HomeMy WebLinkAboutMOUNTAINSIDE VILLAGE BLK 2 LT 1Mountainsid
Villag
lock 2
Lot I
020-172
-09
~t~,~ MUNICIPALITY OF ANCHORAGE
i/~O~ ~.~ ~ DEPARTMENT OF HEALTH & ENVtRONIv1ENTAL PROTECTION
H~'.l, ENVIRONMENTAL ENGINEERING DIVISION
825 [_ Street- Anchorage, Alaska 99501 Telephone 264-4720
-- ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT
~GAL DESCRIPTION
LWII Absorption area D~elling R PERMITNO. ,. , ,
~ ~ Matorial~ No. of compartments '
~ ~ ~1- capacity m gBIlons Inside length Width Liquid depth
J ~ ~ ~ IF HOMEMADE: -
O ~ ~ Manufacturer/~ Material Liquid capacity in gallons
DISTANCE TO: / ~ t,e ~ ~
~ Typeofcrib /~/ ~diameter Cribdeptb Total effective absorption area
~ DIST NCE
C~ass ~ · ~ Depth Driller Distance lolotline PERMITNO.
~ DISTANCE TO:
OTHER ~L
~PE
MATERIALS
INSTALLER
APPROVED ~/:~ DATE LEGAL
013 (Rev. 3/78)
PIERH :I:. T NO.
E:,EF'FIFiiTHEI'.,I'f' O, HEF:ILTH FIND EI'.,t',/IROHP'IEI',tTFtL. F...JTECTION
8.:.?J.~ '" L.. '" STREET., FtNCHORF~GE., FII<.
2
!1.,,.!t E: IL._. ~. .... IF:II }J",.,~l I[::. H:::~ ~"-~! ..... ~
,:: 8::L ~4'S~:L
I'"tFI::.::):HIJM NLII'dE",E::F~i Of:: 8EDROEq"I'.:S = 4
SOiL RRTII'.a] ,::'}:!;e F:T,.."E:R>=: 225
THE: RE'g!Ij I REI} S :[ ?]% OF THE :S,O I I... FIB:i~,ORF'T I ON S:,'T'E;'TEH ]: S;:
T'HE: LEIqGT'H D :[ ME:NS ]: ON IS THE I_ENGTH ,:.' IN F:EET::, OF THE TRENCH OR [:,Fi:FiINF'iE:L.[:,.
THE DE'F'TH OF:' FI TRENCH OR P]:T IS; THE [:,ISTFINC:E BETHEEI'.4 'T'HIE :!i~UF..'F'FICE OF' THE[
GROI...IN[:, FIND THE [i?,OTTOM O1= "r'FIE EXCI::i',,,'FiTZ O1'.,I ,: I t'.,I FEET ;:,.
'I"H[Zf~:E :I:S IqO SET 14IDTH F:'OR TRE]'.,1CHES;.
T H E G Fi: FI ',,,' [Z I,,.. [)E P T H ~ Ei; 'T'F.IE M I N I I'"ILIH DE P TH OF GRF:I',,.'E L BE'i"I.4 E EI'.,t I"H E OLIT[:: FII_ L P ]: I:::'
RI'.,I[:, Ur'HE E:OT'TOH OF TFIE EXCI::r,,,'FIT I ON ':: 11'4 FEET ::,.
F:'EF~ff"I I 1" F:IF'F:'L. I C:I:::INT HF:I::S THE: RE:SF:'EIf.,I~5:1: E: I L I T'T' ]"0 INFORM TH i S [:'EF'FIR'T'P'IENT DUR I NG "f'HE
IN'.~:;TFIL. L.F:ITION IN:~F'ECT:[CII",I':.'S, OF' I:::ll",l"r' HELLS F~B"J'FICENT TO THIS:; F'ROPER'T'T' FIHD 'THE
NIJHBER OF' RE':ii;I[:'ENCE?.::i; THFI'I" THE HELL. P.IIL. L '-:;ER',,,'E.
.................. -'F ]1.,,.11C~ .:: ;~'Z~ ]:, Zl[ ~'-a ::~; P' Eft: C: T' Z: lO ~"..41 ~S; I]:=~ !--~: IE iF~: EE rL=-.", LM % tf:;E: EE I1::? ........................
E~I:::tCKFZ I...L I NG OF FIN"r' S'T'STEM 1.4 Z THOIJ'f' F :[ NFIL I tqSF'ECT I ON FIN[:' F::IPPRO',,,'FII_ B"r' TH .'[. '.:ii;
DEF:'FIRTMENT I.,.!:[L.L DE: :SUEL:rEC]" TCI PF.:CKSE:CUTION.
i','l ):1'-,I :[ MLIH [:, I E;'f'RNC:E E,'ETP.IE:EN R P.IEL. L. FIN[:, Fli'..]'T' I::li'.J-.'.:.; I TI.'." SEI,.IFIGE D I SF'OSRL '.L':;'./STE:H :[ S;
:1.88 F'EET FOR R PR :[ ',,,'RTE HELL. Cfi;?. :I. SE~ 'I'CI 2E~O F'EET FROM FI PLIE',L. IC t.,.IELL. DEPEND:I:NG
UF'OI'.,! THE 'TYF'E OF i::'LIE~L. IC .t,.IEL. L.
M]:NIHLIH [:,I'=';T'FII'.,ICE FRCd',1 Fi PRI',,,'FTT'I£ I.,.tEL. L TO F:I F'RIVFITE '.T:,EH. ER LII'.,IE IS; 25 FEET FIND,
'l"O FI COHf'll..IF,I:IJT'T' :SEP.IER L. II",IE :1:'-:.; 7!3 FEET.
P.tELL. I.J:K3'L"'; FIRE RE:g!LI]:REE:, FIND MUST 8E RETLIF,'NED TO THE DEF'FIRTMENT I,.IITH]:N :3:8 [."F~'¢':'i;
OF THE I.qELL. C:OMF'LETIOi",I.
O'T'HEI:;: REg!U :[ I',?.EI'"IENT"S MFt'T' F:iF'F'L'T'. SPEC I F' I CFIT IONS F:II'.,I[:, E:ONL:;TRLICT I O1",1 [::' i FIGRFIMS FIRE:.
FI',,,'I:::I i L.f:IE]LE TO I I",ISURE F'ROPEi~: I N'=:;TFILLFIT Z
I CERTIF:"r' TF!I::IT
:].: I AI'"I [::'F:ff'III...!RI;: HITId THE REC!LIIREPIEi"4T"_=; FOR Oi",I-'SI]"E SEI,.IER5; FIN[:' HELL..'E; FI:iS SET'
FORT'H D"¢ THE HLINIC:IPFILIT'¢ OF F~NCHORRGE.
2: I HILL II"~STFIL.L. THE S'¢S'TEM IN F:ICC:OI:~'.I}FINC:E 1.4iT'H THE CODE'S.
3; I UI"~[:,EF~;'.E;TFIN[:, 'T'HFYI" T'HE ON-SITE E;EI.,.IER E;¥STEM I"IFCT' REQIJIRE ENI...RI:?.GEHENT I!:::' THE
RE'.~;IE:,EI'.,ICE i5; F~..E[:, TO ]:NC:LIJDE MORE THFIN 4 IE:E[:,RCIC~HS.
'"'=': ......... ...........................................................
Mr. Dan Rogers :
SRA Box 475R /
Anchorage;, AK / 99507
'" Subject: P~colation Tests
.. ..... /Mountainside Village
Gentlemen:
4040 "B" STREET
ANCHORAGE, ALASKA 99503
(907) 278-1551
October 21, 1980
W.O. ~1A19551
Grid: 3439
We have completed percolation tests on Block 1, Lot 3;
Block 2, Lots 1, 2, 3, 4; and Block 3, Lot 5 of Mountainside
Village Subdivision.
Test holes were drilled by Denali Drilling, Inc. using a
continuous flight auger mounted on a Nodwell carrier. Test
ho. le logging and percolation tests were performed by Mr. O.M.
Hatch and Mr. T. Barber, Alaska Testlab geologists, and
Mr. M.J. Holum, DOWL engineer.
After the hole was drilled, a 3/4" slotted PVC pipe was in-
serted in the hole to maintain an open hole. The hole was
'filled with water and ].eft overnight to saturate. On the
following day, the hole was refilled with water. The water
level wa~ recorded at ~0 minute intervals for the next hour.
During the tests, the water levels were between 3 and 7 feet
below ground surface.
The minimum percolation rates were observed during the last
10 minute interval. We suggest that on-site waste disposal
systems be designed as follows:
Percolation
Rate
(minutes/inch
Block 1 - Lot 3
Reco~]ended
Absorption Area
Per Bedroom (sf) .
8.0 150
Block 2 - Lot 1 2.86
Lot 3 20.0
Lot 4 2.86
5.0
Block 3 - Lot 5
100
225
225
100
125
Block 2 - Lot 1
Mountainside Village
Date: 10/16/80
Logged By: O.M. Ilatch
W.O. #A19551
Depth in Feet
From To
0.0' - 1.0'
1.0' - 2.0'
2.0' - 16.0'
Soil Description
Brown Peat (Pt) , moist, soft.
Brown Sandy Silt (ML), moist, stiff, NP.
Brown Silty Sandy Gravel (GM) with occasional
cobble~-, moist, ~e~ dense to dense, sub-
rounded particles to 6"+.
Bottom of Test Hole:
Frost Line:
Free Water Level:
16.0'
None Observed
None Observed
Sample Depth
1 5.0'
2- 10.0'
3 15.0'
Type of
Sample.
Unified Soil
Classification
Grab GM
Grab GM
Grab GM
Remarks: Refer to Sheets 1-3 for Unified Soil Classification
explanation.
Figure 2
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. o2o-172-o9
1. GENERAL INFORMATION
Expiration Date:
Complete legal description Mountainside Villaqe S/D, Block 2, Lot 1
Location (site address) z792o Steamboat Drive
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Janelle Martinson
960 E. Susitna Dr., Wasilla, AK 99654
Day phone 227-3347
Day phone
Real Estate Agent
Mailing Address
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
m
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] Individual Holding Tank
[] Community On-site
[] Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my:.%eal ~.?.ixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures o'~ed in the Certificate of On-Site Systems Approval Guidelines for this Application,
shows that the ~n-site v~a~C.;[~supply and/or wastewater disposal system is (are) safe, functional arid adequate
for the number o~;b~i:trOb'ms'and type of structure ndicated herein. I further verify that based On .the information
obtained from th~; iCunicipality of Anchorage files and from my investigation and inspection, th% ~n-s ~e.~ater
supply and/~r wastewater disposal system is(are) in compliance with all app cable Municipal and'eState ~d~s, ' al
ordinanc~s,'~nd regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services, LLE Phone ~72-82z8
Address P.O. Box zoo2z7, Anchorage, AK 995zo
Engine~,r~S,~rinted Name, Steven R. Pannone, P.E. Date
Engineers Ci~m~ents: in condu~xing an adequacy test, [ attempt to provide a thorough, conscientious e~gineering analysis of the system in
accordance with MOA DSD Guidelines A Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water _.?~ ~c- ~ ,~_
levels that may fluctuate during the year, and the water usage of the family belin, served b,, the s,,stem · ~,~.'*~.'~, _~..,..~,.'....~4~ ~.~.
.... ,, ~ ; - ~%r.: ...... -,.,,;~ ~
These condtt~ons are outside the control of the evaluator ofth~s system. All systems eventually fail and ~ c9,.-' ~.~
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that ~' ~ '"",-~9,t&~ )~-'D '''~ ~ ~
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future ~.....~...,,,~.3ul.~....~.......~.....~
performance nor give any estimate of how long the system will continue to meet the operational ~~(----
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it '~~ ~ 49
confer any legal right whatsoever. *~ .......
5. DSD SIGNATURE *,~z:'(~
~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~/~'/~/
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type Private
Date completed Unknown
Total depth Unknown ft.
Mountainside Village S/D~ Block 2r Lot ·
Parcel ID: o2o-~72-oq
IfA, B, or C provide PWSID #~ Well Log (Y/N) N
Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Cased to ~zj-,.~ft. Casing height (above ground) 2/,
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
ColifOrm . Neg colonies/100 mL
Arsenic: il/0 ug/I
B, SEPTIC/HOLDING TANK DATA
ft. 28 ft.
g.p.m. 2.x g.p.m.
Nitrate ~.o~ mg/L
Date of sample: ,.12.,l:zo.,.,
Collected by: DRM
Tank Type/Material
Tank size =25o gal.
Foundation cleanout (Y/N) Y_
Date of pumping ,.1=612o~
ABSORPTION FIELD DATA
Septic ! Steel Date installed 9/8h. q87
Number of Compartments _~ Cleanouts (Y/N) Y
Depression over tank (Y/N) N High water alarm (Y/N) N
Pumper Isaacs Pumping Service
Date of adequacy test &/23,/2015, Results (Pass/Fail) __
Fluid depth in absorption field before test & in.
Elapsed Time: 200 min. Final fluid depth _~ in.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N
Date installed ~181',987 Soil rating (g.p.d./ft2 or ft2/bdrm) 22~ SFIBR
Length ~4 ft. Width ~ ft.
Total depth 1_A2 ft. Eft. absorption area ~ft2 Monitoring tube Y
Pass
System type Deep Trench
Gravel below pipe ~o
Depression over field N
For ~. bedrooms
Water added6oo gal.
Absorption rate >= 6oo+
in.
New depth~_~ in.
g.p.d.
If yes, give date
LIFT STATION
Date installed
"Pump on" level at __
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at~
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankJlift station on lot lOO+
Absorption field on lot lOO+
Public sewer main 75+
Sewer/septic service line 25+
Animal containment areas 50+
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots lOO+
On adjacent lots lOO+
Public Sewer manhole/cleanout lOO+
Holding tank lOO+
Manure/animal excrete storage areas lOO+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~o. Property line lO.
Water main ~.o+ Water service line 25+
Wells on adjacent lots lOO+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~o+ Building foundation lO+
Water Service line Ao+ Surface water lOO+
Curtain drain 5o+ Wells on adjacent lots ~.oo+
COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review, of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone, P.E.
Date
Absorption field' 5+
Surface water ~oo+
Water main 75+
Driveway, parking/vehicle storage lO+
COSA Fee
Receipt Number
(Rev. 11/05)
in.
Waiver Fee $
Date of Payment
Receipt Number
2011-05-02 13:02 AAROW PUMP & WELL 188(32806416 >> Fax P 1/1
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
17920 Steamboat
Brian R, Wille
Aarow Pump & Well Service LLC
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
- I '/ 7). - d. ¢~ HAA# !~ll~'~'"~tr'' (.'.( '~:~('
1. GENERAL INFORMATION
Complete legal description
Lot I; g~'~oc& 2; Mountain Side. Village
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
17920 Steamboat Drive.
Anchorage, AK
T¢.rry Es4e. y Day phone
8050 Kinq Stree% Anchoraqe, AK 99518
Agent Jach~ Vande. nberq/ Jac~ White Co.
Address 3201 "C" Sire. et Su2~e 200 Anckora.qe¢
Day phone
344-4768
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
NOTE:
Day phone 762-3113
AK 99518
Individual well XXX
Community well
Public water
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
NOTE:
XXX
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) £ronl 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.
S & S ENGINEERING
Name of Firm_
~7034
Address Eagle Riv,er, Alaska 9P577
Engineer's signature_
Date .~L//3 /~O
DHHS SIGNATURE
~ Approved for ¢
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certific~ztes 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) 8ack MOA ~¢21
Municipality of Anchorage
DEPARTMENT OF HFALTH & HUMAN SEP, VICES
EnvirOnmental Services Division
825"L" Street. Room 502 · Anchorage. Alaska 99501· (907)
Health Authority Approval Checkhst
LegalDcscripfion:l-0~ ~o~< ~ ms,~,},~ ~,,~ w*~mcelLD.' 0~
DATA
Well type/~R ~ v/~- r t/
If A, Bi or C, attach ADEC letter. ADEc water system number
Log present (Y~) tv O
Total depth
Sanitary'seal ~ x/~ 3'
Date of test
Static water level
Well production
Date completed
Cased to 9'O / -!
FROM WELL LOG
o/~ B ~
Casing height (above ground)
Wires properly protected (~'N) "'/¢ S
AT INSPECTION
g.p.m. /. (o g.p.m.
WATER SAMPLE RESULTS:
Coliform O Nitrate
Dateofsample:t~/5-/q6 2- I/~ ~/ ~6
B./.~E~'~O/D1NG TANK DATA
Date installed °1 / ~ } Tat~ size ~ S'O
O, 6 6-- Other bacteria O
Collected by: S & $ ENGINEERING
17034 Eagle River Loop Road No, 204
Eagle River, Alaska 99577
Number of Compartments & Cleanouts ~q) Yg_3'
Foundation cleanout ~/N) Ye. 5 Depression (Y/]~ /'/o
DateofPmnping O/-lo /~5~ Pumper 0~-,/t~
High water alarm (Y/~)) ~ o
C. ABSORPTION FIELD DATA
Date installed c4/ g/ Soilrating (g.p.d./ft2or~_~) ~'%~" SystemtypeT~'¢c/4
Length q hi / Width ;). ,V Gravel thickness below pipe / O Total depth
Effective absorption area ~ ? o [ c,4 ~cS~Monitoring Tube present(~/N) Y~3 Depression over field (Y/~/ /¢ O
Date of adequacy test [ / ~ ~ / q 6 Results (Pass.ail) /o ~j j- 3' For ~ bedrooms
Fluid depth iii absorption field before test (iu.); O lnm~ediately after~6 ~ gal. water added (in.): O
Fhfid depth 0 (ins.) Minutes later:
Absorption rate = 6 o 0 Y- g.p.d.
Peroxide treatment (past 12 months) (Y/N) /,~c~e tc~c,,,v If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (Y/N) "Pump~
High water alarm level at* ~*Datum
Size in gallons
"Pump oft" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
/sep-ti~/lmlding tank on lot
Absorption field oti lot
Public sewer main
_; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station
Sewer/septic s~rvice line
SEPARATION DISTANCES FROM E~C~tOLDING TANK ON LOT TO:
Building foundation
Water main/service line
% Surface water/drainage /0 o Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
/
Surface water
Curtain drain ~:,~o
Driveway, parking/vehicle storage area
Wells on adjacent lots ? o o -/- Property line
F. ENGINEER'S CERTIFICATION
1 certify that I have determined thrufield inspections and review of Mumcipal records t,~ cO~e~v>~ are
in conformance w, ith ~lOA. HAA guidelines in effect on this date.
Engineer's Name /t0/x~.'zr C. (~o:aw ~n~Se~~
........................
HAA Fee $ ~ ~D / ~ Waiver Fee $
Date of Payment Z ~/~ ~ ~ DateofPayment
Receipt Number /~ W~7~)~-- Receipt Number
Rev. 8/95 eSS: haa.wk.doc
CT&B Ref.~
CT&E Environmental Services Inc,
Laboratory Division -=- ..... -------- - .....
Laboratorv Analysis Report
L1 Br'K~ MOUNTAIN SID~ VILLAGB
clie~%t Name S & S ENOIN~ERING ~O~K Order
Ordered By R. COWA~ Printed Date
Project Name Collected Date
ProJect~ Received Dabs
PW$ID UA
Technical Director
20823
01/23{96 ~ 09:~$ hrs.
01/23/96
STEPHEN C. EDE
8ample Remarks: SAMPLE COLLECTED BY: MO~ C.
qc Allowable Ex%. ;~[al
Parameter ge~ult~ Qua[ Unibe Method biml[a Date Date Init
NSt~a~e-N 0.65 t~/b EPA 300.0 ION ~0 01/24/96 MCE
S== Spccial Imetruc~ione Above UA - U~avallable
- Undetected, R~po~ted valu~ i, the practical ~ant$~ioat~on l~mi~, bT - ~ Than
= Secondary dlluBtol~. GT - Gre~er Th~ll
200 W. Potte~ Qdve, Anchorage, AK 99518-1605 -- Tel: (907) 562,2343 Fax: (907) 551-5301
ENVIRONMENTAL FACIL{T[ES IN AtASKA. CAUFORNiA, FLOR[0A. ILLIN0[S. MARY~NO, MICHIGAN, MI$~0URI. NEW JERSEY. OHI0. WEST VIRGtNIA
Time
Date Date Date
InsPector Inspector Inspector
Comments
Conditional Approval
Date Sewer Installed
Permit No.
Soils Rating Well To Absorption Area
Well to Tank
Septic 'Tank Size
Holding Tank Size
Well Log Received
Property Owner
Mailing Address
APPLICANT FILLS OUT LOWER HALF ONLY
Buyer ~til1'l~
Address
Lending Institution
Realty Co, & Agent
~,ddress
Legal Description
Street Location
Phone
Type o.f' Residence
t~' Single Family
[] Multiple Family
)ther
No. of Bedrooms
Individual
[] Community
~ublic Utility __- -.
~osal
Individual
[] Public Utility
E Holding Tank
ATTACH WELL LOG. A well log is required for all wells dritled since June
1975. For wells drilled Drier to that date, give well depth (attach log if
available.)
Year Individual lnstalled:
When Connected to Public Utility: __
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INrrlATIED.
ALASKA [ rIUIROi'IITleFITAL COFITROL S[ RUICe$,
MUNICIPAL OF ANCHORAGE
ENVIRONMENTAL F[-:OTEC1 ION
RECE, IV D
December 28,1981
Department of Health & Environmental Protection
825 L. Street
Anchorage, Ak. 99503
Attn: Les Bucholtz
Dear Les:
On December 28,1981 I inspected the well and took a water
sample for loan approval for Lot 1 Block 2 Mountainside
Village Subdivision.
The results of 'the bacterial test for the water is attached.
It was satisfactory. The well has a seal and is approximately
1 ft above the ground level. The electrical wires are not
encased in conduit.
The septic tank is 100 feet from the well. The trench is at a
greater distance. The sewer system has caps on ~tll
standpipes.
S. ~
1220 UJcsl 25lh J~ucnu¢ e J~nchorocl¢' Al~sko 99503 · (907) 276-1361
