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HomeMy WebLinkAboutHUNDRED HILLS 1ST ADDITION BLK 5 LT 7
· Municipality of Anchorage ?:,.~ _~1 of 3 ..
'- DEPARTMENT OF HEALTH AND RUMAN 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
Permit Number: ,':~V'J c::l'~-'OO~'~:) PIDNumber: O'7~- Z ~I '-O'Z.
Name:~'"tt~-4~, ~'~e~'l~''Ell'' Wastewater System: ~New D Upgrade
~,m: ~O ~:~O ~ ~s~-~, ABSORPTION FIELD
~o.~: ~¢-~113 · No, o~droo~.: ~De'epTrench D Shallow Trench ~Bed UMound DOlher
LEGAl. DESCRIPTI O N Soil Rating: Tolal Deplb from odginal grado:
Lot: ~ BIock;~ ~v~Subdtv~l°n:~i~b~ ~[~ ~ Oeplh to pip,j, bollom~ ~lr°m~,°riginal~ ~grads: FL Gr~vel depth~benealh pipe Ft.
I /~ Fill added abova origin¢ grade: Gravel lenglh:
owm l. ..m m,o.w -,-_
Gravel widlh~ Number o[ linss: [ Disl~nc~tween lines:
WELL: ~New D Upgrade ~ T~/ ~. , [___~r* Fi.
Classification (Private. A,B,C); Tolal Depth: Cased To: Tolal absorplion area: Pips m~lerial:
Date~rilled: Sla,,c Water Lc,el'. installer'.
IPump Set al: Casing Helght Above Ground:
~leld: ~ GPM ~ o~ %~ Fi. FL
> :~, TANK
SEPARATION DISTANCES ~se¢~o ~ Ho~in~ ~ S.T.~.~.
To 8epll~ Absorption Lilt Holding ~¢/Pdvale Manufacturer: Capacily in gallons:
From " Tank Field Slallon Tank Sewerglnes ~ ' ~'
/ / Malerial: Number ol Comparlments:
su,,Oew.t.r ~/~ > ~ LIFT STATION
Line
Drain (, ,, ~ ...
Remarks: 5o'1~g ~e~/~ me ~ BENCH MARK
' I EiqGINEER'S SEAL
Inspections performed by: 0~ ~$ Dates: 1st ~/~
' "='"' '
Department of Healt~and Human ~i~s approval '
Reviewed and approved by: 7~ate://~2~-F~
72-013 (Roy. 0101) MOA 25
Permit No, ~vac~~ Page of
"'~ -..~ Municipality of Anchorage
DEp~-P~MENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION ·
P.O. Box 196650 · AncXho~age, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disp'osx,al System and/or Well Inspection RePort
Legal Description:
.\
\
72-013 A (1/93) ·
Permit No. otS"OoG 8 ~ ' Page
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN ~dEFIVICES
ENVIRONMENTAL SERVICES DIVISION
P.O, Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
LegalDescription: t.o~-'-/j ¢.y--~;, t4~Jo~ bHcc~ s/.~> PIDNo,:
CIo -re
CIo ' ~
4"4,
~uC. ~¢~pE:. L~'~O L~'JZL.~ GF,~oP'~
72,1113 A (1/93) *
81/29/1998 21:55 9876942141 DIVERSE GRAPHICS PAGE
( erlffie Irilltng
SULLIVAN WATER WELLS
P,O, BOX §70272, CHUGIAK, ALASKA 90567 · TELEPHONE
^O0~ESS r~ ~? .':70 /~_t~=-;.D__~ s'rw~(' ,~x'~;~., o~ w~n~ ~;r . / 0 0
......................... DRAW DOWN FT ....
oErMIT NUMBER KInl) OF cASJN('; _ .(~ O~
KIND OF FORMATION:
F,o,,l,~ I..-le'. '°-f q?. F"--Z~(; '~ '~ c f.S .... _~.~ ~.'(
From .... F L
Fro~'__ Fl,
From.__ Ft. I. ..... Ft.
From ....... Fl. ~o __FI.
Ft, lo .... Ft.
__let
Fl,
, Fl.
From ~__Ft.
From .... Ft, to .....
From Fl, to .....
Fi,
From ...... Fl, to__Fi
From ............. FI. 1o..-- Ft.
From~Ft, ~o.~Ft
From Ft, to ..... Ft,_
From Ft, to ....... Ft
From Ft,
From ....... Ft, lo Ft .........
From ........ Ft, to__ FI
From Fl. Io Ft,
From .... FI. to .... Ft,
From FL to Fl, __
From .__
From--
FI, to ......... Fl .....................
.............
MISCL, INFORMATION:
FEB 22 1996
Municipal ty of Anchorage
Dept, Health & Human Sam ees
b)'
DOC cO,
SULLIVAN WATER
P.O, BOX ~70~2, CHUQIAK, ALASKA 9955~ · TEL~PHON E ~B8-2759
Ended'
",!LIMBER
_._Ft. to Ft.
.Ft. h.L __.Fl
~ Ft. lo~Fl,
Fl, Io ...... Fl.
Ft. to ........ Ft ..........................
~l~'l, ~o_._ --FI,
From ....
From ~ Fl, to
From .... Ft.
........ Fl, to Ft __
From__ Fl. h)-- __l;'l
.... Fl, to Ft
.......... Fl, lo_. Ft
.... Fl, to Ft,
· _Ft, to 'Ft"--"--
.... Fl, to ' Ft.:__
.__Fl, to Ft. ~
Frown .... Fl, (o
From_____Ft. to .... 'Fl,
From ~.m Fi'. to
Mpp. icipalit¥ o~ AncBora~e
From ..... Ft.to, D~t. i~'~umaaBervices
From ..... Fl. lo ._Fl .........................
):ORMATION;
DRILLER'S NAME .~m ....
DIVERSE GRAPHICS PAGE
~ HERED': c?'r;,:,: .T~qAT I HAVE..-RURVEYED THE
- ' ' ......... '~'"~'~'~' DA~/
INDIOATED. ~T ~$ TH~ RE$~NSlBILI~ OF THE
~ TO DETERMINE THE ~I3TENOE OF ANY
E~EMENT~, COVENANTS, OR RE~TRICTION~
WHI~ DO NOT ~PEAR ~ THE RE~D~ ~BDI-
VISION P~T, UNDER NO CIRCUMSTANCES S~
~Y DATA H~N BE USED FOR CON~T~U~ON
~ FENCE LINEg, OR FOR EgTABLISHINB ~ND- ~~
ARY LIN~. DEAWN~
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AiND HUMAN SERVICES ~
P.O. BOX 196650, 825 "L" STREET, ROOM 502 ~
ANCHORAGE, ALASKA 99519-6650 ~73_0__~
0N-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950068
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:MCGOUGH MICHAEL J & RHONDA L
OWNER ADDRESS:9370 HILAND ROAD
EAGLE RIVER, ALASKA 99577-9411
DATE ISSUED: 5/01/95
EXPIRATION DATE: 5/01/96
PARCEL ID:07828102
LEGAL DESCRIPTION:
HUNDRED HILLS 1ST ADDITION BLK
5 LT 7
LOT SIZE: 106816 (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 C~PTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343~4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
~pril 26, 1995
MunicS, pality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Servi¢:es Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Alaska Water & Wastewater Services
"Preserving The Last Frontier"
Ref: Septic System & Well for Lot 7, Bk 5, Hundred Hil. ls S/O
To whom :bt may concern:
Attached is the application, site plan, and design drawings
for the sub~ect well & septic system. Comments are as
follows:
i. TRENCH DESIGN: As can be seen f rom reviewing the
percolation best results, the soil "perked" faster than 1
minube/~noh at the location proposed for the sysgem. There
~as a ~rge pocket of coarse gravel in 'tH ~l, but it was
surrounded by gravelly sandy soil. A sieve analysis '~OLllld
the surrounding soil to be c:Lassified as SW. I did not
net;ice any large pockets of coarse gravel in TH ~2. A sieve
analysis of the soil classified it as SW-SH. Based upon
~his information, I am proposing bo forago the use of ~ sand
fil~er, and use an application r~e of 1..2 gpd/f~2. S~.noe
~he proposed home will have 4 bedrooms, ~he total design
~low is 600 gpd. Based upon this, the minimum ameunt of
absorption area is 500 ftz. The proposed trench is 27 Sect
wide, 4 feel deep and 65 feet long, providing an absorption
area of 520 f~2. A 1250 gallon septic bank ~ ~ 1. 1 be
iesballed.
2.. GROUNDWATER: GroLIndwater was monit, ored 1t days a'l:ter
the percolatien tests were done, and nc) water was
encountered. Regardless, ib 5. s my intent. Lo monitor .the
groundwat, er immediately prior to construct, ion, during the
height of break-up.
L~. SURFACE: WATER: The majority of Ehe sS.~.e was covered
with snow during my site visi Es, bherefc]re, ib was not
possible to verify bha. t there are no surface war. ers. Per
the homeowner l;here is no surface waters wi[.hin 100 fee~..
Based upon l;he topography of the site and the porosity of
Telephone: (907) 337-6179 · Fax: (907) 338-3246 · 8471 Brookridge Drive · Anchorage, Alaska 99504
~.he soil I have no reason to ~;uspeot ~.here will
surface waters within 100 feet of the proposed
system. See the abtaohed photographs. Rega~-d]_ess,
fever&fy this during oonsbruo'bion.
be any
septic
I will
4. TOPOGRAPHY: Attached is a topographical survey_ There
are no slopes gr'eater than 25~ wit:h.in 50 feet of the
proposed septic.- sys'be~.
All of the adjacent properties are undeveloped at this time.
I am unaware of any negative impaots that this installation
would ~mpose on future adjacent, wells, or septic syst~ms.
If you have any question, please call me a 3~7-6!79.
Si rice rel
P.E.,
Owl-J~d/( ~nsu],tant
McGuffl.WPS
Lo'T' & D,K.
'2oo' oF u P(:::~
I oo"I~ 'v,,, ~.~
.~,o. LoCA-q"tOr4 of::: C.b~.J:~,Q-OtaT.~' ~
PERFORMED FOR=
LEGAL DESCRIPTION:
1'
'Municipality of Anchorage
· '/'~DEPAR,T,,MENT.OF HEALTH & HUMAN $ERVIOES
· 825 ' L Street, Anchorage, Alaska 9950.)-0650
sOiLS LOG -- PERCOLATION ,rEST
WAS GROUND WATER
· i~.:..N, CGUNTER ED ?
IF YES, AT WHAT ' ~t
DEPTH? ~
Deplh b Waler Alter N.I ,~-
i~onllorlng? · Dale:
SITE pLAN
/
Date
PERCOLATION RATE ,
TEST RUN BETWEEN
8
roil
line
Net
Time
{minutesJlnch) PERC HOLE DIAMETER ~3 if
,ER"ORM'~D'.OR=
LEGAL DESCRIPTION:
£
14
16
17
.18
19
2O
·Municipality of Anchorage '
WAS GROUND WATER
· · . I~;.N, CDUNTERED?
,,,
DATE PERFORI~.
tlon: h4
SITE .PLAN
/
;O'MMENTS
IF YES, AT WHAT
DEPTH?
0eplh to'Water Alter H [ ]~
/~onllorlnl]?
Reading
I,
' (~rol$ I Net
Date ~'lm. ' Time
PERCOLATION RATE ~'".___L
TESTRUN BETWEEN -- ~
Water
' Drop
_. {minule~/Inch) PERC HOLE DIAMETER _ ,
. FT AND ~ ~' ,, FT. '
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIOEL NES IN EFFECT ON TtlS [~ATE,
7'2.ooo (nov.
.. CERTIFY THAT THIS TES~, WAS PERFORMED IN
PROJECT NAME:
PROJECT NO,: 5186
CLIENT: AWWS
BORE~OLE/LOCATION: TH,I
SAMPLE NO,: 95-S-1
DEPTH:
GRAIN SIZE ANALYSIS (ASTM D422)
LOT 7, BLIP[, HUNDRED HILLS S/D
DATE TESTED: 4/21/9§
TESTED BY: TS
REVIEWED BY: RJPC ~
DESCRIPTION: Well
Phone: (907} 561-4085
EBA Engineering Inc.
907 East DowllnE Road~ Suite 27~ AnchoraEet Alaska 99518 ,.
SIEVE ANALYSIS TEST
SIEVE DIAMETER TOTAL %
SIZE (mm) PASSING
6" 152.4
4" 100
3" 76.2
2" 50.8 100
1" 28.4 95
3/4" 19 92
1/2" 12.7 87
3/8" 9.5 84
# 4 4,75 71
#10 2 49
# 20 0.85 26
# 40 0.425 13
# 60 0.25 8
#100 0.15 6
#200 0.075 4.8
HYDROMETER TEST
ELAPSED DIAMETER TOTAL %
TIME (mm} PASSING
0
0.5
1
2
4
8
16
$0
60
250
1440
% GRAVEL:
% SAND:
% SILT/OLAY:
D60-
D30-
O10-
Cc=,
USO:
FC:
% .02 mm
Fax: (907} 561-7071
28,9
66.3
4,8
3,24
1,06
O,31
10,7
.1,1
6.7%
SW
100.0
90.0
80.0
70.0
60.0
%RNERBY
WEK~HT .60.0
40.0
30.0
20.0
10.0
I00
lO
GRAVEL
#4
GRAIN SIZE DISTRIBUTION
U.S. STANDARD SIEVE OPENING8
#10 #20 #40 #$0 #100 #200
1 0.1 0.01
GRAIN SIZE IN MILLIMETERE
R~Nn L. 81LT AND CLAY
0.001
DATE PRINTED 4/24/95 REVS.'93
PROJECT NAME:
PROJECT NO.:
CLIEN.T:
BOREHOLE/LOCATION:
SAMPLE NO.:
DEPTH:
GRAIN SIZE ANALYSIS (ASTM D422)
LOT 7, BLKJ(, HUNDRED HILLS S/D
5188
AWWS
TH-2
95-S-2
DATE TESTED: 4/21/95
TESTED BY: TS.
REVIEWED BY: RJPD
DESCRIPTION',. Well'grd,~ gravel,
Phone: (907~ ,~1-4085
I
EBA Engineering Inc ..... I
907 East Dow//nE Road~ Suite 27r AnchoraEe~ Alaska 99~18 'Fax: (9.07~.~61-7071
I
SIEVE ANALYSIS TEST
SIEVE DIAMETER TOTAL %
SIZE (mm) PASSING
6" 152.4
4" 100
3" 76.2
2" $0.8 100
1" 25.4 96
3/4" 1 g 95
1/2" 12.7 84
3/8" 9,8 77
# 4 4.75 59
#10 2 44 '
# 20 0.85 33
# 40 0,425 25
# 60 0.25 20
#100 0,15 16
#200 0.075 11,2
HYDROMETER TEST
ELAPSED DIAMETER TOTAL %
TIME (mm) PASSING
0
0.8
1
2
4
8
16
30
60
250
1440
% GRAVEL:
% SAND=
% SILT/OLAY:
DS0.,
D30=
D10..
Ou.
USO:
FO:
% .02 mm
40,5
48.3
11.2
4.89
0,70
SW-$M ,T,D u ~,/-I
100.0
00.0
80,0
70,0
00.0
%RNER BY 60.0
WEIGHT
40.0
30.0
20.0
10.0
0.0
100
IIIII I I
I
lO
GRAVEL
GRAIN SIZE DISTRIBUTION
U.S. STANDARD SIEVE OPENINGS
_Ih , 1" -h
1 0.1 0.01 0.001
GRAIN SIZE IN MILLIMETERS
,RAND L 81LT AND OLAY
DATE PRINTED 4/24R5 REVS/93
I
II.
III.
IY.
Ve
INTRODUCTION
To fxctlitate platting .and development of 'Hundred 'H.~,lls
Subdivision, First Additon, YE] Consultants was retained to
complete this soils investigation. The investigation was
completed in accordance with Municipality of Anchorage Title 21,
as it pertains to developments with on-site water and sewer.
FIELD INVESTIGATION ~,
Test holes were dug during the peri.od between July'g and July']7,
1987, except for Lot 2, Block 4,. which was.du 6 .
I986. All holes were dun w t ~-~*- ,_'.? ~ S.e~t?.ber 24,
. t h a ~o~.uu, monitoring :ubes were
placed in the test 'holes on each lot and monitoring for
groundwater was a~compltshed between July 17 and July 24, 1987.
The locations of the test holes a're shown on the attached map.,
Test"hole logs and results of groundwater m
appendix, onitorfng are in the
SAMPLING AND TESTING
All of the samples were of the "disturbed" type obtained from the
wall or the bottom of %he test pits that were dug with a backhoe.
Results of all tests are contained in the appendix to the repor$~.~
GENERAL GEOLOGY .,
Hundred Hills Subdivision is located the South Fork.¥alley, wNt.ch
Is a hanging valley that extends several miles south and ~outheast.
from Eagle River Valley. The SoUth Fork of Ea'gle River fl'ows
toward the north along the floor of the South Fork Vatle~ ]'he
site is ~ '
alptne~ ~lopes range ~rom 5% or ~n~ ~. ~_~ . aract~ed ~as
the upperat a 2200-foot elevation and can' be ch ,
· ' .~ ,n uencn areas, up to '35%~tn
reaches which essenttal1~ are the 'slope~ of' the
surrounding mOuntains. The site generally has a. southwest
exposure to the sun. No evidence of permafrost was found in our
investigation. .
DISCUSSION
Sotls' generally consisted of sand and gravel overlaid by one (1)
foot of organic silt topsoil. We found some isolated pockets of
s41t and in some a~eas, the slltcontent 6f the gravel was higher.
However, percolation tests showed all lots to be suitable for on-
site septic systems. .
We encountered bedrock in two (2) loCations. One was the steep
hill area at the northern ~ortion of Lot 1, Block 5. Bedrock was
hit at a dep:h of four (4) feet, and the test hole was relocated
to Reference Point No. 310 {shown on attached map). The other
encounter with bedrock was at Reference Point No. 306. Rock was
VI.
found at a depth of 4 feet. A sec, ond test hole was dug at
Reference Point ~o, 307 to serve Lot 6, Block 4, and no rock was
encountgred at this location.
No groundwater was found in any of' the test holes either during
original logging or during the secondary monito~ing, e×cept~ as
noted below. We believe that the groundwater.was at its high
point for the year. This was evidenced "by the seasonal
groundwater, spring between Lots 2'and 3 in Block 5, which r~ns
approximately one (1) month per year and was runn.ing during our
investigation and monitoring period, Additionally, significant
rains occurred during the monitoring period.
A test hole dug on Lot 2, Block 5 in the vicin'ity of. the .spring
did encounter groundwater at approximately 6 ~eet, The test hole
was relocated to Reference Point No. 311'on Lot 2' and no
groundwater was encountered..
SEPTIC SYSTEMS
With the,exception of Test Hole Nos. 202., 209, 2~2, and ..227, soils
encountered in the subdivision percolated at rates less tham f
(5) mtnu'tes per inch. ~i~ means that sand f~ ........ tye
~ed on most -- ,~:ra will. nave
O~e~he ]o~ an equivalent of 125 square f~
per bedroom will required .....
Some of the test holes were given ~ vfs~al rating and subsequent
sieve .analyses showed these soils :o ac:u~lly be in the gM
range. ' However, similar soils were perc tested in the fteld and
found' to percolate at quite rapid rates, tn the
classification. . - vtsual
Locations of test holes on specific lots are described on the
enclosed table titled, "Test Hole Locations, ttundred Hills" and
are shown' on the site map included in this report.
O0 'S. ,
'099
MUNICIPAL, Pr C? 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
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
t~Y__~- '~ P---~'~P~ ~G-~H Day phone
Lending agency
Mailing address r,J/~_
Agent
Address /'J
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
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
X
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
5. STATEMENT OF INSPECTION BY ENGINEER
o
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 inform&tion 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.
Alaska Water &
Westewater Services
Name of Firm,,- .............._ .... Phone
Address ~_____~~ ~__.~/~~ //_,~-/~
Engineer's signature "-..J Date
/?/? .
DHHS SIGNATURE
/~/ Approved for z¢ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Mu~i(~ipality 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.
72-025 (Rev. 1/91) aGck MOA ~21
L
Legal Description:
A. WELL DATA
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division &~C4~ I V
825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907)
Health Authority Approval Checklist
~oT' --/3 12,V--, ~5"3 ParcelI.D.:
¢Vu,4~¢.,~--~ ¢Vlt, t..~ ~/~ ~ I
ED
Well type
Log present (Y/N) N ~==
Total depth
Sauitary seal (Y/N)
~:EB ~.0 1996
MuniciPality o~ Anchorage
Oept, Health & Human Services
If A, B, or C, attach ADEC letter. ADEC water system number
/
Date completed ~ I/c~ ~
Cased to '~tO Iq., Casing height (above ground)
Wires properly protected (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform ~ [:::> Nitrate
Date of sample: 2/l~/qlo ~A
B. SE~IC~OLD~G TANKDATA ~~
Date installed ~~ Tal~ size / ~
AT INSPECTION
. I ~?f/j~ Other bacteria
Collected by: ~,e:,l~J C=5 £
Number of Compartments'~
Foundation clemiout (Y/N) XJ~_,,.q Depressiou (Y/N) tOO High water alarm (Y/Il)
Date of Pumping NI ~ Pumper t',,2
ABSORPTION FIELD DATA
Date installed ~/~l ~clX' Soil rating (g.p.d./fl
Length ~ ~ Width R t_ ~ ! Gravel thickness below pipe
Effective absorption area ~"4-Z¥' Monitoring Tube present(Y/N)
Date of adequacy test
Results (Pass/Fail)
___ Cleanouts (Y/N) V
System type
!
Total depth -/'
Depression over field (Y/N)
For -~'~F bedrooms
FMd depth /" (ins.) Minutes later: / Absorption rate = / _g.p.d.
Peroxide treatment (past 12 months) (Y/N) / If yes, give date
Fluid depth in absorption field before test (iii.); / hnmediately ,after.-'""" gal. water added (in.)'/
Date installed .~
Manhole/Access(Y/N). ~...~__..~ le~~lp off' level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ~, I ~ /....~ On adjacent lots
Absorption field on lot I ID ~ ~ On adjacent lots
Public sewer main tx.) }t~ Public sewer manhole/cleanout
Sewer/septic service line ] 0 'q' ~ ''~ Lift station
SEPARATION DISTANCES FROM SEtYI'IC/HOLDING TANK ON LOT TO:
t
Building foundation I ~" 4- Property line ~EE; Absorption field
I
Water main/service line > I O Surface water/drainage ~' I © O Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ~ [ '*' Water main/service line ~'~ C) ~ ~ ~-ou~;~
Surface water 2~ }CBC) Driveway, parking/vehicle storage area ~- t._~
,
Curtain drain t'4 Wells on adjacent lots '"" ~ I O O Property~ line }O /4-'
F. ENGINEER'S CERTIFICATION /[
in con/brma2fce with/~OA,dI, ffA ~eline~ in effect on this date. r ~ ~
/
.............. ~ ...........................................................................................
HAAFee $ ~C."LD,(DcD
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
CT&E Environmental Services Inc,
Laborato~ Division ~,¢'.~.,~,~;,~,-~.~'~;,¢i.~:,~--¢;.~: <
, O,,J Drive
Drinking Water Analysis Report for Total Coliform Bacteria 200
Arlchomge, AK 99518.150::
READ I. VSTRUCTI03'$ O.V R.~VER~ SfDE BEFOR~ COLLECTLYG 3,43fPLE Tel: (907) 5~2.2343
PRIVATE WATER SYSTEM
~'-;e,,, R.s,,,,.,. ~ .v,,~/m.,,,','e ]~~
C~ ~C;gnd [nvOiCg
S.-L,',[P LE DATE:
3[on(h
SAMPLE
Routine
Repe~t Sample (for routine sample
wi~h lab reft no, )
Sped~l Purpo[e
Y~ar
Trented Water
Untrea,ted Water
Time Collected
Collected By
Fax: (907) ~6~-3301
TO BE COMPLETED 8',' LABOP~.\TCF.':
Analysis shows ~hi~ Ware,~ SAMPLE ~o bo:
Sample over 30 hours old, results may
be unreliable
not b¢over 48 houei old ~( ~xaminafion
to Md(care reli~bN resuk~, Plea~
new sample via spe:iai~liv¢9 m~ii,
Tlm~
Analysis B~gan ( ~ ~
Analvtieal Method: ' '
,..,.¢Zt~,Mem o r a ne Filtc:'
Number oFcoionies,:100 mi,
Client notified of uns~tisfactoC,' results',
Time.:
BACTERJ'OLOGICA_L WATER .A2q,-~T, Jf$l$ R.ECOR.D
MMO-3FUG Result: Totol Coliform
,Membrane Filter: Direct Count
'V'erifi~ation: LT8
Fe¢~l Coliform Confirmntion
BGB
£, Coil
Om m Co(oriies/100 nil
CO LIFIR.'.I.
~,~TC ' rot; ,%t,~¢r,,,~. '
Final ~lembrane
R~ported
Collfq,~m/100 mi
CT&E Ref,#
Clicm Sample ID
Matrix
CT&E Environmental Services Inc.
Laboratory Division ~,~,~r~rj~_~,~,~r,~xr,~ar~,,~r~r~r~L; '
Laboratory Analysis Report
960452,158i Collected Date 02/08/96
L7 B5 Hund Hills S/Dt0452-01
Drinking Water Technical Director
Smnple Rerharks:
QO
Re*uLts Oua[ cOL Units
,1~8 ,1
.100 U ,I m~/L
~PA 353.?. NO,IN 02110/96 08/10/96
EPA 553,2 NO~/N 0~/12/96 02./12/96
200 W. Potter Drive, AnChorage, AK 99518-1605 -- Tel: (907) 862.2343 Fax: (907) 561-5501