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HomeMy WebLinkAboutROLLING HILLS ESTATES BLK D LT 1ARolling Hills Estates Block D Lot 1 A #011-072-50 Y MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ❑.l NEW ®e c—AtAVc _.IaL/'la— 57.E I�UPGRADE MAILING A DRESS 2 1& -7 A���� LEGAL DESCRIPTION L©T I L0CAZ RQ L_LI NH I LJ—,s: LOCATIONd L-0 /I -73 /t NO. OF BEDROOMS Well a Absorption area Dwelling t PERMIT NO. DISTANCE TO: 67�, E VY E ZQ w� Manufacturer t 6 /'� e�/('� �p / N T ie2l Material No. of compartments ur Liq. fcapacity in gallons (;.j � .— IF HOMEMADE: Inside length Width Liquid depth 0 J0Z Well Dwelling PERMIT NO. S F Manufacturer Material Liquid capacity in gallons O DISTANCE TO: Well Foundation Nearest lot Tinel PERMIT NO. w = J LL Z No. of lines Length of Bach line Total length of lines Trench Trench idth Distance between lines Z w ' Ga inches ~ ¢H Top of tile to finish grade f i0 Material beneath tile �� Total effective absorption area �( o inches Length Width Depth ,^i l! PERMIT NO, w wo~. Typif fcgb Crib diameter� Crib depth Y P Total effective absorption area Lu y DISTANCETO: Well 101 Building f nation qx Nearest lot line 21-1 .G f JE6tSY LIZ/He Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER SA,N R PIPE MATERIALS Nee, e (2- ^SOIL SOILTEST RATING _ 0 M/ Q INSTALLER REMARKS �n f L hf 0 pipq �. 491H �fo*; �'•• JUNE 25. 1971 , '/x,441 i ct >>�j.ONAL APPROVED DAT%E LEGAL / - �7 `/'J 2'itt Lap 'Type of sail avbsor`ption system is: TREMSH Ms -3,x i.ynum no,irriber, of- bedrc)ovm-.- 4 r,ating (SQ F ­1'/141R)= 150 rhe required size o -P -the soil absorption system W, The length dimerisicjri is -the (in -Feel:) of the treTICAI or, draiFffield., Tl ­ie depth of a trenich or pJA is the disi-tance bet -ween the sutoftace of the groc-jund and the bottom of the (iFF feet). Thetoe is; rlo set width for, t F"PT-1 C: "IE: s, �; 'The; gravel depth is the miniumun depth of gravel betweeri -the outfall pipe .aric! the? tpottom of t1 ­,e excaivHtion (in Feet)., aM ex $0 A. -rh A TO :.-AL Z V.-:� 1 Z_� ��k. !-,Tas -to in-Formthii.s. depar-tynent dUring the of ply wc.Ils adjacent to tthic��, pi-oper-ty and the .• ei, of toes; i den ces t:' at t( --,e viell v,J.11 ser,ve,. "w...._. ­ ... I tAJ(71 c 1=2 '.k ..R.. K C"': "T :1 CffM1E,--.r'.'; A-% 1F.2". EE' e Bar. k fi 11i n q o I DEPAR­nrit, 3. jt_ HEAL.IT! N, -\1D CIN ap p to ova 1 by 'phis ANS K' C EMWErr, wic.1 IORAGE, AK. 99�501 264 - WARO M M --- TH3 X -T- �S4'.."HE.�k4if UR $....!!F"" , C". &4-'. T`'u EiH*._' I::'A: 4 -VH 1 9 ( 80111DO-43 ) At P[ I CPJ-%A .TDE 1FRAINiKiL.0-4 54:-E2 WEST T.L.3 A4 k.-_D\1LJE 99!.ii.102 LCK."ATIC)NI 1'_3AND I AKE WAD L.E...'C"AL LO ­r I BLOCK D ROLLING, HIL.L.-Si ILOT S1 ZE 22000 SGRjARE FEET 'Type of sail avbsor`ption system is: TREMSH Ms -3,x i.ynum no,irriber, of- bedrc)ovm-.- 4 r,ating (SQ F ­1'/141R)= 150 rhe required size o -P -the soil absorption system W, The length dimerisicjri is -the (in -Feel:) of the treTICAI or, draiFffield., Tl ­ie depth of a trenich or pJA is the disi-tance bet -ween the sutoftace of the groc-jund and the bottom of the (iFF feet). Thetoe is; rlo set width for, t F"PT-1 C: "IE: s, �; 'The; gravel depth is the miniumun depth of gravel betweeri -the outfall pipe .aric! the? tpottom of t1 ­,e excaivHtion (in Feet)., aM ex $0 A. -rh A TO :.-AL Z V.-:� 1 Z_� ��k. !-,Tas -to in-Formthii.s. depar-tynent dUring the of ply wc.Ils adjacent to tthic��, pi-oper-ty and the .• ei, of toes; i den ces t:' at t( --,e viell v,J.11 ser,ve,. "w...._. ­ ... I tAJ(71 c 1=2 '.k ..R.. K C"': "T :1 CffM1E,--.r'.'; A-% 1F.2". EE' 1 :1 FRI.E.-TI) Bar. k fi 11i n q o I sari y F, y st em wi t h a ut I i na 1 i ns pe c t i on sand ap p to ova 1 by 'phis dep.artment will be suhnjiect to blillimUnj Q&taj1CC1 t>e&Ween a well and any on --Site seviagf.., disposal system is I(DC.5 feet. For, a pr'boate well or, ISO to 200 feet fr-ctm .a puL.dic well depending upon the, type of puk�)A.c: iAje!:L:1I. MAWLIM distance fr,om a prAvate well to a private sewer line is 2S feet and t 0 C OMYTIRM i t y S e I- I J. rf e is 7E-, feet., Other, F-WILArements may apply. Ejecifications and construction diagroaryls ar`e available to insure pr,opei- in'.,,taliation,. rnix c_ 'III k. lau F- I cei,tify that 1:` I -,-.ar,-tfamiliar, with the requirnementS, fOr' On­SitR sewers and wells as set forth by -the Ohinicipsality of Artchormljje„ W 1 will install the systern in accordance i,aiith the codes,, B,' I 3rider,5tan-1 that the on --site sewer system m.,ay requif,e enle,irgevyievlt if the residence is Pernodeled to inCILICIR rnor,e than 4 bed r,00rns,, ... ;1Gi'4 'SUED HY a�. V4.0 M U ted T C I F=13 AFL I T `a' ID F-7 R r-4 1:� F -i t-1 r -f r-1 4-2 = DEPARTMENT OF—HEALTH AND ENVIRONMENTAL ReOTECTION / 825 'L STREET, ANCHORAGE, AK. 99' L 6 264-4720, tR6�L� F::§ P-4 C:A iDP,!— I`e SS iE 44E= -FR F:'E=FZ M1 T -'ERM I T NO. C r� 'L I CANT • 1 E t(Cl f1 (l (� vl - s y 3 W �' :AT I ON 22 -op C1 SQUARE FEET SAL t i !gI Dc LST SIZE 'E OF SOIL ABSORBT I ON SYSTEM I S : :!IMUM NUMBER OF BEDROOMS = L" SOIL RATI14u' CSQ FT: BR>= IS -0 REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: Fn--rH /� Lr PtilRM_r l� <pC} �C`eS F3 lEL L7�F"�"9-4 THE LENGTH DIMENSION I5 THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE :GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET?. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET X r�U I FRc�E> �EB�--i-�rr� I Z� %02 O ��L_�C3 RMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE STALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE MBER OF RESIDENCES THAT THE WELL WILL SERVE. -r W CDj C :;:> ] X 6 :E3 F:>F= C:� -r T e-3 P'-.8 :E5 i=l FZ r=- F? E Q U I Fes' E E> ...,..., — — 6KFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS PARTMENT WILL BE SUBJECT TO PROSECUTION. NIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 0 FEET FOR A PRIVATE WELL; OR T3 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. LL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS THE WELL COMPLETION. HER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE 9ILABLE TO INSURE PROPER INSTALLATION. �"EFZM I _r EXF=' F FESS G�� �d'�6�+�� e?�s `fl r S CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET 10TH BY THE MUNICIPALITY OF ANCHORAGE. .1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQ eJIRE ENLARGEMENT IF THE SIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. GNED:__ APPLICAN _ _ _____ a .'SUED V3. 2 SOI LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION TEST Pouch 6.650, Anchorage, Alaska 99602 276-2221 SOILS LOG - PERCOLATION TEST PERFORMED FOR: a o a 'A DATE PERFORMED: �/ � e Ig t Il LEGAL DESCRIPTION: �-o SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 -•-15 16 17 18 19 20 COMMENTS t .! , WAS GROUND WATER S�_^_ ENCOUNTERED? ` OI v ^M1 P l- IF YES, AT WHAT F — DEPTH? . -./.,1 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT f PERFORMED BY:CERTIFIED BY: CG 2 - DATE: SAAB -Ho 0-1"TER ANCHORAGE AREA BOR H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA. 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME ��, ADDRESS PHONE a/ ' 6LL%f/� lLG si LOCATION_/�J zi #w �1 %�'� LEGAL DESCRIPTION �� /l SEPTIC TANK: r9� NUMBER OF / DISTANCE FROM WELL i / MATERIAL 4 J! COMPARTMENTS J, %d> LIQUID LIQUID CAPACITY.' 0 c GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT NUMBER OF PITS OUTSIDE DIAMETER OR WID��, LENGTH�Z3 , DEPTH / LINING MATERIAL ..DISTANCE FROM WELL �Q BUILDING A�F , F/SQ. FT.OUNDATION 4 7 NEAREST LOT LINE "�' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) (� %� TILE DRAIN FIELD: DISTANCE FROM W NUMBER OF LI ABSORPTION A STANCE BETWEEN LINES - FT. LENGTH OF EACH LINE L1E- ESTI LOT LI WIDTH L LENGTH NES_ —IN. TOTAL DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE: IN. ABOVE TILE WELL: DISTANCE FROM / WATER TYPE' / L ,L DEPTH ��� BUILDING FOUNDATION. SAMPLE, NEAREST ` NEAREST i SEPTIC f7 SEEPAGE` / OTHER �t LOT LINE /� SEWER LINE'7C Ilt,TANKL— SYSTEM—��� CESSPOOL SOURCES_ DISTANCES: ,7C=67/ A7/5'= lev ` F.> IS 4 =7 D 9( ` 4 , Cz = �4e DIAGRAM OF SYSTEM DATE APPROVEDw� HFeTTH `iirn GAAB-HD-2 GREATCA-ANCHORAGE AREA �'IROUGH Case No. HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 qjl� 279.2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT MAILING ADDRESS PHONE NO. v RESIDENCE ADDRESS LOCATION OF INSTALLATION LEGAL DESCRIPTION 49 7- / ° ?. �,/_' a APPLICATION TO INSTALL: SEPTIC TANK SEEPAGE PIT ,.r , DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS k TO BE INSTALLED BY ED 0 Vfte IY ,212 ANTICIPATED DATE OF COMPLETION �?4 hY- /L)D M (ZU 't Lst^ BEL WTO BE ALLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS �'_3 ILL LIVID , PERMIT TO INSTALL A DISTANCES: AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED SEPTIC TANK SIZE�j iF TYPE $''f SEEPAGE AREA ���' TYPE'S 'N t 6 f k pl F- - f HEALTH AUTHORITY i i • iI IiTSTEIII ■■■■■■■■■■■■■f1■■■■■■■■ lei 6 f k pl F- - f HEALTH AUTHORITY i i • iI IiTSTEIII ■■■■■■■■■■■■■f1■■■■■■■■ ■■■■e■■e■■ff■I■11■M_■■■■■■ ■■■Pii'lil■■Ii■'�■■11■' � ■■fill■■ ■■■I■■E ■■■I■■■■■■■U■■E■M■■■■ly■ ■■■Iir'ii■■■■E■■NI■2■W21X■ ■■■■■■■6'J■■■■■1I■■■■■1M■■ MEMO II■■II■"!1%■■■. ■■■■■■■11■■■■■11■■■■■■■■ ■■■■■■=11■■■■■1I■■■■■■■■ ■■■■■■ 11■■■■■11■■■■■■■■ ■■■■■■■I1o■■■■1I■■■■■1M■■ ■■■■■■M"11■■■■!I■■■■■■■■ ■■■■■■INSIN■■■■RI■■■■■■■■ OR 1 �, LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE f�,r� APPLICANTS SIGNATURE -71z(/o(, 3g. -Y Yhd�... \ Municipality of Anchorage .. 1. Development Services Department Building Safety Division , �- Onsite 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 FOR A SINGLE FAMILY DWELLING Parcell.D. 011—m -w COSA# GY0031 1. GENERAL INFORMATION Expiration Date: / O — .2 Q — OG Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ROLLING HILLS ESTATES SUBDIVISION: BLOCK D. LOT 1A 5432 WEST 73rd AVENUE * ANCHORAGE. AK 99502 JERRY do MICHELLE RALSTON Day phone 248-0307 5432 WEST 73rd AVENUE • ANCHORAGE. AK 99502 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone :0• a 9. . TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer 0 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 Onsite 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 samples. (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 seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 12. O& Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysts of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or 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 confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for "k bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory l/ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Nitrate Advisory Other By: /B.v IIMI tE-79 •r �ltt��YtOFON-Sfr��ii ATERA . WTERA _ yI�STFWATER PROGRAM : •All Original Certificate Date: -7-2-0-OG Municipality of Anchorage ° • Development Services Department Building Safety Division . Onsite water R Wastewater Program 4700 Bragaw 60vet P.O. Banc 196650 Anchorage, AK 99519.68W www.muni.orglonsla (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ROLLING HILLS ESTATES S/D: BLOCK D, LOT 1A Parcel ID: 011-072-26 A. WELL DATA Well We SATE If A, B, or C provide PWSID# NIA Well Lou (YM) NO Date completed PRE 1970 Sanitary seal (YIN) YES Total depth 90+ ft. Cased to 40+ ft. FROM WELL LOG Date of test Static water level ft. Well production g•p m. WATER SAMPLE RESULTS: Wires properly protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 6/29/06 85 ft. 4.4 g.p.m. Coliform O colonies/100 mi. Nitrate <<D mgA. Other bacteria 0 colon"100 ml. Arsenic: 6.75 ugA. Date of sample: 6/29/2006 Collected by: GEG, Ltd. S. SEPTIC(HOLDING TANK DATA Tank TypelMatedal Tank size gal. Number of Compartments Foundation cleanout (YIN) Pumper C. ABSORPTION FIELD DATA PUBLIC SEWER Date Installed (YIN) tank (YIN) _ High water alarm (YIN) Date installed Sob rating (g.p.dlft'or ft%xtrm) PUBLIC SEWER Sys type Length ft. Width ft. Gravel below pipe —ft. Total depth ft. Fat. absorption area _ ft' Monitoring btbe Dnra�8£i�eld Date of adequacy test For bedrooms Fluid depth In absorption 6 ems_ in. Water added _gal. New depth _in. Flap e:_ min. Final fluid depth _ in. Absorption rate a. g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 3 type) If yea, give date D. LIFT STATION Date installed "Pump on" level at _in. Datum E. SEPARATION DISTANCES Size In gallons "Pump otP I High water alarm level at Cycles tested Meets alarm & cirailt requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots 1001+ Absorption field on lot N/A On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manuretanimal excrete storage area 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Budding foundation Water main Property line Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Budding foundation Water Water service Una Surface Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspactions and review of Munk0al records that the above systems are in conformance with MOA COSA guldednes in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date -7/12 /of. parkingivehicie storage COSA Fee E V &I U o Waiver Fee i_ Date of Payment - Date of Payment Receipt Number Receipt Number, SCS Ref# 1063534001 Client Name Gamess Engineering Group, Ltd. Project Name/# Rolling hills Est. [ilk D LIA Client Sample ID Rolling hills ESL Blk D LIA Matrix Drinking Water Sample Remarks: All Dates/rimes are Alaska Standard Time Printed Date/time 07/112006 15:16 Collected Date/time 06292006 10:00 Received Date/ Time 06292006 13:30 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Mcthod Container ID Limits Date Date [nit Metals by ICP/MS Arsenic 5.75 5.00 ug/L EP200.8 C (<10) 06/30/06 07/08/06 M11 Waters Department Nitrate -N ND 0.100 mg/L EPA 353.2 Microbiology Laboratory Total Coliform 0 D (<10) col/IOOmL SN1209222D A (<I) 0629/06 ALR 0629/06 TLF rVo r. µw.00 w -'o oco �O00000� ' v L "- r ------ © ---------------- ---- ---- o' --- 1.IK3 83J.InB 3AUV1333n ,S I 0 1.M3 '10313 V '3131 Sl t00, � N0V813S 1N3wdOl3/�3a �d .69'Lll HU60N In N] 9E9E-9L2-L06 3>1d� In M aNVS O M 84009 20je:;Jew eLS:LO 90 82 unre S 00'04'38" E 125.07' O YO�O - - } : �`; 29= -eeaves Q. o S x AlIlLLf1 ,OL � o. _______ ___________LN3W3SV3 ------ i _____________ $ o.Ew aoZ OO -r -t El x UE_r 4J 0 p 5 e u }t: 0 p fi x T.:.o_ Io tc°c :�5 l- x—x—x—x Q 'c h o c Q / ° o s - � 30' (I Li.e.; YL t"- `,�.L N Y a woo L O a = c 0 0 0 (V n S n.1Y OYv w' N L6 O Se •�tp,s d;'ES p YpY ✓J1 Sa /WO�t V! 601 e W F 11! N a Q � ri N � f - W 1// O N J P ?�0 f JLdi N 27.9 U 3 Q to QI 0 91 z . vl J �m Y e� U') Sc o lLpU J �: rn ai w mi b 0W0 = 00 11.0 V7 Z Fpm zY J F o Z DQ Z mW J 10 -� 30' UI W p O 1" 29.] Q J ------ © ---------------- ---- ---- o' --- 1.IK3 83J.InB 3AUV1333n ,S I 0 1.M3 '10313 V '3131 Sl t00, � N0V813S 1N3wdOl3/�3a �d .69'Lll HU60N In N] 9E9E-9L2-L06 3>1d� In M aNVS O M 84009 20je:;Jew eLS:LO 90 82 unre M9wn ovQ�?: •. Qapp N p oil LL- OQ' :� N ••: c0 O 3 � � m _•••••C J•,••Q �0 M n i o;B:Si .-_ _. MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services R. On -Site Services Section P.b'. box* 1'966'50­'-'Ahc'6ora'g':' 6�,'Alaska 99519-6650, 343-4744 CERTIFICATE OF HEALTH AUTHORITY .--APPROVAL-FOR-A-SINGLE FAMILY DWELLING, Parcel 'lb.f 011--07HAA#--- "CAAEILA 1. GENERAL INFORMATION* Complete Iega,1,'dds6npb6h' Location (site addressor directions) Property owner''qeV &,.,t OJLA,� ES I-Je— Day phone M'a'i'lin'g address', q, Lending agency -P, ay phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. 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- ing to the legality and status of system. 4. 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. r 72-025 (Rev. 1/91) Front MOA 021 ,i jorn s, aauibua puoissaloid aul ui suoissiwo ao saoaja aol alglsuodsat lou si abejoyouy to AI11sdloiunA ayl •ponssi si aluolllliao s aaolaq slep azo pue ao suoiloadsui lonpuoo lou op SHHO to saaAoldw3 •sluawaalnbei alels pus leaapal ululaao Ajsiles olaapio ui suolinilisui bulpual alayi pup sawoy to s.iessyo.ind of Asalinoo a ss siyl saop SHH4 ayl *8i ssly to alsiS ayl ui p9J9lsi69a Jaau'bua lsuoissaloac. luapuadepui us Aq anogp g ydeibend ui uanl6 suoilpluesaidej eqj uodn Aluo passq salsoll!lJaC) lenoaddy Al!aoglny LMUGH sonssi (SHH4) saoituoS uewnH pus 411saH to luewpedat] a6eaoyouy to AllledlolunA ayl :suollelndlls 6uimollol ayl ul!M 'swooapaq -swooapaq icb Imo'' C�1 algia aol 1pnoidde ieuoll!puo0 •panoaddeslQ Jo; pano.iddy �s 3unIVNJIS SHHO ainleu6ls s, aeul6u3 ssaipp`d auoyd nC c 0 wa!d to awpN •uolloadsui sigh/ jo alep�aul uo loalla ui sulolleln6aa pup 'sooueulpio 'sapoo alelS pup led!o!unW Ile yl!M eouelldwoo ui si welsAs 1psodslp jejumelsem jo/pue Alddns aalem el!s-uo aUl 'uolloodsui pup uollebllsanu! Aw wal pup sell a6eaoyouy to Allledlolunw ayl wojl paulelgo uollm iolu! eqj uo paspq leUl Al!aan aaylanl l •uiajay poleolpul aanlonils to odAl pup swooapaq to aagwnu aUl aol alunbapp pup leuollounl 'ales si welsAs 1psodslp aalumelsem Jo/pue Alddns aalem el!s-uo ayl leUl smogs uolleoildde lenoiddy Al!aoulnV gllpaH Sll.11 to uolle6llsanu! Aw luyl Aluan ! 'molaq umoys alep uo!lep!IeA ayl to su pup olaaay paxllle lues Aw Aq paigpoo sy In '9 833NION3 A13 N01133dSNl d0 1N3W31VIS 'S W. DIMOND BLVD. ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 Municipality of Anchorage October 18, 1993 Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: HAA for Lot I Block--l-Rolling Hills Estate Contaminated Well Gentlemen; On September 28, 1993 this well was chlorinated. The lines and well was flushed on September 29, and a sample collected an September 30. The residence is occupied. A confirming sample was collected on October 12. Both samples were satisfactory. Yours I Tobbe Spurkland P.E. Municipality of Anchorage K Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 November 16, 1993 Tobben Spurkland, P.E. 203 West 15th Avenue #206 Anchorage, Alaska 99501 A Subject: Waiver Request for Lot 1 Block D Rolling Hills Estates Waiver Request #WR920064, PID #011-072-26, HA920651 Dear Mr. Spurkland: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are a private well to the septic tank of 85 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sin rely, Robert W. Robinson Civil Engineer On-site Services ljm:#6 Concur: r�" ohn Smi Program Manager On-site Services MUNICIPALITY OF ANCHORAV- Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR920064 PID# 011-072-2t;' HA# HA920651 Permit # Date Received: November 4, 1993 Legal Description: Lot 1 Block D rolling Hills Estates S/D - AMENDED Engineer: Tobben Spurkland, P.E. 203 West 15th Avenue #206, Anchorage, Alaska 99501 Applicant: Norman Helwig Estates ****** Waiver Requested: Private WEll to septic tank of 85 feet Criteria: 1. Geology: , A. Water Table �g3 B. Soil Sorption C. Permeability D. Water Table Gradient (qt) E. Horizontal Separation TOTAL:: 2. Special Conditions: -IXe J7i�if�G7 6✓r Points: 6,0 a.3 V . S oco i-7 QT t,! • -,�I , "..a., V rc , , , v� Waiver is Granted: /` _ Waiver is NOT Granted: List Condit'/ons or Reasons for above: d /eS GO��G►� �' v� �D // / 0 2G 4V✓�� 9 Date: Rec #: ****** Amount: $ Date Paid: /107` / Jlz 0 4,104 /`Ls e S-1 i�7f v`r1 `/PCl '✓'/ n7`r�jV�l 7`/, /000 677 64 160 �� t,�`/ Gu�S ����n�� 4/,�/f✓ �v�,vr� fie �'<�7� /��/,� ori ,, live`l on 4 OFv/ �d0 p _.... 1 0g�/\��J U1�� /'� /���� �����^�� �P. , J I� 6751W.0M8ND0LV0. ANT'HORAGE, AlASKA995,02^JY104 N0-1) 248-5095 Municipality of Anchorage October 13 1992 Division �f Environmental Health ' Department o� Health and Social Services 82O L Street Anchorage, Alaska 99501 Subject: REQUEST FOR WAIVER OF SEPARATION DISTANCES FOR PRIVATE WELL TO SEPTIC TANK LOT 1, BLOCK D, ROLLING HILLS ESTATE We are submitting a re�uest for waivers from the separation distances stated in Title 18, Alaska Administrative Code, Chapter B0.020. During an Health Authority Inspection for this property it was discovered Lhat the separation between the well on subject property and the septic tank was less than the required 100 feet and tha� a waiver is required. The attached siteplan shows the approximate layout of the septic system.. The system was upgraded in 1980 with the installation of an additional tank and trench. No well log exist for this property, however well logs for lots 4,57, and 18 of Block D have been inspected and evaluated. By going through the DEC's procedure of analyzing the potential for contam�nation I arrJ.ve at the following points: Ground Water Soil Sorption Permeability Gradient Separation ( Silt�Clay) 3^5 ( Silt Conclusion: Almost sure to be tion, The lot slopes to the east and surface W. 73rd. runoff Ave. from the septic Yours Tobbe� � v Spurkland F�|�, north, away from the well. Any system location will flow towards MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION OCT 13 1990 �� RECEIVED 94 ,1 WEST 73R -D, AVE, 1.7 N xz 94,2 LJO 92,2 15 0 15 30 45 60 75 90 SCALE., 1' = 30 FT, TOBBEN SPURKLi V� EfND P.E. r I KUCK B RZILLIN6 HILLS SEPTIC SYSTEM ASBUILT 203 W 15TH. AVENUE L17, DATE, OCT. 14 1992 ANCH. AK. 99501 SEC 15 WN R3V I NORMAN HEL V16 11 SHEET, 113 GRID- 2124 IE *' MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services it On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 011^ 0U- ol-450 HAA# w: )CIqc�(06� 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 5y y✓2 W 7 16A Ll _s (ZLAto Property owner rVAA4A 1444'r ck Day phone ,gN3-- 5g5;L Mailing address 532- L& �3� I? '? S-0A. Lending agency ei R6'e4l&fto. •y _I-a� dA rnlAtd Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attegt- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site IV 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 systema 72-025 (Rev. 1/91) Front MOA#21 La# vow MOU9 (Lsn 'A9H) ezo-ze -�jonn s,aaoul6ua leuolssaloid aql ul suolsslwo ao saoaaa aol apsuodsai IOU si a6eaolouy to Allledplunlnl all •ponssl sl aleollppao a aaolaq elep azAleue ao suolloadsui lonpuoo IOU op SHHO to saaAoIdw3 -sluawaiinbei alels pue jeaapol uieliao Alslles oliapio ui suoilnlllsul buipual alall pue sawol to saaseloind of Asolinoo a se sill saop SHHQ aql •eilseIy to alelS aql ul paaalsibaa aaauibue leuolssaload luepuedepul ue Aq anoge 9 gdw6wed ui uan16 suo!leluasaidaa all uodn Aluo paseq saleoiplia(] Ienoiddy Aluollny glleaH sanssl (SHHd) sao!naaS uewnH pue g11e9H to luawlaedaa a6eaogouy to AllledlolunIN all :suo!le1nd!ls 6u!Mollol eql glinn 'swooapaq •swooapaq aol lenoidde leuoil!puo(] -panoaddesi(] aol panoiddy m 3unIVNJIS SHHO '9 Z5 J,z p ale(] ainleu6ls s,aaau!6u3 °1 ssaappv 9'/4bIg-bte auogd-,r4 �7n P11 A c vr,2 q wall to aw2N -uo!loadsui sill to olep all uo loage ui suo!lelnbei pue 'seoueu!pio 'sopoo alelS pue led!o!unw Ile ll!nn eoue!ldwoo ui sl welsAs jesods!p aalennalsum ao/pue Alddns aalenn al!s-uo all 'uo!loadsu! pue u011e6!lsanw Aw woal pue sal!3 a6eaolouy to AI!Ied!oiunW aql woal pau!elgo uoilewaolui aql uo paseq legl A;!aan aaglanl I -u!aaaq poleoipui a.inlonals to ads l pue swooapaq to aagwnu aql aol alenbope pue leuo!lounl 'ales si walsAs lesods!p aalennalsenn Jo/pue Alddns aaleM ol!s-uo aql legl snnols uo!leo!ldde lenoaddy A3!aoglny glleaH sill to u01le6!lsanu! Aw legl Aj!A9n I 'nnolaq unnogs alep uo!lep!len aql to se pue olaaaq pax!lle leas Aw Aq paipl.iao sy E133NION3 A8 N01103dSNI d0 1N3W31V1S 'S Municipality of Anchorage ' 16 Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L4041 BK D Ral4u4 v 11 Parcell.D. 011'QZR'A(e L1K574114 py-At V NI Well type R If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Iq Date completed 'P'►"t- 1512 Driller Total depth Cased to 150 Casing height �e2 if Sanitary seal (Y/N) Y Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: AT INSPECTION B/zgb Z. 83 T3• -#,,, Septic/holding tank on lot On adjacent lots /5 d Absorption field on lot u8 ; On adjacent lots >! 3 O Public sewer main "A Public sewer manhole/cleanout N/A Sewer service line > a2.5r Petroleum tank 714 WATER SAMPLE RESULTS: I Coliform X Nitrate Other bacteria J� Date of sample: g/y8 0 41yZ E 91ZIr Collected by: S.!t%rtsb A 4u__J TNTC_ O b i l�f l�c�o �-i Hca Q15 B. SEPTIC/HOLDING TANK DATA 5.epi Date installed 1170 a J1 9C) Tank size 1000 -k,50'0 Compartments ` Cleanouts (Y/N)— Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) Nl%� Alarm tested (Y/N) +�� Date of pumping h% /iT Pumper T//om. ,Ma t,x SEPARATION DISTANCES FROM SEPTIC/HQ4= 1f TANK TO: Well(s) on lot (o On adjacent lots —Foundation �1 Topropertyline > -Absorption field 33 Water main/service line >Sy Surface water/drainageNO K� 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed . Size in gallons Vent (Y/N) — NONE High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installed l 1J70 G 19 8 D Soil rating 1 5o System type 416n -b Length /a ID Width 3 Gravel thickness S Total depth �6 Total absorption area Cleanouts present (Y/N) I Depression over field (Y/N) Date of adequacy test Results (pass/fail) for bedrooms Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 its On adjacent lots i 1'30 Property line >S o To building foundation To existing or abandoned system on lot On adjacent lots i 5 � Cutbank' &f Ae, Water main/service line >S ID Surface water to-hC� Driveway, parking/vehicle storage area > S o Curtain drain N E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature 17 Engineer's Name 4,✓1 V ✓�cLa rc� �� Date HAA Fee $ ee. Date of Payment v Date of Payment Receipt Number o2 �� oc Receipt Number Municipality of Anchorage 4 Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 August 20, 1993 Tobben Spurkland, P.E. 203 West 15th Avenue #206 Anchorage, Alaska 99501 A Subject: Waiver Request for Lot 1 Block D Rolling Hills Estates S/D Waiver Request #WR920064, PID #011-072-26 Dear Mr. Spurkland: Your requests for a waiver and Health Authority Approval are denied. As we have repeatedly discussed, numerous tests on the well serving this lot have shown high counts of "other bacteria" even following chlorine treatments. This office will take no further action on either the waiver or Health Authority Approval until such time that the source of water contamination has been identified and remedied. If you have further questions regarding this matter please call our office at 343-4744. S'nc'e Wly, Robert W. Robinson Civil Engineer On-site Services COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES 51NGE 1908 REPORT of ANALYSIS Chemlab Ref.# :93.3700-1 Client Sample ID :RHS L1 B "D" ROLLING HILLS Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :MOA*HEALTH & HUMAN SRV -H20 QUALITY WORK Order :68843 Ordered By :JIM CROSS Report Completed :08/02/93 Project Name Collected :07/28/93 @ 14:35 hrs. Project# Received :07/28/93 @ 16:00 hrs. PWSID :UA Technical ReleasedcByr: /,- 7 C Sample Remarks: ROUTINE SAMPLE COLLECTED BY: J.E.C. AND R.W.R. MOA WATEROUALITY MONITORING PROGRAM. Parameter Nitrate -N QC Allowable Ext. Anal Results Qual Units Method Limits , Date Date Init 0.10 U mg/L EPA 353.2/300.0 10 07/29 LLH * See Special Instructions Above UA = Unavailable *'k See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than IA ON? S Member of the SGS Group (Societe Generale de Surveillance) ���COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES SINCE 1908 REPORT of ANALYSIS Chemlab Ref.# :93.3700-3 Client Sample ID :RHI L1 B "D" ROLLING HILLS Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562.2343 FAX: (907) 561-5301 Client Name :MOA*HEALTH & HUMAN SRV -H20 QUALITY WORK Order :68843 Ordered By :JIM CROSS Report Completed :08/02/93 Project Name Collected :07/28/93 @ 14:35 hrs. Project# Received :07/28/93 @ 16:00 hrs. PWSID :UA Technical Director:STEPHEN EDE Released By : / "?l Sample Remarks: ROUTINE SAMPLE COLLECTED BY: J.E.C. AND R.W.R. MOA WATER MONITORING PROGRAM. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init -------------------------------------------------------------------------------------------- Fecal Coliform 0 #/100ml SM17 9222D 07/28 07/29 GPP * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than ��� BE3B Member of the SGS Group (Societe Generale de Surveillance) COMMERCIAL TESTING & ENGINEERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY 4 ueoww,on. TELEPHONE (907) 562-2343 5633 B Street Anchorage,Alaska 99518. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. # ED g PRIVATE WATER SYSTEM Mailing Address city SAMPLE DATE: �- 8 SAMPLE TYPE: State Mo. Day Year rnone no. Routine' j) ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ❑ Satisfactory C> 6,, o��60 ❑ 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 k (.0 00 Analytical Method: Membrane Filter " No. of colonies/100 mi. SAMPLE Time Collected No. LOCATION Collected By Lab Ref. No. Result* Analyst �� 1 � L ( ISO t2od.Ll/,(G 4tL� � 'f35 ...)G• 93.3700 -Z m 21 _ 3 4 I IU m 5 I m A ,D.E •C � � BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count 'Z�� ` D.i� =s ooml BEFORE Verification: LSB BGB Fecal Coliform Confirmation �— COLLECTING SAMPLE Final Membrane Fill e sults Coliform/1100 mi Reported By rDate 2gr 9 3 TNTC = Too Numerous To Count p.m. OB = Other Bacteria PART ONE OF TWO REMAINDER !0� SGS Member of the S TO FOLLOW A;;eS �1 cca y jJoha-r7 a j L- �y�'�= Client BPO :14223 (EXP. 12/92) BPO Req# Client PO :NONE RECEIVED PO Req.# Ordered By :DAN BOLLES CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FAX: (907) 561-5301 FEDERAL TAX I.D. #36-0937920 Bill To: MOA'HEALTH & HUMAN SRV -H20 QUALITY ATTN: MARC LITTLE 825 L ST., RM 501 ANCHORAGE, AE. 99501 Contact Person MARC LITTLE Phone (907) 343-6586 INVOICE 60072 OCT 29 92 ........................... " ION: .. Cb payable WOREorder Date OCT 29 92 Chemlab Ref #: 210212 CT&E# 046081867 Acct # MOAMBPO Report Printed: OCT 29 92 @ 10:29 SEND REPORT(S) TO: MOA"HEALTH & HUMAN SRV MARC LITTLE -H20 QUALITY DIV. 825 L ST., RM 501 ANCHORAGE, AE. 99501 Special Inst. Chemlab Test Sp# Client Sample Description Matrix Code Parameter Tested .............................................................................=................. 1 LT 1, BLE D ROLLING HILLS WATER 20005 TOTAL COLIFORM Method Charge SM16 909A 5.00 TOTAL DUE 1 5.00 1@10"BGS Member of the SGS Group (Soci6t6 G6n6rale de Surveillance) fOR KNERCIAL TESTING & ENGINEERING CO. AK DIV _Z41 CHEMICAL & GEOLOGICAL LABORATORY TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. # 71 PRIVATE WATER SYSTEM SAMPLE DATE: Mo. SAMPLE TYPE: - L Day Year WA ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ? ❑ Treated Water ❑ Special Purpose i ❑ Untreated Water SAMPLE Time Collected No. LOCATION Collected By 2 3 4 5 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ❑ Satisfactory tisfactor CA ❑ 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 / 6 l/ 2 L.tQ L Time Received I I OF� Analytical Method: Membrane Filter No. of colonies/100 ml. Lab Ref. No. I� ENI Gro No EN No Analyst A.D.E.0 -/01Z-(019- BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count%/J%G, -N100 ml BEFORE verification: LSB /ue9�Cye BGB /Ue `fl�L/e' Fecal Coliform Confirmation COLLECTING SAMPLE Final Membrane Filter Results Coliform/100 ml Reported By '-2 Date�Z- TNTC = Too Numerous To Count Time: ��®� a.m. p.m. OB = Other Bacteria "OW"OWFor Confirmation (SphsGs Member of the SGS Group (Societe GenArale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 57636 Chemlab Ref.# 92.4538 Sample # 1 Matrix: WATER Client Sample ID L1/D ROLLING HILLS - 5432 2 73RD PWSID UA Collected AUG 28 92 0 14:00 bre. Received AUG 28 92 1 14:30 his. Preserved with AS REQUIRED Analysis Completed AUG 31 92 Laboratory Super sox STE H N C. EDE Released By Client Name :TOBBEN SPURKLAND, P.E. Client Acct :TOBBENS BPO# PO# :NONE RECEIVED Req# Ordered By :TOBBEN SPURKLAND, P.E. Send Reports to: 1)TOBBEN SPURKLAND, P.E. 2) .................................................................................................................................... Parameter. Results Units Method Allowable Limits ------------------------------------------------------------------------------------------------------------------------------------ NITRATE-N ND(0.10) mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: UA. Remarks: .................................................................................................................................... 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA. Not Analyzed LT -Less Than, GT -Greater Than 16OWN S'"S Member of the SGS Group (Societe Generale de Surveillance) rte, 5. LEGAL DESCRIP ION ��bC_V � (_j STREET LOCATION DATE RECEIVED INSPECTION APPOINTMENTS NUMBER OF,BEDROOMS TIME ❑ One W Four ❑ Other TIME TIME ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY J9 INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled DATE since June 1975. For wells drilled prior to that date, give well DATE DATE INSPECTOR YEAR ON-SITE SYSTEM WAS INSTALLED. INSPECTOR INSPECTO ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF ANCHORAGE DEPT. OF I::7ALTH & DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTI$WlRONPOEPdT f::CTION' 825 L Street . Anchorage, Alaska 99501- • MAR 19 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 E C � E F�CI1TtES® REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER // O +�. .tom t / MAILING ADDRESS SCt 3 2. W. Ak y f1 -v z - PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE Q MAILING ADDRESS 3. LENDING INSTITUTION PHONE Q a,c` Leh MAILING ADDRESS 4. REALTOR/AGENT PHONE /Lio 41 e— MAILING ADDRESS 5. LEGAL DESCRIP ION ��bC_V � (_j STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One W Four ❑ Other D. L SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY J9 INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM YEAR ON-SITE SYSTEM WAS INSTALLED. INDIVIDUAL/ON-SITE** ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) i �: ,� �� � �. �-i�-[ • h �_ P_ n � ".�_t7,��r,�«. .c`r1 Q.,.a-BA Q,2 Cho � �+-Q=._ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHEP, ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE E:1 PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: / 60 If Tank is homemade give dimensions: SOILS RATING o TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS Z�-'APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must a o ❑ DISAPPROVED any certificate) DATE �-3- BY GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received �- 7�7 Time of Inspection % Date of Inspection REQUEST FOR APPROVAL OF ob-0 s-tINDTVIDUAL SEWER & WATER FACILITIES ..'r+ FOR „�f z �r e —�-- 1. Approval Requested BV:�� Address: a o 2. Property Owner:l� 3. Legal Description: 4. Location: A 5. Type of Facility to be Inspected: Number of Bedrooms: 5. Well Data: A. Tyne e" dir;_R C. Construction 7. Sewage Disposal System: A. Installed,, Phone: ,I Phone: / r B. Depth co D. Bacterial Analysis B. Installer C. Septic Tank: 1. Size pGa 2. Manufacturer D. Seepage Pit: I. Size aC/KJ 2- 2. Material (fee E. Disposal Field: Total.Lergth of Lines 8. Distances: A. Well To: Septic Tank ('a � 1 Absorption Area�� /�� , Sewer Lines , Nearest Lot Line Z�- Other Contamination B. Foundation to Septic Tank, Absorptior. Area cep {f C. Absorption Area to Nearest Lot Line t •"' T. eq,ie,st.for Approval of Individual Sewer & Water Facilities Page'Two 9e Comments: t Anrnroved �,guj� Disapproved —Date��^ 3 Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM! N OP 13 q I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities located at: SinnPH no+n