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Home My WebLink AboutT12N R3W SEC 25 SW4 SE4 NW4 NW4 .~ 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 PHONE z[~ NEW MAILING DDRESS DESCRIPTION LO TION . ~ f-~ ' / ' /N6. OF BESeems Well ~, Absorption a~¢a Dwe~/~X PERMIT NO. MateEa No. of compartments L~q. dapa ty in gallons Inside length Width Liquid depth , ~ Well --I / Dwellin9 PERMIT NO, ~ ~ Z DISTANCE TO:~t/ O Z ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot Ii PERMIT. NO. No. of lines Length of each Ii e Total length f lines Trench ~. Cf ¢,.~ Material beneath tile Total~¢fectiveabsorpti~n,rea Length Width Depth PERMIT NO. ~ Type of crib Crib diameterz~/~ Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS ~ SOIL TEST RATING INSTALLER REMARKS 72-01~ lev. 3/78) LfZ(3FIL. M"F [Ei",ITEP. PF?.t:E;EE; :.1_24~:g E. IR"dI:I IRD OFF UPI::'EI~: HLIFFt,'iFir,! SI.,.L'i../4. 5:1.4. N1.,.1:1./4. NI4!,..-'4. :!525 LOT' SiZE d.E:E:.K~IEI SQUFIF'.E FEZET T"~"PE CIF :'];OIL I::IEI'.~;CIF?.EF'['!ON S"i.'S'TEH iE;: 'T'f;:EI"JC:I-I HFI'?:;IMLIM i'.,II..IME:EI:~:: OF E,'EDROOHS = I'HE F?.EQU:I:RE[:, L:!;IZE: OF THE: SOIl_ FIE:,SORPr!O!'-.I S'~.':Ei"['EI',I THE L.ENG'!"H [1:, I t'"IEt",I'_:':; I Oiq I S THE LEIqGTH ( I i",! FlEE:T) OF TI'E: T'I:;:.'EI',!C:I'! O[;~: DP. FI I r.,IFI EiL.[). I-HE DEPTH Cfi:': I::t TP.E:IqCH OF?. 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B"/ TH I El: [:'EF'E:ffE:TMENT' 14ILL E~E SL.Ib.~rECT TO F'F::OSECUTIOFL ffi ! f-,I ]1 MUM L':, I STFIF,ICE BE'I"I,.IEiEN F:I 14ELL FIf"~E:, f:l!",l"r' ON'-"S Z TE SE:!.,II:::I(3E: [) Z SI::'OSRI._. S"r'E;TI!~J"I J: S :l.elE~ Fli£ET FOF?. FI [':'F:I',,,'FI"['E I,.IEE!...L.~ Cfi;?. :l..'SIZt ]"O ;~?~)el FEL::T F'F~:OM FI F'LIBL. IC P.IELI... E:,EPE]",tD![",!C'i UPON THE T"r'F'E O1::: F:'I_JE',I_.ZC: P.IELL.. !4ELL. L. OG5 FIF:E REZQLIIf~:EI::, FII",ID MLIST BI::!: F;~:r£'I-L.IRNED 'FO THE C, fZPFtF~'.TMENT' 14ITH!I'q ]:EI DF:fT'S OF THE 14[~L.t_ COHF:'LIET!OI',I. OTHFZI:::: I'~:EQU Z I:;:E[',IE:i'.,ITE; MFI'-r' FiPI::'L~'~.'. SF'EC I F I CFff' I ()NS FIND CONSTI::dJC:T Fi',,,'Fi:!iLI::tE~L.E TO Ii',!SIJP. E PROF'Ef;J: ZI'.,IS'I'F-ILL.F:I'I"~C$,I. I CEI:,?.T ]: I::":-' THFIT i: I FiM I::'FIHILIF!I;:: 14ITI--I TH[:': RE:QLIIREf,'IENTS FOF.?. OI'..!-.'_:~::('TE: SE.[,.IE[q:S FIN[) t-4ELLS FIS SErf FOFi:]-H B'.r' THE: M.L.INIC:ZF'IaL.ZT'~.' OF F:tI'.~CI-IORFIGE. 2: I I,.III.~L ZN::?FFIM_ THE 'S"r'STEM IN CCOF;:DFINCE 14ITH THE COB, ES. ::{:: I IJI'qDEF?.EYFF~ND T'HF:IT THE' L~;'s'STEM I"iFI? I'q:[:~L::!LI I Fi:E: Ei'.,II.FIP. EiFEHE!",!]' I F THE: FJ:E'_'~;:[DE:t'qC:[F: IS; I'?.[i:]"IODEEL. E:[:, THFi?,I El S i GN E ISSUED E:"?_. V2i:. 2 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222~ SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 16 17 18 19 2O SLOPE ~.~.~ ~,~ WAS GROUNDWATER [] PERCOLATION TEST DATE PERFORMED:~ SITE PLAN ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE minutes/inch) TEST RUN BETWEEN FT AND ~ FT - 72-006 (7/76) ~ 21, 19'78 Mr. Gary Randall li35 W. 8th Ave. Suite No. 5 Anchorage, Alaska 99501 Subject: Soils investigation for sanitary sewer systems for proposed subdivision of the SW 1/4, of the SE 1/4, of the Nw 1/4, of the NW 1/4, of Sec 25, T12N, R3W, SM, Anchorage, Alaska, into two adjacent lots. At your request of July 12, 1978, I conducted soils investigations at the proposed locations of two sanitary sewer systems on the subject property. This investigation, which was accomplished on July 18, 1978, consisted of the inspec- tion of soils removed during drilling of two, 6" diameter test holes, using solid flight augers powered by a track mounted Mobile B-50 drill rig. After completion of drilling the test holes were filled with water and percolation tests performed. The results of the percolati9n tests are tabulated on an accompanying sheet. The topography of the area where the soils test were conducted has an irregular ground surface with general westerly downslope of a 5-10% grade. In addition test hole No. 2 had a southerly downslope of approximately 5%. The vegetation consists of scattered spruce and birch to 40' tall, with dense groups of alders and willows, and a ground cover of tall grasses with some mossy areas. The soils encountered are graphically shown on the accompanying test hole boring logs. ~hese soils consisted of 1 foot layer of organics and organic silt overlying essentially Silt with some sand and gravel to a silty gravel with some sand to a total depth of 20 feet in both test holes. No water tables were encountered in either test hole. An accompanying sketch shows the subject property with the approximate locations of the test holes in relation to the property lines. The sketch also shows the proposed subdivision of the property into two adjacent lots. The test holes were so located as to provide soils information for the acceptability of a sanitary sewer system on each proposed lot. I appreciate the opportunity to be of service to you. Please contact me if you have any questions regarding this soils investigation. Very truly yours, Michael B. B/gmann Consulting ~eologist Box 191, Star Route A Anchorage, Alaska 99502 (907)344-9150 Attachments: Drawings of test hole boring logs, test hole location sketch, and tabulation of percolation test results. xc: Department of Health and Environmental Protection July 21, 1978 Subject: Percolation tests on the SW 1/4, uf thel SE 1/4, of the NW 1/4, of the NW 1/4, of Sec 25, T12N, R3W, SM, Anchoraqe, Alaska. The percolation tests were performed on July 18, 197~, by filling the 6 inch diameter, 20 foot deep test holes with water, and measuring the drop in water level periodically for one hour. TABULATION OF PERCOLATION TEST RESULTS TEST HOLE NO. I TIME LEVEL ET(min) DROP RATE(rain per inch) 1506 4.0" start start start 1516 8.5" 10.0 4.5" 2.2 1526 11.0" 10.0 2.5" 4.0 1536 12.5" 10.0 1.5" 6.7 1546 14.0" 10.0 1.5" 6.7 1556 14.75" 10.0 0.75" 13.3 1606 15.5" 10.0 0.75" 13.3 Average percolation rate for entire hour = 5.2 min per inch Average percolation rate for last one half hour = 10.0 min per inch TEST HOLE NO. 2 TIME LEVEL ET (min) DROP RATE(min per inch) 1353 9.25" start start start 1403 28.0" 10.0 18.75" 0.5 1413 39.25" 10.0 9.25" 1.1 1423 48.0" 10.0 8.75" 1.1 1433 56.0" 10.0 8.0" 1.3 1443 64.0" 10.0 8.0" 1.3 1453 68.0" 10.0 4.0" 2~5 Average percolation rate for entire hour = 1.0 min per inch Average percolation rate for last one half hour = 1.5 min per inch NOTE: The percolation rates for Test Hole No. 2 are very good, but are not indicated by the soil type encountered during drilling. These rates may be accounted for by a thin layer of extremely permeable gravel, therefore I reco~m~end that I be present when the ditch is opened so that I may ascertain whether this hypothesis is true. There will be no fee for this service. Michael B. Bergmann Consulting Geologist Box ].91, Star Route A Anchorage, Alaska 99502 (907)344-9150 T.H. NO. 7-18-78 Organic Silt: w/trc sand & __ ~avel, sl moist, loose, --~reddish brn. %-- -- -- 1.0' T.H. No. 2 7-18-78 0.0I Organic Silt: w/some sand & __ _~ gravel, sl moist, loose, ~reddish brn. Silt: w~Jo~e-~and & gr~vel,1'0' occ cobbles, sl moist, med dense, gry bm. ~ ..... 4.0' Jilt: w/some sand & gravel, sl moist, med dense, gry- bm. (GM'ML) Note: Increase in moisture from sl moist to moist at 10.0'. Becomes siltier with depth. Gravel: w/some sand, occ cobble, sl moist, med dense, grybrn, increase in moisture to moist at 10.0' (GM) NO WATER TABLE ENCO6%~TEP~]D 20.0'TD NO WATER TABLE ENCOI~TERED Test hole boring logs represent soils encountered on the SW 1/4, of the SE 1/4, of the NW 1/4, of tile NW 1/4 of Sec 25, T12N, R3W, SM, Anchorage, Alaska. Bud Jackson Property. 20.0'TD Michael B. Bergmann Consulting Geologist Box 191, Star Route A Anchorage, Alaska 99502 (907)344-9150 Due N 165.0' Due N 165.0' N 1/2, of the SW 1/4, of the SE 1/4, of the NW 1/4, of the NW 1/4, of Sec 25, T12N, R3W, SM, Anchorage, Alaksa, Bud Jackson property. T.H. No. 1 S 1/2, of the SW 1/4, of the SE 1/4, of the NW 1/4, of the NW 1/4, of Sec 25, T12N, R3W, SM, Anchorage, Alaska, Bud Jackson property. I I I T.H. No. 2 Due N 165.0' Due N 165.0' NOT TO SCALE Distances are approximate and have not been measured by surveying methods as to locations of test holes. The solid perimeter lines represent the property lines of the SW 1/4, of the SE 1/4, of the NW 1/4, of the NW 1/4, of Sec 25, T12N, R3W, SM, which is proposed to be subdivided along the dashed line into two adjacent lots. Michael B. Bergmann Consulting Geologist Box 191, Star Route A Anchorage, Alaska 99502 (907)344-9150 WATER WELL LOG ' WELL OWNER LOCATION ~ . ~,~,. ~,~.. I~. · SIZE OF CA~ING ~,'~' DEPTH OF HOLE/~. STATIC WATER L~EL ~ ~ POSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 , )~,~,~ use o~ WELL FEET OF DRAWDOWN. REMARKS DATE COMPLETED PUMP TO BE SET AT____~_~u~_~~ ~O~o°-&~ / . .~ 0~. ...~g 0___. to~ ...~g O~ ...~o t;O~ to 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# ~ [~01 ~ ~rhln-~ 1, GENERAL INFORMATION Complete legal description SW¼; SE¼; NW¼ NW¼; Section 25; T12N; R3W; S.M. Location (site address or directions) 177~1 Rya Pnn2,. Anohnrmg~ Al~m Property owner William Mayer Day phone 562-2079 Mailing address 3300 Providence Drive, Suite 205, Anchorage, Alaska 99508 Lending agency City Mortgage Mailing address Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. .5 N NOTE: 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. 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. 72-095 (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 Engineer's signature DHHS SIGNATURE ~._ Approved for ~ .S ENCqN~,,I~RII',IG 17034 Eagle River Loop Road ~0.. E,,gte-Rive,, ....... .~.., Phone Date bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Date 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 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-O25 (Rev. 1/91) Back MOA #25 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~Wt]~l~Et/H /i~UO'/H [~JQJYH Parcel I.D. DIT-?'Z/-ZO A. WELL DATA Well type ~uPc-f.E. If A, B, or C, attach ADEC letter. ADEC water system number Log present(~N) YE~ Date completed ~/~cl / ~c/ ~'~ Driller ~OS~ Total depth I~-~t Cased to '~o' r~ Casing height Sanitary seal ~YN) 't//~-~.~ ./~ Wires properly protected {~N) FROM WELL LOG AT INSPECTION Date of test ~ -~ct--'~-cl ~-l"~-Cio Static water level L~O' Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I(]0 ~ + Absorption field on lot ~(~(~' ~ Public sewer main Sewer service line c~ ¢ 1- ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ~'~//~ Petroleum tank IOo % °z WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: L'/'Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed C eanouts High water alarm (Y/~.~ Date of pumping Tanksize ]~00 ~ ~"~Compartments Foundation cleanout (~N) ~/~' ~ Depression (Y/~) /~Jo ~--~0 Alarm tested (Y/N) l/;;;Z-~-/c/~-~'- Pumper A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I0O' To property line [O Surface water/drainage On adjacent lots JOO' + Foundation. ~/~ Absorption field ~;' Water main/service line /0 ~ I00 'r 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION / Date installed _~//~' Manufacturer Size in gallons ~ Manhole/Access (Y/N) Vent (Y/N) "P~"tev. gl at "Pump off" level at Y High water alarm level '"'"'"'"'""~ _~ _/Cyc~ Meets MOA electrical codes (Y/N) ~~ D. ABSORPTION FIELD DATA Date installed c~ -I Length ~-'~rC~ ~'~ Width '2'~ Total absorption area Depression over field (Y/~) Results ~s/fail) P,/~S~ Peroxide treatment (past 12 months) (Y/¢_~_ Soil rating /~.~ s¢//~. System type '~'/2~_~OC¢- Gravel thickness (~ ~/~ - Total depth / ~ r Cleanouts present (~N) ~:~ Date of adequacy test ~- / ~-~' O ~' for ~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 100 ~ ~ To building foundation On adjacent lots Surface water Curtain drain ~or~_ On adjacent lots /OO ~ Propertyline ¢O'-O ' To existing or abandoned system on lot Cutbank ~o~F~ Water main/service line /0 re_ Driveway, parking/vehicle storage area ~0 ~¢- 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. Signature Engineer's Name Date S & S ENGINEERING T703,i F. agie ~¢iver Loc ~ Road J~Jo. ~ ~'{agle River Alaska 9~57X HAA Fee $ /7 Date of Payment Receipt Number 72-026 (Rev. 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number iHAFER o, No, CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE I 50644 Chemlab Ref.{ 92.0320 Sample t 3 Matrix: WATER Client ~ample ID PWSID Collected Received Preserved with RW1/4,$EI/4,NWI/4,N/WI/4,SEC25,T12N,' UA YAN 26 92 @ 15:00 h~s. JAN 27 92 ~ 14:40 hrs. AS RgQUIRED Client Name :S & S ENGINEERING Client Acct :RNSENGP BPO{ : Req{ : Ordered By :RAY PO{ :NONE RECEIVED Analysis Completed : JAN 29 92 Send Reports to: Laboratory Superv~sog : ~EPNEN C. ENE 1)S & S ENGINEERING Parameter Results Units Method Allowable Limits NITRATE-N 2.6 m~/1 EPA 353.2 lO Sample ROUTINE SAMPLE COLLECTED BY: 3.W. ' RSW, RM. Remarks: I Tests Performed ' See Special Instructions Above UA-Unavailable ND' None Detecte4 '' See Sample Re~arks Above NA- Not Analyzed LT-Less Than, CT-Greater Than ~SGS Member of the SGS Group <Soci6t~ Gdndrale de Surveillance) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # C~RTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~[,'~ - 4t,~ - ~("~ HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) _qW ~; _q~ ~; NW ~; NW ~; _qFC.. ?5; TI~N: R.gW: Location (address or directions) 1270i Rya Road (b) Property owner Mailing Address State of Alaska Telephone:(home) Business (c) Lending Institution Cit~ Mortqa~e Mailing Address ATTN: Warren Gossett Telephone 563-0~00 405 WeSt 36th Avenue, Anchorage, Ak 99503 (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 Eagle River, Alaska ~'577 2. TYPE OF RESIDENCE Single-Family ~x Number of bedrooms 5 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 DISPOSAL On-siteX~ 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 le^o~ddv leUOp, lpuoo to sw~eJ_ leUO]Mpuoo--- peAoJddes!Q /? peAo]ddv 'lYAOt:ldd¥ SHHd '9 euoqdele.L ejNi~=i~Ni~N~ S '~ S sse~ppv wJ!j lo eWeN A. WELL DATA Well Classification Well Log Present ~N) ',,-/ Date Completed Total Dept'h|'~--~ ~ · Cased tp '~ Depth of G. routing Static Water Level '~* (.lr4'~ 1~,) PumpSetAt Casing Height Above Ground ~'~ ~ Electrical Wiring in Conduit ~.¢/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~ ~6:;:' MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 MUNICIPAUTY OF ANCHORAGE 343-4744 ENVIRONMENTAL SERVICES DIVISION Legal Desqription: ~'~ /~c MAY 2 1990 ', Yield Sanitary Seal on Casingd~N) Depression Around Wellhead ; On Adjoining Lots ; On Adjoining Lots To Nearest Edge of Absorption Field on/Lot To Nearest Public Sewer Line /-,I/¢& To Nearest Public Sewer To Nearest Sewer Service Line on Lot. ~--~" IH-' Water Sample Collected by ~5 ~:::~"//",/~/¢--4/-,,5d¢ ;Date Water Sample Test Results ~"~'~ ~ ~ ~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~'.--/~'~ Size / ~"'-E::)O No. of Compartments Standpipes (~/N) '~' Air-tight Caps~[~'N) Depression over Tank (Y/~ Pumping/Maintenance Contact on File Holding Tank High-Water Alarm (Y/N) y Foundation Cleanout~/N) t// ,/~te Last Pumped ~-~ 2~/~¢/~ /,4 ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well / ~:2¢2 ! J~ To Building Foundation To Property Line ! ~ To Disposal Field To Water Main/Service Line /(.2 I To Stream, Pond, Lake or Major Drainage Course Comments f~ /¢/...~L)~' ,~/.-d_~'. 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ ~'~O '"~/~ Type of System Design Date Installed d'-- ! ""~ Length of Field Width of Field Square Feet of Absortion Area Depression over Field (¥/~ Depth of Field [ / ~/¢-~ ,~ravel Bed Thickness "~ Statndpipes Present Date of Last Adequacy Test Y Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Founda~.~7,4 Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Veh..j~le Storage Area Comments To Property Line ,/ (~ /-1~'-' To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) /-4//~. D. LIFT STATION Date I~ Size in Gallon%*'---~ "Pump On" Level~ High Water Alarm Level at ~ Tested for Meets MOA Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ Pumping Cycles during Adequacy Test. Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA g~ inspection. Signed B & f; B.c'!G!N~ERING Company 17034 F.~IIa River Loop~.,,~Roag No,. 2~ Date ~/~ .~ ~ ~ 3~ / MOA No. of this Seal Receipt No. Date of Payment Amount: $ 72 026 (Rev. 7~88) Back Receipt No Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET -ANCHORAGE, ALASKA 99518 ° TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE ~or Work Order ~ 21784 Date Report Printed: MAY 18 90 ~ 17:08 Client Sample ID:NWL/4 SEI/4 NWl/4 SEC 25 T12N RSW SM PWSID :UA Collected MAY 17 90 ~ 15:10 h~s. Received MAY 17 90 @ 16:20 ks. Preserved .ith :AS REQUIRED Client Name : S & S ENGR Client Met : SNSENGP P.O.# NONE RECEIVED Req t Ordered By : R. SMAYER Analysis Completed :MAT lS 90 Send Reports to: Laboratory Supez/~sor :STEP~N C. NDE lis & S ENGR Released Sy~ Special FAX RESULTS UPON COMPLETION. Instruct: Chemlab Ref ~: 901414 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 1.1 mg/1 EPA 353.2 lO Sample ROUTINg SAMPLE. SAMPLE COLLECTED BY RDJ. Remarks: Tests Performed See Special Instructions Above UA=Unavailable None Detected *' See Sample Remarks Above Net Analyzed LT=Less Than, GT=Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage. Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 DEPT. OF ,~, & I E]qVIRONMENT~L pF:O ~ECTION I SEP 1 5 1979 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplgte requests will not be processed, Please allow ten (10} davs for processing. MAILIN'~ /~[~D'F~E~S ' PROPER~'Y"RESIbEN~If different from ~ve) MAILING ADD'SS ~ PHONE PHONE PHONE 4, REALTOR/AGENT PHONE MAILING ADDRESS B"-REET LDOA N r2 B. TYPE OF RESIDENCE' { NUMBER OF BEDROOMS [] One [] ...Four [] Other [~/"SINGLE FAMILY [] Two [;~ Five [] MULTIPLE FAMILY [] Three [] Six WATERSU Y 7. ~DIVIDUAL* L~ COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for ell wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) **If individual/on-site, give installation date If system is over two (2} years old an adequacy test is required [~] PUBLIC UTILITY by this Departm.ent. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) ' THIS SIDE FOR OFFICIAL USE ONL', : DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NS PECTO R INSPECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIViDUAL/ON -SITE DATE INSTALLED Connection Verified iNSTALLER [~Septic Tank or~ [] Holding Tank ~"~~ Size: ~__cO . If Tank is homemade SOILS RATING give dimensions: I ~ ,' TYPE OF TANK MANUFACTURER ~,~ . ~._~. TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS [~APPROVED FOR .'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED . ~~ DATE BY (Titlel LEGAL DESCRIPTION 72-010 (Rev. 3/78)