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Home My WebLink AboutHIDEAWAY LAKE BLK 1 LT 5Ak\-�Ascuo 9*tae StK) `AI 4C)\eS*,o Lk"w\koww v`1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name ;'08&k7 &RIoifSarl DISTANCES TO SEPTIC ABSORPTION WELL Address F RD M TANK FIELD lftAW zha- U, +41. Ik 99-o4 WELL Capacity in gallonssp (az� Phone(s) P11660 ermit No. No. of Bedrooms LOT LINEA _ /cyr�L v % �o _ LEGAL DESCRIPTION Lot - A Block Subdivision f�I i �a/ L�JI'� FOUNDATION �� , L r mss` Township, Range, Section / A93 p) Sere 9 _1A'v / /� w,F AS -BUILT DIAGRAM (Show location of well, septic system, property lines, loundabon, driveway, water bodies, etc.) TANKS I— Gravel width FT STC—II Total absorption area Distance between lines SQ FT % FT 1 X SEPTIC ekilifo ❑ HOLDING Manufacturer Capacity in gallonssp (az� I ZJd Material No. of Compartments _ /cyr�L v % 7/" TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade Total depth from original grade F 13 FT Fill added above original grade Gravel depth beneath pipe -� FT % S' FT Gravel length Gravel width FT >`' FT Total absorption area Distance between lines SQ FT % FT Number of lines Soil rating {S© SOFT Pipe material F8_10 _ Installer��/p r irrry �_ Date Installed WELLS PRIVATE ❑ OTHER (Identify) Classification (A,B,C) Total Depth Gasetl to FT FT Installer I Dale Installed. REMARKS: A,, muVof( UP*tAE. Municipal and Slate guidelines in Ellett on this dale: Health Department Approval: 72-013 (3/85) Insf�efctions Perfor/r� d bV U �� R -r! �p/ R— / Date: cerlily that this inspection was performed according to all Dale: - L 40 J ENGINEER'S SEAL MUNICIPALITY OF ANCHORAGE Department o� Health & Human Sgrvices 825 L Street� Anchopage, Alaska 99501 343~4720 ON�SITE SEWER PERMIT Permit Number: 880091 Upgrade Date IgsI. Ied: 06/21/88 Engineer Designed Owner Name: ROBERT ERICKSON Day Phone: Owner Address: 11060 HIDEAWAY LAKE DRIVE 274~8691 ANCHORAGE, AK 99516 Parcel Id: 015-471 09 Lot Legal: Gubdivision: HIDEAWAY LAKE Lot: 5A Block: 1 Se�tion: 24 Township: 121\1 Range: 3W Lot Size 47498 (sqt" or acres> Max Bedrooms: This Permit: 3 Total Capacity!I 4 SEPTIC TANK: Minim�m total s�ptic t�nk (::apac:ity: 1�2�0 g�llong. Each septic tank must have at least 2 compartments^ Depth to top of septic tank(s) < 4"0 {eet requires insulation over Lall k(s), ' ENGINEER MUST VERIFY INTEGRITY OF EX:us TING 1250 STEEL SEPTIC REQUIRED MINIMUM SEPARATION BETWEEN TRENCHES 15"0 FEET. — ' NOTlFY DHHS FOR FIRST AND SECOND INSPECTIONS. CALL 343�4681. THIS PERMIT EXPIRES ON DECEMBER 31, 1988" I CERTIFY THAT: 1, I am with the requirements for on~site sewers and wells as sot forth by the Municipality of AnchC.)rage (MOA) and the State of Alaska" 2" I will install the system in accordance with all MOA codes and regulations� and in co0pliance with the dign criteria ohis permit. 3" I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent clr nearby lot. 4, I understand that this permit is valid for a mi�.Iximum of 3 bedrooms^ I also understand that the capacity of the total yystem is 4 bedrooms and any enlargem t ili Signed: � (Owner} ROBERf��RICKSON � '� � / Issued By: DATE: ' __�~�_�_.^~�_��~~.��_~ A `CS ALASKA MUIROWHIAL WOOL SRIHS, InC. o 6n9ineerinq & @nuironmental Studies SPECIhTCATIO\S FOR A TRENCH -TYPE WASTEWATER DISPOSAL SYSTENT HIDEWAY LAKE SUBDiVISION, BLOCK 11 LOT 5A 1.0 GENERAL 1.1 The drawings, sheets l through 4, shall he a para of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DIHIS), the conditions of the permit, and all applicable rules and .regulations currently in effect. 1.3 All elevations and depths are advisory, and are to be verified or modified in the field by on DHHS approved inspector. 1.4 It is the responsibility of (he installer to adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. 1.5 If the installation is not inspected by an AECS engineer, AECS will. not be responsible for the design. An engineer at: AE.Cs :should be consulted prior to construction, to determine the number of inspections that will. be required and to cNpla n what these inspections will involve. 2.0 SEPTIC TANK 2.1 if there is an existing septic tank it may be used if it meets the capacity requirement for the residence and the approval of the MOA. 2.2 The septic tank shall he a UPC—Approved i.wo—compartment tante, constructed of 12—gauge steel with bitumastic coating and set level on undisturbed soil. If the tank is buried at a depth of 4 feet or less, it may be insulated with an overlying layer of 2 inch burial type polystrene rigid board 'insulation. 2.3 The septic tank and bed shall be a minimum of 100 feet from any private well or body of water, 150 feet from Clrtss C wells, and 200 feet from Class A or B wells. unless otherwise specified, Tess than the required separation distance must have prior approval or waiver by ADEC or MOA. 2.4 The septic tank small be a minimum of 5 feet from the house foundation, and a minimum of 10 feet from the absorption area, 2.5 Piping shall be Pitted with a mechanical watertight calder coupling on the outlet and inlet of the septic tank. Piping shall he 4 -inch, solid PVC ASTM D3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot. If the piping is buried at a depth of 4 feet or less, 1200 West 33rd Auenue. Suite B • Anchorage. Alaska 99503 •1`9071 561-5040 it must be insulated with an overlying layer of 2 inch burial !ype polystrene rigid board. 2.6 Clennouts shall be installed as designated and capped with Rip -tight. rain caps (.Jim caps or equivalent), and extended a. minimum of 1 foot- above ground level. 2.7 If a lift station is required it shall be combination lift station septic tank per Anchorage Tank and welding, Inc. design. Specifications are attached. 3.0 Absorption Area 3.1 The gravel for the trench shall be 0.5 to 2.5 inch, screened rock with less than passing #200 sieve residual. All substitutes must have prior DOHS approval, 3.2 The bottom and sidles of the excavation shall he raked with the backhoe blade to insure that it has not been compacted during excavation. The bottom elevation shall be level. 3.3 Meritor standpipe(s) shall be placed as shown in the drawings, and shall be rigid RVC ASTM D3034, or 4 inch cast iron. The section shown with holes may be 0.5 inch holes drilled on 6 -inch centers on opposite sides of the pipe, or a regular section of perforated sewer Pipe, clamped to a solid section, with either a no hub coupling or a solvent joint. A rubber rain cap (Jim cap or equivalent) shall be installed over the LOP of the pipe. 3.4 The distribution pipe shall. be 4 inch rigid PVC with a minimum crush strength of 1.500 lbs. All distribution pipes shall be laid level. 3.5 Trenches may be paralleled, but must have a minimum separation d_i.stance between the trenches of 6 feet or 2 times the gravel depth (whichever is greater). 75 feet is the maximum allowed linear length of any trench. 3.6 1P the final grade over the trench is less than 4 feet above gravel, insulation is required, using the burial type polystyrene rigid. There shall be 1 inch of insulation for every foot of soil _Less than the required. 4 feet of cover, but there must be at least 24 :inches of soil cover even though _insulation is used. },The solid pipe extending from the septic tank to the drai.nfield shall also have'4 feet of cover or an equivalent layer of insulation to prevent freezing of the line. 3.7 If insulation is not necessary, the gravel shall be covered with a layer of nonwoven Geotextile fabric (such as Mirafai., Pibretex 200 grade, Poly Pilfer X or equivalent). 4.0 K SPECT10VS 4.1 A minimum of two inspections are required for the installation of the trench. The first inspection will be of the, excavation to verify ML installation will be in the proper .soil. 4.2 The second inspection will be after placement of the gravel, monitor standpipe and distribution pipe to verify groper installation before backfill. "f VU QIfJ@ER'S SEAL) otw Municipality of Anchorage �° Co T DEPARTMENT OF HEALTH 8. HUMAN SERVICES O0000•oo o•• •• ••••°• •@ 825 "L" Street, Anchorage, Alaska 99502-0650 j Ott) SOILS LOG —PERCOLATION TEST ®e e•• ROY C@REID, JR. ; & 2251 �� R PERFORMED FOR:C$ DATE PE - � LEGAL DESCRIPTION: / /'4 tl4d 4-4cfT /Township, Range, Section: 7;�?/L) /0,3 -'a S �� DEPTH SLOPE SITE PLAN _(.EEz..1� Gr-avcl 7�a �,^j-1--r--I T-7 1 4 K 4 a(I e 5 6 i 7 8 10- 11 t 12 13- 14- 17 31417 ilm 19 20 S,/14) Si.,d,l 6, ri.t / r 6m) Trace o{ T. /7r. 1 WAS GROUND WATER NO ENCOUNTERED? S IF YES, AT WHAT L DEPTH? O P E Depth to Water Aller Monitoring? __ Dale: �r Reading Date Gross Net Depth to Time Time Water Net Drop PERCOLATION RATE — (minulesimch) PERC HOLE DIAMETER TEST RUN BETWEEN _ FT AND _ FT 1 COMMENTS J7..r,1 S ��✓P,_.1 ✓�N�d y�o�.�ar.I M41, _ PERFORMED BY. / , Re r? d I �e r d/ — CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE'_ AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. '� " 72-008 (Rev 41BE � 72-008(Rev.41BE� S'x'pq_� 2'y c/ ALASKA ENVIRONM`'NTAL CONTROL SERVICE. , INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907)567.•5040 JOB— !-srL-- ,:. � �{,(✓r e%L�?, �,��: ,�,� SHEET NO. OF — CALCULATED BY �' IrP"J DATES �tr -- CHECKED BY re DATE SCALE_ j'V2Y�•.-h A�ra/'. _ ![w/ r� cad✓>/n 4f i/% 600 _570, �s' 2.r� �?.,•_c�, IC��c C _/Sri �� a,2d k /Sari Cf0STf2Nv,r%1 _ 6,c re e rrl rv`E ` j'V2Y�•.-h A�ra/'. �xzo < 6000 20-4. A: a C/ CA 4/ (v wad (tse y, e .. _. _.._ __. _... CY �✓�5. 77/ _l. ✓,CJI? 7 -/G. -t., _ ,ow as w.yfl, __ � ( A 44 0469*# 00040 see $tol 0 G �• d Y C. REID, JR.: 0 ...0 45 __. 71F pp 0 O p�O p O 00 O O 00 T--- --- -- - - - — - 00 O O cp fooM �00 N A 00 u A 0 ~ p o y < 3) m m 31 r rn 'R O C e Ir n A m z A W (JI Q z 0 z H � Q rn � O O 0000 00 ` 0 O I 1 ro C9 00 0 00 X x co x 0 p m H '• H � m � m H O � Z m H H (7 '4 H a rA zz x H 3 n D (n f- > p Z rn D r. O z P \ m 0 D. 'S O � Z = 0R1 mi <<. 21 H M'O[EO3o <� to ap H po nL m W U. T m z rLq Z O-• z { Z n F z 0 z H � Q rn � O O 0000 00 ` 0 O I 1 ro C9 00 0 00 X x co x 0 p m H '• H � m � m H O � Z m H H (7 '4 H a rA zz x H 3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL FNGINFERING DIVISION 825 l- Street - Anchorage, Alaska 99501 '1001011011(1264-4720 \ - ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WEI_I-. INSPFC T ION RFPORT NAME--�.._. PHONF C, •,I�{"r/�-.L-�4 r,6��(��j�'7t 6�'Vt9l�. DUPGRADE MAILING ADD�E$,S _ LEGAL DESCR IPTIO(T IJON �c�r�c LOCATION /, �� NO. OF BEDROOMS �F1 7 Well _ Absorption area,Dwelling PERF4IT NO. `} DISTANCE TO: %r Il ` �r ALJ a Q Manufacturer ��-, ; /�4= Material No. of compartmen s LU N ILiq. caj'a ity in i�I Ions I i � •E70 IF HOMEMADE: Inside length Width Liquid depth < ---. _ DISTANCE TO: Well Dwelling s PERMIT NO. p _ Q - i N Manufacturer Material Liquid capacity in gallons 9 LU 2 iL1 F Z Well DISTANCE TO. _%� No. of lines Length of ap- 4in Fou ndson -- 1' �__ Total len of nes Nearest lot li'n/e, f� Trench widLl PFRMITy Distan an lines z 0 ._ �.. _ ----- --- ! G- inches _ I� a CC I.. p ----�- ---- -- ---- Top of tile. to finish grade �- Material beneath tile l inches Total effectiver tion area -1b� w Length Width Depth PERMIT NO. C7 a as w Total Crib depth oral effective absorption area Type of crib Cdiameter uj DISTANCE TO: Well Building foundation Nearest lot line a J LU � Class DISTANCE TO: Depth Building foundation- Driller Sewer line Distance to lot line PERMIT NO. Septic tank Absorption areas) OTHER (•� _— - `\ PIPE MATER/_IIALS q��'' SOIL TEST INSTALLER REMARKS i TJ_1 57 III 1 r i APPROVED DATE 1� `� ! DEPHPTMENT TION �25 'L' STREET, HHCHORHGE < 99501 � 4 �I V | P�RMTT nr � HPPLICHH� ROBERT C ERlCKSOH 540 L ST 99501 274~8641 = LOC8TION � �� LEGHL L5H B1 HlDEHNHY LHKE LOT SIZE 999999 SQUHRE FE� TYPE OF SOIL HBSORPTION SYSTEM IS� DRHINFIELD MHXIMUM HUMBER OF BE�ROOMS � � SOIL RHTING (SQ FT/SR)= 85 � THE REQUIRE� SIZE OF THE SOIL HSORPTION SYS �TEM IS | THE LENGTH DIMENSION IS THE LENGTH (lN FEET) OF THE TREMCH OR D�HINFIELD THE DEPTH OF H TRENCH OR PIT IS THE D[STHNCE BETHEEN THE SU�FHCE OF TH� ! GROUND HND THE BOTTOM OF IEC (IN FEET) . �AHE �..... ZJ �^ � THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN �ND THE BOTTOM DF THE EXCRVHTI0N (IN El- I_; Fi 1:7, EHHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMEHT DURING THE IMST9LLHTION INSPECTIijNS OF HNY WEL�S HDJHCEHT TO THIS PROPERTY 8MD THE � �UM�ER OF RESI�EHCES THHT THE WELL NlLL SERVE � BHCKFILLING OF RNY SYSTEM WITHOUT FINRL lNSPECTION HND 9PPROVHi BY TH[S - | �EP�RTMENT HILL 6E SUGJECT TO PROSECUTIOM` i HI�IMUM DISTHHCE BETNEEN H WELL HHD HNY OH SITE SB� �lSPOSHL SYSTEM IS i00 FEET FOR H PRIYHTE NELL OR 150 TO 200 FEET FROM H �UBLIC WELL DEPENDIHG � UPOM T�E TYPE OF PUBLIC HELL �� . MINI�|UM �ISTHNCE FROM H PRIVRTE WELL TO R PRIYHTE SB�ER LTNE IS 25 FEET HND � TO H COMM�HITY SEWER LINE IS 75 FEET NELL LO6S HRE REQUIRED RND MUST BE R|TURHED TO THE DEPHRTMEHT NITHIM ]G DHYS T�E NELL COMPLETION REQUIREMENTS M9Y RPPLYC. -D HND CONSTRUCTIOM Id, HRE | RV�ILH8LE TO INSURE PROPER INSTHLLHTION �Y�� I CERTIFY THHT � �� I HM FHMILIRR NITH THE REQUIREMENTS FUR ON~SITE SEWERS HND NELLS HS SET '^FORTH BY THE MUHICIPHLITY OF HNCHORRGE � WILL I- I- THE SYSTEM IN HCCORD��CE WlTH THE CODES / QUIRE ENLHRGEMENT rF THE . MS / SI6HE�- 17. F: —n . . / ft / �. ' i, 2 3' 4 5 7 ..g 9 10 12 13 14 15- 16- 17- 18 19 516- 1713192021 22- 23- 24- 25 2232425 PRO JECT_1{jdden I aka Suhd- CLIENT�}�t, Sps1rks W. O•--7897 I - C TEST HOLE NO.�__�� ELEV. TOP OF HOLE_��_p_ DATE- 12/j/77 G .L J It, r 2 3 4 5 6 7 3 0 1 2 t t M -W DRILLING, Inc. P. O. Box 4-1224 • 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner Bob Erickson__—_____ -._Use of Well T)Qme_€Lti_Q,_ Location (address of: 'township, Range, Section, if lmown; or distance main road_____'___ __Lot�_A Block. 1 Hideaway Lake Subdivision n Size of casing__— -Depth of Hole-81—feet Cased to --.TL _._feet Static water level__30_-__._ft. (M5,K 9 (below) land surface. Finish of well (check one) open end ( x x); Screen ( ) ; Perforated Describe screen orWell pumping test at- L _-gallons per (If ) (minute) for--s.___hours with____1DD%____, -----xf of drawdown from static level. Date of completion___7��1s_i 2�`,_ 1982 - WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness Casi -stic&� ----.. - --- — 2 '1'0 --- —Organic- - ------ - ----- - --TO--_--_ -- —3] 1ty 3 Y.e1_ _- --. _ -- . --MUNICIPALITY 9F-ANCHORAU'[- -- DEPT. CF HE;_'TH tNVIRO.\�;olaN]Al. PhOFeCTIOh. ____ MAY - _26 -TO- __134- -'74_ -TO - - -TO- - -- ---------- - - -- - - ------ ---- ---- ----- rF nlfje�ct -------X1'0---- --------- --------------�`�°-�-Bj�I?r�,�---'--- --- i-, ,a-r1nnco ALASKA OUInOWnTAL COnTnOL kriUUS, IN. enyneerinq 6 Environmental Studies MUNICIPALITY OF ANCHORAGE DEPT. OF H`.F.LTH is ENVIRONMENTAL PROTECTION June 6, 1983 [, �CEI !°`4 ® Department of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99502 Re: Hidaway Lake Subdivision, Block 1, Lot 5A On May 28, 1983 I recieved a call from Mr. Bob Erickson regarding Lot 5A, Block 1, Hidaway Lake Subdivision. It was brought to our attention that a parking area had been placed over the septic system and you required insulation on top of the drainfield. I visited the lot when the drainfield was dug up and the insulation was placed. A 4" high density burial type rigid polystyrene board was placed over the entire drainfield and 4' of earth cover on top of that with a gravel surface. If you have any questions please contact me. Sincerely, �% 1 Dan J. Roth Civil Engineer Approved: Leroy C. Reid Jr. hD, PE Presid t 1200 West 33rd Auenue, Suite B • Anchorage. Aloska 99503 e (907) 276-1361 & 2081jASS0C13T1R ofRrlc1tarnce SpenardOfee • P.O.Box4-2200 Anchorage, Alaska 99509 • (907) 274-6.565 MUNICIPALIT`% Ur alvfrHC7fiAGi DEPT. OF I:NVIRONM€NIAL PROTECTION ESCROW LETTER RE: ERICKSON, Robert C. Lot 5A, Blk. 1, Hideaway Lake Subdivision RECEIVED I, the undersigned, owner of the above referenced property am aware that according to the certificate of occupancy and the certificate of inspection on-site sewer and water -Facility the following items remain to be completed: 1. Finish grade & exterior landings 2. Rasie cleanout to septic tank and trench area to insulate the portion of the sewer system under the driveway An appraiser's estimate to complete the above -is $300.00 I am aware that the sum of 12 times the above figure will be set up in an interest bearing savings account at First Federal Savings & Loan Association of Anchorage for completion of these items. Upon completion of these items and an inspection, by First Federal, these funds will be released to the undersigned. Should these items not be completed, within a reasonable length of time, First Federal Savings & Loan will use these funds for completion. C Robert C. Erickson HOU SM - ham = LENDERER I9h� SY S��t lay 'L3r 1983 C. i;I,Jicl�soll 13 11 Ly i I c in : 1, cy t JC -1.. 111t1ck 1. I I i d to at,? a,., j a k,' .31.11.-)E 11 v 7_:-i j o Yl Ji:ar We Adividual semm ocad swLey racilibiell calumt. tul'uwily Aulls h.- V('. cr)il�)Ji-'A�ed� illCh C1Ee2IIOLlt 110CAN No OQ thc it, .IOU): (4) Aw, c.i.eayi(out rice U'" Lr) he immai lud U; thu, hwatmAq vrea. iiotity this 03pautmurk Mr, a %glell unn. nc)tcmi diucrulnuich-,s hr.we Oeeii 1j: tllto)-(' cilly f ur-Llw)- ciucst imis , 1) 1 E2 as to ca I! thi a top kit! (I E)L 26 1—d/20. S i rl u. e2 1: e.lI, C. Pr�-,iLt A,),-sociat:(' Erivirmimerita( Municipality of Anchorage: On -Site Water & Wastewater Program w (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-471-09 Expiration Date: 1. GENERAL INFORMATION Complete legal description HIDEAWAY LAKE SID; BLOCK 1, LOT 5A Location (site address) Current Property owner(s) Mailing address Real Estate Agent 11060 HIDEAWAY LAKE DRIVE, ANCHORAGE, AK, 99516 CHRIS & MADRA JAY Day phone 11060 HIDEAWAY LAKE DRIVE, ANCHORAGE, AK, 99516 MEHNER-WEISER GROUP W1 PRUDENTIAL Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: 317-5686 762-3111 TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: _ Distance: in Received by: e y`� Date. COSA to be released to the engineer, unless olhelYase requested by Use engineer. COSA Fee $ 62- ` 0 Waiver Fee $ _ Date of Payment -7 3c)�� l Date of Payment Receipt Number cc�OCot�� G Receipt Number COSA # ©JG� l , �J7 f Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validati .n da,(, shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. /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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address GARNESS ENGINEERING GROUP, Ltd. 3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, AK, 99507 Engineer's Printed Name Engineers Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSO Guidelines 8 Regulations. The reported results described the performance ofthe system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational ife of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever 6. DSD SIGNATURE M System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Phone 337-6179 II Date 2- ` 1! OF Al to Ag *o. 4L Conditional approval for bedrooms, with the following stipulations: >f 7957, * pROFES510N��0� 0 VA%I IL S j Original Certificate Date: 6.7 _ 7 The rMnicoitKor Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory IR- 10119,191 Nitrate Advisory Arsenic Advisory Other ON-SITE✓ WATER AND WASTEWATER PRO Original Certificate Date: 6.7 _ 7 The rMnicoitKor Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory IR- 10119,191 Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description A. WELL DATA HIDEAWAY LAKE S/D; BLOCK 1, LOT 5A Parcel ID: 015-471-09 Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (YIN) YES Date completed 8/25/1982 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 81 ft. Cased to 81 ft. Casing height (above ground) 24+ in. Date of test Static water level Well production FROM WELL LOG 8/25/1982 70 10 AT INSPECTION 515/2014 ft. 65 ft. O.D.M. 2-5+ 9.p.m. WATER SAMPLE RESULTS: Coliform Jer colonies/100 ml. Nitrate 5,-'+mg./L. Arsenic: No ug./L. Date of sample: 7/16/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Collected by: GEG, Ltd. Date installed Cleanouts(Y/N) 8/23/1 YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A 7/912014 A+ HOME SERVICES Date of pumpingPumper— C. ABSORPTION FIELD DATA BELOW EXISTING GRADE 8/23/1982 85 Date installed 6/24/1988 Soil rating (g.p.d./ftlor /bdrm 150 System type TRENCH/TRENCH Length 37/30 ft, Width 6/3+ ft. Gravel below pipe 4175 ft. *8.75 "416 Total depth *13.8 ft. Eff. absorption area 450 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **"515/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 50 in. Water added 600 gal. New depth 74 in. Elapsed Time: 120 min. Final fluid depth 71 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date - '"PER INSPECTION REPORT. "`ADEQUACY TEST PERFORMED ON SOUTHEAST (1988) DRAINFIELD ONLY. SEE ATTACHED LETTER. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump offlevel at wa er alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100+ On adjacent lots 1004 Public sewer main Sewer /septic service line N/A 25'+ Public sewer manhole/cleanout Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 1004 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 70M 5'+ Wells on adjacent lots 1004 Property line 51+ Absorption field 5' PER INSP REPORT Water service line '101+ Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 10'+ Water main NIA Water service line `101+ Surface water 100'+ Driveway, parking/vehicle storage "0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 'THE HOMEOWNER RETAINED ONE STOP SERVICES TO LOCATE WATER LINE AND GEG INSPECTED AFTERWARD. DISTANCE BETWEEN WATER LINE AND SEWER LINE IS UNKNOWN "REQUEST ADVISORY NOTICE FOR TANK AND DRAINFIELD. SEE ATTACHED LETTER. G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date F-! 2 i /14 (Rev. 10/12/12) A. ?ROFESSI�� E7 Municipality of Anchorage s Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 141374 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 5A of Hideway Lake subdivision. This inspection revealed a nitrate concentration of 5.21 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. =_ PM]PdSEB BnBLele CCCICI �. (A49JEL, y'� o SMW CSIIULT �ry°yyry. N T bAl}NO YRAC( SIDE BUDMi SETBACK W REM BLe.ONO S:RAIX 'V>7°3g,QG 10 1y o m 7pB 06, o rn 4A �k 1 9• rp N 'n tNn EXISTING HOUSE ,+ N rN C. WELL e / 33 / / / e UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. OT SURWY SURVEY TYPE SYMBOLS ❑ ❑ FOUNOATION AS-eu¢T FINAL STRUcn AS-OUILT ' SET REBAR ' DRAINAGE I ASPHALT ❑ PLOT PUN ... A5 -WILT ... LOT SCIEfl ... TOPOGRAPHY O FOUND REBAR 0 9 e. WOOD FENCE "' CONCRETE T . MRECERTFIA11p1 IS-BUp.T ... No ERS SET g ASSUMED ELEV. -X —X X METAL FENCE WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED, WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION �r, Prepared by PLOT PLAN of •y Robert E. Johns, Jr. & Assoc. .W"",I � ,o.�� •••„°, P • • ♦�. Professional Land Surveyors y naa aea > .trBr.a r r w lee emr. u AwwK m na r� e•a m w s.N a my r1`•�\ _J ' •• 1700 Brink Drift. dwara• w•a mw.a r en•a.w na•. e..• Air••' AF ANCHORAGE. ALASKA 99504 Scale: 111 — 60' Rec. Lot S.F. Ree. Plat Flle No. T.aar w wa m•cL FDl1NDAA0N A$ -BUILT �• .. ..•.1h % •• •' +• •• 4 PaCet E AX.. t. M.Dy wtMA MI I m» P.am.a a, wane eAwr"m. ma w as Baru. ••• S Yed Date Surft : 06/30/14 raw b . Y REJ Checked b OBERT E. S.•••• M .f RT .FM K Data Drown: 07/01/14 Grid: 2640 W.Q. 14-284 m» ma m .weo-ATma wt wr • •• o FINAL STRUCTURE AS -BUILT ��10, .. 4-:121— ;• ,e�� Legal Description: K. ar.n E +eaa s. AeaY rw, eat I �+ fa, ••'•... •. ••• you 4w .sunw. m er at w Bat r w 0o. Pr....•••"•' • Lot 5A Block 1 ,"„,mm�s.i•..,",r�.a, 4�Oi:��. HIDEAWAY LAKE GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS - July 17, 2014 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road, P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 REFERENCE: Hideaway Lake S/D; Block 1, Lot 5A: Adequacy Test Results and Configuration of System. To whom it may concern, The septic system on the aforementioned lot consists of a 1250 gallon septic tank and two trench type drainfields, installed in 1982 and 1988. The monitoring tube for the 1982 drainfield was separated near ground level and non-functional. Total depth for the 1982 system is based upon the elevation of the in-line cleanout at the northeast end of the trench. Soil cover over the invert of the drainpipe is approximately 4.75 feet. Liquid levels could not be measured because of the separated monitoring tube. The adequacy test was performed on the 1988 drainfield which has an effective depth of 90 inches. According to our field measurements (5/5/2014), the monitoring tube extends 95" below the invert of the drainpipe. The highest measured liquid level during our adequacy test was 16 inches below the invert. Soil cover above the invert is approximately 5.91 feet. The septic tank and both drainfields are located under the driveway. The 1988 inspection report and H.A.A. state `all under driveway' in regards to the septic system. GEG Advisory/Disclaimer: The septic tank is 32 years old at this point. During our inspections, tank levels were normal and no depression was observed over the tank; however, this is based on a visual, surface level inspection which is not a comprehensive verification of integrity or remaining tank life. The tank will likely need replacement in the near future. When the tank is upgraded, it will have to comply with current code which will require either the location of the tank to be moved or the driveway abandoned and blocked off in the area of the tank. GEG, Ltd. has not verified the integrity of the tank and assumes no liability for damage/injury associated with 3701 East Tudor Road, Suite 101 'Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com the configuration of the current septic system. 1f you have any questions, please contact us at 337-6179. .E., M.S. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com Page 2 aft MUNICIPALITY OF ANCHORAGE Department of Health &Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # `)- 101— 07 HAA # R ( — L A(n_� Imo} 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) "-r r Tl,,/ E31J Location�,(gddre'ss or directions) (b) Property owner ,�oi#�% LI�'t/�'KSrnl Telephone: (home) Business (c) Lending:lh5titu'tfon ' Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here EY, f hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3. WATER SUPPLY Individual WellCommunity ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ ' Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Pagel of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 date of this inspection. Name of Firm �5 Telephone qX7`�-S�s'�3 Address Date ? y 0� f�( Q r'� n6N 666s 66 e( of LER gY C. REID, JR. R .2251 0#9 all 0 Op ••660600••!' 6. DHHS APPROVAL Approved for bedrooms by ddkX&0_e1Date Approved _Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHF -IS) issues Health Authority Approval cerificated 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. 72-025 (Bev. 7788) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date I 7-54 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) ;;* �7.<K I f�ibh'hjlf-/ �.� 7-/-zw /ZAj f� Location (address or directions) 1/(366 /-1r•114-1 '2�. (b) Property Owner .�a � �Coj Telephone: Home Business X74- 8'ol Mailing Address_�� (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address _ Telephone Telephone (e) Mail the HAA to the followina address: or: Check here 0, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIIDrENCE Single -Family tcx Number of Bedrooms 3. WATER SUPPLY Individual Well. Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ 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. Page 1 of 2 72-0a5 rRPv 8186) Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 date of this inspection. Name of Firm �W> Telephone Address Ilev) j3ri' /DvE rey9zr 3 /1�� P� 99si Date 717-9f 6. DHHS APPROVAL Approved for bedrooms by Date Approved Disapproved Terms of Conditional Approval Conditional CAUTION 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. Page 2 of 2 72-0251nPv e'86i Back A. WELL DATA ,Ql toN ICIPALITY OF ANCHORAGE (MOt-q C,�y�L�Tt oks HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: 407'5/4 oal [, ";E z X3Li sCZ- Well Classification ' ,R/yt -- If A. B, C, D.E.C. Approved (Y/N) IL)IA Well Log Present �N) — Date Completed — rTl Z� $ Yield _& kph r Total Depth Cased to Depth of Grouting 114 Static Water Level Pump Set At r Casing Height Above Ground — ^f Sanitary Seal on Casing(Y N) Electrical Wiring in Conduit 6)N) Separation Distances from Well: To Septic/Holding Tank on Lot Depression Around Wellhead (YO L ; On Adjoining Lots /y .141 - To Nearest Edge of Absorption Field on Lot " ; On Adjoining Lots / / e 7- yo To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole — To Nearest Sewer Service Line on Lot Zj f Water Sample Collected by /SGS ; Date Water Sample Test Results a/it % '�- W/ iZI-� Comments (% � fi v) 7z`57� - � 3'tN_e 7_ i 4L4 B. SEPTIC/HOLDING TANK DATA Date Installed t I x Size y�0 No. of Compartments — Standpipes 6)N) _ Air -tight Caps ON) Foundation Cleanout(Y N) Depression over Tank (Y z_ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) wt -f -Jor Holding Tank High -Water Alarm (Y/N) A)1A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well ��Z� To Building Foundation �7 r i To Property Line To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage r Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 4S0 Type of System Design 799_741 Date Installed 4,4/6/N*- Length of Field o.N/F>. 39 uPC,. 30 Width of Field �� / e P4• 3 �� Depth of Field aR147• y / uPb. 13' Gravel Bed Thickness Square Feet of Absorption Area `% Standpipes Present UN) Depression over Field (Y® &-3 88 �akiE,i*sft Sf/sTeh, Results of Last Adequacy Test ya0 C /aA Date of Last Adequacy Test /.3 )wv-1 Separation Distance from Absorption Field: To Water -Supply Well 109 / To Property Line UP4, ''� 1/0 , ozi¢. 30 To Building Foundation upt? • N `� °iOly ;W' To Existing or Abandoned System on Lot /7 lie7WI1 G/,t/i On Adjoining Lots To Water Main/Service Line /a �` To Cutbank (if present) I To Stream/Pond/Lake/or Major Drainage Course /� 9 - To Driveway, Parking Area, or Vehicle Storage Area /% 1�A("9e �� SS/3rr7! / isa497�j Comments D. LIFT STATION stalled 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) �umpmgs during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav%e%heccc eld, �erified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. !/vim Date� Company�Cf MOA No. 4A A44 44 Receipt No. 0202 Date of Payment �7 D V Amount: $ / / Q �— Page 2 of 2 72-026 (1 vaa) ."o0°°0�0 °tp��A♦qq♦ 09909.14 s ea ° ROY C. REID, JR. o A c CE - 2251 p� °° •i , r.. fs CHEMICAL chi GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ®� FEDERAL TAX ID # 92-0040440 LABORi DRIES ANALYSIS REPORT BY SAMPLE for Work Order # 7476 Date Report Printed: JUL 5 88 8 07:50 Client Sample ID:L5A, Tests Performed BI HIDEAWAY LAKE Client Name AECS PWSID :UA ND= None Detected Client Acct AKECSRP Collected JUN 27 88 H 14:45 hrs. P.O.# NONE REC D Received JUN 27 88 0 15:40 hrs. Rey # Preserved with :4 DEG. C Ordered By : A. WEIN Analysis Completed :JUN 29 88 Send Reports to: Laboratory Sup`_e,r//viso STEPHEN C. EDE 1)AECS Released By : �C/li • 2) Special Instruct: Chemiab Ref #: 1549 Lab Smpl ID: 1 Matrix: Water Allowable Parameter Tested Result/Units Method Limits --------------------------------------------------------------------------------------------------------------- NITRATE-N 2.1 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY A. WEIN. 1 Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than CHEMICAL, & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street &Z- s Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY n PUBLIC WATER SYSTEM LD ( .# I II e: A I hows this Water SAMPLE to b PRIVATE WATER SYSTEM r Name Phone No. 1�� t, 33` 6 - Melling Address �� 9 gsa3 City Slate Zip Code SAMPLE DATE: o Z 7 F 8' Mo. Day Year SAMPLE TYPE: � Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose � Untreated Water SAMPLE Time Collected NO. LOCATION Collected B 2 I O/S �% i✓ -J 3 4 5 I I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE ..jr is s U 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 b' 2-7,6'�-? Time Received Analytical Method: Membrane Filter " No. of colonies/100 mi. Lab Ref. No. Result* Analyst EE BACTERIOLOGICAL WATER ANALYSIS RECORD J Membrane Filter. Direct Count Verification: LTB Final Membrane Reported By TNTC = Too NumberouS TO1Count' OB = Other Bacteria iyld Coilform1100ml _BGB Coilforml100ml Y Date Time: a.m. p.m. PART I OF 2, REMAINDER TO FOLLOW LAmIjulEuH ENGINE -ERS PLANNERS SURVEYORS �, e :/ 700 1 ��Ntr ra ONLY • su< . FNo t N O.ULY N � M \ 1V e 2820 "C" STREET, SUITE NO. 3 ANCHORAGE, ALASKA 99503 PHONE (907) 272-9231 4�r /1 6 �-� pF A�mw Ar too 4,- >�'4 so *!�� • 'k 6 R•••tt t• •o 006000 •• 4_ t ..o° stop o• •.A 0. UR C. REID, JR.•. wti ra ! E-2251 w FS f •Ott fNN ' �� on•ti�` .rys�,n k(�; �4V V ,X 0 1,Y 9 arm r �1 ZPA •,•...... •45,� v*'4 TH ✓ *�® t�Gerald V. Randall Jr.a / �P % NO, 4053.5 eo *006.11,6000 1 � ROFESS I ON AL t'P<.�� " SURVEY CERTIFICATION: I hereby certify that I have surveyed the property shown and described hereon and that the improvements situated thereon are within the property lines and no encroachments exist other than noted. NOTE: It is the contractor's responsibility to check top of foundation In relation to finish grade and building setbacks In relation to lot lines and easements. -- LEGAL DESCRIPTION: LEGEND: �� r /,� . • 5/8 REBAR SET DAN. BY: �% + LJL /T O/ O 5/B REBAR FOUND O 2"x 2" HUB & TACK SET CHKO: EXISTING S. J% /_1LDATUM ASSUMED GRID: y ^ / / ✓ /� F.B.tf TI�t'��Wf�Y L /1/,C �UL7O• SCALE: 7/ 7i/�� DATE: ' I �, e :/ 700 1 ��Ntr ra ONLY • su< . FNo t N O.ULY N � M \ 1V e 2820 "C" STREET, SUITE NO. 3 ANCHORAGE, ALASKA 99503 PHONE (907) 272-9231 4�r /1 6 �-� pF A�mw Ar too 4,- >�'4 so *!�� • 'k 6 R•••tt t• •o 006000 •• 4_ t ..o° stop o• •.A 0. UR C. REID, JR.•. wti ra ! E-2251 w FS f •Ott fNN ' �� on•ti�` .rys�,n k(�; �4V V ,X 0 1,Y 9 arm r �1 ZPA •,•...... •45,� v*'4 TH ✓ *�® t�Gerald V. Randall Jr.a / �P % NO, 4053.5 eo *006.11,6000 1 � ROFESS I ON AL t'P<.�� " SURVEY CERTIFICATION: I hereby certify that I have surveyed the property shown and described hereon and that the improvements situated thereon are within the property lines and no encroachments exist other than noted. NOTE: It is the contractor's responsibility to check top of foundation In relation to finish grade and building setbacks In relation to lot lines and easements. -- LEGAL DESCRIPTION: LEGEND: �� r /,� . • 5/8 REBAR SET DAN. BY: �% + LJL /T O/ O 5/B REBAR FOUND O 2"x 2" HUB & TACK SET CHKO: EXISTING S. J% /_1LDATUM ASSUMED GRID: y ^ / / ✓ /� F.B.tf TI�t'��Wf�Y L /1/,C �UL7O• SCALE: 7/ 7i/�� DATE: ' APPLIC AT FILLS OUT UPPER HAL ONLY Time �� Property"Owner ("Hi..Cl 6��-F- � ( ��0,� Phone Mailing Address -(�II� 0�_. ` {�E`. T� r G L,o;- .. c /�_ Zip Code "_ 'i `�-(i `f Buyer "T(Q< �� n, "-I-<'v�i�v Ca �y (,A Inspector Address Zip Code MUNICIPALITY OF ANCHORAGE DEPT. OF H'ALTH - ENVIRON?JcNTAL PROTECHON Lending Institution �- t/;, '� f" , (�,`u r,- (_. ,(�� V 'u'/ Phone Address Zip Code DATE - Realty Co. & Agent r" • Phone Address Zip Code Well To Ab orption Area Well Log Received Legal Description 1 -� S 7` �. , i,:- 4 \--� �c f (,� �._, <.- r (��-C A (e(>14i t.:, (,..- Well to Tank `1 `N Septic Tank Size Street Location C /9 �c aT� _, .• r- ,(, Fw-,. �:z�i;�( v UbZ<<- —/S; Type of Residence !! 11 (((- 5' -Single Family ❑ Multiple Family No. of Bedrooms_ ❑ Other Water Supply 'Individual ij.;-; ,.•'/ l ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal "e Individual Year Individual Installed: i ' •,� ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ( 11 (��c�St 4 �1cc P Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE DEPT. OF H'ALTH - ENVIRON?JcNTAL PROTECHON WY (zf; APPROVED BEDROOMS \ 'CONDITIONS OF APPROVAL ( ) DISAPPROVED QS ( 1' /')-tONDITIONAL APPROVAL' DATE - r" • (t�+� ( �1 ' d Soils Rating Date Sewer Installed Well To Ab orption Area Well Log Received 'p ,— V ? Well to Tank `1 `N Septic Tank Size 72023 13821 CHEMICAL & GL,.LOGICAL LABORATORIES k, ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER AA. 274-3364 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. i ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. I LOCATION Collected By 1 L — 2 J 3l 1 4 L J 5 Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result' Analyst 10ml loml loml loml 10ml 1.0ml 0.1ml L I I.D. NO. Water System Name Confirmatory Phone No. Mailing Address +No. of colonies/ 100 ml. or No of Posilive portions. City SAMPLE DATE: I I 1 Mo. (�' C= Day State Zip Code Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. i ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. I LOCATION Collected By 1 L — 2 J 3l 1 4 L J 5 Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result' Analyst 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Data Collected HEAD INSTRUCTIONS Date Received BEFORE COLLECTING SAMPLE Time Received Source a.m. -- n.m- 1 •h Nn Presumptive 10ml loml loml loml 10ml 1.0ml 0.1ml L I L J Confirmatory 24 Hours +No. of colonies/ 100 ml. or No of Posilive portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Data Collected HEAD INSTRUCTIONS Date Received BEFORE COLLECTING SAMPLE Time Received Source a.m. -- n.m- 1 •h Nn Presumptive 10ml loml loml loml 10ml 1.0ml 0.1ml 24 Hours 4e Hours Confirmatory 24 Hours 48 Hours Multiple Tube Report: Membrane Filter. Direct Count Verification: LTB Final Membrane Filter Results. Reported By Broth 24 hours: __Broth 48 hours: 10ml Tubes Positive/Total 10m1 Portion$ Coliform/100ml Data Time Coliform/100m1