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HomeMy WebLinkAboutJUNIPER VALLEY BLK 5 LT 1Municipality of Anchorage Page , of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ® Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: Na Wastewater System: New ❑ Upgrade ft Ss: ABSORPTION FIELD Phone: L1 / °� I '( No. of d rooms: p Deep Trench Shallow Trench 17 Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating v Total Depth from original gradei %� GPD/Sq. . Ft. Lot: lock: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 2- - \ �� 1 nL L Ft. Ft. Townshi r. \ Ran e: Sectii n: ,.� Fill added above original rade: t Gravel length: G I Ft. Ftl WELL: New ❑Upgrade G ravel.OaW: hDi P1'k �:;1 Ft. Number of lines: Distance between lines: 2— Ick Ft. Cla sif' n (PrTate, A,B,C): \v Total Depth: Ft. Cased To: Ft. Total absorption area: v- �l% 1 SQ. Ft.�VC--- Pipe material: / Driller: Date Drilled: Static Water Level: Installer: // , Date , tallM: t: Ft.- Yield: Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES VSeptic o Holding o S.T.E.P. To Septic Absorption Lift Holding Public/Private Man factuSer: Capeity in gallons: From Tank Field Station Tank Sewer Lines ri v •} • CIC-4f Well / 1 t r Material: Numb of Compartments: Surface Water LIFT STATION Lot t t i Size in gallons: Manufactu Line � '� l(�I'M Foundation t /� . { G1 L))L� .Pump on" level at: "Purnp off' level at: Hig r alarm at: Curtain I� ` Pump Make & ModelElectrical Inspections performed by: Drain ��( ,, UU Remarks: BENCH MARK / Location and Description:/.C7 l� t��l.fLYlL` 2 Assumed Elevation: < 1 C:�_,) ENGINFXzB'S SEAL %% l tj 5 & S ENGINEERING t� e Fi Inspections performed by: I7034 Eagle Ryer Loop Road Na.f.s: 1st x'11 I I r d®0U!!ea Cg0a9®a e�eHP Engle River Alaska 99577 2nd i". ao�Et1 % GI14,F WF1 a No , (12.16 ®iP 600 AV approval 60�e,°epese®aeaea°'`' Department of Health Hu an=r)ate: / dw `,� Reviewed and approved by: /r¢ 72-013 (1/91) MOA 25 Permit No. X11 oz� � Page �Z' of Z Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES,DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343 -4741 - On -Site Wastewater Disposal System and/or Well Inspection Report i 72-013 A (2/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910275 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:DISOTELL CARL A OWNER ADDRESS:P. 0. BOX 770210 EAGLE RIVER, AIC. 99577 PARCEL ID:05075149 LEGAL DESCRIPTION: JUNIPER VALLEY BLK LOT SIZE: 217364 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 5 LT 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 9/09/91 EXPIRATION DATE: 9/09/92 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 (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: '�/C��L�/1/r///i Zii✓( SS LA-8DATE:�U�1� ISSUED BY: `'�'� DATE: 9 - el - '% / HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN Aug"t 23, 1991 Mun,ic%pa?ity o� Anchojzage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L S.tAeet P.O. Box 196650 Anchokage, Atahka 99519-6650 REFERENCE: Lot 1; Btoc(z 5; Jun,ipek Vattey Subdivision; ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Requut you .issue a pe.jon,i-t .to dit Pt a weft and .instatt a septic system to seue a p4oposed 3 bed)Loom house on .the jce6en.eneed pn.opehty. This is a tajcge mountainside tot with 6evvat poitti.o" o6 the pnopeeAty having stopu .in excess o4 250. Howevek, wheeAe we have dmignated the puposed ohigina2 and atteAnate aseptic situ, the 4tope5 ane ge2tkek. In pakticu vL, when.e the ab,soAption bed .is p4opose.d. Due to the taiLge tot size we do not anticipate any adva,se eb6ect/s on neighbo)ting p4openties by the in,s.tatta-tion o6 .the puposed wee2 and septic 3y3.tem. I� you have any que6ti,ons ok hequ,ine additionat in4okmati.on 4ok your jLev,ieu, please contact us. S.incekePy, ROGER J. SHAFER, P.E. RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE Iy ��I m vx� o ►� Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ..jM (I -NO NEEIFIA ) c. PERFORMED FOR: DATE PERFO T '1Z � LEGAL DESCRIPTION: �� rJ5 �1�I,�L 1111.- Township, Range, Section-1rl.�-1- D E PT,I`-I �krrty) o(L. 1 2 �- 4 a -fit 12 13 14 15 16 17 18 19 20 COMMENTS 1-1�j SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT i L O DEPTH? P E Depth to Water Afterp t 2 Monitoring? 1 Date: V SITE PLAN 6 a litit• 7 - Q l - 8i 9 (9 10 �• 0 1 11 12 13 14 15 16 17 18 19 20 COMMENTS 1-1�j SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT i L O DEPTH? P E Depth to Water Afterp t 2 Monitoring? 1 Date: V SITE PLAN h PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT 17034 Eagle River Loop Road No. 2 PERFORMED BY: Q Eagle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT 72-008 (Rev. 4/85) CERTIFY THATTHISTESTI WAS PERFORMED IN N THIS DATE. DATE: `� ��' `' litit• _����� h PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT 17034 Eagle River Loop Road No. 2 PERFORMED BY: Q Eagle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT 72-008 (Rev. 4/85) CERTIFY THATTHISTESTI WAS PERFORMED IN N THIS DATE. DATE: `� ��' `' ' (ENGIAEER'�S'.SEf�L) e Municipality of Anchorage -r DEPARTMENT OF HEALTH & HUMAN SERVICES r, , 825 "L" Street, Anchorage, Alaska 99502-0650 v. SOILS LOG — PERCOLATION TEST 11 ✓, -.r+{ PERFORMED FOR: , Gi'G>T�IrIi DATE PERFORME[}:'"•`T"i's`'��� 1' LEGAL DESCRIPTION: PtzPTH (FEF, • ��- 1 2 3 - 4 5 =�' s .. 6 �• 7 8 P i 9- P 10 Q" 11 O� 12 13 14 15- 16- 17- 18 19 20 COMMENTS Township, Range, Section: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE S �t L O — P E Depth to Water Aller Monitoring? Dale: g�� SIT PLAN MMMMM s .. woo 119- f U PERCOLATION RATE l o (minutes/Inch) PARC HOLE DIAMETER TEST RUN BETWEEN 14 -FT AND v!/ FT a W a 6111 1 EGMl V PERFORMED BY: 17034 Eagle River Loop Road Ido. 21011 I Eagle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN 1 THIS DATE. DATE: �'� J-" r f DOC Co. Cba SULLIVAN NATER `YELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 _ r OWNER OF LAND f�T� �� ELc C t�.u�c' I DEPTH OF WELL _t 4.6 ADDRESS k L&)< 7770 1 n E lam— STATIC LEVEL OF WATER FT. LEGAL DESCRIPTIO41 r JJ " j I O A DRAW DOWN FT. _ DATE. - Started Ended — ___ GALS. PER HR - PERMIT NUMBER _ KIND OF CASING KIND OF FORMATION: FromFt. to_�,_Ft. rzy;f�� S l t KU �- From Ft. to _Ft._ — From�Ft. to� FL !< < 7 r �U ���' `Ifroni. Ft. to--Ft.- o_ Ft._ — ,,,I�_!!l From�Ft. toFt. ZM- 410/#14J From—?—Ft. From Ft. to Ft._ From Ft. toFt. ✓Ud t (_-,A40 "Ftom Ft. to Ft e From Ft. to-aaFt.k?C 40%C�' (� ��• From Ft. to Ft_ — Fron,141_Ft.toQ, Ft. Id dADC✓le 2A44zr ,�J From Ft. to _Ft. From_ Ft. tc Ft. /57= Oa 1W From Ft. to Ft._ Froma24 Ft.to_,2,h,.-;I__Ft. �r/I�JC%�- .S b4 ✓� _ From Ft. to _Ft._ _— — From Ft. to Ft. From—Ft. to Ft. From Ft. to Ft. Fromt. to Ft. — �t. From Ft. to Ft. pO E fro i to Ft. _ From Ft. to Ft. __ mlt. to Ft. — From Ft. to Ft.—r)I i nirii�ra�'1� A LdnrWt.— F — [dept. 1104th From Ft. to Ft. os NI-jumanFt. to1Ce$ Ft. — From _Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL.INFORMATION: � 71 DRILLER'S NAME Municipality of Anchorage O "a„ e Development Services Department {a . Building Safety Division, . On -Site Water and Wastewater Program 4700 South Bragaw St. s " ` P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL tORA SINGLE't`AMILYDWELLING rr i Parcel I.D. 050-751-49 ` ' HAA Expiration Date: _ _J 2- Ra - O 3 1. GENERAL INFORMATION Complete legal description, Lot 1; block 5; -Juniper Valley Subdivision Location (site address or directions) -4171 Mariah Dr. Current Property owner(s)j,-rPd Rnd1P;, Day phone �94-4480 Mailing address r" r PO Box 770527 Eagle River; AK 99577 Lending bgency Day phone Mailing address Real Estate Agent Day phone Mailing Address ' Unless otherwise requested, HAA will be held by DSD for pickup.. Z. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:; TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 19 individual Water Storage ❑ Individual Hoiding tank ❑ Community Class Well ❑ Community On-site Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 teissued 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 Health Authority Approval Guidelines for this application, shows that the on site water supply and/or wastewater -disposal system Is(are) safe,116nctionai and adequate for the number of `.: ,•.:jai' bedrooms and type of structure indicated herein. I further yenty that based on the jnformation obtained from the .,.....,•. Municipality of Anchorage files and from rnY ` ' "'"�'""'�'a�rl irs, ecGon,'the on-site water supply and/or i..:-.:. wastewater disposal system Is(are) in compliar Municipal and State codes, ordinances; :::•,.; and regulations in effect at the time of installation.. , : •:' t '' ° r''' :.;..:'.:: +' : ,..r,:'.:;' 694=2-979' Name of -Firm rS &. S ; Engineering= _' _ r, :- -P11+i-ie — . .� •'.{l'A.�t•:K r(yt'i. i+f l;:]rjf .�1 ..:• �fi. �; f, •'`•�— ''!• Address 17034 N Eagle RiV.Pr 11.aOLP 'Sf P_ 7f1 '•Raul—e "iter, 'AK •99577 Engineer's Printed Name Robert C' Cowan '' ' 'Date '{,,,�`i •' c: � :i.5.:u.i' �.L'.''p:V}fi' ��, !!�_i•.j'�I�� •C.'' ._.3 '.. .'' 't? ',i i•aY +l''„!.7. Y't "t,'V t''.' 1 f:,` 1N..,, •rwb '• . •''.'',. ^'1)-:,.'':}.::.'�.., .'�'y'.,?''•?1 i~t •••: .1{tJ iL , .P • nww, moi.,.'.:': c:!CQwAN, 5. DSD SIGNATURE Rof3E4. Approved for.. 3 bedrooms.., .,,`.:Y,':,:1�r�^9E+.`•.:; :::.;:;+;L� Disapproved. i ; ,:: S;= Oji# Conditional approval for .-%`.bedrooms; with the following's tipulations: ; • yi> ,L: '' air -:i'.'!• ii:•: :'�:. •�+ s; +: .. Additional Comments `� ' 'r �; '�� 'WATER ANiI "• )m=' ::WASTEWATER all Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: (Rev. 01:02) X Maintenance Agreements Supplemental Engineer's Report .Other Original Certificate Date: �- 3 O -O 3 Municipality of Anchorage • �'' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1,0r1 >•�✓LQC.k s fuit/�E7L �%� Parcel ID: A. WELL DATA /fpr Well type 2,E If A, 8, or C provide PWSID # = Date compieted / Sanitary seal (YIN) Total depth Lft. Cased to . f _ft. FROM WELL LOG Date of test o Static water level Well production S g.p.m. WATER SAMPLE RESULTS: Coliform _6 colonies/100 ml. Nitrate lmmg./I. Arsenic: mg./l. Date of sample:V*0' j B.' SEPTICIHOCDtNG TANK DATA Well Log (YIN) y Wires property protected (YIN) Casing height (above ground) _ 9 n. AT INSPECTION t 4 3 ft. • YS g.p.m. e pis. A/6 - Other bacteria -a— colonies/100 ml. Collected by: $ S &16it I've" Tank Type/Matertair f! s 9'�iG.L_ Date installed 47 / Tank size, "l ipo gal.' Izlumber of Compartments ? Cleanouts (YIN) _ y Found${ion cleanout (YIN) gepression over tank (YIN) High water alarm (YIN) Date of pumping 0 Pumper :T S C. ABSOI`iPTION FIELD DATA h Date installed '��/ Soil rating ( / ' r ft`/bdrm) Q t� System type SM 'T�c-ENG Nr Length :24 i%/_ ft. Width S_X: ft. Gravel below pipe ?� ft. Total depth (0 ft. Eff. absorption area S_4!!�_ft' Monitoring tube �_ Depression over field ^J Date of adequacy test 7S 3 Results (PassiFail) / For .3 bedrooms Fluid depth in absorption field before test 0 in. Water added5 gal. New depth,] in. Elapsed Time: min. Final fluid depth Q in. Any rejuvenation treatment (past 12 mo.) (YIN & type) K Absorption rate >= 4-6t g.p.d. If yes, give date — D. LIFT STATION Date installed Size in gallons "Pump on" level at Datum in. "Pump off" level at _ in. E. SEPARATION DISTANCES Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/liit-s4e4ien on lot /00 /Q' Absorption field on lot 14:5101-f- Public sewer main A/A- r r /septic service line 25 I- Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 10n /+— On adjacent lots /00 r?,- Public sewer manhole/cleanout /v Holding tank N/'4 SEPARATION DISTANCES FROM SEPTIU 101:19IN TANK ON LOT TO: Building foundation S f Property line Absorption field g r� Water main Af .5R Water service line / O �+- 'Surface water /t Wells on adjacent lots •�!� ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line l t Building foundation l Q r Water main�0 Water Service line _� Surface water ' Driveway, parkingfvehicle storage .a— Curtain drain /0J&gw-A;V-0WA1 Wells on adjacent lots—ZQ_ F. COMMENTS G. ENGINEER'S CERTIFICATION / certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name 681io -r C. Cor-'#,✓ Date 9 /;t1 /0 3 HAA Fee $ 3 74�- v Waiver Fee $ _ Date of Payment R /.v Date of Payment Receipt Number d a0 Receipt Number (Rev. 12/01) i Vis"!.: 'w c.::=::'l-✓':+'♦2 �. ROBERT c. COWAN ! Q ��, CE -8801 in. 9-23-03; 5:17PM; :907 5615301 0 2/ 7 S -G$ SGS Ref.# 1036082001 All Dates/Times are Alaska Standard Time Client Name S & S Engineering Printed DateMme 09/23/2003 17:06 Project Name/A Various Collected DateMme 09/17/2003 1535 Client Sample 1D Ll, 115, Juniper Valley Received Date/time 09/192003 13:15 Matrix Drinking Water Technical Director Stephen Ede PWSID 0 Released!/jam/' Sample Remarks: Parameter Qualifiers Results PQL Units Method Container ID Allowable pap Analysis limits Date Date Init Waters Department Nitrate N 0.404 0.100 mg/L EPA 300.0 B (c=10) 09/19/03 JJB Microbiology Laboratory Total Coliform 0 coV100mL SM1892= A (<—I) 09/18/03 KC O N W • P Q * ~ V O O 00 Q • - - -� O W Y m .N J i Q o 'N 3 T N O w ry m h d v C y 'v O W _._ - -..•� p C Ing �c O _' `_ •` Y N .' O N 3 c_ N C 7 • • tiC •• C♦ O �. O C C f00 uj M.o/ N�d��. `b dv M • ♦' • q CL G N L 1 N J m /Q • • F • w `♦�: �:. ,per v N N ; O d O u�i v N N o= od-0v',v vrn co/M\y/ • Ar V > v ^o v N w C C M O W F- N _� C O C C y v F urj .- m v N .- o p rIT \O o p" N 9 pp 7 o v n 2aao.vo dv w5 PS F / ygE 2 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. # 151 -'--\2t HAA # A Qc' O.C� \� 1. GENERAL INFORMATION Complete legal description Lot 1; Block 5; Juni.pen. Vae,2ey Subdi.vizion; Location (site addres$ or directions) Tent Dni.ve Property owner Cane. DisotW Day phone 694-5797 Mailing address P.O.Box 770210 Eaqte Riven, Ataska 99577 Lending agency Day phone Mailing address Agent Arlriracc Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water Day phone 7 - NOTE: 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 XX 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. 1191) Front MOA U21 20 VOW HDUB MA '�U) 9MU •�aom s,ioeu!6uo leuo!ssaloid agl ui suo!ss!wo ao saaaa jol alq!suodsea IOU si a6eaogouy to (l!lpd!o!unw aql -panssi si aleo!lpaao a aaolaq elep azAleue ao suo!>oodsui lonpuoo IOU op SHHQ to saaAoldwg -sluawaa!nbei alels pue leaapal u!eliao /,4s!les o1 aapio ui suo!lnl!lsui bu!pual a!agl pup sawog to saasegoand olAselinoo p se s!gl saop SHHO agi'e�!sely to alelS aql u! paaals!6aa aaau!6ua leuO!ssaload luapuadepu! up Aq anoge g gdpa6eied ul uan!6 suo!lpluasaadai aql uodn Aluo paseq saleo!l!laao lenojddy Allaoglny gllpaH sanss! (SHHd) sao!naaS uuwnH pup gllpaH to luawvadaQ abejogouy to Al!led!o!unw eql NV1111GJ , ale© :/8 j� � :suo!lelnd!ls bu!nno!lol agl gl!m 'swooapaq 110, �H�lSS3dt)Hy �� e0see0njQO B'ggti .o °pp, Cc' - •ON o Q� t33�VH 'f >d bOi9 ux ane$ a a ow 01"06098" POP e�fei op edv W 40 sluawwoo leuo!l!ppy Jo} lenoidde leuo!l!puoo panoiddes!a swooapaq a aol par)oaddy N aunIt/NJIS SHHd '9 b _ L algia einleu6!s s,jeeu!6u] LLSdd eMsely'aanla 016e3 ___WY70N peon door aanl?{ alfe3 4E0LL ssaippy auogd �JNRI33N1']N2 q Q w11 O awe �l N •uo!loadsui s!ql to elep eql uo loago ui suo!leln6aa pup 'seoueu!pio 'sepoo alelS pup led!o!unW Ilia gl!M eoue!ldwoo ui si walsAs lesods!p aalemalsem ao/pue Alddns aalem al!s-uo agl 'uo!loadsui pup uo1le61lsanu! Aw woal pup sal!l a6eaogouy to Al!Ied!o!unW agl woal pou!elgo uo!lewao;ui aql uo paseq legl ll!aan aagljn; I •u!aaag paleo!pui ainlonals to adAj pup swooapaq to aagwnu eql aol alenbape pue leuollounl 'ales si walsAs lesods!p Jejumelsem JO/pue Alddns aaleM al!s-uo agl legl smogs uo!leo!ldde lenoaddy Al!aoglny gl!iaaH slgl to uo1le6lls8nul Aw leUl A}!aan I 'molaq umogs alep uo!lep!lpn agl to se pup olaaaq pail;}e leas Aw Aq pallpiao sy H33NION3 A13 NOLLOUSNl d0 LN3W31V.LS °S Municipality of Anchorage Department of Health & Human Services or HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: l S J�� �� Parcel I.D.��� A. WELL DATA Well type�'�'— S/k� If A, B, or C, attach ADEC letter. ADEC ater system number _ Log presentcS�'N) Date completed Driller ✓�����*� Total depth 2�� Cased to �Pv 1 Casing height_ `2 Sanitary sealdpN) Date of test Static water level Well flow Pump level FROM WELL LOG ,,I /11 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Wires properly protected VM) g.p.m. AT INSPECTION ; On adjacent lots t ; On adjacent lots Public sewer main ��% Public sewer manhole/cleanout Sewer service line i� Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate I Other bacteria Date of sample: B. SEPTIC/HOLDING TANK DATA M Collected by: * S e�6Z _ Date installed �'_ ?"r> -91 Tank size � 4:11::,(C�16:> Compartments CleanoutEtT�7N)y—Foundatip cleanou�N) High water alarm (Y/N) Alarm tested (Y/N) Date of pumpingPumper _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Depression (Ydgp r - �e t k Foundation Wells) on lot ` On adjacent lots � _ To property line �^ Absorption field Water main/service line �e r ( Surface water/drainage �,� A- 72-026 (Rev. 7,91) Front CONTINUED ON BACK PAGE aagwnN }d!aoad luaw (ed to ale0 $ :aa_d aan!eM 00 ,1,7 ,vaAuoa l%; Na:Jv,lQp1, aagwnN ld!aoay luawhd to ale(] $ aaJ VVH 2 �, ale(] "!�°+>arltlni �emUaoiiv �aA:i �r.boa p aweN s,aaau!6u3 LL566 uc y,-� Fra "* =+ i; bog 'oN peotj dool iamu 01BLA veol. I. aanleu6!S 'Sdn;�',nxu BOG-�x aao �`4i ��B JNIa313NIONi3 S'11 S 'uolloadsui sµll {o alep au; uo loejja ur sauflepn6 VVH pue ypW pe o4 paw.10{uoo ao 'pai{iJan 'p9400y0 aney ley; ftjp.reo NOlIVOId11EI3O SAd33NION3 '3 u!eap u!e;an0 —ate eaae a6eao;s alo!Uan/6u!�laed ` (ennan!a0 i 10��— aaleM aoelanS mo, au!lao!naas/u!ewaaleM— I�, 4 ilueq;n0— o�slolluaoefpeu0 lol uo wa}sAs pauopuege ao 6u! s!xa of � e; uo!lepuno; 6u!pl!nq of Jo au!l Alaadoad -k ��,os;o! luaoefpe u0 ;ol uo IIaM Ol 0-131d NOIldHOSOV WOdd 30NViS10 NOUVHVd3S alep an!B 'say( ll �) (syluow a ised) luawleaal ap!xoaad swooapaq ao } (l!e}/ssed) s;lnsa>d ;sal Aoenbape to ale0 - C!:N7,k) pla!} .lano uo!ssaada(] _ — (N/gPwasaid s}nouea10 ea.ie uo!ld.losge lelol G— 41dap lelolr ssauilo!ul lanea0 4}P!M yl6ua-1 ad (1 walsASZ� Q�J bullea l!os b_ 0'7�_ Pallelsu! ale(] - as;enn aoelans — palsa; salo�0 le lana) „}lo clwnd„ vlva a131d N0I.Ld80SSV •a slot luaoefpe u0 lol uo IIaM :Ol NOUViS ldlg NOW 30NH1S10 NOliVUbd3S (N/)l) ssaooy/aloyuew aa.rn;oelnuew (N/),) sapoo leouloala dOW slaaW ;e lana) „uo dwnd„ lan91 waele aalenn 1461H (N/,k) luaA suolleb u! az!S Palleisu! ale(] NOLLb'1S l.dl, 'O CIHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 52264 Chemlab Ref.# 92.1208 Sample # 1 Matrix: WATER Client Sample ID L1 B5 JUNIPER VALLEY PWSID UA Collected MAR 26 92 @ 15:10 hrs. Received MAR 2.7 92 @ 15:30 hrs. Preserved with AS REQUIRED Analysis Completed : MAR 30 92 Laboratory Supervisor i STEPHEN C.�EDEE Released By ����'" _ `, LL�L' Parameter Results ---------------------------------------------------------- NITRATE-N Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO# Ro(l# Ordered By Send Reports to: 1)S & S ENGINEERING 2) PO# :NONE RECEIVED Units Method Allowable Limits --------------------------------------------------------------------------- 0.11 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: R.J.S. Remarks: 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT-Greator Than * % SS Member of the SGS Group (Socidte G6n6rale de Surveillance)