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Home My WebLink AboutWEST ADDITION KNIK HEIGHTS BLK 2 LT 1We t Addition Knik H ight lock;? Lot 0 7-37! -35 MUNICIPALll'YOF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'I'ION ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet-Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT ~]AI LING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS ---[ .... ~Well ~bsorption area qDweHing PERM~ NO. ,, DISTANCE TO: I ~ ~ IDISTANCI ): ] ~_~_.~ L____~ __ ~ ] Manufa~urer ~ ~ ~ ~Matef~l~ No. of compartments ~' [ Liq. ca(~city in gallons f~ I W~dtb L(uddept~ , ~ ~ I IF HOMEMADE' ' _ _. '-' ~ ~ k ;isTANcETO. IWe,l Dwelling PERMITNO. ~ ~ ~ ~Manufacturer ~ateria, Liquid capacity in gallons ~ ~ z/No. of line~ / Length of eacb line Total leng~ of Jines I Trench widtl~ Distance between Ih~es ~of ti~ to finish erade - ~ Material beneatb tile ~ Total effective absorption area ~ I ~ngth Width Depth PERMIT NO. - I ~s*~c[ro2 ........ / ........ --'~-- ¢'~S Depth DTiller [ Q~sta,~c~ to ,o~ ,~n~ ~NO. I OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER R EMAR KS APPROVED DATE LEGAL IHE L..E:NI:3q !..I !:::, :I: i'"!E:i'..!li":: :[ (::q'.,! :i: :~; "i"1-..I~:!: L. tE!'.,!GTH 'i'!-!i!:~ E:,i:!i:F'TH Cfi:: i::~ Ti;ifli:i'.,!(::H (:!!:i: i:::':~"!" :I:i~:; "i'HE D]:Si'FIi'.,!E;I::: I:i!fi:E'f'HE:!:~:i'.,! r'HE SUi:;;;F'FK:::E: (:!F' ()iF;:(:)LJF!!:::, Fff',![::, THF: E',CJT'T'CH'"! (:i,F THE L:i:::'::E:I:;IVF::IT':!:EE'! T'!.'.!EI:,;:E ]: :iii; !",i(::! L:;l::.:'r' i.,.! :!: DTI-! i::;'EiFi: T'Fi:EN(i;~ IE:S. THE: (:~F;i:Ft',,,'E:L. DE.r::'"t'H :I:S TH'E: r,! :[ N :i: P'tU!',! I:::,E:F:'TH OF:' !::;1i'.,!i:::, 'TH!i!!: I:~E!T"i"Oi'! (::E:: "!'H!E E:i:.:iCFIVI:::!T:[!:::!I':! ,::J:N ~::'llii:!~ii:'i"::,. :I: (:::i:ii:!:;:T :[ !:::'¥ 'I"HI::iT :I..: :1: Fti"! !::'Flh'l :[ !... '!: !:::ff;?. H:["i"H '-I'I..!E: l:;~:[.!i:!:;:!i...l:!:F;~%i',!li:.k!'T'S i::'(::~!:;i: ON..-.:!::[ TIE F(:)Fi'.TH !.iiF'r' THE: I'"!UN :!: E: ]: PR!.. :i: F'¢ (::~F: ;2: :i: I,.! :[ i..L ~: t",!'.:~;TI::!L.i._ '!"HI:E :~:;"r':E;"~E:i"'l :[ hl !:::!(:;C;E~F~:DFli",I(:::E: !'! ]: 'i"!'"1 !1"!1:: :~:: ]: i. JNI::;'E:F~:STFff',![::' 'T'HRT THE: ON'"':~;]:T[: :~;!EI'.!E:I:~: ::;"¢S'!'E:i"I I"ii:::iV F~:E:(;HJ ]: !:;:r: ENi..F:ff;~GIEFff~:i'.,Fi' :~:i:::' ]HIE ........... ,. ,..~ ....... ,--v ....................................... ~-~..-~., .......... , ......... ../-~ f R & M No. 562082 .-'[ Yh' C lq 0 R A.G E ~. Joe Dremer Ocean Technology, Ltd. 2502 West Northern Lights Blvd Anchorage, Alaska 99503 Test Hole and Soil log report for Sanitary System Lots 4 & 5, Block 1 and Lots 1, 2, 4 & 7, Block 2 West Addition Knik Heights Subdivision Dear Mr. Dremer: We are submitting herewith the boring logs, percolation results and our conm~euts regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of September 23, 1975, and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A total of six test holes were drilled at the locations shovrn on the at- tached location diagram. Ail[ test holes were drilled for defining general subsurface soil conditions and five additional test holes were drilled to a depth of ].2.0 to 18.0 feet for the purpose of runniug percolation tests. Excavation x~as accomplished with an auger type drilling rig. As illustra- ted by the accompanying logs~ the soils encountered indicated a somewhat erratic subsoil profile° A water table was not encountered in any of these test holes. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to tiaa above, please do not hesitate to contact us. Very truly yours, Vice President JWR/[¢ED / j a Encl, xc: GAAB TH-10 10-1-75 ORGANIC S '0.0' -0.5' SILT TRACE SAND (~fL) 3,0' S;~NDY GRAVEL TRACE SILT (GW) ].0.0' SILTY ,qANDS TRACE GP~&VEL 1.3.0' SII,T TRACE SAN]) NO WATER TABLE 20.0' T.D. represents location showqa on Diagram A01 Consultants Inc. ~.CHO~AO~ ~^,.~^.~= ALASKA JUNEAU OCEAN TECIhNOLOGY LTD° Log of Test Hole Anchorage, Alaska .0-2-75 [SCALg 111=31 IOWN ~¥ ~FED [c>~o s¥ ~,'~D ~oJ. NO, 562082 ]OW~ NO, A04 Leyden Fairmont Road R Consultants lac. ANCHORAGE FAIRBANKS ALASKA JUNEAU 8-8-75 1"=200 PJ OCEAN TECHNOLOGy LTD. LOCATION O I AG Pdl~H ANCHORAGE, ALASKA 56208~o ~o, ~-n~ MEMORANDUM DATE: TO: FROM: SUBJECT: May 4, 1982 Laura Crow Senior Office Assistant Request for Refund - Account ~2460 Please make arrangements for the following refund. The applicant had a private engineer perform the inspections of the installation of ~he on-site sewer system. Receipt It 177804 Account ~ 2460 Amount ~30.00 For: Lot 1 Block 2 Knik Heights West Subdivision Pah Wolfe Star Route A Box 60-G Anchorage, Alaska 99507 Thank you. ( Laura e. Ward Senior Office Assistant Sewer and Water Program 91-010 (5t78) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Pleo6e complete either Io~ lb or lc.) A.D.L. No. la.JJBorough Subdivision Lot Block I~.J I/4qlr$. Section No, Township N[~ Rango E~] Meridian -- o~'__ at__of -- S[] W~] ,c.lj DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL;. ~ Street Address and Are. of Well Location ~--Z~, COMPLETION 2. WILL LOG FeefSurfaceBelow 4. WELE~DEPTH:ff.(flnol) 5. TE OF/~_ -- Materiel Type Top Botlom /~.~r, ~m,~ _ ~ 7. USE:/mOomeaHc O Public Supply O Industry '// ,,0..-6 ,., o,,,, diom.~in, fo___ ft. Depth SHckup 9, FINISH OF WELL', Sel between ft. and ~,~. Bock filHng Grovel poc~ Equipment used II. PUMPING LEVEL bolow land surface and YIELD ~UNIcj~I~ O~ L~ft. after,~ hr,. pumping ~ g.p.m. tM~,~~T. o. ,._A~C~O~GE -. .~.~ ~s. p.mpi.~ . ,,~UN~E · ,~CAL '?~C1'10N Material; ~ Neat Cement ~ Other: --__ ~ ~ ~ · . Length of Drop Pipe fl. cepocily g.p.m. T 14. REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION; 15. Weler Temperature _~o ~ F ~ C This well was drilled/~der ~y ~risdlclion on~lhis reporl is true lo the best of my knowJedge and belief; /~ Registered Busin;ss Nn~e ' · -- ' Contract License Number } ' . ~ ~ ~ . . Form OS-WWR (11/81) Copy Distribution: WHIT[-Stofe D~8, PINK-Otiller~ CANARY-Customer M LI N :I: C I I:::' F.'~ L ]: T '/' (::) I::: A N C I'"1 0 I::~ ~tl (3 Iii: !325 L. St.r.e:et., r~r'lc:hc-max;:je~, ~:l. asM.::a ~Yc7501 :::.!;.q.:::.;-...4.'72. C) El N .... !!; ]: '1' Ei 14 IE L. L. F:' lie [::;: I¥1 I T I:::' a )* c ~, 1 I d:0 ]. '?'-... 37 ]..-:55 L.c)'L L..e g ;a 1: Sc.th (::1 :i. v i ~ :i. on ~ I<1~1 ]: I< 14E I (~H"f'S WE~T Lot. J.ot. S:i.:.ze~ 4.8834 (~C:l,, F'L. of ac:r"e~i~) Max ]3~?d p c:)om~ ~ 'T'h :i. ~ I:::'~r' nl i 'L ~ 3 Tci'L a 1 Cap ac i t. y ~ Day F:'l'lc~r'~e: :~ ?";/4 t5 .-'7 4 5 6 B ]. oc: k: 2 NE:L.I...~: I...c)g rnLts~H:. I::)e'? ~ubrnit.'Led t.o Mur~:Lc::i. pali'L¥ c)~ ~::~r'ic:hcH"age :0epar't. me~r'rt:. (::)f' I'Je:alt. h a'd"ld I"Ju.(f~ar'l ~;i;.~r'¥:i.c:e.w.:, k,,]:i.~LJ'h :i.l'l :!!;() da"¢~ IgC' ~,~(~]. ]. (::{::)/'rr~:) ].c-~t. :i.c:,lq. ['HIS I:::'IEF;:M]:T li!i:Xl:::'IJ::;:lES IEX'.l;!i;'l'IIq(.} WELl... !3HC'.IWN C]h.I SUBM!'T L..I::IE) I;::'OR NE:N Wt:ii:L..L. ~I'TH]:N 30 ]: CE:I::~.T' :1: FrY 'T'FIJY[: :l.,,i am fam:i.].ial' wi'Eh t. lqe! r'(.:~qt.~ir'~me~r'Yt:.~ for' or'~.-.-~it.~ ~ew(.'..'m~ ancJ w(.:(.~].l~s as ~;~'t'. ¢cx't.h by t.l"~e IdLu'aic:il::)a].ity c:,f' (M']chor'age (MO(.~) arid 'Lhe> S'La'Lc,~ of' F.~la~l.::a, 2, I ,~:i. ll :i.r~srLa:l. 1 'Lhe~ s;sysst. E,)m ~,l"1 AtC::C:Of'EI~ArMzE,) w:i.'Li"~ all MOA alqc:l :i.n ccmq:~liarl(::e ~,,~i'[.h t. Jq(~ c:le}~gn c:r'&t, el-ia c:)F t.h:L~ per'mit.. :5. I w:i. ll aclh6scr'e t.o all IdC}(.~ alq(:J ~;t, at.e of' ¢.~:La~;ka I'eqLtir'e~me~r~t.~i!i ~'OP t. he ~;et, lc)ac:l< ~il;(,},,)L~J(.'.,:,:,i"~g~:¢~ fisyss'[,6;qfl C)t"1 '[,J"JJ.~; (:ir' CAl"ly acl.jac:e)n'L (:~p iqear'by ].c)'L,, any enl. ar'g~m~;~n'L t,,~il], r'eqLtJ, r'e o.n addit.:Lorial Q6H"tYi:i.'f .... / "on'n::' .... 8400 Hartzel[ Road Anrhorage, AK ]ANIE E. OLSEN REALTOR® Office: 904-344-0501 Home: 907-248-0899 1~530 ~cho Stree~ .Anchorage, Alaskc~ 9953R /-07' :L .S ID MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section ~ "' ~' ......... P,O. Box 196650 Anchorage, Alaska 99519-6b-~)~'~ONMENTALSERwCEs~ DIVISION 343-4744 FEI) 1 911 Parcel I.D. # .o,2-.-r- 3 7 1- 3 5 CERTIFICATE OF HEALTH AUTHORITY APPROV^L F,OR A S,N 'E FAM,LY OWELL,NC RECEIVED HAA # ~&~OOZS 1. GENERAL INFORMATION Complete legal description Knik Heights West Lot 1 Blk 2 Location (site address or directions) 12081 Elmore Rd. Anchorage, AK Property owner5°hn Simpson Mailing address12801 glmore & Michelle Liebold Day phone 907-345-5866 Rd. , Anchorage, AK 99516 Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: --3 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng 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 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. NameofFirm F, a9]~ R~v~r Rnglnp~r~ng Services Phone 907 594 5195 Address PO box 773294, Eagle River, AK 99577 Engineer's signature Date ~-/-~ -?F DHHS SIGNATURE · X' Approved for J~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 courtesyto 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) Back MOA ¢r21 Municipality of Anchorage .......... ,,, '-, - ........... DEPARTMENT OF HEAL-r'H & HUMAN SEf~[t{~'/+~NI'AL $~RVICF.,S DIVI~IO, N Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 3~--~;'4~;~ ~}~ RECEIVED Health AuflnorJty Approval C;lnecklist Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~-2- ~ "8.2. Tank size Foandation cleanout (Y/N) Date of Pumping .~ C. ABSORPTION FIELD DATA Date installed {/' Length ,,9, ~ t Width Date completed ff~ ! q ~ ~' ~> Cased tO [ ].,~ r Casing height (above ground) ~e_)' Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION --/q~ ~r /-gq,- ~ g.p.m, g.p.m. Nitrate /,,~X ,,,s~/z, Other bacteria Collected by: /~o o?a/Number of Compartments ~, Depression (Y/N) .,,t./o High water alarm (Y/N) Pumper Effective absorptiou area 7_.6"~ Date of adequacy test I-~ Fltdd depth in absorption field before test (in.); ~'~' ~ hnmediately afterg~'~ gal. water added (in.): Fluid depth '~ ~ (ius.) Minutes later: CtT~ ,q,'~ Absorption rate = --k- qS'O .g.p.d. Peroxide treatment (past 12 months) (Y/N) /4.~cO If yes, give date Monitoring Tube present(Y/N)/ Results (Pass/Fail) Depression over field (Y/N) For '-~' bedrooms __ Clealroots (Y/N))t~:S Soil rating (g.p.d./fl2 or fl2/bdrm) ~5-' ~'~,/,.~, System type ~' "/ Gravel thickuess below pipe ~"..2, * Total depth Legal Description: A, WELL DATA Well type Log present <~q'q) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number /12/$3 D. LIFY STATION go Date_h~stallcd Manhole/Access (Y/~I'~'----- -- _ High water alarm level at* Cycles tested SEPARATION DISTANCES Size in gallons "Pump on" level at* "Pump oft" level at* ....... *~Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot .4-- Absorptiou field on lot Public sewer main Sewer/septic service linc 4'.5-~ On adjacent lots On adjacent lots *' l ~' Public sewer manhole/cleanout /,f,//4 Lift station /4/',.,4 SEPARATION DISTANCES FROM SEPTIC/HOL-Dt'N~ TANK ON LOT TO: Building foundation /'/~' ' Property line ,t'-J-"~' ' Absorption field Water mai~ffservice line /4/',M Surface water/drainage * t~ o Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation O"J- r Water main/service line Surface water 4-/,~ dY Curtain drain /b"./] Wells on adjacent lots Driveway, parking/vehicle storage area · .~- ac-co Property hne F. ENGINEER'S CERTIFICATION I cert!/.P &at I have determined thrufield inspections and review in con,/brmance with MOA HAA gui&lines in effect on this date. Signature~ :--~~ Engineer's Name Date ~--/.& ~ CJ],67.36 HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Paylnent Receipt Number Rev. 8/95 eSS: haa.wk.doc CT&E Ref.# Client Name I'rojm Client Sample ID Mat~ Orffered B~ PW~ 9J~¢425001 Eagle River Bngmering Knik 1-1ts We~t El B2 t~ik ltts West L1 f32 BfpJfiag Wa~er 0 Sample Remarks: Client Printed Date/Time 02105/98 17:1 l Colle~t~l Date/T~me 01/29/98 13:25 R~iv~ Date~ime 0I/g9/98 14:0fl TMmical W~r: Stephen C, Erie Units 1 ~53 o 5PA ~.0 10 mag (11/29/~fl ItgV MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE ('~ J '7 - · ;~ ,'//" £NVIRONMENTAL SERVICES DIVISION DEPARTMENT OF HEALTH & HUMAN SERVICES - DIVISION OF ENVIRONMENTAL SERVICES JUKJ ]. 5 }gI~RTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL J.JL~--l~)~q~j~q OF ON-SITE SEWER AND WATER FACILITY R E C E IV E D 26.,4. Application Date ~'/'/,..3' /,~ GENERAL INFORMATION (MUST BE COMPLETED PRIOFI TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) I a~o I (b) Property Owner I.,f~cfl(~c¢' /-Or~ Telephone: Home 5'q~- 7¥~'~ Business Mailing Address J ~OI ~ ¢~ ~ ~c~o~ ~ (c) Lending lnstitution ~¢~ ' /. ~a4 ~ O~ ~{~ J~ Telephone Mailing Address ~or ~ ~ ~ ~ (d) Real Estate Company and Agent ~R~ ~/~ ~n~ Address ~OO ~rfz~(I ~ ~c4or~e ~ ~o7 Telephone ~ ~q~ ¢~/ (e) Mail the HAA to the followino address: or: Check here [~, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family [] Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public [] Note: It community well system, must have written confirmation from the State Department of Environmental Conservation altesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 77-025 fRev 8/861 Front 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 water supply and/or wastewater disposal system is safe, functional and adequate for tile 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 F(¢¢("/¢~1° ¢'"'¢¢/1~"f r..~z./' ..¢~r'~'f¢-~¢ Telephone Address __ Engineer's Seal DHHS APPROVAL / Approved for'¢¢¢(- Jbedroomsby Approved ~" Disapproved Conditional Terms of Conditional Approval Date CAUTION ']-he Municipality of Anchorage Depadment of Health and Human Services (DHHS) issues Healtb Authority Approval certificates based only upon the represenlations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does th is as a courtesy to purchasers ol 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. Page 2 of 2 72-025 fRev 8/86) Back MUNICIPALITY OF ANCHORAGE FNVIRONMENTAL SERVICES DIVISION JItN 1 5 1988 RECEIVED WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: Well Classification Ipr'~'f/~ ~-~- Well Log Present (Y/N) ~ __ Total Depth //~ Cased to Static Water Level ~"~ ! Casing Height Above Ground __ r~/ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line If A, B, C, D.E.C. Approved (Y/N) Date Completed J-~ 1¢)~ Yield ! 1'~ Depth of Grouting /,/, Y Pump Set At I1~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Nt~J. Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) ; On Adjoining Lots ,r~ too ' I$0 ' ; On Adjoining Lots ~' /00 / __ To Nearest Public Sewer Cleanout/Manhole hi,/J-, To Nearest Sewer Service Line on Lot I',/,,4. Water Sample Collected by ./~d~J¢~¢'"' · Date Water Sampe Test Resu ts ~~ , '~ ~ /~~ . - .-. { , .' Comments __~ ~(1 ~nl(e~ /~ ~ b~t~¢ SEPTIC/HOLDING TANK DATA 2~ Size lO0o~ No. of Compa~ments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y~M) N Date Last PumpCd--¢'~/ ~ A. ; foF ..... Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ~ 5'o' To Water Main/Service Line Course Temporary Holding Tank Permit (Y/N) ~, 4-, To Building Foundation ~' To Disposal Field I~" ' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026 fRev 8'861 Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~//8¢/'~ '~ Width of Field Af~ Square Feet of Absorption Area Depression over Field (Y/N) N Results of Last Adequacy Test Separation Distance from Absorption Field: ~" /,"~:¢(r~ Type of System Desig n -/"rlCn¢ 4 Length of Field ~./ Depth of Field l~ Gravel Bed Thickness 6" t Standpipes Present (Y/N) ~" ,/ / Date of Last Adequacy Test ~"'//~ /~'/]' L,/ . To Properly Line ¢'22 ' To Existing or Abandoned System on ; On Adjoining Lots ;> $O ~ To Cutbank (if present) A/, ~ ;~ (OO~ 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 D. LIFT STATION Date In'stalled Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Company Receipt No. /,.,0 ~,.2_., Date of Payment Amount: $ "/~//'~). Page 2 of 2 72 026 IBev 8/861 Back CHEMIC. AL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SA~LZ for Work Order $ 7197 Date Report Printed: JUN 13 88 @ 14:47 Client 8ample ID:L2, B1 KNIK HTS. PWSID :UA ~ Col¢cto~o~d3ON 10 08 @ 11:00 hrs.~ gec~d JUN 10 88 Client Name : ALPINE DRILLING Client Acer : ALPINET P.O.# NONE REC'D Ordered By : DAVE llARPER Analysis Completed :JUN 13 88 Send Reports to: Laboratory Sup~r~:STEPNENC~EDEF. nv../ I)ALPINE DRILLINO Released By : X~'-2~-~-~ 2)FLATTOP TECNNICAL SERVICE/TED MOORE Special Instruct: Chemlab Rof ~: 1377 Lab Smpl ID: I Matrix: Water Allowable ?a~amotor Tested Reault/Umts Method Limits NITRATE-N 0.73 ms/1 EPA 353.2 10 Sample ROUTINE SAMPLE Ramrks: SABLE COLLECTED BY DLR. Test~ Performed ' Soo Special Instructions Above Uh~Unavallable None Detected "See Sample Remarks Above Not Analyzed LT-Less Than, GT-Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 562-2343 5633 B Street / TELEPHONE (907) Anchorage, Alaska 99518 Drinking Waier Analysis Report for Total Coliform cte'ria [] P~IVATE WATER SYSTEM N~rne % - ' / ~ Phone No. / ' Mailing Addres~ SAMPLE D~E:Day SAMPLE TYPE: /~ Routine Check Sample (for routine with lab ref. no. E~ Special Purpose sample ) [] Treated Water /E-J, Untreated Water SAMPLE NO, LOCATION I Time Collected Collected By TO BE COMPLETED BY LABORATORY sshows this Water SAMPLE to be: factory [] 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 Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* I/ f?2 I FF1 Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC = Too NumberousITo OB = Other Bacteria BACTERIOLO61CAL WATER: ANALYSIS .ECORB Membrane Filter: Direct Count Coilform/100ml Verification: LTB Final Membrane R ults Reported By , . _ . BGB ~ Coilform/100ml iTime: /,~¢2g) a,m. Count PART 1 OF 2 REMAINDER TO FOLLOW MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date. Y~',Y ~¢'/ /'''" ~ ¢2 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner ~/~tf¢tt /~or¢:~ Telephone: Home 3' tI.5---TYS-5" Business Mailing Address f~/ ~ ~ ~or~w ~/~ (c) Lending Institution ~ N~f'/ ~ ~/ ~ Telephone 9.?¢- lt~8 Mailing Address ~r~r~ ~¢ft~ ~ ~ (d) Real Estate Company and Agent ~ R~ R~(~F ~r - ~m~ 0/~¢~ Telephone ¢ ¢¢ - ¢~ 1 (e) Mail the HAA to the foHowin~ address: or: Check here ~, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family [] Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72-025 trey 8/861 Front 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 water supply and/or wastewater disposal system Js 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 F'(~z¢'¢O/¢ 7'-~¢,4~;~/ ..Cwrw'~t,~, Telephone Address I?'¢-.,3c~ ~'c~4~ 5"~.,./ ,A/~c~/¢,~¢¢ ,,¢~r ¢¢5-r ~" ~' Y..('-/3,4-% Engineer's Seal DHHS APPROVAL Approved for ,~~bedrooms by Approved ..¢¢~'~ Disapproved Terms of Conditional Approval Conditional Date CAUTION 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 Anohorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/86) Back 1988 RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4744 Legal Description: Well Classification Well Log Present (Y/N) Total Depth I I ;~ Cased to Static Water Level '762 Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption*Field on Lot To Nearest Public Sewer Line M,A. Cleanout/Manhole N, Water Sample Collected by '77. F'. M Water Sample Test Results Comments i'm'l', & ! ~tP If A, B, C, D.E.C. Approved (Y/N) N,,4-. Date Completed 5//8-9/~¢ ~ Yield __ Depth of Grouting pf,/k Pump Set At '.:=' Io ¢/,r Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) ~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date tO tort-fo,-,,, //oo ,*I .~ O, B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) tr' 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 t~-0 To Property Line ~ To Water Main/Service Line Course .~ (Od Air-tight Caps (Y/N) N,A. N, A. Size ~Q~_cr/ No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped $-/ 8. O ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field to"' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026 IRev 886~ Fron~ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ¢¢/ £.e / ¢ 2 Width of Field ~f~" Square Feet of Absorption Area Depression over Field (Y/N) N Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /,,i,/I. 1~30(r~ Type of System Design '7-re'/~c Length of Field '~ 2 ~ Depth of Field Gravel Bed Thickness ~' ~ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line 5-0 ' To Existing or Abandoned System on ; On Adjoining Lots '> Yo ~ To Cutbank (if present) To Water Main/Service Line N, A. To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION ~J,,4. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed d"~'~ ~ ~ Date 3-'/~¢?'Z~0 Company Receipt No. Date of Payment Amount: $ MOA No. Page 2 of 2 72 026tRey 8/861Back ~' ~'~ ~ ~ ~-~:?'* .... ,'-~"A Engineer's Seal ~ ~:-.. -. c~ - 3589 .' ,.,;. zz CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONF (907) 562-2343 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I~ PRIVATE WATER SYSTEM Name Phone No. Malhng Addcess · City State Mo. Day Year Zip Code SAMPLE TYPE: ,~ Routine N' Check Sample (for routine sample with lab ref, no. J-/t$/~:,F _ ) J Special Purpose [] Treated Water i~' Untreated Water SAMPLE Time Collected NO. LOCATION Collecled By 4 L J TO BE COMPLETED BY LABORATORY Cnalysis shows this Water SAMPLE to be: ~Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Dato Received Time Received Analytical Method: Membrane Filter No. of colonies/100 mi. Lab Ref. No. Result* I I Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By TNTC = Too Numberous To Count OB = Other Bacteria BGB ~)_ .... Coillorm/lOOml CHEMICAL _&_ GEOLOG(CAL LABORATORIES OF ALASKA, ,~.~,,/'t,~io~,~'o.',r~s;~,~ FEDERAL TAX ID # 92-0040440 Client Sample ID:LI, B2 KNIK HTS, PWSID :UA Collected 1,~Y 13 88 ~ 11:15 hrs. Received 1~¥ 13 88 @ 12:00 hrs. Preserved with :6 DEG. C Analysis Completed :t,BY 16 88 Laboratory Superv~sqr :STEPHEN C. EDE ~ Released By : ..q~ ~;;'~ / ANALYSIS REPORT BY SAMPLE for Work Order I~ 6641 Date Report Printed: t4AY 17 88 ~ 15:55 Client Name : FLATTOP TECIINICAL SERVICE Client Acct: FLATTOT P.O.~ NONE REC'D geq ~ Ordered By : TED MOORE Send Reports to: 1)FLATTOP TECHNICAL SERVICE 2) Special HOLD FOg PiCK UP. Instruct: Chemlab Ref$: 1021 Lab Smpl ID: 1 l~atrix: Water Allowable Parameter Tested Result/Units Method gindts NITRATE-N 0,35 mR/1 EPA 353.2 10 Sample ROUTINE SA~4PLE Remarks: SAMPLE COLLECTED BY T. 1400RE i Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT~Greater Than WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol A Geophysicol Surveys LOCATION OF WELL (Pleose complele either Io, lb or lc.) l,orough u ,.o, B,o:, ] Drilling P .... if No. AID. L. No. Section No. Township N[~ Range EE~ Meridian WE} - S~'~ l 'l DISTANCE AND DIRECTION FROM ROAO INTERSECTIONS ~. OWNER OF WELL: ,},) ,,~,) . Address: ~'~ Street Address end Area of Well Locolion 2, WELL LOG Malarial Type Feet Below Surfoce 16. WATER WELL CONTRACTOR'S CERTIFICATION: 6. ~ Cobl" tool ~] Rotory [] Driven [] Ouq [~ Auger E~]detted I~ Bored L~other: 7. USE:,~ Oomeetic [] Public Supply [] Induslry [] Irrigation [] Recharge [] ¢ommericel [] Test Well [] Olher: 8. CASING: [] Threaded ;[~ Welded diem, ,ii in. to /'" ;.. ff. Deplh Weight '~' lbs./ft. diem, in to fl. Depth Stickup__ ft. 9. FINISH OF WELL: Slot/M'e* h Size:. Sol between Longlh: fl end ft. Bock filling Grovel pack I0. STATIC WATER LEVEL: fl. [] Above or ~-] Below lend eurf(~ce Equipment used: Date II. PUMPING LEVEL b~low lend surf~ce and YIELD ~"{;" .;ft. after : hrs, ])umping ' g.p.m. ft after hrs. pumping glp.m. 12.GROUT NG Well Grouted: [] Yes [] No Material: ~ Neat Cement [] Other: PUMP: (if available) Htr) /,' ~: Length of Drop Pipe ft. capacily glp. m. [] Subm. [] Jet ~ Cenlrificd L~ Other 15. Water Temperature .... o [] F [] C This we[ was drill,ed under.my ju isd cllon and this report is true to the best of my knowledge end belief; ,'. Form OZ-WWR (11/81) Copy Distribution: WHITE-State DGGS, PlNK-Driller~ CANARY-Customer ApPLI( FILLS OUT UPPER HAt ONLY ~. ~ .,~.~/,:! /~.') Phone Pr~!perty.Owner ~-~ Buyer ~ddress :T~D ~-~?~ -, Zip Code,r Lending Institution ~2z~/~,~ ~'/',d~: ) t.p,/'~ r~ Phone Realty Co. & A~nt Phone Address Zip Code Legal Description Type o~ Resi~nce ~ SinCe Family ~ Multiple F~mily No. of B~drooms. ~ Other Water Supply ~ I~dividual ATTACH WELL LOG. A w~l Io~ is requi~ed for ~F) wells drilled ~ince Ju~e 19Z5. ~ Community For wells drilled prior to that date, eve w~ll d~pth (attach Io~ if available). ~ Public Utility Sewer Disposal ~1 Individual Year Individual In,tailed: ~ PMblic Utility When Connected to Public Utility: ~ Holding T~nk NOTE: THE iNSPECTION ~EE MU~T ~COOM~ANY ~ACH RE~T BEFORE ~OCE~ING CAN ~E INITI~T~. Time Time Time Time ~_.~,,~Dte ~.~W~'' ~ ¢ Date Date Date Inspector Inspector Inspector inspector Field Notes: ~ ~3) APPROVED BEDROOMS~ 'CONDITIONS OF APPROVAL (. ) DISAPPROVED ( ) CONDITIONAL APPROVAL' BY: ~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~ ~'~ Well to Tank Septic T~k Size CHEMICAL & Gl ',OGICAL LABORATORIES 'ALASKA, INC. -- TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER ' 274-3364 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I,D. NO. Water System Name Phone No. Mailing Address Zip Code City SAMPLE DATE: MO. State Oay Year SAMPLE TYPE: E3 Routine [] Check Sample (for routine sample with lab ref. no. ) [;3 Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~ Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No, Result* J *No ofcolonles/1OOml or No of Posrtiveport~ons Analyst = READ INSTRUCTIONS BEFORE COLLECTING SAMPLE O6-1220 (b) Rev, 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected source _ Date Received__ Time Received p.m. Lab. No. ~resumptlve 1Omi 1Omi 1Omi 1Omi 1Omi 1.0mi OJ. ml 24 Hours 48 Hours :onflrmatory 24 Houri 48 Hours EMS Broth 24 hours= Multiple Tube Report: 3[Ornl Tubes Positive/Total 3. Omi Portions Membrane Filter= Direct Count Collform/lOOml Verification= LTB BGB Final Membrane Filter Results , Coliform/ZOOml