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Home My WebLink AboutAMYS TR A ~ MUNICIPALiTy OF ANCHORAGE ~e~ .~1 l~i~~~ DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION ~--~ \ - \[c~ ~-~-~(-~ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT IPHONE I ~NEW MAI LING ADDRE88 LOCATION NO, OF BEDROOMS Well Absorption area Dwelling PERMIT NO. DISTANCE TO'. ?/ ' ' ~Z Manufacturer ~,~ ~~/~ Material Nc. of compartments kiq. capacitg in flallons Inside lenflth ~idth Liquid depth /~'~ IF HOMEMADE: ~ O ~ DISTANCE TO: Well Dwelling ~ PERMIT NO. O Z ~ Manufacturer Meterial Liquid capacity in gallons ~ Well ~ Foundation / Nearest ~o~i~e PERMIT ~ ~ ~ ~ ~, of lines ~ngth of each line Total length of lines Trench width Distance between lines -- ' /~ ~ ~ inches ~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO, ~ Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS ~,, ~.~ ~t ~ SOIL TEST RATING /~ ~. INSTALLER ~ i REMARKS x/ / / ~--~ ..~ ~__~ ee ~. (~ ~ APPROVED~. / / ~ 'q~t1~$6~"~ LEGAL (Rev. 3/78) L:'lii:t'::'.~af~:TH[!':N~l' H :[ LL. I-?F: ~;t. E',.TF'C T TO F::'F~:OF;Ei (':1.. T ]': H :!: H :!: HUh! .1::~ :t: '.:ii;TF:INCE: F. rE:'I"HF!::F:!'.,t F:t Hr.:.'L.!.. FINE:, F:[H"r' :]..[Fji~;i!t FIEE::T F'OF.'. !:I tx'l';~::['v'F!-Ft.:~: H[~:L.I...; :] . '.:-!i !}:t 'iCI 206 FFE!.:ii:t' I::'F:Or'I Fl F:'UBI~.](:: !.,:I[C[.! i)EF'F:Ni":,TN(:~ Hf:::L.i i...OG:~; F:!F::..F.: I~:[i:C[U:I~t:;?.E-:[':, F:I.I",IE:, _HI..!?[' E:F!: ,[;?.F::'T'UF~.:f.,!..F.':I:, 'TO THE: [::iF-' 'rF.ll:.:.: HE:L.L C:OH!-::'[ E:t']' 01'.,I. C!"i !...Ii.:.:::F?. [~::IE[i]U :1: I:~:E:I',IE:N"F:!!:; hlF:!"r' FII:::'t:::'L.% :i:}; F::' [!:: C: ][ F' FI'v't:::! :( L.l::tFifi..3:.!!: TL) :[ I",IL:.'i...IF~:F: F:'IRI3F'F:'D: :[ [",!:~;"1 t:::11..t .F:I"[' ]: ON. ::t.' 'i' l:::lt'l F'F!I"ITt.r:i:f:ff~:: HI:TH THE: F.:F'F:q ZI:;~i::'t"!t:-:.-t",I'T":: F'L'~F.-: F~ * ""'"'"i'D: .............. .......... P, '".:::' .,- ':!:t}:HI::F.'c FINE:' t,-!E:I..L.:!i!: I:::!'::! '::: ~::: .... l:::'l"'.F'TH. , F.J:"r' 'H"'!I:: HUN 't: r" ........ ]: F'I::iI. ].' '1" t r',:: FII'.,tF:H ~'~F'R ::.iF!:. 2 T H T I. I :[ I' .....H ......TI-.IF: ':;-,'.r'? I E I'I ............ ' ...... ::'.' :]:f'.,1 FCr:C~:[:,FI'.,IC:I::- H'["f'H 'T'!...tE ::i!: ' :[ I...li ,t[. [:.I .:::, ] P- t'.,!1 .... THI:::IT 'FH[!: r' i'-,~-..:~i :t: -I' E: S:i;E;!.,.IEF: ::~ "r'S-[ EU l'"lF:l"r' F:~i:(::!L.I .[ !:;::[::: L'::I",!L. FIt:;~:G[EiHF::N T :!. !::: 'i HIE t:'U: :'::, i F:,i:" i"t" l'i: :~ :E; I:~:~I:.:::hiOt?,I:F. iL. ii:~L:, "ICI '1' NC:!...U!:'i::! I"t~"fl:,i:E: i HI::IN ,q- F:'F:I",F" I'1 ,t":.. ............................ r ...... op ,' Herbert Werre Acme Drilling ~U~c~p~.._ Star Route, Box 5~5. Hil~ry ~ichleg ,...J~.,~2 78 98' 99' WELL LOG ~'' top soil 8' gravel 98' soft grey clay - 99' sand, water and gravel - 134' hard sand and clay -3/4" gravel.pack to llS' ~ ll2 ft casing p~rforated at 100 ft to lO1 ft ~ Static water level 51" Well produces l0 to 12 gal e~minute~ Pi,tless adapter installed at 10' 6" from top of casing .Pump set at 100 ft from top pf casing January 5, 1978 Hilary Michlig Star Route Box 592 Chugiak, Alaska 99567 Subject= Lot 93 Section 7 T15N RiW Permit %77851 A permit issued by this department for well and/or sewer system has expired. Permits are issue~ on a calendar year basisv as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further qUestions, please contact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer and Water Section t Ht:::. I_...l:i:.l",l(] f H I..:, .I. t'"It:EiI'.tl;:, .[ LiN iii :::, I I."IEi I_I:i{NG'I'H ,( ;11N l;::'lz, lii~ I ) UI-- I I-'l[iil I I';~'.EI",IC:t"I OF;i: l)l:,i'J~::l i[ t'.,t1:-' ~ EL.I). I1'--1i:::. I..;,I::iI--'tH UI-u I::I i I-?.EiN(ii;i.-.I Ot-i1 F.'].I ~('._-.; 'ti--II.:.il i]Z:,]]'.r;ilHidli~.:t.;] Ei',E.'tNEti£1q 'I"HE '.~i;UIq~FF:tlj~:tE OF:' 'i"t-"tt~i L:il.;:~i.lu...ilND F'II'.,tD 'tk'll:E Eu~_II'I"IZH'"I OF:' I'1-'I1~.i E)-:iL':I:UI'v'I:::II Ji(.)l",l ,;ii[l'.,t i'~1::[:iI ). I HI:::.I,:'.I::i .t. % N t) L.-.iI:~i I' 14.1. D I I'-I F L) 1'4'. 'l'l:,i: E] N C;H E.'X,. I i.-.ll:r, l.:il-~'.H'v'l::il._ I.)t::LI:;'IH ~E; THE] I"'I]iI'-,I]~I'"IUI"I E;,I~:]F:'I'H O1:::' Glq'.tU:l'v'lL-i.I..~ E',IEI"t.,.It:EEit"4 'THE:_' I--ilk!t) i Idli:] I;~:OI 'J iJl'"l ()l": I l"ll:iil I::] ::.:: (]i: l-::l 'v' l::-l 'l i11Dt",t ,:i i[ I",1 l:::l.:i;li!il I ). 0 r-J- E CO. GE(. ,'ECHNICAL fl' DEVELOPMENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG r~8-2280 Soils ~ Foundations Land Development Performed for: Name: /-///z_~-' /V/}~s////~. Tel. No. Mailing Address: Legal Description: ./.~7 ~l ~£c': 7/ ';/?~".~t,"/ )dV'~'/ ~',jz/. Depth (feet) $ol] Characterlstlc~ o :z 6 7 8 9, lO 11 ,. 12'" 13, 14, 16 imm Ground Water Encountered: Yes ~/ No Proposed Installation: Seepage Pt~~ Comments: If yes, what depth ,, Orain Field Performed by: Date: of nchora e P.O. B~JX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES May 30, 1986 Robert A. Shafer, P.E. S & S Engineering SRB 196X Eagle River, Alaska 99577 Subject: Lot A Amy's Subdivision ~ Waiver Request, WR86-059 Dear Mr. Shafer: Your request for a waiver of the required 100 foot separation between the well and septic tank on the subject property has been approved. This distance has been waived to 91 feet. This waiver is valid for the existing four bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SiTE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERTA. SHAFER May 18, 1986 CIVIL ENGINEER 694-2959 MUNICIPALITY OF ANCHORA(~E DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 MAY I 9 1986 RECEIVED ATTENTION: Steve Morris REFERENCE: Lot A; Amy's Subdivision Request you approve the attached Health Authority Approval application and issue a waiver of the horizontal separation distance between the well and the septic tank located on this property. The horizontal separation distance established when the on-site septic system was installed and approved in 1978 was 91 feet. In order to verify that the septic tank was equipped with water tight seals the outlet end of the tank was excavated until the outlet pipe could be examined. It was determined that water tight seals do exist. The topography in this area gently slopes at approximately 5% away from the well and in accordance with the attached well log there is a soft gray clay layer that exists between 8 feet and 98 feet with the domestic water being produced through perforations in the casing at 100 to 101 feet. The static water level in the well casing raises to 51 feet which is still well within the surrounding clay strata. In accordance with our risk analysis calculations, it is our opinion that no bacterialogical pollution is possible and therefore the horizontal separation distances prescribed by 18AAC.72.021 are not required in this case. If we may be of further service, please contact us. SRB 196X EAGLE RIVER, ALASKA 99577 ROBERT A. SHAFER May 22, 1986 CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Steve Morris MUNICIPALITY OF ANCHO~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIOJ~ MAY P, 5 1986 RECEIVED REFERENCE: Lot A; Amy's Subdivision This letter provides additional information to our letter dated May 18, 1986 in accordance with our telephone conversation dated May 22, 1986. In accordance with information available it appears that a perched water table could exist at a depth of approximately 8 to 9 feet below the surface. This water table would be riding on a soft, gray clay material and is assumed to flow in the same direction as the slope of the ground surface. If the above assumptions are correct and the water table should become polluted from a failure in the integrity of the septic tank then the flow of the polluted water would be away from the well casing, therefore eliminating any possibility of contamination around the well casing. zf we may ~ of further service, please contact us. SRB 196X EAGLE RIVER, ALASKA 99577 GEO "ECHNICAL 8- DEVELOPMENT CO. Box 90, Davis St., Eagle Riv~.'.r, Alaska 99577 694-2774 or 688-22B0 Russell Oyster 694-2774 Soils 8 Foundations Earl Ellis 688-2280 Land Development SOIL LOG Performed for: MR, LESLIE /~ENT Mailing Address: In].et l/iow Drive Tel. No. 688-~750. Chugiak, Alaska 99567 · Legal Description: Lot 9:), Section ?, TiSN, RiW, Sewa?dMeridian ...... ~ojl. C_ha~a.~tert stlc~ 0 1 2 ML - Silt with some sands arJ gravels. Topsoil with roots and organics. '250 sq, f ;. per bedroom seepage value. 3 GP-.GM - Silty :,~andy Gravel ~ntth cobbles to 6 inches. Fairly loose material with some thin lenses of sarD. y silt. I50 sq. ft. per bedroo~! seepage va]r,.eo 6 7 GP-GM -- Silty Sandy Gravel ~lth cobbles to 6 inches. tho above material on].y more compact° 125 Sqo ft~ per bedroom seepage value. Water sta~ling at 9'. B~'of Pit 11 ~ .//,~/l .~' ~'~,,. · Ground Water Enc~.3~{~,o Yes x~ NO If yes, what dept~~ "~'~'~r~'' ,,... Propose~ Installation. ~e~~ Drain' Field pit ].o?~ed th~ same. No evidence of )tedrock in the area, Gromxlwater co~itions a.~noted. [ ~_~ Performed b ' Date: ., ___ Nearly the stone ldO. .......... GEO'i'ECHNICAL 8- DEVELOPMENT Box 90, Davis St., Eagle River, Alaska 9957? 694.2774 or 689-2280 Russell Oyster 694- 2774 Soils Et Foundations CO. Earl El~is 688-2280 Land Development /: / SOIL LOG Performed for: Name: MR. IESLIE~ ?el. No'. 688-2750 Mai 1 t ng Address: Inlet View Drive Chugia_~k:_ 'Legal Description: Lot 93, Section 7, T15N, RIW, Seward Meridian _De~~. Soil C h ara cie, r i___~sli r~S:t 0 1 2 3 GM - Silty SarC. v Gravel, Topsoil with roots ,,re. orgat~ics. 225 Sqo ft, per bedroom seepage value. ML - Silt with ..4omo s~.nds and gravels, 250 Sqo ft. per bedroom seepage 'value° 6 GP - Sandy Gravel, very compact material. 1'.50 sq. fi per bedroom seepage value. GV~- ~andy Gravel, very clean. 100 sq. ft. per bedroom seepage value. '8 11 12 Ground Water Encountered GP - Sandy Gravel ~¢ith a trace of si].t. Very compact Trace of' seepage at 9'-9.5' 150 sq. ft. per bedroom.seepage value. Bottom of Pit Yes No ~ If yes, what dept~~ Proposed Installation: Seepage Pit Drain Field Col~nents: Test pit measured approximately ~' x 10' in ~].an area. All sid~s~f~ pit logged the same, No evidence of bedrock in the area. Groundwater e'ondit, ions as. noted. Performed by: FROM. Herbert Werre A~~l~l~i~g Star Route~ Box_.393 Chugiak, Alaska-99567 July 3.79 ADDRE~c. .................. /~ .. V~LL LOG 4'' top_soil 8' gravel 98' soft grey clay - 99' sand, water - 134' hard sand · " gravel pack to ll5 't casing perforated ,t 100 .c water level 51' produc~s l0 to 12 per ~ss adapter installed ,at 10 of casing set at 100 ft from t( pf 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 Application Date 5-7-86 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lo_t (Al Amy's ( old lot 93, sec. 7, T75N: Location (address or directions) _ So. Birc~ood_~...' past (b) Applicant Name Hilary Michlig.__ (c) RIW, S.M. ) Adri~n Ln.... through the corner onto Knik View Dr.; last house on rt. Telephone: Home 688-3409 Business Applicant Address SR I Box 2383 Chugiak, Alaska 99567 Applicant is (check one): Lending Institution [] ' Owner/builder []; Buyer []; Other [] (explain); ,. (d) Lending Institution City Mortgage. Telephone Address (e) Real Estate Company and Agent Address Telephone (f) ~l~Tthe HAA to the following address: __S~SEL~NEERIN. G SRB 196X EAGLE RIVER, AK 99577 TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms 4 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. 4. SEWAGE DISPOSAL Onsite,{~ 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 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA'i 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 & S ENGINEERING Telephone 6~"~''-' ~-~-~ 7 ~' Address SRB 196X EAGLE RIVER, AK 99577 ~AY J El 1986 Date DHEP APPROVAL Approved for Approved bedrooms by Disapproved '~'~'~ Date Conditional Terms of Conditional 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 70..~o~ tl 1/R41 WELL DATA MUNICIPAb~¢ OIIV~TY OF ANCHORAGE (MO~) DEFr. OF I-I~[..~1.I AUTHORITY APPROVAL (HAA) ENVIRONMENTAL' PRO C'~H IEOC~LiST' FEBRUARY 1~84 MAY g 1986 264-4720 Legal Description: ~ RECEIVED Well Classification Well Log Present ~'N) Total Depth t'~P ¢¢ ! Static Water Level Casing Height Above Ground Electrical Wiring in Conduit(r2i~'N) Separation Distances from Well: To Septic/l--Je~tfrrCTank on Lot To Nearest Edge of Absorption To Nearest Public Sewer Line Cleanout/Man hole Cased to ''~ ~ ['7.,- I .~t' Water Sample Collected by Water Sample Test Results Comments ,~ ¥,JCCL.4., If A, B, C, D.E.C. Approved (Y/N) Date Completed ~"~- rT~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casin~)'N) Depression Around Wellhead ~ I ; On Adjoining Lots Lot I ¢'~) ~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~-~.~,.5~ i ~/~3.~ ~-h~ ;Date B. SEPTIC/~TANK DATA I c~ - [I,-~'7~ Size ~ ~c, No. of Compartments Foundation Cleanout ~N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) Date Installed Standpipesd~N) Air-tight Capsd~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic~ Tank: / Comments ~(~ -r",~.,~. To Water-Supply Well To Property Line To Water Main/Service Line Course ! To Building Foundation -~- To Disposal Field ~ ~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~o- / / Width of Field /,¢" Square Feet of Absorption Area Depression over Field (Y~D. Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ! t::~¢ 'r/ta~'f)~ Type of System Design Length of Field ~ / Depth of Field ~ Gravel Bed Thickness z./-~-D "~ Standpipes Present~) Date of Last Adequacy Test ! log Lot To Water Main/Service Line / z~ /..~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area comments ~~¢'~ ~ /~¢O ~ To Property Line /7. To Existing or Abandoned System on · On Adjoining Lots '~ ! To ~utbank (if present) Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) Pump Off" Level at /,~ Vent (Y/N) . ~ // Pumping Cycles during Adequacy Test. Meets MOA 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 the date of this inspection. · : GINEERING Signed Date SRB 196X Company EA_G[E~VER,_AK 9~57.~OA No. Receipt No. ~ Date of Payment ,-~-- t,c:::~- (~ Amount: $ (,_o%¢, ~ Page 2 of 2 72-026 (11/84) CHEMICAL & GEOLOGICAL 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 BY'WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# /'~ PRIVATE WATER SYSTEM Name Phone No. Mailing Address City SAMPLE DATE: State Zip Code Mo. Day. Year SAMPLE TYPE: ~]~Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose .) [] ~reated Water ,~=:Untreated Water SAMPLE NO. LOC.~TION ' Time Collected Collected ~ 31 4 I 51 TO BE COMPLETED BY LABORATORY Analy'sls shows this Water SAMPLE to be: .~?isfactory [] U~satisfactory [] S~[mple 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. Analytical Method: Membrane Filter No'iof colonies/100 mi. LabRef. No. Result* Analys~t' BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS ' BEFORE : COLLECTING SAMPLE ~ TNTC = Too Numberous To Count OB = Other Bacteria Membrane Filter:. Direct Count Collformll00ml Verification: LTB Final Membrane Filter Result,~ ~ BGB 'Dpte Time: . CoilformllOOml 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 Tract. A; Amy's Subdivis±on Location (site address or directions) 19621 Ganoe, Chug±ak, Alaska Property owner Tamla ~letch~_r Day phone 688-5143 HC 78 BOX 2383, Chugiak, Alaska Mailing address Lending agency Mailing addreSs Day phone Agent Beth Simpson/SIMPSON REAL ESTATE Address P.O. Box 112342, Anchorage, Alaska 99511 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 "~ TYPE OF WATER SUPPLY: NOTE: Day phone 345-6644 xxx Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XXX 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 'H~O~ S¢Ie8U!6U9 IBUO!SSe,toJd 9LI:~ U! SUO!$S!LUO JO SJOJ~e JOJ elq!suodseJ ~,ou s! e6eJoqouv jo ~l!l~d!o!unl/~ eq.L 'penss! s! eleo!,t!~eo ~ eJojeq m, ep eZil~Ue ~o suo!loedsu! lonpuoo ~ou op SHHO ,to see~oldtU=l 'm, UeLUe~!nbe~ elm, s pub i~JepeJ u!e~JeO/gs!l~s ol Jap Jo u! suo!in~!lsu! 6u!puel ~!eq~, pu~ se~uoq ~o s~es~qoJnd o3 ~sa~noo ~ se s!ql seop SHHO eq.L '~lSelV ~o e~IS eq~ u! pe~els!6e~ jeeu!6ue leUO!SSejo~d luepuedepu! ue ~q e^oq~ S qdeJ6e~ed u! UeA!§ Suop, e~,ueseJd9~ eq~, uodn ~lUO pes~q sm, eo!j!~eO IeAoJdd¥ /qpoqlnv qlleeH senss! (SHHO) seo!~aS UeLUnH pue qll~aH jo lueLu~deo e6e~oqouv jo ~!led!o!unlhl eq.L s),uewwoo IBuop,!PPV :suop, Blndp, s §U!MOIIO,t eq~, ql!M 'SLUOOJpeq JOJ IBAoJddB IBuop,!puoo 'peAoJddBs!Q · SLUOOJpeq ¢ euoq8 jo,t peAoJdd¥ 'X gI:In.LVNgI$ SHHa ejm, BuD!s s,Jeeu!Du=l sseJppv LUJ!_-I ,to euJBN · uop, oedsu! s!q), ,to e),Bp eq~, uo ~,oejje u! suop, BInDeJ pub 'seouBu!pJo 'sepoo m,m,S pub IBd!o!unl/N lib qT!M eouB!lduJoo u! s! Luels/~S IBSOdS!p JelBMelSBM Jo/puB Xlddns Jm, BM m,!S-UO eq), 'uop, oedsu! pub UOp, Bbp, SeAU! XLU LUOJJ pUB Sel!J eBBJoqou¥ JO/9,!lBd!o!unR LUOJJ peu!BTqo uop, euJJo,tu! eq~ uo pesBq ~,BqT ~,t!JeA Jeq~J n,t I 'u!eJeq pm, Bo!pu! eJnlonJ),s ,to ed/9, pub SLUOOJpeq ,tO JeqLunu eq~ Jo,t e~,BnbepB pue iBuop, ounj 'e,tBs s! LueTs~S IBsods!p Je),BMelSBM Jo/puB Xlddns JeTBM m,!S-UO eq~, leq~, SMOqS uop, Bo!lddB I~AoJddv ~,!Joq),nv q),leeH s!ql ,to UOp, BDp, SeAU! XuJ ~,Bq), X,tpeA I 'MOleq UMOqS eTBp UOp, Bp!IBA eq~, ,to SB pub m, eJeq pex!JJB lees XLU ~q pe!,t!~Jeo sV '9 I:FI::INION::I AG NOI.LO::IdSNI .-I0 /N:::IINg.LV.LS Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:"~'[' ,~ ,~q'~% Parcel I.D. A. WELL DATA Well type Log present ~N) Total depth Sanitary seal ~N) If A, B, or C, attach ADEC letter. ADEC water system number Y Date completed ~ .--z.p_-i ~ Driller Casedto ~'~' PP-~'-Io~' Casing height Wires properly protected (~/N) FROM WELL LOG AT INSPECTION Date of test ---j ..~z~ Static water level Well flow Pump level \ t2~' OV--- SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~" ~ I. I ;On adjacent lots Absorption field on lot / 0~'~ ; On adjacent lots Public sewer main ~ I,N Public sewer manhole/cleanout ,?..~:~ t ~ Petroleum tank ,,~Sewer servia line WATER SAMPLE RESULTS: Coliform ~4'~ ~'' '/' o~ '-~-0-- Nitrate t~,~'~,, Date of sample: \ ~ ~ L,, - c~ ~ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~c> ,- ~-~ ~ Cleanouts ~)/N ) ~ High water alarm (Y~) Date of pumping Other bacteria S & S ENGINEERING 17034 Eagle River Loop ROad No. 204 Eagle River, Alaska 99577 Tank size ~'7..-~' c> Compartments Foundation cleanout<(~/N) '~ Depression (Y~:~ Alarm tested (Y/N) I-~-~ '"~ ~" Pumper ~, ~__. m SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ,'~ To proPerty line Surface water/drainage 72-026 (Rev, 7/91 )Front On adjacent lots Absorption field lc~~'~ Foundation Water main/service line- CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA' electrical codes ~ SEP~ROM LIFT STATION TO: V~effon lot On adjacent tots Manufacturer Manhole/Access (Y/N) ~ "Pump on" level at ..__ ~el at J Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed \ID ~ \~, ~"! ~ Length ~C:>t Width Total absorption area Depression over field (Y~j~ Results ~i)fail) t¢~ Peroxide treatment (past 12 months) (Y,~) Soil rating ~ c~:>~ 115~- System type Gravel thickness [,~ - t ~'* Total depth Cleanouts present(~N) Date of adequacy test I o 7_\ ~ for (4) ~--~¢¢-- /'J~,JE- i'(¢J~¢~4 If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water \ Curtain drain E, ENGINEER'S CERTIFICATION On adjacent lots ~ ~2(::;,t '~ Property line To existing or abandoned system on lot Cutbank ~5 ).~, Water main/service line, Driveway, parking/vehicle storage area S gnatu re 17034 Eagle River Loop Road No 204 Engineer's Name Date (~ ~ ~ ¢-''' HAA Fee $ //.~ ~ Waiver Fee: $ Date of Payment / --'4'~x'"J-- Date of Payment Receipt Number ,=.~--,~ 0C"7 L-C~- ~Z'f-.~' ~'~ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 I certify that I have checked, verified, Or conformed to all MOA and HAA guidelines in effect on the date of this inspection. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS RESULTS for INVOICE t 5045? Chemlab Re£.t 92.0209 Sample ! 3 Matrix: WATER FAX: (907) 561-5301 Client Sample ID : TRACT A AMY'S S/D PWSID : UA Collected : JAN 16 92 ~ 11:00 hrs. Received : JAN 17 92 { 14:10 hrs. Preserved with : AS REQUIRED Client Name :S & S ENGII~ERING Client Acct :SNSENOP BPO$ : Req$ : Ordered Ey :R. S~L~ER POS :NONE RECEIVED Analysis Completed : JAN 20 92 Send Reports to: Laboratory Supervisor : STEPHEN C. EDE 1)S & S ENGINEERING Released B7 : /~ ~y~ 2) Parameter Results Units Method Allowable Limits NITRATE-N ND(O.IO) ~/1 EPA 353.2 Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: 1 Tests Per£ormed ' See Special Instructions Above UA-Unavailable ND- None Detected ** See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-Greater Than ~SGS Member of the SGS Group (Soci(~t~ G(~n,~rale de Surveillance) 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. # J t~ PRIVATE WATER SYSTEM Name S & $ ENGINEERING Phone No. C~ty SAMPLE DATE: SAMPLE TYPE: Stale Mo. Day Year I~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose Zip Code [] Treated Water [] Untreated Water SAMPLE No. LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory r-] 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 I / '-~' IC~'~ Time Received J q I~ Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* Analyst z.ozo I FTli I FY] I TNTC OB = A.D.E.C./-,-¢0"9~ ~(J'/ BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count (,~ Coliform/100 mi Verification: LSD BGB BEFORE Fecal Coliform Confirmation COLLECTING SAMPLE Final Membrane Filter Results /~ Coliform/100 mi '-" = Too Numerous To Count,., , PAET ONE OF TWO: ' ~ Other Bacteria , I : ' ' I [ ' REllAINDERTO FOLLOWl;:i :,!:::