HomeMy WebLinkAboutSUE TAWN ESTATE #2 BLK 1 LT 16Onsite File
Sue Tawn
Estate #2
Block 1
Lot 16
#051-501-37
An updated as-built survey is required at
time of future COSA or field upgrade
(waived to close out OSP211467)
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page / of j
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: bS P 7i( -167- PID Number: O5) 50 X37-000
Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade
Name
'�
ABSORPTION FIELD S �
PM s'o'
I�(�39�t4a� 0
Deep Trench ❑ Wide Trench Bed Mound
site Address
J 9071�& tit-LA 554- LP4qt GIAU4)iAV- Ab-
❑ Other
Phone
`707- 6:B- 657.E
Number of Bedrooms
1 3
Soil Rating
JTotal depth from original grade
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Fl.
Subdivision ,� r q Block Lott
sUC �W C5TW
s ASkay
Fill added above original grade
Ft.
Gravel length
Ft.
V a
Township ,, t Range Section
T v l5 I 1W 15;
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
Toi
Septic
Absorption' I Holding Sewer
Total absorption area
Number of trenches
Dist, between trenches
From
Tank
Lift Station
I Field I Tank Line
Ft z
Ft.
Well
�17r
II
1
TANK J3 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Gal.
j
Surface Water/
N!A
l
+
Material
n�;'��'�c�(aD�
Ia RA�-0 WAX C04e
Number of compartments
Lot Line
I -2 `
,
f NA
i
Foundation
04e-LIFT
STATION
Manufacturer
Capacity
Gal.
Remark:
iya HIAT�-{Z �tVGztltJT�y2.'�
• �a SUf�Y�CE �/{i`�L—{LS(5
Alarm location
Electrical installed by
. I Oar yAc.11flQ� G 2.z---s9�rNss�.waM.'f
Installer
PIPE MATERIAL House to tank Tank to
SDS 35 drainfield SDS 35
f
Z—P- S 5�`](/'alt��tl`f� i{EXGiW(a�c?�
Drainfield CO/MT
Inspector 'Q^V4--_ Gc`�j,1D�� p,�'�St�p,
BENCH MARK (Assumed elevation) qft
Inspection
V f l 22.21 � d Gl "z�z( f"
Location and descri tion
PyASiS l�ss�rt�
dates: cow
is O��ID JSA(�-,S1,p�N� A1�Ny
3'd Il•'Z�-Z.L 41h jZ• 6• Z 1
�Fala�
ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF
/ mp
'Im xF
Conditional Approval: Date
'
T
DAVID R. C04t_IDGE
Se tic S stem �:
p y CE No 8474
Approved Date 3 1023 s�F
. .��.�•���..s
Note: this approval does not include well permit requirements.
(Rev 05/02118)
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211467
Work Type: SepticTank Upgrade
Tax Code Number: 05150137000
Site Legal Address: SUE TAWN ESTATE #2 BLK 1 LT 16 G:1160
Site Mailing Address: 19028 MELISSA LN, Chugiak
Owner: COOLIDGE DAVID &
Design Engineer: DAVID 000L I pGE
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms
11/10/2021
11/10/2022
101626
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (i8AAC80)
3. The wastewater code requires inspections during the installation, The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: The septic tank shall have a minimum 20 -inch manway riser to the first compartment (AMC
15.65.205F.1).
Received B�
Issued By:
Date: 11 10. Z-1
Date: 1 i d 02021
3
MUNICIPALITY OF
Z
Development Services Department
On -Site Water & Wastewater Section
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D.
Property owners) %>ANID GpOUD
Mailing address I _—"11 t> VVY44*55 MLO
Site address 1 '9 VIt-1115,51k "t"I'S CAV41&V—
Legal description (Sub'd., Block & Lot) :5US TN'VVN *�:*?— L -V 1
Legal description (Township, Range & Section) S(f--Ir %5 N tz-"W
Lot Size Sq. Ft. Number of Bedrooms -
Phone: 907-343-7904
Fax, 907-343-7997
Day phone 107- 7�10 "7(rl C'
Prls I-'- C -milt- t ' AV- -r
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(JZ all that apply)
Single Family (SF)
Absorption Field
F-1
Initial n
(w/wo ADU)
Septic Tank
Upgrade
Duplex (D)
❑
Holding Tank
F-1
Renewal ❑
Multiple Dwellings
0
Privy
17
(SF and/or D)
Private Well
El
Water Storage
71
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify)fiat the ove information is correct. I further certify that this is in accordance with
applicable Muni i7l Codes.
(Signature of proVerty owner or authorized age
Permit/Rush Fees: a ,2 J5 Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: 0 rJ3 Q Receipt Number,
Permit No. Waiver No.
G:'Development ServicesiBuilding Safety',On Site Water and WastewaterTorms\Client FornisTermil Application.doc
Tank Replacement Narrative for: Lot 16 Block 1 Sue Tawn Estates Addition No. 2
Parcel 1D # 051-501-37
Tank Replacement scope of work:
The scope of work for Lot 16 Block I is to remove the old existing 1000 -gallon steel tank and
install a new 1000 -gallon I-IDPE tank and connect to new 4" pvc sewer pipe that will connect
into the existing 4" pvc sewer to existing drain field. The existing single cleanout will be
removed and a new double cleanout will be provided downstream of the new HDPE septic tank.
See attached site plan (scale. 1" = 10') for a depiction of the proposed tank replacement. Also
enclosed is a 1993 as -built done by Mark Seward, PLS showing the house layout on lot 16.
The Lot 16 tract is over 2.3 acre (101,626 sf) in size and there are no adverse impacts to any
adjacent properties. The existing septic tank location is located within a lawn area and is well
away from any lot line, well casing or water service.
The minimum required septic tank setbacks noted per 15.65.205 will all be far in excess of the
required minimum setbacks. The distance from the existing well to the new septic tank is 140+
feet. The new septic tank will be placed more than 10' from the house foundation and more than
5' from the nearest deck support (8 -in sonotube) foundation as required per 15.65.205e and d.
No exceptions or waivers to setback requirements are needed nor requested with this request.
The permit fee will be paid by credit over the phone once the application request is confirmed.
Thank you for your attention and consideration.
'l• 5. zif
Date
i.
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ASBUILT—NO CORNERS SET THIS DATE.
I HEREBY CERTIFY -THAT I HAVE SURVEYED .THE
FOLLOWING DESCRIBED PROPERTY'
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY. OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI—
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USl D FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SEWARD & ASSOCIATES LAND SURVEYING 688-4566
SCALE=
DATE,
J
GRID= ,�. :
or
.... ..
Jo •
FBI # Duane milk sword
91B
41
DRAWN=at�-�S*A•
-53C3
~.~ 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 PHONE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
Manufacturer
~~ Z DISTANCE TO:
F_m ~~-- ~ ~ No. of/llnes I Longth of each~line
~__~ ~ Top o~tile to finish grade
Absorption area
IDwelling /~ /
M a~.r~ ~ /
W dth
Inside length
Dwelling
Material
Found@tion Neare
'~-~'~ / s~ I~ne
Total length of lines Trench width
Material beneath tile
NO. OF BEDROOMS
Driller
Sewer line
PERMIT NO.
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
Distance between lines
inches /
inches
Total effective absorption area
Depth PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Septic tank Absorption area(s)
Distance to lot line PERMIT NO.
OTHER
PIPE MATERIALS
INSTAELER
REMARKS
APPROVED
D TE LEGAL j
72-013 IRev. 3/78)
F'ERMI T NO.
DEF'RRTMENT '-'"':', HEALTH RND EN',/tRONMENTALI ]:OTECTION
,-,¢-._ %,,? STREET., RNCHORAGE., Al<. 9'_,,.. ~J'±
264-4720
82.:03:57 )
AF'F'L I F':RNT
LOC:AT I ON
LEGAL
HAMI'IRN uuN_ _,RM J.~,b, EAGLE RIVER
LOT 16 BLK ::L SU~ETAI.CF,?';BUB "~....]._ LOT '--;IZE
,L-4. 4-Z77~, .
999999 SQURRE FEET
T","F'E OF '--' - "-"- '' ' '. ': "- ', '-.
_,UIL ME,_,uF..FT.LIJN _,"r~TEI1 I.=,. TRENC:H
MR?:IMLIM iqUI1EER 13F BEDROOMS = 3: :,OIL RHTIN= ,::SQ FT,.'"BR)=
THE REC4UIRE[:, _I,..E OF THE
· =,JIL HB_,uRFTIuN -,T_,TEM IS:
[:"EF" TH= 7 LEI'4LSTH= "- --
;:Cb "3 F-: R %-'E L C-'EF' TH = 5
THE LENGTH DIMENSION IS THE LENGTH '::IN FEET) OF THE ]'RENCH OR DRAINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFRCE OF THE
GROUND AND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IS NO SET WI[:'TH FOR TRENCHES.
THE GRA'v'EL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETHEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REL---.~Li }- E:EE~" SEF"T I C: TR~-~::] S % ZE= 1£~00 ~SRLLC,~-~'S
PERMIT RF'F'LiCFINT HRS THE RESF'ONSIBILIT'./ 'FO INFORM THIS DEF'BRTi"IENT [:,JRING THE
INSTALLATION IN_FEL. TIuN.=', OF Rtq"r' !--!ELL:, AD..TACENT TO THIS FRLFERTT AND THE
NUMBER OF RE_,IE. ENL. E_, THRT THE .WELL WILL _,EF-. E.
EHL. I',F.~LLI~.Ib OF AI'.,I'¢ .=Y--,TEll WITHOIJT FINAL IN_FEL. TIu?,t RI",tD HFFR ..... B"? THIS
[:,EPFtRTi'tENT W.[LL 6E _-,LIB..TEL. T TO FI~.u.=,EL. LtTILIN.
MINIMUM DISTANCE BETWEEN A WELL AND AN'¢ ON-SITE SEHAGE DISPOSRL SYSTEM IS
±80 FEET FOR R PRIVATE WELL OR 'J.50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MA"r' AF'PL"r'. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVRILRBLE TO INSURE PROPER INSTALLATION.
RES E~- EL-EIflE. ER ->1.. 1 ..... -=-
i CERTIFY THAT
t: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEHERS AND WELLS BS SET
FORTH BM THE MLINICIF'ALIT¥ OF ~NCHORAGE.
2: I WILL INSTALL THE S9STEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAV REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
_, I uNED .......................
NT HRMMAN CONST
V4. 0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
1
4
5
6
7
8
9;
10-
11
13-
14-
15-
16 -
17-
18-
20-
SLOPE
SITE PLAN
ENCOUNTERED? ~
E
IF YES, AT WHAT
DEPTH?
(~ ross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
~'~ ~'-~ (minutes/inch)
FT AND -- FT
CERTIFIED BY:
72-008 (6/79)
3~-~ G 650
· ~H(,HO~.~G~, ALASKA 99502~0650
(907)264-41~1
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
December 6, 1982
TO: Whom It May Concern
Subject:
Soils test conducted October, 1975 and the soils log on
file, at this department, has a soils rating of 125 square
feet per bedroom for soils test ~16. T~st #16 is on Lot
17 Block 1 Sue Tawn Subdivision Addition %2. This will
support an on-site septic system. (see attached)
If there are any further questions, please call this office
at 264-4720.
Sincerely,
John W. Lynn
Environmental Specialist
JWL/ljw
OWNER OF LAND
ADDRESS -.:~ /< I
LEGAL DESCRIPTION
DATE-Started ~' i/
PERMIT NUMBER
Dr illingq c o g
by
DOC Co. dba
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
DEPTH OF WELL
<d /4 .: c /,~ /,. STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
/77
KIND OF FORMATION:
From (.; Ft. to . Ft. /'~/~. d From --Ft. to Ft.
'~'¢ Ft. ~/.:O ~<J~ ~ From Ft. to Ft.
From :/ Ft. to , ~
From _( ~ Ft. to ,-~ [ Ft. /~,.~ffe~d ~:5 ~,,) From Ft. to Ft.
From. '7c~ Ft. to 'TJ Ft. ,~ T~ :~' (~,,~t From Ft. to Ft.
, ? ~ From Ft. to Ft.
From ;z~L) Ft. to t~/ Ft. ~_'/:~7 CD~k/~&:~ From ' 'Ft. to Ft
..... / From Ft. to Ft..
.... c~ t;' t From Ft. to Ft.
From, / '"'f,,c: Ft. to d:~ ~ 7 Ft. ~'gd~7~''~' From Ft. to Ft.
From Ft. to Ft. ttd /~' ~ From Ft. to Ft.
MISCL. INEORMATION:
DRILLER'S NAME
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # I~'~,.~ \ - .~,['"~ ~ _ .~'~
1. GENERAL INFORMATION
Complete legal description
HAA#
Lo;t 16; lock l; Sue aw 2
Location (site address or directions)
Property owner
Mailing address
Lending agency
Dennis Stantorf
P.O. Box 670931
19028 Meli~sa Lane
Chu~iak, AK 99567
Day phone
Chugiak~ AK 99567
688-4210
Day phone
Mailing address
Agent
Caroline McPhee/EAGLE RIVER REMAX
Address 16600 Centerfield Drive Ea_qle River,
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE:
Day phone 694-4200
AK 99577
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Fronl 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 inves_ti_gation 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.
Phone ~- ~-~;7 ~
Name of Firm $ & $ EN~INr-ER~.N(~ ~
17034 Ea{jle Riverm ~.~,}dop RR/<~ ~ No. 20_4
Address Eagle River, Ala~EF'9957,.,~ ~
Engineer's signature ~'~
Date
DHHS SIGNATURE
~X~ Approved for '~'~-~- ~-~) bedrooms.
/
DisapprOved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date ~/'-~.~
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 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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
A. Well Data
Welltype '~-~./~
If A, B, or C, attach ADEC letter. ADEC water system number
Log present (~/N) "t Date completed ~'"'~ L_. -'5 ~ Driller ~,~---'-'-,-/
Total depth '~-/1 ~ Cased to ,~o' ~- Casing height
Sanitary seal (~/N) ',// Wires properly protectedd~N)
FROM WELL LOG AT INSPECTION
Date of test
Static water level / '~;>"l ~
Well flow \ ~* ~
Pump level1 O~/.--
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot \ ~ ~ ~
Absorption field on lot
Public sewer main ~-'~'h-
Sewer service line
g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: -7 ~28 ~ ~ /'~ -/2 ~ %7
/
Bo SEPTIC/HOLDING TANK DATA
Date installed ~ ~ fi~,'~
Collected by:
Cleanouts ~N) ,,~
High water alarm (Y~)
Date of pumping
Other bacteria
$ & $ ENGINEERING
1 ~'~,3~ ~.ag~e ~[ver Loop ~oad ~o.
Eagle River, Alaslca 99577
Tank size \ ~ ~ c> Compartments
Foundation cleanout ~N) '-/ Depression (Y~)
/_.( Alarm tested (Y/N)
"7 - 1 3 ~ ~: .~ Pumper ._~-_~.. ~_~.~..cj-
Well(s) on lot ] o
To properly line /o
Sudace water/drainage
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
~ ¢' On adjacent lots /
~ ~ Absorption field
72-026 (3/93)' Front
Foundation
Water main/service line
/5-"
CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at ....----""'"P~mp off" Level at
High water alarm level ..-~'"~Cycles tested
Meets MOA electrical codes (Y/N)~,....---'''''''~
SEPARATION ~M LIFT STATION TO:
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed '~, ~ %'~
Length ~.~' Width
Total absorption area '~ ~- ,~ *~
Date of adequacy test -'1 - ~% ~'5
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y.~)
Soil rating (GPD/FF) ~ S" '/'/~f- .System type
Gravel thickness ~ ' .Total depth
Cleanout present ~/N) '.,/ Depression over field (Y,~
Results,~ail) ~?,~--~ for '~ ~'~-. Bedrooms
~ ~ I'z-" After test o~ '~
~,o ,.~¢. V~,~ ,J~ If yes, give date '-~'~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~. ~d~
To building foundation
On adjacent lots ~o
Surface water
Curtain drain
E. ENGINEER'S CERTIFICATION
On adjacent lots ~ ~ c~ Property line
\ ~ t '~' To existing or abandoned system on lot ~'~
~l~, Water main/service line /~~ ~
Driveway, parking/vehicle storage area
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
HAA Fee $ F-)
Date of Payment ~- ~--'h ~'~
Receipt Number
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
COMMERCIAL TESTING & ENGINEERING CO.
ENVIRONMENTAL LABORATORY SERVICES
Chemlab Ref.~ :93.3385-5
Client Sample ID :L16 B1 SUETAWN ~2
Matrix :WATER
REPORT of ANALYSIS
5633 8 STREET
ANCHORAGE, AK99518
TEL:(907) 562-2343
FAX:(907) 561-5301
Client Name :S & S ENGINEERING WORK Order :68269
Ordered By :RAY Report Completed :07/16/93
Project Name : Collected :07/12/93 @ 12:30 hrs.
Project~ : Received :07/13/93 @ 17:00 hrs.
Technical 'Director:ST~F~ EDE~
PWSID :UA Released By : .J~~f
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
Nitrate-N 1.66 mg/L E~A 353.2/300.0 10 07/15 LLH
See Special Instructions Above UA = Unavailable
See Sample Remarks Above NA = Not Analyzed
Undetected, Reported value is the practical quantification limit. LT = Less Than
Secondary dilution. GT = Greater Than
~SGS Member of the SGS Group (Soci~t~ G~rale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA NEW JERSEY, SOUTH CAROLINA
APPLI~r~T FILLS OUT, ~ UPPER HAL, )ONLY
Property?wrier ~i~ ( i . (,.',~i Phone
Address - Zip Code
Lending Institution / ~/ ./L J ~ /~ Phone
Address /2(.; 3 ~/7 ~'/:'~ / Zip Code
Realty Co. & Agent ~ Phone
Address Zip Code
Street Locati~
~pe of Resl~nce
~ Single Family {~/
Water Supply
~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ Community For weirs drilled prior to that date, give well depth (attach log if available).
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
a ~'~oldingTank
j ~ . NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE ~NITIATED.
Time Time Time Time
Date Date Date Date~-)
I" --
Inspector Inspector Inspector Insp,~tor
Field Notes:
SEP o 1 1983
'CONDITIONS OF APR~E ...... B
~,~.APPROVED BEDROOMS ~p[, O~ Meal~n ~
(
( ) DISAPPROVED Environmontal Protection"
I ) COND T,ONAL APPROVAL'
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
September 9~ 1983
Chambers Const.
P.O. Box 77-1450
Eagle River, AK
99577
Subject: Sue Ta~;n 16-1
Approval for the individual sewer and vlater facilities cannot
be granted until the following items have been completed:
o We have no record of a sewer and well permit being issued.
Soils and as-builts are also needed.
Please notify this Department for a reinspection when the
noted discrepancies I]ave been corrected. If there are any
further questions, please call this office at 264-4720.
Siacerely,
Jim Roberts
Associate Environmental Specialist
j~RSS/p/E1