCES FROM WELL- To Septic/Holding Tank on Lot ; On Adjoining Lots p' To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line 7�-75_ t To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 2'5 - Water Sample Collected by Water Sample Test Results CommenttAlOr B. SEPTIC/HOLDING TANK DATA Installed Standpi Y/N) Depression over' Size / Jr 1 No. of Compartments /N) Air -tight Caps (Y/N) Pumping/Maintenance Contact a (Y/N) Foundation Cleanout (Y/N) Date Last Pumped ;for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TAN To Water -Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Building Fou To Disposal Field Page 1 of 2 72-026 (Rev. 7/88) Front C. ABSORPTION FIELD DATA S ' s Rating in Absorption Strata Type of System Design Date In Iled Length of Field Width of Fiel Depth of Field Gravel Bed Thickness Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line _ Statndpipes Present (Y/N) Date of Last Adequacy Test To To E)risting or Abandoned System on On Adjoining Lots To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION ate Installed Size ( ons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions..- Manhole/Access ,(Y/N) — "Pump Off" Level at Vent (Y/N) ping 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 on the date of this inspection. r. Signed S & s ENGINEERING,��, Company 17034 Eagle River Loop Road No. 204 r �ti tib , E!1• v , Al 1 99377 Date y Qw i Se i' >11.t.i• er.4 H Yr • MOA No. C — xg Receipt No. 4Qg) � Date of Payment _ Amount: $ z 2 ©a Ge'n'e NO. ; A.,; � r '• .."n�fi cfu' +mow ..+v1'Ky Receipt No. 'J Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA., INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 mn�N3 FEDERAL TAX ID #i 92.0040440 IABORATO RIES Client Sample ID:L2 ALTERWOOD PWSID :UA Collected DEC 12 88 a 18:15 hrs. Received DEC 13 88 ! 15:00 his. Preserved with :4 DEG. C ANALYSIS REPORT BY SAMPLE for Work Order i 10889 Date Report Printed: DEC 14 88 ! 14:42 Client Name S & S ENGINEERING Client Acct SNSENGP P.OJ NONE REC D Req # Ordered By : RJS Analysis Completed :DEC 14 88 Send Reports to: Laboratory Super or :STEPHEN C. EDE 1)S & S ENGINEERING Released By 2) Special RESULTS READY FOR PICK UP AT 1530 P.M. 12/14/88. " A MUST** Instruct: Chemlab Ref #: 3713" Lab Smpl ID: 1 Matrix: WATER Parameter Tested Result/Units Method -------------------------------------------------------------------------------------------- NITRATE-N 1.4 mg/l EPA 353.2 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. Allowable Limits -------------- 10 .............................................................................................................. 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, 5633 B Street INC. TELEPHONE (907) 562-2343 Anchorage, Alaska 99518 Drinking Water Analysis Report for Total COlifOl Bacteria upw,►Tow�a I TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D.# /-PRIVATE WATER SYSTEM Phon No. Name Mailing Address U` State Zip Code City L�-� SAMPLE DATE: I I :J FEE Year Mo. Day SAMPLE TYPE: ARoutine ❑ Check Sample (for routine sample ❑ Treated Water with lab ref. no. untreated Water ❑ Special Purpose Time Collected SAMPLE Collected By No. I L LOI N AT 2 3 � -- 4 L� 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORAIUi-tr 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 ml. Lab Ref. No. Result* Eln ED ED m ED BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Analyst 2�— Coilform1100m1 Verification: LTB BGB Coilform1100ml Final Membrane Filter Results Reported By Date Time: �da a.m. p.m. TNTC = Too Numberous ,jo Count