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Home My WebLink AboutKOEHLER LT 64A P.O. BOX 6650 ANCHORAGE, ALASKA,~,~,.,_-aa': n,p c,~.x~'~,~ ~ i907) 264-4111 TC ;'. Y ,';,L'O ',vz ES DEPARTMENT OF HEALTH & HUMAN SERVICES January 10, 1986 TO: Permit Applicant Subject: Permit # 850383 Lot 64A Koehler Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit DEPAR]'M!ZN'I' OF' HIEALTH Al',lb ENV:[RONNE:NTAL. PRC)TEC'I']i£iI',t ~:) ..... L. ~ i F~E::E:. I , AN[;HOF~AGE, AK 995() 1 ......... ~=:~, % 'T" E?E~:: EB flEE l~, ~ ~' fl.. ,. F" ED:: fi::;~ IP"fl ]:: 'T' 85C)3~:;~; HAND WRITTEN }7 tc 2185 ' AFl. I..1CAI I l i1 A D D R E S S ~: COI'4'TAfZT' F'I'tOIqE Je LEGAL Dlii!:SCR I P ,", I....OT S :1: ZE ,", SLJBD :1: g I S I ON,", K[IEHLEI:~ SECT I ON: El 'I"OWNSH :1: F:': :l 5N 1 ,, 2'.5A (°l'; .............. c~.., F. I , £)R L.,O'I": 64A RANBE~ :I.W E LOCI .... 0 ]: c: e r' t i f y t h a t: . ;I.,, :[ am famil:i, ap with the r'equil*rJmer'rLs for' on'.".~it~ sewers and wells as set fc)r'tl"~ by the Idunicipa].&ty caf Ar'~chc)page (M[]A) and the State of Alaska,, 2?. :1: will :Ln~'i:.al:l. the system :i.n accondanEe NSt. h a~:[ IdO~ codes and r'egulatti, ons, arid ir'l c:olllp],J, arlc;e with the des:Lgn c:piter':La c)J' th:i.~ 3,, I will adher'e 'l:.c~ all I'flO~ ar'id State c:~f Alaska r'equir'ements fDr' the set:. back dis{arlces ¢r'c)m ar'ly e~.Jist:i.r'lg well, wastewatep dispDsa:t, sys{em [~r' i::)ublic sev~er'age system on 1:.his on apy adjacent ap near, by let,, ZF: A L.];FT STAT:[Oltl IS INS'I"AI..LIED iN AN AREA COVIERIED ElY MBA BUIL. DINE~ THEN (1) AN IELJE[;T'I::~ICAL. I:,E:RMIT AND INSF'ECTIOI~ 1'4LIS]' BE OBT(.~INED; (2) AST~BUIL. TS WILL NOT BE AI:::'PRCIVED WITI.IOUT AN IEI....ECTRI[]AI.... INSPECTION RE]::'ORT; AND (3) THE API:::'L. I CAIxtT = ROBERTA. SHAFER June 23, 1985 CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION SYSTEM DESIGN WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM OESIGN Municipality of Anchorage Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 64A; Koehler Subdivision ATTENTION: Robby Robinson Dear Robby, Mr. Ken Strible had Chuck Bart Excavating install an on-site waste water disposal system for a three bedroom residence on the referenced property in October 1984. We performed the soil test and inspections at the time the system was installeld. Copies of the soil test, permit and inspection report are attached. Ken Strible actually constructed a one bedroom house and subsequentally obtained a health authority approval for two bedrooms. Ken Strible's father and mother, Mr. aud Mcs. ?om Strible, own a fifth wheel camper trailer which he b~'ings to Alaska with him during the summer while he works construction. Ken Strible is seeking a permit that will allow his father and mother to connect their mobile home (one bedroom) to the existing on-site waste water disposal and water supply system. Since this connection is within the total design capacity of the on-site waste water disposal system and is to be used temporarily only during the summer months as a "mother or father-in-law"arrangement it is our opinion that this does not violate the single family dwelling concept'and that the horizontal separation distances prescribed by 18AAC72 and Municipal Codes for multiple family dwellings are not applicable in this case. Request you issue the permit~equested. ~OB~RT~A. SHA ~Rt P.E. SRB 196X EAGLE RIVER, ALASKA 99577 ¢,~~ MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE ,,,,~ NEW ~GAL DESCRIPTION ~ ~ MonufacturW__~ ~e f No, of co;p nts ~ ~ ~ISTANCE TO: Well Dwelling t PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~[~[J~ N°'°flines/ Lengtho~achi~e/~o Trench~Oth.~ 0 "inches Distanceb~F~s ~'~ Top of tile to finish g~e / Material beneath tile ~ //inches Totalef~rp~ar Lengtl~ ' Width Depth PERMITNO. / Type of crib Crib diameter ~e~ib aep Total effective absorption area m ~ell ~uildiff~ f6undation ~earest lot line m ~ISTA~Cfi TO: " ' DISTANCE TO: ~uilding foundation Sewer line Sep~______ ~ Absorpti~ OTHER PIPE MATERIALS SOI~ESTRATING ~ / l'' ~1 .CIPALIT¥ OF ANCHORAGE DEPARTMENT OF FIEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE ,.,~ NEW ~ IJPGRADE ~--13-/._2 t~:' 1 L, IF HOMEMADE: [ Inside length Well / Dwelling ~ Manufacturer DISTANCE TO: No. of lines/ DISTANCE TO: Width Crib diameter Well Depth Building foundation /]aterial beneath tile Depth Driller Sewer line OTHER PIPE MATERIALS ~T- EI~STRATING / ' APPROVED NO. OF BEDROOMS.~ Dwelling M ~i' No, of co~np6r,t~ents ,,' J Width -- ~ .... Liquid depth PERMIT NO, Material Liquid capacity in gallons ¢X ~-- Total PERMIT NO. / ~_~ Total effective absorption area 1 Nearest lot line Dista,,ce to lot line PE~ ~¢ C:C)t',l'Tff>l[:Tl" t:::q II::)tqE!: ',', L.. E: F'h':~d.. I....[)T !!i :[ ZI!!!: I'lhX F:: (q ('31.... IE F~:i:\,qi!!:l::~e, ["M'::: c~'c?',577" !iiiL.IEq) '.[ g ]; !il ]; OIq ',: ~i!Z!iZY'I" ]; DN ~ D 'T'EII,,,IIqI!~H ]1; I::' ',', DEP/ARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST SLOPE 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? b~rt A. $~eter No. 1~7oE SITE PLAN /Jo o P E IF YES, ATWHAT DEPTH? \ / Gross Net Depth to Net Reading Date Time Time Water Drop // PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN .. FT ~.J~ ~ FT COMMENTS PERFORMED BY: 72-008 (6/79) / I II "~ ' -' r ~ ' "tl~ ,.r '... ~r- ~'r:' , ' ~ . '~ 120 ' ' ' ' ,~ '__' ~] : . ..... ~e~' · - -' ', ~'r r ,,~. "', ~-- ~ .... · ..... /~'~/.n ~,'/ '..:. - ,... · / / ~'-~ ~a~ ,' . ,~ D.-U '_~ I~' . · .... ~. · ; ~ . . /.~ ,~7 , 1~1 1~ ~ . ~ ~ ~ .... - . ', .... ' ~ ' ' ~ ' ~ ' ' ----- ' ~ ~' .r '~ . .' ,-:,--., -':'~;.',~' :,~ ~" ~ ~ . 21~ ,~.. - .. . .~* ...... · . 'e"~'~'~ '~ :"" ~ ' ~ :" ~ ~0 ......... " ' ' ~0 '~" ' , .......... '~?¥'':~r.'.' , ~ ............. ; '~ ..... . ~ .... .. ~ . ~., ~ ......: ......"~',' ; ~...~.->;:,~..:/- ~ ~:. . ~ / r ..... · - ]~ ~- ~ · "~ .... 2~ ~1 ~'.~':~1-"1~ '~'7~?~''''''' ' .... '2~2 ~. II.~r- ' · :~ ~'~ ,. ~ei .... ga~ · ' ' " ' rr~-' U,_,.. ' .... ~90 ' ggO ' . ,.... ....... ~t' ~,~,--r,...' ~0'~ ' . ' , '/ ......... ~' ~.__ : -; . ~ ~ ' ... ''': . '',gg~ : '9~ ' ' ,." .... r' '~2 -- : --~ ' ' ~ ~ g~2~' ,e~. · · ..... ' . ~9~ ...... ~8~ .... '' .... , ' " ......... · ~,~ .,..r.. -.. .... , ~ ~: ~?' ~.,. . , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 64A, Koehler Subdivision Location (site address or directions) 20533 $cen±c /. , , '*%,',, '%~,v ~"-~ ~" * Ke~ ~' & L~nda Day phone Prope~y,owne'r ~ ~. S~roble Mallin~a0dreSS~:~B~5' 672423 Chu~ak, ~K_99567 ' ~_~ ........ ,City Mortgage Day phone ~-~n~~,'~ ':~ark .~gr'fi.~O~t . Day phono Address 694-4499 263-0700 263-0?00 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Three ( 3 ) TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWA'rER DISPOSAL: NOTE: XXX Individual on-site Holding tank : Community on-site 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) Front ~IOAft21 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 dateof this inspection. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Date. 2/2/99 DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ' --: -- . . Date The M~nici,',p, ality of 'A.,r~.~h0rage Department of Health and Human' Services (DHHS) issues Health Authority Approval Ce'rtificat? based only upon the representations given in paragraph 5 above by an independent professional eqgin, eer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their li~nding institutions in order to satisfy certain federal and state requiraments. Employees of DHHS do not conduct 'iiispi~fions or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible roy errdrs or omissions in the professional engineer's work: Legal Description: Lot A. WELL DATA Well type Private Log present (Y/N) Total depth 82 ' Sanitary seal (Y/N) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICER l! C E IV [ D Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-~ 5 1999 Health Authority Approval Checklist 64A, Koohlor s/d Parcel I.D.: Y Municipality of Ancn,orage Dept. Health & Human Services 051 -091 -48 If A, B, or C, attach ADEC letter. ADEC water system number Date completed 10 / 29 / 84 Cased to 8 2 ' Date of test Static water level Well production WATER SAMPLE RESULTS: 0 Coliform Date of sample: 1 / 31 / 99 B. SEPTIC/HOLDING TANK DATA Date installed Z O- 84 Tank size Foundation cleanont (Y/N) 7 Date of Pumping FROM WELL LOG i0/27/84 uz2 ki2 o w12 6 GPM Nitrate Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION 26.5~ g.p.m, cT 3.SGPM g.p.m. 2 · 07 mg/L Other bacteria 0 Collectedby: stuart Gilbert, Depression (Y/N) /v 10/21/98 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed l 0 - 84 Length 40 ' Width Effective absorption are,'i '480 1, 0 O0 Number of Compartments 2 Cleanouts (Y/N) Y High water alarm (Y/N) N Soil rating (g.p.d./ft or ft-/bdrm) 30 ' Gravel thickness below pipe Monitoring Tube present(Y/N) Y Date of adequacy test _ 1 / 11 / 99 Resnlts (Pass/Fail) Fluid depth iu absorption field before test (m.); IZ ¢t Fluid deptb /2~" (ins.) Minntes later: o/~9 Peroxide treatment (past 12 lnonths) (Y/N) N 125/l_5~stemtype_trench 6 ' Total depth 122" Depression over field (Y/N) N For 3 B e d r o o nbedrooms hnmediately after ¢7t) gal. water added (in.): 1~ '~ Absorption rate = > ~'O g.p.d. If yes, give date D. LIlT STATION Date installed N/A Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* *Datum "Pump off' level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot G T Absorption field on lot Public sewer main N/A Sewer/septic service line 103.5' GT 112 ' GT 25 : On adjacent lots GT 1 l 0 ' ; On adjacent lols GT 1 I 0 ' Public sewer manhole/cleanout N/A Lift station no evidence Fo SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Bnilding foundation 1 1 ' . Property line 20 ' Absorption field Water main/service line G :. 53~r~ace water/drainage n on e Wells on adjacent lots ob serv~dJ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building fonndation Surface water Curtain drain no ENGINEER'S CERTIFICATION 2 6 ' Water main/service line c,~ 5 0 ' non observed Driveway, parking/vehiclestorageareaGT 50 ' e vi d 012 c o Wells on adjacent lots G T 1 1 0 ' Property line GT 110' 10' 1 certily that ! have determined thrufield inspections and review of Municipal records in conformance with MOA HAA guidelines in effect on this date. Signature Date HAA Fee $ ~'~.")~),,(~' 5 Waiver Fee $ Date of Payment ~ ~,. cjq Date of Payment Receipt Nmnber ~53 t-L ½~, ~ Receipt Nnmber Rev. 8/95 eSS: haa.wk.doc CT&E Enviroflmental Services t,c. , ~ CT&E Ref.# 990207001 Client Name SG 'reelmical PrOject Name/# Outside Faucet Client Sample I:D Outside Faucet Matrix Drinking Water Ordered By PWSID Sample Rer~ks: PaPame~ar ~ttrate-N. Resutts P~L Uni___t~ OB/lO0 HL. NO COL! 2.07 0,100 Client Printed Date/T~me 01/18/99 ·10:53 Collected Date/Time 01/11/99 '18:00 Received Date/Time 01/~.2/99 08:10 Technical Director: Stephen C. Ede Method Limits Date Date Inlt aMI8 9~228 01/12/9~ I~AP 6PA 300.0 10 max 01/12/99 01/12/g9 SCL R E C E iV FEB, :5 19~9 Munic;pah~y ol A;,,:;no~ Oept, Health & Human £O/E~O'd '~0£c:l:9%,,',06 3BU;~OH3NU ISS S'g13 E0:9l; Drinking Water Analysis Report for Total Coliform Bacteria 200 w. ~o.e, =,,e Anchorlge. AK 99818-1605 ?£4D INSTRUCTIONS 0/¥ REYEP~£ SID£ gEFORE CO£L£CTING ~4t}IPL£ Tel: (9071 562.2343 MUST B; COMPLg~']:~ By WA-rg& SUPPLIER PUBLIC WATER SYSTEM I.D.~ ~PRIVATE WATER SYSTEM SAMPLE DATE: SAMPLE [3 Rou~'ino Repeal Sample (foe routine with lab tel no, Special Purpose Fax: (907) 661-5301 ~'o {BE COMPL£T;D BY LABORATORY Analysis shows this 'a/ilar SAM~L£ to Satisf~to~ S~ple over ~0 hau~ rid, ~sul~ may ~e unreliable S~ple mo long in transit; samde should not be Owr 48 houri 0Id al e~aminalion m indicate reliable mulu. P4cue sen~ Dote Receiv~ Time Reeeive~ Analytical ~'lethod: .~.C~¥femb~e Filter Cl MMO-MUG . * Number ofc010nies/100 mi. Result~' Analyst I CI Tre. ted W~ An~'h Fbkl Jul~ D~w. ~ T~me~ ~OlTiffi~nt$: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MU(J Reeuil~ To~i Collfofm .. g. C~Ii Membrane Ftlta~ ,Oit'~ Coume ~/--~ I it.ll Coliform Caallrmadoa -, , FTnel Membe~ne FiReJ, R~I~., RECEIVED [] Fixed TOTRL P. 01 81/18/1999 23:01 6947112 SGTECHNICAL PAGE JR's Pumping Service P O Box 773511 Eagle River, Alaska 99577 (907) 694-6454 Invoice DAYE INVOICE # 10/21/98 2692 BiLL TO Dove, Tim c~ Linda 20533 Scenic Dr PO Box 672423 Chugiak, AK 99567 QUANTITY Pumped Septic 'l'imk paid m full check /i221 DESCRIPTION TERMs. ~ROJECT RATE AMOUNT 85.00 85,0O RECEIV ED FE!3 3 ~c~l Muni(zu)ah~y OI Ai](;llor~§8 uept. FeaRn a Human Services I'fiank you for your busil'~ess. Total $85.00 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 1. GENERAL INFORMATION Complete legal description Lot 64A; Koehler Subdivision Location (site address or directions) 20533 Scenic Drive, Chugiak, Alaska Property owner 5inda St:roble Day phone 688-4372 Mailing address P.O. Box 670321, Chugiak, Alaska 99567 Lending agency Mailing address Agent Address MORTGAGE Day phone Eagle River, Alaska Day phone Unless otherwise requested, HAA will be held for pickup. 3 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Xxx Community well Public water NOTE: 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev, I/91) Front MOA #21 5. 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/orwastewaterdisposalsystem is safe, functional and adequate for the number of bedrooms and type ofstructure indicated herein. I furtherverifythatbasedontheinformation obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s 8, S ENGINEEEING Phone i7034 Eagle I~ivet' Loop Road NO, 21~_ Address Eagle Eiver, Alaska 99577 Engineer's signature DHHS SIGNATURE Approved for ~~,)bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does th is 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) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-.¢'T ~,~/i~. ~Z. oC.,w~,b.¢:¢.¢_.~<~ Parcel I.D. A. WELL DATA Well type ~¢-"J¢'~¢¢~ Log present (~/N) Total depth ~% Sanitary seal ~/N) IfA, B, orC, attach ADEC letter. ADEC water system number ~ Date completed ~, °¢"¢~'~ Driller Cased to ~-o ~ ~' Casing height Wires properly protected (~/N) '-/ Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION MUNiCiPALITY OF ANCHORAGE "~ - 'Z. ~ ~ '~1 '~f4VIRC-=,~MMENTAL SERVICES DiViSiON SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /oo Absorption field on lot \o~ Public sewer main ~\~' Sewer service line 7-~' ; On adjacent lots ~ co ; On adjacent lots Public sewer manhole/cleanout Petroleum tank '2-~' WATER SAMPLE RESULTS: Coliform O c.o ~-,/\o~ ,4.JL. Nitrate Date of sample: --~..[..~.c~_ / B. SEPTIC/HOLDING TANK DATA Date installed \O Cleanouts~/N) High water alarm (Y~ Date of pumping Collected by: Other bacteria ~ 'p ~ ¢-- $ & S ENGINEERING 17034 Eagle River LOOp Road No. 204 Eagle River, Alaska 99577 Tank size \ CoO ~'~..- Compartments '7,- Foundation cleanout (~/N) ~ ~ Depression (Y/~ Alarm tested (Y/N) Pumper _,~¢- · ~_.~-~L~.S t'a~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Io~, ~ On adjacent lots ~o~ ~'~ To propertyline ~o\ .v- -~ ~ Surface water/drainage Absorption field \c,'o Foundation Water main/service line 72-O26 (Rev. 7/9~) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/.~~ Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) ~ ~ --~Pu~p off" level at .-~Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~.O- 5~ Length ~o~ Width Total absorption area 4'~O Depression over field (Y~) Results ,_.~/fail) Peroxide treatment (past 12 months) (Y,~ Soil rating 17-%' - 1¢O ~/~' System type Gravel thickness ~ ~ Total depth Cleanouts present ~'/N) ~' .~ Date of adequacy test ~ ~ ~.1 for 'T"'~ p-~. ~ (':~.) bedrooms //"~/°~/~' If yes, give date _ '~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /I~D To building foundation On adjacent lots Surface water Curtain drain On adjacent lots / Property line To existing or abandoned system on lot Cutbank "J/,~' Water main/service line Driveway, parking/vehicle storage area E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ;~ ii[ § [!NGINEERING '~:"'~'J~ '~ . : '"~'~" '-'"' Signature ~ ~'f.).~ Et~gle River Loop Road No. 204 Engineer's Name Date ~h?.:,i~ eh,,er, Ale, ska 99577 HAA Fee $ //.~ Date of Payment ~-~'~ Receipt Number ,::~-~- 72-028 (Rev, 3/gl) Back MOA 2~ Waiver Fee: $ Date of Payment Receipt Number 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 fez INVOICE ~ 52078 Chemlab Ref.$ 92,i09i Sample ~ 9 ~atrix: WATER Client Sample ID ?WSID Collected Received Preserved utth L64A KOEBLER S/D Client Name :S & S ENGINEERING UA Client Acer :SNSENGP RAR 20 92 @ 14:50 l~. EPO$ : ~R 20 92 @ 16:20 h~t~. Roq# : AS REQUIRED O~derod By ;R.J.S. POW :NONE RECEIVED Analysis Completed : ~R 23 92 Send Reports to: Laboratozy Supervisor : STEPHEN C. EDE 1)S & S ENGINEERING Relea,ed By : ~~--~ 2) / Parameter Results Units Hethod Allowable Limits NITRATE-N 0.45 mt/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: I To~te Performed ' See Special Instruction* Above UA-Unavailable ~D- None Detected '* Soo Sample Remarks Above NA- Rot Analyzed LT-Le~ Than, OT-Oroater Than Member of the SGS Group (Soci~t~ G(~n~rale de Surveillance) CHEMICAL & GEOLOGICAL LAB ORATORY A DIV[SION OF COMMERCIAL TESTING & ENGINEERING CO. TI:LEPHONE (907) $62-2343 5633 B Street And~orage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPI.ETED BY WA'~ER SUPPLIER ~ PRIVATE WATER SYSTEM ~ atlng Addro~ .... State TO BE COMPLETED BY LABORATORY 'Year Treated Water U~3troated Water Time Collected Collected By' Mo. Day SAMPLE TYPE: [3 Routine ,~_Check Sample (for routine sample with lab rof, no. c~.,'~,_[p_c~__.[,,,~.,t.,~_) [] Special Purpose LOCATION L SAMPLE 1 2 Analysis shows this Water SAMPLE to be: ,",~ Satisfactory ~ U nsatistaclory [] Sample 1oo long in transit; sample should not be over 30 hours old at examination to indicale reliable resulls. Please send new sample via special delivery mail. Dele Received ~ Th'ne Received - ~ ~/~"~ ~ Anelyllcal Method: Membrane Filter ' No. of colonies/lO0 mi. Lab Roi. No. Result* READ INSTRUCTIONS Membrane Filter: Direct Count Verlticatlon: L.SB RGB B EF O R E Fecnl Coliform Confirmation Analy~,t L~.,~ ;' COLLECTING SAMPLE TNTC = Too Numerous To Cc OB = Other Bacteria Final Membrane Filter R.e.,,ulls .e.orte .... /¢"- pART 0~[ OF T~O ~EHAtflDER TO FOLLOW ~ Coliform/lO0 rnl Coliform/100 mi MUNICIPALITY OF ANCHORAGE DEPARTMEN'i- OF ItEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTI-IORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 /~.,/~.%/~ Application Date GENERAL INFORMATION (a) (b) (c) Legal Des. Oription (include lot, block, subdivision, section, township, range) Location (address or directions) ~ · , - ,.__ z/~ Applicant Name~~~--.-- Telephone: Home ~~. Bus, ness _ Applicant Address -~ _,~~'~ ~ ~ ~- ~-- ~ ~~~" ~-~ Applicant is (check one): Lending lnstitution ~ '~e~uilder~; Buyer~;Other~ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address .... Telephone Telephone TYPE OF RESIDENCE Single-Family [~ Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well,~ Community [] Public [] Note: If community well system, rnust have written confirmation from the State Department of Environrnental Conservation attesting to the legality and status. 4, SEWAGE DISPOSAL Onsite"~ Public E] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72 025 (11,84) Page 1 of 2 ENGINEERING, FIRM PROVIDING INSPECTIONS, 'rESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as olthevalidation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-s~te water supply and, or wastewater disposal system is safe, functional and adequate for the number of bedrooms and typo of structure indicated herein. I further verify that based on the inlormation obtained from the Municipality of Anchorage files and lrom my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal arid State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm !5 .P. ', .... k~-,,'"~,;, ~'"'"L-¢,~.~-,~'""' ':' Telephone Address ..~;. Date Approved for ~---" bedrooms by .... ~ ,~% ~'L('__ 'ate /// Cond~t ona ~ Approved ~_.~. ~ Disapproved ...... ' ' Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 abow~ by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGI~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR t 8 264-4720 LegaIDescriptJon: ,~-~'?~ ,./., ECEIVED Well Classification ~/~.~'ZLE/','~I~' If A. B. C. D.E.C. Approved~N~ Well Log Present ON')' Date Completed /O -,.~,¢/'-,, ~3 ¢ Yield Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit Cased to _ ~/f45 / ~ Depth of Grouting Pump Set At Sanitary Seal on Casing~/N-~ Depression Around Separation Distances from Well: To Septic/Holding Tank on Lot /oO" ~'' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _~"D~ '¢ ~ ; On Adjoining Lots To Nearest Public Sewer Line ,/t¢/~ To Nearest Public Sewer Cleanout/Manhole ,,,Ac//n~ To Nearest Sewer Service Line on Lot water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA To Water-Supply Well To Property Line To Water Main/Service Line Course Date Installed _/O ",~%~ t/_ Size Standpipes ~)N)% Air-tight Ca ps ~,N')" Depression over Tank ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~ Separation Distances from Septic/Holding Tank: /~ ~ _/~ ~ ~ No. of Compartments Foundation Cleanout~/,N~_ Date Last Pumped ,/.r-C'..~m~tZ",,-! Temporary Holding Tank Permit (Y/N) To Building Foundation / ~ '/ '/~ To Disposal Field _ ~ '~ To Stream, Pond, Lake, or M~jor Drainage Comments Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata /,._~¢C' /,/~ Date Installed ~' 2) - ,pj-.- - ~ c/ / Width of Field Square Feet of Absorption Area Depression over Field~-~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line /t~//,~-- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Pr esen t~/,NcF Date of Last Adequacy Test /,////¢ To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank~/,~ent) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I~ have checked, verified, or conformed to all MO.,A and I~AA guidelines in effect on the date of this inspection. Signed ~'~ ~ '~., ?,f~ I~.E!~FIIN ~ Date ~'"~"' '~ ~';~, Receipt No. ' ........ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) HEMICAL & GEOLOGICAL LABORATORIES b,, ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Water System Name / Mailing Address ~ · SAMPLE DATE: (') See h on back Phone No. State Zip Code / Mo. Day Year SAMPLE TYPE: ~otJtlne r-] Check Sample (for routine sample with lab ref. no. J [] Special Purpose [] Treated Water ,l~;~J, Jnt reat ed Water SAMPLE NO. LOCATION I { /-o¢- /~ ¢",,¢- I Time Collected Collected TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: .~Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Tirne Received Analytical Method: Fermentation Tube Membrane Filter Lab Ref. No. Result* Analyst i-r-) i-f-'1 F-F1 F-F-3 06.1220 (b) Rev. 1983 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE MembraneFiltec Direct Count Verification: LTB BGB Final Membrane Filter Results Reported By ::~. ;. ~_ ,L/// Date I Time: Coilformll00ml Coilformll0Oml '/.-.//. ~,'-'· / ~( ~" a.m. COLLECTING SAMPLE TNTC = Too Numerous To Count