HomeMy WebLinkAboutABBOTT LOOP MANOR BLK 2 LT 9Ld 9
OCT-ZI-99 19:15 FROM-CTE ENVIRON~NTAL 5615901 T-IgZ P.03/03 F-901
CT&E Environmental Services Inc.
Lal~r~mr~ Division
pUBLIC WAT~.R sYST£M LD. #
ZOO W. Porter Drive
Tel: {9071 662-2343
d~g Water ~alysis Report fo~ To~l Colifo~ Bacteria ~' ~
READ IHSTR UcTION$ ON ~FE~E ~IDE BEFO~ Co[~cYING S~PLE Fax:
TO BE ~1
h~s W~ SAMPLE ~
~ S~lc ov~30~ o1~ ~u ~
SAMPLE DATE: ye~w ~- - /
SAMPLE TYPE:
~ Roudm~ ~,/
wl~h ~h rtl, no,.__---.--.-
.~aalln~l~ /u MMO-MLTC~
DaI~ .._..___.~, Tu~':' .------------~
~ Sl~cl~d i~ 'rim collmm~d
I~OL~ WAT~ ANALYS~ RECOILU
Membf~4~ ~ ~ Cmm~ _
OCT-2l-g§ Ig:14 FROM-CTE ENVIRONMENTAL
'~tK CT&E Environmental Services
5BiSgOI
T-IgZ P.O~'/03 F-gOJ
CT&£ Ref.#
Client Nmne
Project Name///
Client Sample ID
MalrLx
Ordered By
PWSID
995700001
S & $ Engineering
Lm 9 ~lk 2 Abbo[[ Lp
Lo[ 9 Blk 2 Abbott Lp
Drinking Water
Sample Remazks:
Client PO~
Prinled Dare/Time 10/21199 15:03
Cnilec~ed Dalefrime 10115199
Received Date/Time 10/15/99 17:10
Technical Direc~orj Stephen C. Ede
Released~ ~
Limi=s Date Da~e lniz
Total CoLiform
Ni~ra~e-N
0
0.500 u
co[/lOOmL SHI8 9222B
0.500 mg/L EPA 300.0
1D/151~9 KAP
10/19/99 10/15/9<) SCL
D: LIFT STATION
Date installed
Manhole/Access (WN)
High water alarm level at*
f~~S zen gallons
Cycles tested ~
E. SEPARATION DISTANCES
"Pump off" level at*
Absorption field .on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ,4,/~'~ i ~//
I00
On adjacent lots /~//,/~
On adjacent lots /~'//~
Public sewer manhole/cleanout
Lift station /'~'/,'~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation~-"~'/.,,u~'/~_.~/~//~L/'~"Property line ~*[ft~ field
Water main/service line Surface water/drainage J Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION F~N LOT TO:
Property line __~oundation __ Water main/service line
Surface water ~' Driveway, pa[king/vehicle storage area
Curtain drain J Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
I certify that I have determined t
in conformance with MOA HAA guidelines in effect on this date.
Signature $ & $ ENGINEERING
· 17034 Eagle River Loop Road N0.2_O4
Engineer's Name Eagle River, Alaska 99577
Date //~//i~.~/ ~ .~
/00 /
HAA Fee $ ~. c~
Date of Payment I (~/~-/9 9
Receipt Number .~B ~-~ ~" ~'~"'--~ ~
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
R£C£1
· chora e OCT
Mumctpahty' ' of An g ..~· ~P~P ]~.~0o~ /~!~'~\
DEP^RT~ENT OF HE^,TH & HUM^N SER~'~.,¥ o~..
Environmental Services Division '~"~Nr4L s~,'v(:~o~,~(~'~--'}
· Vlc&,e bi
82,5 L Street, Room 502 · Anchorage, Alaska 99501 (g07) 848-4-744- v/s/ON
Health Authority Approval Checklist
Legal Description:
A. WELL DATA
Parcel I.D.:
Well type /,~/~"/?-~-'~'=-
Log present (Y~
Total depth ~ :~'~'
Sanitary sea~}N)
01,¢
~,,~,¢¢0 'WCasing height (above ground).
Wires properly protected (Y/N) ;/~-
If A, B, or C, attach ADEC letter, ADEC water system number
Date completed
Cased to
FROM WELL LOG
Date of test ~ J
Static water level ~
Well production / ~
WATER SAMPLE RESULTS:
Coliform ~
Date of sample: /'0//~/~(~
S. SEPTIC/HOLDING TANK DATA
Date installed ~"L¢.~/-.-/E'~ Tank size
Foundation eleanout (?/lq)
AT INSPECTION
g.p.m. .~'/ g.p.m.
~ ~X",/'p ~'~ Other bacteria
Collected by: ~ L"~'''-'-~/~-'--
Nitrate
Number of Com __ Cleanouts (Y/N)__
Depression __ High water alarm (Y/N)
Date of Pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating
System type
Length Width
;kness below pipe
Total depth
Effective absorption area
g Tube present (Y/N).__ Depression over field (Y/N) __
Date of adequacy test
Results (Pass/Fail) For
bedrooms
Fluid depth in absorption riel
(in.);
Immediately after__ gal. water added (in.):
Fluid depth
Minutes later:.
Absorption rate = g,p,d.
Peroxide treatment
months) (Y/N)
If yes, give date
72-026 (Rev. 3/96)*
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 furtherverify 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 wastewa~er, disposal syste~ is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspect, ion.
NameofFirm ' S&SENGINEERING ~ _~.' Phone
17034 Eag e Riv~er~.oo~ Road No...~04- , . ; ; : , ~ ..
bedrooms, with the folloWing ,,itipulations:
6. DHHS SIGNATURE .
~ ~ Approve~J'for
Disapproved.
· - · ,:. Conditional approval- for
.........--~.,--~ "*" ' ""' Date
By:
/////'q/ . . :.. _. .. -_,.
The Municipality of Anchorage Department of'F~ealth and Human Services {DHHS) issues Health Authority
Approval Certificates based only upon the representations given in 'p~l;agraph 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 ceAain federal and'state requirements. Employees of DHHS do not
conduct inspections or aaalyze data before a certificate is issued. The MunicipalifyrOf Anchorage: is not
responsible for errors or omissiohs in the professional engineer's work.
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Envircnmental Services
On-Site Services Section
P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
CERTIFICATE Or HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Com plete'/eoat description
LOcatIon (site address or directions)
Prope~y Owner' ~~-- ~~
Mailing address
Lendi~'g a"~ency,
Day phone
Day p'hone
Mailing address
Address '
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
· Community well
Public water
Day phone
NOTE:
tng to the legality and status of bystem. : ':
TYPE OF WASTEWATER DISPOSAL:'
Individual on-site
Holding tank
Community on-site
Public sewer
If community well system, provide written confirmation from State ADEC attest-
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.