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Home My WebLink AboutKASILOF HILLS BLK 8 LT 4A Municipality of Anchorage Page 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: '~b'~c~CJo~'~ PIDNumber: N~m~: ~ ~ Wastewater System: ~New O Upgrade Address: q,.o.~ ~ A~.~. ~fl ABSORPTION FIELD Phone:~_ ~/~O~ JNo. of Bedrooms: ~ ~DeepTrench ~ Shallow Trench ~Bed ~Mound DOther LEGAL DESCRIPTION S°il Rsting: ~. ~ GPD/Sq. Ft. Total Depth fromm. ~°riginal' grade: _ Lot: ~ Block:~~%l~¢Rubdiv~i°n:~iLL~ Deplh to pipe bottom~ from original grade: Ft. Gravel depth~..~, cbeneath pipe Ft~ Township: Range: ~ Section: ~ Fill added above original grade: Gravel length: ~ I ~ - ~ ' Ft. Ft. WELL: ,~ New ~ Upgrade Gravelwidth: ~ I Number of lines: Distance between lines: ~ '~ Ft. [ ~- Ft. Classification (Private, A,B,C): Total Dept~: Cased TO: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: Pump Set at: Casing Height Above Ground: ~ ~.. d/K ~,. ) + ~,. TANK SEPARAT)ON DISTANCES ~Septic ~ Holding ~ S.T.E.P. TO Septic Absorption Lif~ Holding Public/Private Manufacturer: Capacity in gallons: From Tan~ Field S~ation Tank Sewer Lines ~ ~ ~ ~ Well' J~O~ ~ [~l ~ ~ ~ ¢-I Material:%~L Number of Compartments: Surfaca Water [~'+- too!,- .~ -~ ~ LIFT STATION Lot r ~ ~ ~ Size in gallons: lManufacturer: Line ~5 ~ ~-~ / __ , "Pump on" level at: ~f~e, at: J High water alarm at: Foundation ~l ~ O --~ ~ Pu~p Make~& M d~Electrical Inspections performed by: Curtain Drain ~ Remarks: BENCH ~ARK Location and Description: Assumed Elevation: /~o . 17034 Eage River Loop Road, NO. 204 % I nspecbons performed~q; ~' ........ Dates: 1st ~-2~ ~ Department of Headman Services approval Reviewed and approved by: Date:/2- 2/-¢%- 72-013 (Rev 9/91) MOA 25 Permit No. $W950752 Page ? of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AN[;) 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 LOT 4A, BLOCK 8, KASILOF HILLS S/D 01516115 Legal Description: PID No.: ST1 98.2 ST2 1 do4~- 86.0' ~ FINAl GRADE-~ MT1 )3.6'~ I ,1250 (AL , [SEPTIC 'ANK A B 77.7'~ FCO 6' 43' &73.0' Np wATE~ FOUNI ST2 52' 50' CO1 55' 51 ' - CO2 57' 52' CO5 93' 72' MT1 134 96' EW TRENCH- L , 72-013 A (Re','. 9/91) MOA 25 7 WELL L' ~t,attc Water LevelI 4OFt, feet Oraw Down . ~/A .f feet T_ype Material., ~F~ 6 ft, tO HEFTY DF 8540 AKL ANCHORA ILLING, LA ORIVE ]E, AK 99516 -0593 Jackson Develop ~6 4a.r~k, 8 gallonls Per Minute Total Feet ng RECEI\ DEO ?, 0 Municq)a[ity ol t De ~t. Heal'~h & tqur ED ~chorage an Services PAGE 1 OF 1 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:SW950252 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BURGESS V A DR OWNER ADDRESS:10840 STROGANOF DR ANCHORAGE, AK 99516 PARCEL ID:01516115 DATE ISSUED: 8/30/95 EXPIRATION DATE: 8/30/96 LEGAL DESCRIPTION: KASILOF HILLS BLK 8 LT 4A LOT SIZE: 28706 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST 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 (ISAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343 4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: DATE: HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN E~TENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. August 18, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 4A, Block 8, Kasilof Hills S/D Request you issue a permit to drill a well and install a septic system to serve the four bedroom house on the referenced property. Two test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation no water was encountered in test holes ~1 & ~2 and after seven day ground water monitoring, their monitoring tub~were found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, sep~tic systems or drainage patterns by the installation of 'the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. If you requ:Lre additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure MuNiCiPALI~D( OF ANCHOnJu'Qb ~.NVI?,oNMENTAL SERVICES DIVISION AUG 2,5 995 RECEIVED 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1" = 40' $~ALE SITEi PI. AN I DESIGN UTILITY EASEMENT ~ ~ ~--mrqk j~ ii ~ ~ ~ ~rq~ ., 0 -~ PROPOSED 4 DRWC BEDROOM HOUSE z~z>~ ~Om-~m~ oo ::~m0 -- C)--O 7-~ o-~ zO ROBERT C. COWAN, RE. ROBERT A. SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOIL~EST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 4A, Block 8, Kasilof Hills S/D August 18, 1995 GENERAL: 1. 0 De The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench to serve the proposed four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 4A, Block 8, Kasilof Hills S/D August 18, 1995 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from 'the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before grave]. (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward° Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above fina]. grade. The portion of the monitorinq tube extending through the gravel shall be perforated f~'om the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 4A, Block 8~ Kasilof Hills S/D August 18, 1995 Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic 'tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 4A, Block 8, Kasilof Hills S/D August 18, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etco Thus, the inspecting engineer is 'to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.0.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 4A, Block 8, Kasilof Hills S/D August 18, 1995 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 625 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED~¢j'~-~-/,~{. ;~'~'~ Township, Range, Section: ~~ PERFORMED FOR: LEGAL DESCRIPTION:_ 5 6 7 8 9 SITE PLAN &-m SLOPE WAS GROUND WATER ~/ O ENCOUN'FERED? s L 11 ~' ~' I1'~ ' IF YES, AT WHAT --- O DEPTH? P 12 E Depth to Water Aider / /~ .~ 13 Monitoring? b/3,.7~_Oate: '7 ~l 14 15 16 17 18 19 Gross Net Depth to Net Reading Data Time Time Water Drop ~,~¢..~4,,c /' ~ o ~7,, _ 20 PERCOLATION RATE l, ~- ~ (minutes/incl,} PERC HOLE DIAMETER (~ ~..~--~ TEST RUN SETWEEN FT AND FT COMMENTS Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: (ENGIN F..~.~ L) ..... Township, Range, Section: 1 2 3 7 8 9 10 11 12 13 14 15- 16 17 18 19 2O 0 ,t,(,,..4 ;vi ~- ~' SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES. AT WHAT '~ O DEPTH? P E Depth Io Water Afler T) fl, '?/~l/q ~ Monitoring? ~/_ Date: Gross Net Depth to Net Reading Date Time Time Water Drop 7/i;~/q~- o,.,; $ :~ ,,~,w 3, 'IS./' - O' i~ q.?y~ I" COMMENTS ~.- x c~.l~/4~ ~'~ ~ 8 ~ ,ER,ORMED B'~ '' .N~N..~IN~ I ~/~ ~,'- CERT ,, THA, T, S TEST WAS 17~4Eagle River ~R~dN~2~ / '' ~' ' ACCORDANCE ~J~ ~IPAL GUIOEL~NES tN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERCOLATION RATE '~ (minutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN [ ~/~' / FT AND FT C /,. I ~.,'v ~'-' J' ~'T& I,~ I ~ L $ ,,./p ,'~ c' .-'L )'- PERFORMEDIN MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 ...... '~ 343-474:4 ....... CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0/,~'-I~/- I 5 ::" . .. 'HAA#_~.~,ct~L-~'"'t~ ERA INFORMATION ...... .~r~'; ;'~:-~ :~¢~ q~':'.; ~ ~'-~ ~7~;: ,'-'-'- Complete legal description Lot 4A; Btbbk'8;"'~a~ilo~"Hllls Subdivision Locatio. 9_(site address or directions) , NHN Stroganoff .Prope~Ygwner,'-.James Cazort Maili'h'gaddr;'ss'." P'.O..Box 241565 Anchorage, Lending agency - Mailing address: ...... Day phone 562.-5800 .... :-:.., AK 99524 Day phone· Agent ...... '~' '' Day Phone :"~;.:' .... ' "" ;3' .,;:;,,-~; Address '"' "'":'"'" '"' "'- ' -..- ,,-; ....... , .... ,.; ,; ...... , .............. , ............ . Unless othe~me requested HAA will be held for p~ckup. · ":;~':: ;'-;'-"' ~':" ': '""~'-' "":'~-Indwidual well -7 ~'; '~"'~-~'~'~:~;: "' &" ~ L~'""'?' ":'-;~ "? .-" ~ '" ;-?,:'~:21-~,~.' ~:" :L '.'~,?_-:..-.'%: -'.':':. ~;,,.~' ?' '..' :,¢ *, ;." '-:,'; U.".';~,~:- , "¢,' ,~' '% ' .. ';. Public water. ..... ....... ...,,' .... . _ . .... NOTE: ff community well system, provide wri~en confirmation from Stale ADEC attest- lng to the legality and status 0f system. . .... .,,,. ~,,(;,: ...... >.~,)/~/¢' '.-, '. ' Individual on'site' . ~ ' -. : ,, ,' ,3 . ~ ', ..~ .:;; ~:.,; .':.7:,u'?,..-'.,' ': .' .-;;,.;Holding tank ;~. ¢;~.~-~.~?,:.,--,.-.?~ ~- . .. ,.,., ...,.,...,...,.--:. · ~ *; ~ "~ ...... ' ~' - ~ '~ '~'~¢ · ' · ,~, .. . Community on-site .4., ..... .,; .... "":" '" " ' Public sewer': - - '- "'''~ .... '""' "¢' ..... NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and ~atUs O'f system. 72-025 (Rev. 1/91) Fronl MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER ' AS certified by my seal affiXed' hereto and as'~i the validation date shown below, verity that my investigation of this Health Authority Approval application shows that the on-site water supply an d/or wastewater disposal system is safe, functional and adequate for the number of bedroom~ and type of structure indicated herein. I further verity 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 wastewate~ disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this nspection.. ' S & $ ENGINEERING Eagle River, Aia.~ka 99577., .... Address .. ' ¢;' ' .,t . Engineer's signature '"': ' ' -~ - ' - ! '-*~.£:-.- ; ~,,t .... .. ,., . . -.' ,.,,,.-'-,,."%0 OF ':': · ..... : ...... . ' ', .. ~ Approved for ~ bedrooms ............................ IL,, ,~ ...... · " ': t" 7-": ';: ' '~"" Cond t cna approva for. ,. ,' bedrooms, .w th the Jollowmg:2stlpulahons:"?.4?' L.' ~: ?;;..J~'~;.,.:~-~:..,,,:.'.¢ ~ .;; ; .'~;.;-, : .7'.,..:'' ':' ,"' ." .' '"-' : '. "' , '. ' '": "'" '-" ..... · - -.,',: ~:',:',:'-2,~ ;: ¢-:,,.,Additlonal Comments ............ . ~ -'~ '~,The Muni~ali~,6,~nchorage Depadment of Hea~th and Human Se~ices (DHHS) i~ues Health Authori~ : ~:,,~proval,~e~if(~,~ased only upon the representations given in paragraph 5 above by an independent :";~Sprof~ibhal en~ m~ registered in the State of Alaska; The DHHS does this as a courtesy to purchaeem of homes (~gd.their lending institutions in order to ~tis~'cedain federal and state requirement, Employes of DHHS do not conduct inspections or analyze data before a :ceAificate is issued, The Municipali~ of Anchorage is not responsible for er~m or omi~ions in the professional ~ngineefs w°rk,' ......... Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825'~[." Street. Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: koTi A. WELL DATA ] Well type DR)v/~ £i Health Authority Approval Checklist 1'1,4- 6L~<. j> KI~$a-~l'e' ht'L'C$ Parcell. D.: ff A, B. or C, attach ADEC letter ADEC water system number Log present Total depth SanitaW seal Date completed f Cased to :3 ti Casing heigbt (above ground) Wires properly protected (~,~tN) Date of test Static water level Well production FROM WELL LOG / , ,r' WATER SAMPLE RESULTS Coliform O ' Nitrate Dateofsample:'l'~/lY/"4- ~c~ ))'/'I/q B. ~--~OLDING TANK. DATA Date iustalled ~ / ;~ ~/q 5"- Tank size ]¢k $' 0 g.p.m. AT INSPECTION Other bacteria O Collected by: S & S Et~61~EEE!NG 17034 Ea.qJe River Loop Road No. 204 Eagle River, Alaska 99577 Number of Compartments ~ Cleanouts ~q',l) ~ $ Foundafion cleanout C'~)'N) ~'~/~ 3' Depression Date of Pu]nping ~'/4' ~tv¢,..,' Pumper ~ /,/o High water alarm (Y/~ ,v o C. ABSORPTION FIELD DATA /'ax, Soilrating ~orft2/bdrm) ]. ~L Systemtype "r~,,¢/4 Date installed q ~, / q J''' ' pr~e /' Length ,~(o / ~ Width Gravel thickness below p,pe ~ - ~ Total depth ~>. &- Effective absorption area -,~ 0 q Monitoring Tube present~_~N) Y~$. Depression over field Date of adequacy test N/4 ~ ,~w Results (Pass/Fail) Fei' ..._--~edrooms Fluid depth iii absorpt~On field before test (ill.); [m gal. water added Fluid depth ii~'~ Absorption rate = Pm~rxid~ 12 months) (Y/N) lfyes, give date g.p.d. ~ c D. LIFT STATION Date installed Manhole/Access (Y/N) ~ Size in gallons ~'Pump ofF' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~mlding taak oil lot ~ ~ 0 Absorption field on lot Public sewer main W / h Sewer/septic sep/ice line /0 to q- : On adjacent lots /o .; On adjacent lots Public sewer manhole/cleanout Lift station Ar / SEPARATION DISTANCES FROM ~HOLDING TANK ON LOT TO: Building foundation 3 {, Property. line /4 3'- Abs?rption field Water main/service line 3o ~- Surface water/drainage / 0 0 ~ Wells on adjacent lots __ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation '70 Water main/service line t Sur£ace water / o 0 4-- Curtain drain NOr~6_ Driveway, parking/vehicle storage area 70 Wells on adjacent lots / o o "/" Property line F. ENGINEER'S CERTIFICATION ........ m con/brmance wtth MOA H/M guide~es m eJ/kct on thts date. Iff,~ / // .5~c¢ "' ~ ", '~7 ',~ , t / a S HAA Fee $ , ~ Waiver Fee $ " Date of Payment [~ 0 ~ ~ Date ~ of Payment Receiptmumber./~ :~3 Receipt Number Rev. 8/95 OSS: haa.wk.doc 16:31 COMMERCXRL ]ES[INU ~ U~'¢b~41~ii CT&E Environmental Services Inc. ~ .... Laboratory Division Drinking Water AnalYsis Report for Total Coliform Bacteria 200 w. Pott,,r Anchorage, AK 99518-1605 R£AD /NSTRUCTION$ ON RI~VERSE $1D,~ B&'FOR~ CO/,£F~CT/NG ,5'AMPL£ Tel; (907) 562.2.343 MU~'T BE COMPLBTBD]~¥f-~r--~R SUPPL]EP, PUBLIC WATER SYSTEM I.D, # PRIVATE WATER SYSTEM Send Results ~. Setld lnvolce LLJ lq [3 Se. d Result$ ~ $*nd lnvoiee Day Year SAJdPLE DATE~ Month SAMPLE TYPE: Routine Repeat Sample (for routine sample with lab ref, Special Purpose Tlnle Collected SA~LE LOCATION Collected By ~ Treated Water 11~ Untrea(edWuter CommentS; Fax: (907) 561-5301 Analysis shows this Water SAMPLE to be: Satist~etory Unsatishctory O Sample over 30 hour~ old, results may be unreliable o Sample too long in transit; sample si~ould not be over 48 hours old at examination to indicate reliable results, Please send new ~amplc via special delivery mail. Date Received }.~./..l~ T{m~ Received , { ~ A~mlyttcal Melhod: J~ Membrane Filter MMO.~G Number ofcolo.ies/lO0 mi. L~I) ReL No, Result* Analyst Serif 1o A.P.LU, Anna FD~ Jun Client notified of u.satlsfaclory results: Phuqed S pok'~ with Faxed Dale: Tlale: BACTERIOLOGICAL WATER ANAi, YSIS RECORD Colonies/lO0 m{ MIvIO-MUG Rcmulb Total Coliform ~ombrane Filter; Direct Count verification: LTB Fecal Coliform ConfirmatiOn BGB COLIFIRM gr,IvIRONM~NIAL FACIUTI~S iN ALASKA, CALIFORNIA. fl,ORIDA, ILLINOIS, MAgYLANO, MICHIGAN, MISSOURI, N6W JERSEY. OHIO. WEST VIRGlt~,'b 12/14/95 18:07 COMMERCIAL TESTIN5 ~ 90?6941211 NU. UJ1 :~ Client N&l~e Ordersd By ProJ ect~ WORK Order printed Dat~ collected Dato Reoei~d DaCe 20157 12/14/95 12/13/95 ~ lO:Jo lir~ 12/~3/95 T~chnical Director 8TEPH~N C. EDE R~leazed By ff~~.. 8~i~"': ! E CODD~GTED BY: BOB C. .'!itrate-N 2,78 m.q/L EPA 300.0 ION 10 12/1g/95 S~e Special In0~ructton~ Above NA - ~ot A~alyz~d ::~* 8~ Sample Remarks ;Lbove : GT = ~reat~r 'fhan