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HomeMy WebLinkAboutILIAMNA ACRES TR 6 Municipality of Anchorage Page \ of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report N~ ~ ~0~ Wastewater System: ~Now ~ Upgrade Ad(r~ ~, ~ ~ ~~ ABSORPTION FIELD Ph~~ Ne. or,rooms: ~ Deep Trench ~ Shallow Trench ~ed ~ound ~Other T~ta} Depth from original grad~: LEGAL DESCRIPTION Soil Rating: ~' ~GPD/Sq. Ft., ~¢~ Lot: ~ Block: S~ Depth t~ pipe botlom Item original ([r~e: Gravel depth beneath pipe Township: Range: Section: Fill added abov~i~in~l fg r~e: Gravel length: Ft. Ft.  Number of lines: Distance belween lines: WELL: New ~ Upgrade Gravel~: ~ Ft. ~ I ~ ~ Ft. Olassifi~ion (Private A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~ Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: GPM / Pump Set at: Ft. Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~Septic ~ Holding U S.T,E.P. To Septic Absorption Lilt Holding Public/Private M~r:/~ Capacit~ ~ga~: From Tank Field Station Tank Sewer Lines Well ~ [~J / / ~ Material: ~~ Number °f C°mpartments: Surface LIFT STATION Water ~ ~ ~ ~ ~ Lot [ ~ Size in gallons: Pump Make & Model Electrical Inspections performed by: Curtain Drain ¢0¢' 2 ~¢~ Remarks: BENCH MARK Location and Description: Assumed Elevation: Inspections performed by: 17034 Ea~~,Da~; lst~~ ~ ~ Department of Health and Human Services approval ~0-~x"'~u'* o ' .... 72-013 (1/91) MOA 25 Permit No. ~'~,.~ c~ 1 (~) ~ C~,)'~r' Page ~ of ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID No.: 72-013 A (2/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PAGE 1 OF PERMIT NUMBER:SW910197 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:SALVUCCI PATSY J & RENEE M OWNER ADDRESS:560 EAST 34TH AVENUE ANCHORAGE, ALASKA 99503 DATE ISSUED: 7/16/91 EXPIRATION DATE: 7/16/92 PARCEL ID:01710105 LEGAL DESCRIPTION: ILIAMNA ACRES TR 6 LOT SIZE: 200600 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. RECEIVED BY: DATE: DATE: July I, 1991 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Tract 6; Illiamna Acres; Request you issue a permit to dri~ a well and install the propsoed septic system p~r our attached design dated June 30, 1991. Two soil test~ were performed for the original and alternate septic sites. Although the groundwater monitoring found water within the test hole #I at 7.5 ft. below the surface, the proposed absorption bed will be installed o~y I ft. below the ground surface due to anticipated seasonally high groundwater levels. This is a large 4.5 acre tract of land wi~h the adjacent properties vacant at this time. Due to the large lot sizes, we do not anticipate any adverse effects on neighboring properties from the installation of the proposed well and septic systems. If we may be of further service or if you require additional information your reivew, please con, tact us. SOILTEST A. SHAFER, P.E. gm PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST DA E LEGAL DESCRIPTION: ~ ~ ~:, 5 6 7 8 9 10- 11 12 I ~-L--I Y~-d hJ,~k,,Township, Range, Section: SLOPE 13- 14- 15- 16- 17 18 19- COMMENTS SITE PLAN ENCOUNTERED? S ~ L IF YES, AT WHAT E Oeplh lo Water Alter...I ~ ~ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN,~ __ (minutes/inch) PERC HOLE DIAMETER __ FT AND '~ FT ....... /.~/~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI~IN ~FECT ON THIS DATE. DATE: / 72-008 (Rev, 4/85) ,,, , ,~, ,,,),"un=c~"au'-of~ ~.~ ~An~k~ra-e DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION~~ ~ I P~l~Township, Range, Section: ~ SLOPE SITE PLAN 10 WAS GROUND WATER ENCOUNTERED? S ~'\ IF YES, AT WHAT DEPTH? ~ OL P 12 E I Depth to Waler After Reading Date Gross Net Depth to Net Time Time Water Drop 14 15 16 17 18 19 20 PERCOLATION RATE TES~I RUN BETWEEN~T AND ~ FT COMMENTS PERFORMEDBY: E~gler, ive,'rAl~k"'~5" I~~ CERTIFYTHATTHISTESTWASPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE~F~T ON THIS DATb DATE: 72-008 (Rev. 4/85) PO©. 6-.650 ANCI.IOI~/\(]E, t\L/~,SKA f~9,502 (907) 264 4 I 11 DEPA}~TMENT OF HEALTH AND ENVHIONMENTAL P,qOTECTION Permit II: 840629 January 31, 1985 TO: Permit Applicant SUBJECT.~ Lois Tract 6 Iliamna Acres Subdivision A permit issued by this Department for an individual well. and/or on-site sewer system has expired as of December 31, 1984. 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 and the yellow copy must be sen% to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. · Sincerely, rKeith E. Bandt, SupeYviso Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 DEPAI:RTMENT OF HEAL. TH AND ENVIRONMENTAL F'ROTECTION 825 I_ STREET, ANCHORAGE, At::: ~795()1 264-4720 PERM I T NO: DATE ISSUED: 840629 HAND WR I TTEI'4 0'7/26/84 AF'PL I CAI".IT: ADDRESS CDNTA[YT PIdDNE: FEJES DE:VELOF'MENT F'. 0. BOX ~. 1-20CI9 ANCHORAGE.~ Al.::: 995:11 349-80 .t. 1 L. EOAL DESCRIP: I..,,[IT SIZE: SUBDIVIS]:[IN: ILIAMNA ACRES SECTION: .]4 ']'OWNSHIF': 12N 4., 55A (SQ. FT. OR ACRE~,5) L. OT: 'TRA[',T 6 RANGE:: :SW BL(]DI<: N/A cer'Li~y that.: I am familiap wi{h the requirements fop on-s:i.'Le sew~P~i and wells as s~t ~c)r"Lh by 'U]e Ml..~nic::ipality c){ Anchor'age (MOA) arid 'Lhe Sta{e c:)f' A].a~iJ.::a, I Nit]. install the system itl accDpdance wJ.'Lh a].]. jvj(]A c::(:)d~:~s and r,(~gu].a'L:Lc~n~s, arid ir'l cc)lflp].J, ance wJ.~.h {J']e design criteria ~:)[ this per'mi'L. I wi].]. ~dhePe 'La ali. MOA and State ~:~( Alaska requirem~nts far the set back d:J. starlc:es ~p(:)m ~rly ~).(J. stirlg J~e].].~ wastewa'Lev disposal, sys'Lem (Ir pul]l~.c: sewe~age system an this or any adjacent op ne~u'~J:Jy ].at. ]:F A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODI"'ZS~ ]"HEN (1), AN ELEC]"RICAL PERMIT AND INSPEDTIO~ MUST BE OBTAINED; (2) AS-BLI:[LTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAl_ INSF'ECTION REPORT; AND (3) 'THI~ EL..EC]T~ICAL. WORK MUST BE-DONE BY A LICENSED ELE[TTRICIAN. .................................. ...... ......... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4 8 ~2 13 '14 17 2O SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, ATWHAT DEPTH? SITE PLAN PERFORMED BY: ,/ Gross Net Depth to Net Reading Date Time Time Water Drop i0 5~/ , ~ I f 72-008 (6/79) PERCOLATION RATE L, L~ TEST RUN BETWEEN ~ FT AND CERTIFIED BY: (minutes/inch) / COMMENTS ALASKA eP'~IROFIITleI"ITAL COFITROL SEaRle,eElS, IFIC. (~nqinttrin§ § {~nuironmcnl~l Studies PERFORMED FOR: LEGAL DESCRIPTION: ~ 0/.,. 1 , ..~,, 3 4 5 ~ ~. 7 ~ 8 9 10 11 12 SOILS LOG - PERCOLATION TEST DATE PERFORMED: SLOPE SITE PLAN WAS GROUND WATER,. ENCOUNTEREDT,, [ ,,,./, >, F~-~'- 0 IF YES, AT WHAT DE,.PTH ? Reading Date Gross Net Depth to Net Time Time Water Drop ALASKA E iiUIROFIlllCF1TAL CO[1TROL S [ UICE!S, IF1C. ~nqin¢¢rin§ $ ~uiraam~nmal Studies SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM- LOT 6D, TRACT 6, ILLIAMNA ACRES SUBDIVISION 1.0 GENERAL 1.1 1.2 1.3 1.4 THE DRAWINGS, SHEETS 1 THRU 3, SHALL BE A PART OF THIS SPECIFICATION. ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERMIT. ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE VERIFIED IN THE FIELD BY THE CONTRACTOR. IT IS THE RESPONSIBILITY OF THE OWNER TO OBTAIN ALL NECESSARY PERMITS OR EASEMENTS. 2.0 THE LIFT STATION 2.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER GALVANIZED STEEL (ASTM A-4444-76)~ OR ALUMINUM CULVERT~ CAPABLE OF BURIAL TO 10 FT. 2.2 THE 36" DIAMETER PIPE FOR THE LIFT STATION SHALL HAVE A WELDED WATER TIGHT BOTTOM OF THE SAME THICKNESS AND COMPOSITION AS THE CULVERT. 2.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG. WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC RICH PAINT OR COATED WITH BITUMASTIC. 2.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED WITH SCREWS. A TWO INCH LAYER OF POLYURETHANE FOAM SHALL BE GLUED TO THE INSIDE OF THE TO[? CAP. 2.5 ALL ELECTRICAL FITTINGS AND CONECTIONS IN THE LIFT STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT SERVICE. 2.6 THERE SHALL BE A HIGH LEVEL ALARM, PEABODY BARNES 6147 OR EQUAL SET AT THE LEVEL OF THE SOIL PIPE FROM THE SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY THE HOMEOWNER. 2.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT A HEAD OF 20 FEET. 2.8 PROVIDE A CALDER COUPLING AT THE CONNECTION OF THE 4" SOLID PVC INFLUENT PIPE AND 4" STEEL NIPPLE. 2.9 THE PUMP SHALL BE CONTROLLED BY A DIFFERENTIAL MERCURY 1200 LUcsl 33r~l Aucnu¢. $ui1¢ [~,, Anchora§¢, Alaska 99503.(907) 561-50/40 ALASKA eiIUIRODme[1TAL COiqTROL IDC. ~nqin¢¢rinq 6 ~nuir~nm~nl~l $1u~ies FLOAT SWITCH, ADJUSTED TO ALLOW A TWO FOOT SPAN BETWEEN 'ON' AND 'OFF', AS SHOWN IN THE DRAWING. ALL RELAYS AND ELECTRICAL CONTACTS SHOULD BE LOCATED OUTSIDE THE CHAMBER TO PROTECT THEM FROM CORROSION, PREFERRABLY IN A DRY LOCATION WITHIN THE HOME. 2.10 COAT THE INTERIOR OF THE CHAMBER WITH BITUMASIC PAINT OR TAR TO APROXIMATELY 3.5 FEET ABOVE THE BOTTOM. 2.11 MOA BUILDING CODES: WHEN LIFT STATIONS ARE INSTALLED WITHIN THE MUNICIPALITY, AN ELECTRICAL PERMIT AND INSPECTION ARE REQUIRED. IN AREAS NOT COVERED BY MOA BUILDING CODES, THE SYSTEM SHALL BE INSPECTED BY A LICENSED ELECTRICIAN TO INSURE THAT THE ELECTRICAL INSTALLATION IS IN ACCORDANCE WITH APPLICABLE CODES AND REGULATIONS. 3.0 SEEPAGE BED 3.1 3.2 3.3 3.4 3.5 3.6 3.7 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES INDICATED. THE SAND SHALL HAVE AN EFFECTIVE SIZE OF 0.4 TO 0.6 MM AND A UNIFORMITY COEFFICIENT OF NOT MORE THAN 4. THE BERM AROUND THE SEEPAGE BED SHALL BE CONSTRUCTED OF IMPERMEABLE MATERIAL, AND ON A SLOPE OF 1 FOOT VERTICAL PER 3 FOOT HORIZONTAL. THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2". OBSERVATION PIPES SHALL BE PLACED AS SHOWN IN THE DRAWINGS. THEY SHALL BE RIGID PVC, ASTM 3033 D-3034. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A SECTION OF PERFORATED SEWER PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP OF THE PIPE. THE INSULATION REQUIRED SHALL BE DOW EXTRUDED BLUE STYROFOAM INSULATION BOARD OF THE THICKNESS SHOWN ON THE DRAWINGS. THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX. 1200 ~.UCsl 33r,J Autmu¢. Suilc [~ ,Anchore§¢. Aloska 99503 ~,(907) 561-50~10 ALASKA ENVIRONMENTAL CONTROL SERVICr INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 SHEET NO. CALCULATED BY CHECKED BY. SCALE DATE '75'2-. ~t / x 39./. ALASKA ENVIRONM~.,, i'AL CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1367. SHEET NO, CALCULATED SY CHECKED BY = I0 oF ~ DATE m~5 · litllllifl: --llllll-½-11-1- ..... 'o: cO o c; To house- r ~o 12OO West 33rd Avenue Suite B ANCHORAGE, ALASKA ~g503 ~ 276-~36~ CALCULATED BY. DATE CHECKED BY DATE C. ~Rc4d. MUNICIPALITY OF ANCHORAGE .... DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 $43-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 1. GENERAL INFORMATION Complete legal description TRACT 'ILLiAMNA ACRES Location (site address or directions) East 142nd Avcnu6 Property owner Mailing address Lending agency Mail?g address Pat Salvuc~i 13!~ N ~q~_reef_, Andho~ge, Day phone A~a6 k.-. 99501 564-9322 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well ~ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. · ' 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 ' ' '~o~ S~eeul~ue i~uolssej0~d eq~.u! SUO!SS!LUO JO sJ0~Je ~oJ elq!.suodseJ lou s! e6~oqou¥ Jo/q!l~d!o!unpj eq.L 'penss! s! m,~o!j!~J@o ~ eJojeq ~l~p'ez~l~U~ ~o sub!loedsu!' ~onpuoo lou op SHHQ lo se@~oldUJ3 's~ueLue~!nbeJ m,~,s pu~ I~Jepej u!B~eo ~S!l~S o~ JepJo u! suo!lm,!lSU! 6u!puel J!eLp, pUB sewoq ~O s~es~qoJnd ol ~se~noo ~ s~ s!q~, seop ~HHO eq.L '~S~lV ~o el~S eql u! peJelS!6e~ J@@u!~ue i~uo!sse,~o~d luepuedepu! ue iq e^oq~ 9 qdsJ6e~d u! ue^!l~ suop, elu@seJdeJ eq~, uodn ,~lUO peseq Sel~!~!~Jeo le^oJddv /qpoqlnv qlleeH senss! (SHHO) seo!A~eS uewnH pue qll~eH ~o luew~J~deo e6eJoqouv jo ,~!l~d!o!unI, N eq.L m, UeW,LUO0 leUO!l.!ppv :suop, elndp, s I~U!MOllOj eq~, q~,!M 'SLUOOJpeq 'SLUOOJpeq '9 ( Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T-P¢'~_ ~., ~YLfA-M/d/b /~C~.~' Parcel I.D. A. WELL DATA Well type Log present ~¢-7N) Total depth Sanitary seal [~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed "~ ~"Z-L¢' ~11 Driller __Cased to (,..-~1 Casing height Y~ Wires properly protected (~N) FROM WELL LOG Date of test '7/¢'l I I Static water level '~'~ Well flow "~c~ ~ Pump level g.p.m. AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main /~/~ Sewer service line c~.~~ + ;On adjacentlots ;On adjacentlots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: (~,c(,,~. r~¢-/~¢,~ Other bacteria Collected by: S ~- S ~_-~lhS~;~"'clC,3(r- SEPTIC/HOLDING TANK DATA Date installed (~_ 1 ~_C~ / Cleanouts (~N) High water alarm (Y/I~ Date of pumping Tanksize /~oO ~_~-¢rL~ Compartments ~ Foundation cleanout ¢~)'N) k//~ Depression (Y/~ ¢0//¢¥ Alarm tested (Y/(~ /'0//3- CV '~/-"J ~L/'_% Pumper ......... SEPARATION DISTANCES FROM SEPTIC/F-~C~C,~G TANK TO: Well(s) on lot /c~.~ On adjacent lots To property line /0 Surface water/drainage Foundation Water main/service line 72-026 (Rev, 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION / Da~eq~' stalled Manufacturer Size in ~- ~ Manhole/Access (Y/N) i ~~evel at ~ "Pump off" level at Vent (Y/N) High water alarm level ~~ Cycles tested ____ Meets MOA electrical codes (Y/N) __~ Sm Ao iON D'STANCS FROM "FT ST^TlOm 70:Onadiacent lots ~Surface D. ~B80~TIO~ FI~D D~T~ w~~~ Date installed Length Total absorption area Depression over field (Y/~ Results (pass/fail) Peroxide treatment (past 12 months) (Y/~ g-I'~-~ I Soil rating 0,~ GP%F- /¢~d~ND System type Width c~ Gravel thickness 0 ,S ~ Total depth t ~ot~)-- ~F Cleanouts present (~'4) ~/~-~' Date of adequacy test for /f~) ~'/,t.,/ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot J"~O To building foundation On adjacent lots Surface water Curtain drain On adjacent lots [O© '~- Property line -~' To existing or abandoned system on lot Cutbank ¢,~O,'ac--- Water main/service line /(~(~ ~ Driveway, parking/vehicle storage area 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 $ & $ ENGINEERING 17034 Eagle River Loop Road No. 204 ~agle Riverr Alaska 9~577 HAA Fee $ /"7 Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number ue.t. unF[~ q~.l~?.~l~ ':~d~o CIIEMICAL & GEOLOGICAL LABORATORY A OIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE(907) 562-2343 ~AX (907) 561-5301 Chem!~b BeE.S 92,1191 ~mple ! 3 }4atrix: WA~EB Client ~plo ID : DBINRIRO WAtE~ I&ACT 6 ILIkI(NA ACBES Collected MIE 25 92 { 14:15 hxs, Analysis Completed : }tAR 27 92 Labozatozy 8upoz¥1sor.___L~. EPHEN C. EDE BPO{ : Ozdorod By :~OOZ~ FOt :MONE ~ECEI~D MD- Nono Detected "See Sample ~e~rks Above HA- Rot Anal)'zed ~ S~ Me~-,ber of the SGS Group (Societal GOnOra{e de Surve:liance) CHEMIC/AL & GEOLOGICAL .LABORATORY .4 DIVISION OF COMMERCIAL TESTI,¥G & 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 7.~_.PRIVATE WATER SYSTEM 17034 E~gle R~,ver Lo~p Roh.~ r~o, 20{ Mo. BeV SAMPLE TYPE: ~ Routine [] Check Sample (for routine sample with lab ref. no._ E3 Special Purpose Yesr [-_] Treated Water [; Untreat,d Water SAMPLE Time Col!ecled No. LOCATION Oolloclod By TO BE COMPLETE[) BY t. ABORATORY Analysis shows this Water SAMPLE to bo: ~:)~? Satisfactory El Unsatisfactory Sample too long in transit; sample should qol be over 30 hours old at examination to indicale reliable results. Please send new sample v!a special delivery mail. Analytical Method; Membrane Filter · No. of colonies/100 mi, Lab Ref. No. Resull* Analyot PT_'5 L_ LZJ ~BAC'rERIOLOGIOAL WATER ANALYSIS RECORD READ INSTRUCTIONS TNTO OB = BEFORE COLLECTING SAMPLE Membrane Filter; Direct Court! ~-~ Colllorm/100 mi Verification: LSB BGB FecM Coliform Conflr*n¢tioq ........................................................... Final Membrane Fitter Re~ult~ .,,/ Coliform/100 ml ,~,:- "~.. % ."z- 7. Reporled By ~" Dale ..... = Too Nurnerou~ To Count ~,m. PART ONE OF TWO Other Bacteria REMAINDER TO FOLLOW