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Home My WebLink AboutLot 20, 21LoT' 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~6CLM^N ~[ 160 t '~'.'C Telephone:Home Applicant Address '~L[O~ \,~/~,"rG~[AL-L.O~7~. qqSO% (c) Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family J~ Multi-Family[] Other Number of Bedrooms ~_ H w ,'-4 WATER SUPPLY [] Community,/'~ Public [] Individual Well Note: If community well system, must have written confirmation from the State Department of Environmental Corrservation attesting to the legality and status. SEWAGE DISPOSAL [] Public~' Community [] Holding Tank [] Onsite Note: If corn mumty well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legali!y and status. Page ~ of 2 72-025 (11i84) ENGINEERING FIRM PROVIDIi~%~/INSPECTIONS, TESTS, FILE SEARCH, D~'~JA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify t~at 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 ~umber 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. NameofFirm__Aot/~ ~ C~[~(~ Telephone ~-~ ; ~ ~ O Approved for~1' bedroom' s by//~ Approved _,/~ Disapprove~'/- Terms of Conditional Approval Conditional 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 coeduct 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 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 264-4726 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~E~N,~HjXj COU',F.T Telephone:Home ~Lqq~-LJ,~qTBusiness Applicant Address ~OL(O~ ~_*/~'"rcMALL-O~T~ AHOYl, (c) Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent ~'~//,~',. Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Other Number of Bedrooms X /'''( WATER SUPPLY Individual Well [] Communityv.~ 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 Public~ Community [] Holding Tank [] Onsite [] Note: If community well system, must have writ'ten confirmation from the State Department of Environ mental Conservation attesting to the legali!~ and status. 72 025 Page 1 o! 2 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 wafer supply aed/or wastewater disposal system is safe, fuuctional aud 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. NameofFirm Aot/_'E--~ ~1 ('.!~..z6.~f~.O_lt,.[C- Telephone ~,'1,_~_'~;~, ~ ,~.x, ~(~ Date L[.- ~ _ 06_6. DHEP APPROVAL /~ ~ Approved for ~'-~ bedrooms by ~/ ~ Approved ~/~ Disapprove~d~ Terms of Conditional Approval Conditional __ 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 MUNICIPALITY OF ANCHORAGE (MO~')''J ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: L_o s .~ WELL DATA Well Classification Well Log Present (Y/N) Total Depth O_ 0 Static Water Level L"O~ ifA, B, C, D.E.C. Approved (Y/N) t',-[ Date Completed ~ - I ~ - ~ ~) Yield Cased to "1 G% ' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Depth of Grouting ¢~:) ,/.A Pump Set At "' [ ~ 0 Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by (vd. 'fi-. ~ ./~.~ ~ L~ ~¢' Water Sample Test Results Comments ; On Adjoining Lots To Nearest Public Sewer Nearest Sewer Service Line on Lot ;Date SEPTIC/HOLDING TANK DATA ~/.,~ Date installed Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84) c. ^.so,P'r,o, F,EL Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption 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 To Stream/Pond/Lake~or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) LIFT STATION 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" L.evel at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Ag.g.g~inst HAA Request ** I certify t h at I.,I~.~e.¢~¢~ h e c k e d,c~C~d, o./c~nfor med to all MOA and HAA g uideli nes in effect on the date of this inspection. Signed ~~X~~ Date _,~'~ ~/~ MOA No. Date of Payment ~"~ '~ ~¢~ "% ..... , _.~ ,'*~'~'~'-~ ~. Amount: $ ~ <=~/ ~ ,~ ~'¢ Page2of2 ~,~.. CE-7125 ~ A CHEMICAL~E~E~)& GEOLOGIC~L~L~ABORA TORIES~ = ~Anchorage, AlaskaOF ALASKA,99518 ISC. ~ Drinking Water Analysis Report for Total .Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER r~. PRIVATE WATER SYSTEM Name Phone No. City State Mo. Day Year Zip Code SAMPLE TYPE: ~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose ) [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 3 I I 4 I I s l I Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~Satisfact cry [] 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 ~'~'-//7 - d¢'~ ~"~ Time Received ~C~.) Analytical Method: Membrane Filte~ * No. of colonies/lO0 mi. Lab Ref. No. Result* I BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filler:. Direct Count Verification: LTB BGB. Final Membrane Filter Results (/(~ ,~ Reporled By ~/"~/,~-~"~.'~'/~" Date Time: Coillormll00ml TNTC -- Too Numberous To Count OB -- Other Bacteria ColIformll00ml ANCHORAGE/WESTERN DISTRICT OFFICE 437 'E' STREET, SUITE 303 /~ICHORASE, ALASKA 99501 274-2533 March 28~ 19~ Herman Nicolette 7048 Whitehall Street Anchorage, Alaska 99503 SUBJECT: Lots 18, 19, 20 & 21, Tall Birch Subdivision Class C Well, Anchorage, Alaska &&21-FA-122 Dear Sir: The Department has reviewed the Engineer As-built plans for the subject project. Final approval is hereby given for the water system and the "Certigtcate to Operate" is attached. Any Future expansion of the subject project will require additional approval from-this office. Sincerely, SWE:pkk ENCLOSURE DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS APPROVAL TO CONSTRUCT Plans for the construction or modification of_ ~--.'~/, ~ ~ ~ ~ public water system located , Alaska, submitted in accordance with 18 AAC 80.100 have been reviewed and are [] approved. [] conditionally approved (see attached conditions). TITLE DATE BY If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contrac~ order no. or desc¢ipRve reference) Approved by Date APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the L. 1 ~, ~,~ 'J.,-' 2 ~/ ~/'/ '~ : ; '~ '~ / ~ public water system was completed on (date). The sYstem is hereby granted interim approval to operate for 90 days following the completion date. TITLE DATE BY As-built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK * ENGINEEPJMUNI.BOROUGH (Complete Section C) 4. GOLDENROD - MUNI-BOROUGH (Comptete Section A) REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) ~'~, _ Na~ .of person requesting approval 2, ~ame' of propemty: owner . . Number-of,.~bedrooms in house 5. Nate~.Jtnalysis: a. Bactemia2~ b. Detergent WeljL data: Casing Size \ Distance fmom well to closest existing or proposed: 1. Sewer line 2. Septic tank 3. Seepage Area 4, Cesspool~. 5. Property Line ~ ~ ~ . 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. Sewage disposal system, a. Age of system d~CT~y~_~z~,~z>~ b. Septic tank capacity in gallons_ C. Name of septic tank manufactu~ 1. If "home made" show diagram on reverse Side of this form. 1, Distance to property,_line.~ ~9 ,z7~- to house foundation,~c~ Percolatic~ Te~t ~eesults f. Percolation Test performed by. ~Use the re~erse.side of this form to show dia£ram." Diagra~"should incl'u~ .~..~he ~oltowlng information: property lines~.well location, house location, '~_~39p_~tmo tank location~ disposa~ area location, location of percolation tes~ a~ direction of ground slope. 9. The ~nformation .on this form is true and correct to the best of my knowledge. Signature of Applicant Date Signed T?. BE FILLED OUT BY HEALTH DEPAET-ENT PERSO~.fNEL ~he above described uanitary facilities are hereby approved, .s. ubject to ~he Conditions: The above described sanitary facilities are disapproved for the following reasons: .: CPJ:ow DATE DIVISION OF PUBLIC HEALTH .... BACTERIOLOGICAL WATER ANALYSIS OFFICE PUBLIC E] SEMI PUBLIC [~ INDIVIDUAL [~ REPORT RESULTS TO' OTHER NAME ADDRESS CITY ADDRESS OF SOURCE Records in this office indicate this WATER SUPPLY to be of: Analysis shows this Water SAMPLE 1o be: E] SaBdactory [] Questionable [~ Unsatisfadory. If an 'lUnsatisfadory' or '1Questionable" stalus is indiccsted above you should take immediole actlon as recommended below. 1. NoBfy consumers woler is polluted. Boil or chemically freal this water as outlined ~n lBe enclosed leaflet "Drink It Pure." When? D o e er of WeLl Depth Feel. Well Casing MoJeriat Oiomeler Depth _ ~) Of Well [] Other 2. Increase chlorlnallon sufBcienlly Io meet recommended residual standards, Determine source of conlaminafion and take action necessary lo n,a~ntain a safe water supply at all times. 3. Check chlorlnotlan and other mechoMcal equipmenL Make cerlain ills funclloning propeHy. SANITARIAN'S REMARKS READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD 24 hours _ -- 48 hours Brilliant Green 24 hours 48 hours Reported by g This analysis indlcat~ Coliform Organisms lo Be: Absent Present DII,~ECllF.',ix]:¢ F()[~ CrOLIJ~( tiNG SA/V~PLES OF WATER FOR BACTI.:I~.IOLOGICAL EXAmINATIOn'! Carefully and Follow Instructions Ex~:~ctly A,'m;~gomonls shoulcl he m(~de Io have wolo~ smlh)los ~oclch the Iclbol'clloly ils quickly as possible After 48 hours oozily i/oil oF fha week bul is wiJJin.cI 1o clccopl samples at cmy llme. In colJocling sclmpJes tronl TAPS o~ PUMPS ploceod os follows: (a) ]holoughly flush tap or puree by ¢l]Jow,illg walel to HJn ¢~eely for five minutes. (b) %hut off ,*.,cdo~ crud flum(~ Ihe oulJot wilh lo,ch oJ J)ulning pcq~eL Tho ~Jame should not bo n/c)le[y passocJ over tho outJof ~)tJ[ shod[d J)o apl~liecJ unHI Jixlu~o shows indication o¢ J)ehlg hoL FJcm~g should I~o diJocJod agoinsl inside edge. (c) Open fixluro ,;o Ihcl~ I:1 small sh ecm] Ilows. (d) Remove I)ollle from mcdJing tubo. Hold I)ollle I)y Jhe Iowoi hall in one I~cmd and wilh Ihe o~l~el Cemove lbo sc[ow ccU~ wffh the fhlgels, JodlviJlg j)apor j~lOlOcHng covol i~ Rk~ce. Fiji Ihe bolHo fo lhe shoulcler. Reploce c(q] with proper covof, scl r]w]l~g fhmJy lido place but do hal apply i)rossu~o whidl will spill cap. (e) Pc~ck ~olJJg Cell cffuJly in mcliJimg lubo enclosing Ihis completed i11JolplcJHorl sheet. In coHeqing sclmplos from SYREAMS clnd RESERVOIRS ploceed els follows: (el) Rohlove cap cllld boM boltle as doscHbod uncJer (el) (b) Coiled scm/pie J/y JloJdil/g bottle h/ ti sJcHiling position oncJ sweeping ii below the sulJ(ice wcller IJ1¢11 hos been in ((lnlacl v/itl~ Ihe hand is ool hlflocJucod info lbo bottle. Avoid colJ¢ciing sulfoco sctJlll STERILE WAllR SAMPLE BOTTLES ARE AVAILABLE UPON REQUEST FROM: Dei:,L of lleollh L~, Weffm'e $OU~IICFNIRAL ~,EG1,)NAI. tABrDRATOR¥ 527 EASE 4ih AVENUE ANCHORAGE, A~.ASKA 99501 DoI)I. of Ileallh & Welfare NORdlEf~N REGIONAL LA[~ORATOFIY 604 BARNE~E~ $TRI!£E FAIRBANKS, ALASKA 99701 Juno 24, 1970 ~,~. william E. Lon~ National Bank of Alaska P.O. Box 600 ~dmrage, Alaska 99501 SUBJECT. Sewer and Water Syste¥~zs for Lot 20 ~ 21, Block 2, Tall Bird~ ~divisioa, Hannah Nicolet b~ar Hr. I~ g. This D~partment taade ~n insP~ction of the s~ject sm-~or and water syste;~ ~d ~ be~ we c~ tell, water is se~ by a drilled well 208' deep, A water s~le taken from the well proved to be satis- factory. ~m sewer system consists of a septic t~ m~d seepage pit for all the sewage oth~r th~ 'the latmd~' facilities - a ~oparate cessp~l is apparently s~plted for the la~d~. ~e smear system is placed s~h ~at proi~r distances from ~e well a~, ~nt~ned b~ the ~s{pool for the lam~d~ is seeping sewage thr~ onto the surf~ oi the groined. Also, ail the sewage from tho ho~ehold m~t pass fllrough th~ septic tm~ ~d fids would clude fire lam~d~' facility. ~r ~part~nt c~ld grant approval to fl~e s~ject sewer and water syste~ if all the ho~ehold sewage passed throu~ tl~e septic tank Sincerely CLIFFORD P. JODKINS, R.S. Administrative Director JilL,' rn cc: lielaaan Nicolet Saait~rian GI~ATER;~CHORAGE AREA BOROUGH 104 West Northern Lights Boulevard Anchorage, Alaska 99503 Date: S-2].4O 9/23/70 BOROUGH: Engineer Health Dep~rtment, P~ii~ l~orks Department Sand Lake Fire Department School District Street ~ames Tax Asseasor Alaska Department of Highways Alaska Railroad Anchorage Natural Gas Corp. Central Alaska Utilities Chugach Electric Association CITY OF ~]~iORAGE: Fire Marshal Hunicipal Light & Power Departmeng Property Management Officer' Public Works Department Telephone Utility Traffic Engineer Water Utility GAB Telecommunications~ Inc. Matanuska Electric Association Matanuska Telephone Association Assistant Superintendent of Mails Description of Property: ~ See attached plat. Owner: Donald L. Jack ~-~X~x / Resubdivision / Vacat~n, ~ i!~j~'~ Gentlermen: Petition has been received by the Greater Anchorage Area Boroogh Planning and Zoning Commission for the proposed__ Resubdivisionof s~bJeet property.' Vacation Attached is a copy of ~e proposed plat. ~il you please submit your co~ents in writing~ specifying any easements or other requirements that your department or agency may need. I~ we do not hear from you by .... 10/9/LO___ you do not wish to submi~ any comments. __, we will assume that If you have no further use for the attached print, please return it with Planning Department Enclosure oq .L_7 ~</ P' 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 ParcelI.D.# c:~1'7 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 42/'3 /o~ HAA# GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address P.~- Agent ~.~. - ~¢~ noF &e~ .~o/~ Dayphone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY:' 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 OFWASTEWATER DISPOSAL: NOTE: Individual on-site f 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 FI~t-,,~,p Address Engineer's signature ,~~ DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SER¥1CES~~'~ 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) Health Authority Approval Checklist Legal Description: A. WELL DATA Well type ?~t taa Log present (Y/N) Total depth Sanitary seal (Y/N) FROM WELL LOG ~/ /--~.. i ~ ~' Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform ~ ~'o~'o,~t~J //oo,~.~_ Nitrate Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed '7/M'/~ Tank size Foundation cleanout (Y/N) Y Depression (Y/N) Date of Pumping A,/./f ('.q.tw3 Pumper H/~ C. ABSORPTION FIELD DATA Date installed 7//~ / ~ ~' Length 5' '7 Width IfA, B, or C, attach ADEC letter. ADEC water system number Date completed dP / l 'Z- / ~) ~'' Cased to Be~rc, c~c - ~,5- ~ Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. Number of Compartments High water alarm (Y/N) W. ,4. Soil rating (g.p.d./fForfF/bdrm) ~. ~ Systemtype ~'ro~c§ ,5-' Gravel thickness below pipe Total depth H. 5- Effective absorption area ~¥~ r~' Monitoring Tube present (Y/N) Date of adequacy test /~. ,4. ( ,~ ec~_) Results (Pass/Fail) Fluid depth in absorption field before test (in.); Fluid depth ~ (ins) Minutes later:. Peroxide treatment (past 12 months) (Y/N) /'-/ Immediately after Depression over field (Y/N) __ For ~ - gal. water added (in.): Absorption rate = ~ ~d'~O g.p.d. If yes, give date /v.,& bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION /',/. ,4, Date installed Manhole/Access (Y/N) Size in gallons "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots ",> tc*O ' On adjacent lots ",> / oo · Public sewer manhole/cleanout Lift station /~. ~. SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK ON LOTTO: Foundation 25- ' Property line -7,3- ' Absorption field _c- ' Water main/service line ~/O ' Surface water/drainage ~> too ' Wells on adjacent lots ".> ,'~,o / F. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ff~' ¥' Building foundation ~5-' Surface water '.~ ~'o ' Curtain drain No,~¢ ~ ~ ~,3 ENGINEER'S CERTIFICATION Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots. ~> ¢~'o ' I certify that I have determined thru field inspections and review of Municipal records float th~ aboV~ ~ystems are in conformance with MOA HAA guidelines in effect on this date. Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* DRILLING LOG Location (address, legal description,, etc.) Size of casing ~ /' inches Depth of hole --~ 2 Static water level ~ 7 R. (~ / ~low) land surface. Use of Well /~O~/e 5 ~z,'c_ feet Cased to 2~' feet Open End ( 1'''~) Finish of well (check one): Description: ~f~// Well pumping test at ~ from static level. Dateofcompletion: ~ 6cf 12 - ~ WELL LOG gallons per (I~*~ / minute) for Screen ( ) Perforated ( ) Liner ( ) t~ ~, hours ~ ~2 O ~. of drawdown Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 'to Z 2 ,to /8 ,to ,to 235 2g$ 'to '29° 2 qo , to ~_~o 'to g~f ,to 31 7/g. 'to g~ ' ' t0 ' t0 ' t0 lTe ,t ?7.- Gpr~ RECEIVED SEP 22 1998 Municipality of Anchorage Dept. Health & Human Services CT&E Environmental Services Inc. Laboratory Division 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 ChemLab Ref. fl: Client Name: Project Name: Client Sample ID: Matrix: 98.3952-5 Flattop Tach. Svc. Lot I Talisman Hts Lot 1 Talisman Hts Drinking Water PWSID n/a Sample Remarks: Client PO#: Printed Date/Time: Collected Date/Time; Received Date/Time: Technical Director: n/a g/22/98 11:00 g/17/g8 15:40 9/17/98 16:25 Stephen Ede Parameter Results PQL Units Allowable Prep Analysis Method Limits Date Date Init Total Coliform (MF) Nitrate 0 co11100 mi 2.370 0.1 mg/L SM9222E~ 9/17/98 KAP EPA 300 10,0 9/17/98 GCP CT&E Environmental Services inc. Laboratory Division Drinking Water Analysis Report for Total Coliform Bacteria 200 W. Potter Drive READ ~NSTRUCTIONS ON REVERSE SlOE BEFORE COLLI:CTING SAMPLE Anchorage, AK 9~518-160~ Tel: (907) 562,2343 Pre-Paid. Thank you. Fax: (907) 561 -5301 MUST BE COMPLETED BY WATER SUPPLIE PUBLIC Water System PRIVATE Water System Flattop Tech, Svc, 145-1355 14530 Echo Strcct [] Send Invoice Ted Moore 345-1355 Anchora6~ Al< 99516 [] Send Results [] Send Invoice SAMPLE DATE: O.~. =3._Z_7, -_~..b~... SAMPLE TYPE: ¥ Routine Treated Water Repeat Sample ~ Untreated Water (refer to lab no. Special Purpose Time Collected LOCation Collected from: Coli'ected; hy (Jntllall: /."/Z.. ~/,~.-,',', ~'.: TO-BE COMPLETED BY LABORATORY A~ly~i5 shOws this Water SAMPLE to be: ~ Sabsfacto~y Unsatlstaclo~' Sample over 30 hours old. ResultS may be unreliable. Sample too long in t~aasit, Sample should not be over Analytical Method: Membrane Filter MMO-MUC. Lab Ref No. 98.3952 Sent to ADEC; ANC Date: Time: FBK JUN Client notified of unsatisfactory results: Date: BACTERIOLOGICAL WATER ANAY$1$ RECORD Time: MMO-MUG Result: Membrane Filter: Verification: LTS Fecal Coliform Confirmation: Final Membrane Filter Results: Total Col(term E. Coil BGB COLIFORM o~: Ol~e~ eaae,,a Pre-Paid. Thank you. .......... ~ ~.. ~?~_%~f ,ho SOS ~,o~ ENVIRONMENTAL FACILITIES IN ALASKA. CALrFORNIA, FLORIDA. ILLINOIS. MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA TOTRL P,