HomeMy WebLinkAboutHIDEAWAY LAKE BLK 1 LT 7A Municipality of Anchorage Page t, of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~¢c~\c:::~-~1'~ PID Number: N~1~t..~. ~.~q.~_.~_~___~ .~ ~._Wastewater System: B New ~pgrade Address: _~,~ ~.~~ ~, ~~ ABSORPTION FIELD Phone': ~ ~ ~~ [ No. or,rooms: ~eep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION soil Rating: Total Depth from original grade: -ot:~ Block: ~ ~ivisi°n: DepI~ to pipe bottom fr, m original ,rsde: Gravel depth beneath pipe ~ 4~ Ft. ' Sec ' Fill added above original g~de: Township: Range: Gravel length: Numbe[ of lines: Distance b edp lines: WELL: B New ~ Upgrade Gra~ll~ ~ Ft. ~ s,: ~ ;~ in~s~. _Clas~ti°n (private, A,B,C):/~~ Total Depth: Ft. Cased To~ Ft. Totalabsorption area:~ SQ. Ft. Pipe material:~ ~~~. Driller: Date Drilled: Static Water Level:Ft. ~e'.~ ~~ Date in~lle~. -- ~ I Yield: ~ Pump Set at: Casiug Height Above Ground: '- ~.~ ~,. ~,. TANK SEPABATION DISTANOE8 ~e,tic U ,o~di.~ U S.T.~.,. F~o~ T~.~ ~i.~d S~.o. T..~ S~,~, Un.~ ' k~ ~ , .u ero, o% ent : Surface i Water ~ ~[~ ~ ~ ~ LIFT STATION Foundation ~ ~1 / / Curtain ~ ~ ~ ~ Pump Make &~od;, Electric~i~spections performed by~~ _~rain _0 ~ Remarks: BENCH MARK Location and Description: Assumed Elevation: ~ ~ E N ~ ~EWS~E&L Inspections performed by: ~7034 Eaele Ri.vet L~p Road ~t~41st ¢~l-~ I~~~~~ .~'. ' ;~[;,~CF] Department of Health~d H~an Servic~pproval ~, ~,". Reviewed and approved by: :_ 72-013 (1/9t) MOA 25 SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE I_EGAL DESCRIPTION: Z 7 &/ ~. ~/~--(./_~ Township, Range, Section: 9 10 11 12 13 14 15 16- 17 18 19 20 WAS GROUND WATER ENCOUNTERED? I N s IF YES, AT WHAT DEPTH' ~ oL . p E Deplh to Waler Alle[ Monitoring? Reading Date Gross Net Depth to Net Time Time Water Drop 7~/~' 7/~ Permit No. ~"~C)10~" J'~ Page. ~-- of ~' Municipality of Anchorage 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 Legal Description: ~I~AI.,~J~ .'~ (_~, 1~.,.t/~, '1 ~"1" ~ PID No.: 72-013A(2/91) MOA25 Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LECAL DESCR,PT,ON:, 10 11 12 13 14 15 16, 17 18 19 20 COMMENTS DATE PERFORMED:'~ ~ Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? 0 P E Deplh to Water...~Jt~. ~ Reading Date Gross Net Depth to Net Time Time Water Drop ,~ 7 , -~" PERCOLATION RATE I'~' ~ (minutes/inch) PERCHOLE DIAMETER TEST RUN BETWEEN ~ FTAND / I~) _FT AOOO.D^NOE W,TH AL. STATE ^NO M~iC,P^. ~,DEL,NES,N E~'EC~O. ~H,S DATE. L~TE: 72-008 {Rev. 4/85) 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 WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910213 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:JOHNSTON ALLAN R & OWNER ADDRESS:il090 HIDEAWAY LAKE DR ANCHORAGE, ALASKA 99516 DATE ISSUED: 7/25/91 EXPIRATION DATE: 7/25/92 PARCEL ID:01547111 LEGAL DESCRIPTION: HIDEAWAY LAKE BLK 1 LT 7 LOT SIZE: 55616 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 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 FOLLOWING SPECIAL PROVISIONS. July 14, 1991 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Al~ka 99519-6650 REFERENCE: Lot 7; Block I; Hideaway Lake Subdivision; PERMIT REQUEST NARRATIVE Request you issue a permit that will allow an existing septic system to be upgraded in accordance with the attached design dated July 14, 1991. The existing septic tank and a portion of the existing leachfield that were installed in 1978 are now too c~ose to an existing stream. In addition, the absorption trench has fa~led an adequacy test for the existing 4 bedroom home. Due to the existence of a creek, lakeshore, section line and utility easements there is only a l~ited area available for the upgrading of this system. This forces us to utilitize an area on bothsides and underneath an existing driveway. It is proposed that the area underneath the driveway will have a 4" layer of high density styrofoam insulation placed over the top of the trench before backfilling. It is our opinion that this insulation along with the cover proposed for this system will provide adequate protection from freezing. The soils in this area are a well graded sand wi~h a slightamount of silt. Based upon our percolation within the test hole we find the soil to be slightly less permeable that determined by the original soil log. The design of this system upgrade will provide a greater area for absorption. Due to the location of the existing septic tank and its age a new septic tank will be required. This area is already developed around the lake frontage and the area to the south of this property is currently undeveloped. Therefore we do not fe~l that the upgrade of this system will have any adverse effect on the surrounding properties. If we may be of further service, or you require additional information for your review, please contact us. :OVERT A. SHAFER, P.E. KS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE $ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS - LEGAL OESCRIPTION 'LOCATION R~ O~STANC~ TO: ~ ~O PERMIT NO. ~ ~ Manufacturer ~ < ~ ~ Material ~ No. of compartments ~ ~ Liq, capacity in gallons, inside length Width Well Dwelling ~ Manufacturer Material tiquid capacity in gallons ~ DISTANCE TO: Well ~ CO Foundatio~ ~C~ Nearostlotline tO PERM[THO, ~" ~ ~ N°' of lines ~ Length of each lin~ ~ Total length of line~ ~ Trench wid'l~ inches Distance betweenUlines~)~'S S I- ~ ~ Top of tile to finish grade ~ ~ Matedal beneath tile ~ ~t xl Total effective absorption area Length Width Depth ~ Type of Crib diameter Crib depth Total effective absorption area ~ m DISTA~C[ TO: ell guilOin~ foundation ~eorest lot line ~ ~lass ~ Depth Driller Distance to lot line PERMITNO. ~ DISTANCE TO: Building foundation Sewer line Sepdc tank Absorption area(si OTHER SOIL TEST RATING INSTALLER ~" ~O DATE LEGAL 72-013 {Bev. 3/781 PERHI 1,' NO. FIPPL I C:flNT ..:rFIMES I<U[.':,RNf'I L.OCFI1,'ION HIDEFINFI'¢ LRt-',E [:,RIVE I..EGRL. [..? B:t HI[:,ERHRY <HIDDEN'.:" T"r'PE OF SOIl... FtBSORBTION S'¢STEM IS MF~XIMUI"I NUMP:,EF:: OF BEDROOI'I'.=J = 4 I]:,EF'FIf~rTME1'.,IT HE~?.1,'H FI1'.,ID E1'.,I',,,'I RCINHENTF'IL. ~::OTb~iCT ]: ~/,1 / ,' ICL 82::5 '"L" STEEET., F¢.~CHOFtFIGE., FII<. S~S,.'50i / I'.[.~/._~,-~, ~ ,,'--, iO::1.4 !4 77'TH FIND '.::i~S~O2 THE R.E(.;!UIRED SIZE OF'" THE SO.IL I"'iBSORF:'TION S"r'STEM 1,HE LENGTH D]:I"IENSIOi'4 IS THE LEN6TH (-N FEET::' OF THE TRENC:I'I '/F:' THE DEPTH OF FI TF..EN~H,' P OR F'IT I2; THE DI:.,T[' : ':lq...E ......... [:,[:. r[ IE[:l'4 THE S.;UF::F'F:iC[E ['F:' THE 6ROUND [siN[) THE BOTTOM OF THE EX[::RVRTIO1'4 (IN FEET). THERE :IS NO SET HI[:,TH FOR Tf4'.ENCHES. TNE GRFIVEL DEF'1,'H ]:S TNE MII'.~IHUH [:,EF'TH OF GF,'R',,,'EL E~ETHEE1'.4 THE OUTF:F~L.I.. P:[FE RNB THE BOTTOM OF' THE ENE:R',/RTION (IN FEE1,'::,. F'ERMIT RPPLICFINT HFIS ]'HE RESPONS:f. BII_IT'.r' TO INFORM THIS DEF'FIRTMENT DURII',IG THE INS"I"F~LL. RTION INSPECTIONS OF' i:IN'T' HELLS FtDJF~t']ENT TCI THIS F'ROPER1,'Y FIN[:, '['HE NUMIE',ER OF RESIDENCES 'I"I4RT THE HELL. I,.III..L SERVE. BRCI<FII_LING Of':' AN'[ SYSTEM 1.4I'FHOUT FINRL INSPECTION FI1'.,ID RPPF::OVRL. E:"? 'THIS DEPARTMENT 1.4ILL BE SI..IB,%EE:']' TO PROSEC'UTION. MIhlIMUH DISTRNCE BETHEEN R NELL FIND FIN"r' Of',I""I"];iTE SEHFIGE DI~;POSFI[.. '.~.';"r'STE:M IS d.C'E..'~ FEET FOR Ft PRIVATE HELI_.~ OR ....' :~;~, 'rEt 200 FEET FROM tq F'IJBI..IC 14ELL DEF;ENE' :~ II'-4U" LIF'ON THE T'¢F'E CIF' pi .... BI )'r': F.t[!iZL. I ..... HELL. LOGS RRE R[.:.'C..!UIRED RND [lUST BE RETURNED "FO TIdE DEF:'Ialq'.THEN1,' l.,llTHIhl OF THE HELl.. COMPL. ETION. OTHER REQUIREMENTS MFI'-r' FIPPL'¢. SPECIFICFI1,'IONS RND C:ONS'T'F'.UCTICfi'4 [:,IFIGF.:RMS:; FIR[!: FI",,'RILRBLE TO INSURE PROF'ER I NSTF~L. LRTIOI'4. I CEIqTIF"r' I'HFIT :t: I FIM FFIMILIi::IF.: I,.IITH THE REr.i!I..IIREHEN1,'S FFtR_ ON.-::SITE _ELIEF4.=,:' ' ""- FINC, l,.IEL.l...S; FIS SE1,' F'OR]'H B'-r' THE MUNICIPFII._IT'¢ OF F¢.~CHOR. RGE. 2: I HILL INSTRL..L ]'HIE S'¢STEM IN FIE:CORDRNCE HITH THE CODES. :~: I Uf',I~T. FIND TFIRT THE ON-SI1,'E SEt.,.IEF.." S'T'STEM ['1Fl'[ F-:tEQI..IIF;% E:IqL..FIF~GEHEIqT IF' THE F..ESIDE~'4~.:.'E ~:EHO[:,ELED 1''O IhlCLI-,~:,E MOF.'.E Tt4fl1'.,I 4 E:E[:,fr.~:OOMS, CLIENT Bob Sparks W.O. 77897 TEST HOLE NO. ELEV. I'OP OF HOLE DAI'E 11/28/77 Peat, PT., anlc Damp, brownish red sandy silty gravel, GM ~.~:~ 11 12 Damp, brown, gravely sand, SW Grab sample 13 14 15 16--- 17-- 18 20-- 23'-- 24 ~ 25 Damp, brown, sandy gravel, GW ~--Hbl e NOTE: 1. No water table at time of drilling. 2. Estimated perculation rate - 2 min/inch. US Slondofd Sieve Numbe, ri 8 I0 16 20.30 405060 I00 ?O0 e?O Ii I00 5O tO 5 I 0.5 OI GRAIN SIZE IN MILLIMETER5 GRAVEL ~ SAND COBBLES I CO.~ RSE j FINE [ ~- S--~ MEDIUN~ J FINE 005 O 01 0005 SILT OR CLAY Symbol (.) Somple Source. Clossiticotion Test Hole 1 Test Hole 3 GRAYISH-GREEN SANDY GRAVEL (GW-GM) GRAYISH-GREEN GRAVELLY SIL1YSAND (SM) PARTICLE SIZE ANALYSIS HARE) lNG - LAW[5ON ASSOCIATES Consulting I:;~ginccrs .~d Geologists Job No_ 5552~, Q05_=08_____ Appr:~"~[4ADate _ 12/77 HIDDEN LAKE SUBDIVISION Alaska PLATE 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 OERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 7; Block I; Hideaway Lake Subdivision; Location (site address or directions) I1090 Hid~vay Lake Drive Property owner Mailing address Lending agency Mailing address_ Alan Johnston 11090 Hid~ztway Lake Drive, Day phone 561-5624 Anchorag£,, Alaska 99516 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: XX Individual well 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 Communi!y on-site Public sewer NOTE: XX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~025 (Rev. 1/91) Front MOA ~t21 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/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverifythatbased 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 Address Engineer's signature S& S ENGINEERING 17(324 ~¢. ~,,~ I ~.~p ~_e~_d Eagle River, Alaska 99577 DHHS SIGNATURE ~X/~ Approved for /~.¢-~(~/) Disapproved. Conditional approval for Phone Date bedrooms. bedrooms, with the following stipulations: Additional Comments · The Municipality of Anchorage D~p~rn~nt of Health ~nd Hurn~n Services (DHH$) issues Health Authority Approval Oe~ifi¢~tes b~sed only upon the representations given in p~r~gr~ph ~ ~bove by ~n independen~ professional engi neet registered in ~he State of Alaska. 'The DHH$ does th is ~s ~ courtesy to pu roh~$er$ of homes ~nd their lending institutions in order ~o $~tisfy certain federal ~nd state requirements. Employees of DHH$ do not conduct inspections or ~n~lyze d~t~ before ~ certificate is issued. 'The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~)25 (R~. 1/91) Back MOA (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.-~. ~'~/ ~t ¢)~¢k't,5/~ ~ Parcel I.D. C::~l, ¢~'~,d¢~ I I A, WELL DATA Well type Log present ~N) Total depth \ z~¢'~-I Sanitary seal ~J;'N) '~ If A, B, or C, attach ADEC letter. Date completed Cased to \ CC'Z- Date of test Static water level We l flow Pump level ADEC water system number ~,¢2¢ "~ ¢ 7¢ Driller' __ Casing height_ Wires properly protecteddC~N) FROM WELL LOG g.p.m. AT INSPECTION g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main b~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULt: Coliform Date of sample: Collected by: Othe ~ B. SEPTIC/HOLDING TANK DATA Date installed ~::~'~'¢2 ~1'1 Tank size [ ~.~ c:~ Compartments '~ Cleanouts~:~/N) '-f Foundation cleanout ~;~'N) '7' Depression (y/~t~ High water alarm (Y/N) ~ /~ Alarm tested (Y/N) ~ Date of pumping _ ~ Pumper ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ C2~ On adjacent lots To propertyline 1~~q~ Absorption field Surface water/drainage / ~ Foundation _ Water main/service Pine 72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date insta I~¢,..,~ Size in gallons ~ ~ "Pump on" _ Vent (Y/N) ~ High water alarm level '~-'~ct~ted Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" level at Well on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed Length ~¢~¢2¢ ~-t ~ Soil rating ~), ,¢ ~?~/'"'~/~" System type Width "~ Gravel thickness Total depth Total absorption area Depression over field (Y/~ Results (pass/fail) ~ ~ Peroxide treatment (past 12 months) (Y~¢~ Cleanouts present C/N) Date of adequacy test for ~ If yes, give date -- bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ \~' To building foundation On adjacent lots Surface water On adjacent lots \c;~;:~ ~ Propertyline Driveway, parking/vehicle storage area Curtain drain To ~/~/~Sting or abandoned system on tot Cutbank ~ Water main/service line E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eff, e,.,¢t:o?t~t~O! this inspection. ~_~ .~..'" ~ ~ ~'~ , " ,-:~'., ;,', '., ~', : ~':' ~i: Signature Engineer's Name Date 17034 Eagle Ri,vet Loop Road '=.agle River, Alaska 99577 HAA Fee $ Date of Payment Receipt Number ,,,¢/¢~ 7 ~'-~--- 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 REPORT BY SAIdPLE for ¥tORKorder~ 37799 Date Report Printed: SEP 3 91 ~ 08:42 Client Sample ID:L7 Bt HIDEAWAY LAKE S/O PWSID :UA Collected AUG 30 91 @ i2:40 hrs. Received AUG 30 91 @ 14:00 hrs. Preserved with :AS REQUIRED Client Name :$ & S ENGINEERING Client Acct :MNSENGP BPO ~ PO tl NONE RECEIVED Req ~ Ordered By :R, SHAFER Anolyeis Completed :AUG 30 91 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE I)S & S ENGINEERING Chemlab Rei ~: 914489 Lab Smpl ID: i Matrix: WATER Allowable Parametez Tested Result Unite Method Limits NITRATE-N 1.5 mg/1 EPA 353.2 lO Sample ROUTINE SAMPLE COLLECTED BY: R.D,J. Remarks: 1 Tests Performed * See Special Instructions Above UA-Unavailable ND= None Detected "See Sample Remarks Above NA~ Not Analyzed LT-Lees Than, GT-Greater Than ~S~S Member of the SGS Group (Soci~t6 G6n(~rale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF C©MMER~IAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER J~ PRIVATE WATER SYSTEM Mailing Address Phc~le No. $ g S ENGINEERING 17034 Eagle~iver Ea$1e River, Alaska 99577 Mo. Day SAMPLE TYPE: ~Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose Slale Zip Code Year [] Treated Water [] Untreated Water SAMPLE Time Collected No. LOCATION Collected By 41 I SI I TO BE COMPLETED BY LABORATORY -Analysis shows this Water SAMPLE to be: atisfactory [] 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 Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count Coliform/100 mi BEFORE Verification: LSB Fecal Coliform Confirmation BG8 COLLECTING SAMPLE Final Membrane Filter Results Reported By~ Date TNTC = Too Numerous To Count PART ORE OF TWO OB = Other Bacteria REilAINDER TO FOLLOW Coliform/100 mi /~%.r7~.' p,m. A. WE '£ Well C~a~ification MUNICIPALITY OF ANCHORAGE (MOA) Heallh Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: / If A, B, C, D.E.C. Approved (Y/N) (-¢ - '~- ~ ~ Yield '7. ~ Pump Set At ~ ('~' Well Log Present (Y/N) tfl _Date Completed Total Depth //d'.~' Cased to /¢o '¢- Depth of Grouting Static Water Level _ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ,/ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ~ Water Sample Test Results ~_'~ ~ Comments Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) /N) ; On Adjoining Lots [ ,//Jo ¢- ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date ~' - /' <~ B. SEPTIC/HOLDING TANK DATA Date Installed ~/'-Z~- 7~Size t'~-- ~O¢~, / NO. of Compartments Standpipes (Y/N) '¢~ Ik) Air-tight Caps (Y/N) Depression over Tank (Y/N) . Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well [ tOO 'f To Property Line / ~ To Water Main/Service Line ( O ToStrea ,~_ond, Lake or Major Drainage Course 72-026 (Rev. 7/88) Front Page 1 of 2 ~/~ FOUndation Cvleanout (Y/N)~' Date Last Pumped ~ (,,) /'-)/~ 'for ' / Temporary Holding 'Tank Permit (Y/N) / To Building Foundation To Disposal Field C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ - ZO - Width of Field / ~ RT ¢'//~?'~ Type of System Design '~- G~) Length of Field .-¢~/-7/ 2 ~ ~ Depth of Field { ~ Gravel Bed Thickness Square Feet of Absortion Area ~-'-/-/0 Statndpipes Present (Y/N) (--) Depression over Field (Y/N) (,,t Date of Last Adequacy Test Results of Last Adequacy Test ''~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / ¢O '/- To Property Line ! To Building Foundation _~, G ~ To Existing or Abandoned System on Lot ~/¢ ;On Adjoining Lots -~O "q To Water Main/Service Line ( O '/- To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course {'O~ To Driveway, Parking Area, or Vehicle Storage Area ~'- ' -~ D. LIFT STATION Date Installed ~'% Dimensions Size in Gallons "~ Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments '~-,~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on.the, dante of this inspection. ., Signed Company. Sagle River, ~tJas~¢a 99577 MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 12:30 HBA HORTGAGE LOAN PRODUCTIOH P,2 at onal Moftga~l~ Loaf~ D~partmen'i ~. O, ~x 1070~5 Ancho~'age, A I~,~k,~ 99510.?02~ (907) 257-$4,74 1500 W. Benso~ $1vd., Fourth Floor An~hor,.~ge, Alaska 99503 February 28, 1991 S and S Engineering 17034 Eagle River Road Eagle River Alaska 99577 Re; Lot 7 Block 1; Hideaway Lake Anchorage Dear Roger Upon the closing of the above transaction, National Bank of Alaska will escrow the sum of $12,400.00, These funds will be used for the completion, installation, or improvement of the presen~ septic system to meet all DEC requirements and to gain the approval~ for a four bedroom home. If you have any questions, please feel free to contact me at my direct line 257-34.59. Sincerely, e$~ree Ovsak Mortgage Loan Closer }fortgage Loan Production cc; file Alaska s Most Conuenlent Bank CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 31123 Date Report Printed: JAN 4 91 @ 15:53 Client Sample ID:LTE1 HIDEAWAY LAKE S/D PWSID :UA Collected JAN 3 91 @ 13:00 hrs. Received JAN 3 91 @ 14:00 hrs. Preeorvod with :AS REQUIRED Analysis Completed :JAN 4 91 Laboratory Supervi~or.:STEPNEN C. EDE P~oloased By : ~~ ~.~.~ Client Nome : S & S ENGINEERING Client Acct: SHSENGP P.O.~ NONE RECEIVED Roq ~ Ordozod By : g. SHAFER Send Reports to: 1)S & S ENGIHEERING Special Inetruot: Chemlab Ref ~: 910021 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 1.3 mE/1 EPA 353.2 10 Sample ROUTINE SA}dPLE. Remarke: SAHPLE COLLECTED BY R.D.J. 1 Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected '* See Sample Remarks Above HA- Not Analyzed LT=tess Than, GT~Greater Than ACHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street ' ; Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# I I I I I I I PRIVATE WATER SYSTEM Name Mailing Address Phone No. S & S ENGINEERING Eagle River, Alaska 995~7.. City SAMPLE DATE: State Mo. Day Year SAMPLE TYPE.: C~ Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose zip Code ) [] Treated Water [] Untreated Water SAMPLE NO, LOCATION Time Collected Collected~ Date Received Time Received Analytical Method: TO BE COMPLETED BY LABORATORY s shows this Water SAMPLE to be: isfactory [] Unsatisfactory [] Sampletoolong in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Membrane Filter * No. of colonies/100 mi. Lab Ref, No, Result* 0021 2_ FT--d FT-] I I I-F Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter Direct Counl. ('~ ,Veriflcat on: LTB BGB Final Membrane Filter Results. 'Reported By Time: TNTC = Too Numberous To Count OB = Other Bacteria Coliform/100 mi Coliform/100 mi PART ONE OF REMAINDER TO FOLLO~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 o TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 32039 Date Report Printed: FEB 20 91 @ 11:05 Client Sample ID:LOT 7: BLOCK 1; HIDE AWAY LAKE SD ?WSID :UA Colleoted FEB 19 9i @ 12:00 h~s. Received FEB 19 91 @ i2:20 hrs. Preserved with :AS REQUIRED Analysis Completed :FEB 20 9i Laboratory Supe~v~pl~N C. EDE Released By : ~ ~ ~.~_./- Ctiont Name : S & S ENGINEERING Client Acer : SWSENGP BPO U PO ~ Req ~ Ordered By : E. S~FER Send Reports to: i)S & S ENGINEERING Chemlab Ref #: 910559 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 1.5 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: R.D.J. Remarks: Tests Performed ' See Special Instructions Above UA-Unavailable None Detected "See Sample Remarks Above Not Analyzed L~-Less Than, GT-Greater Than TO BE COMPI_ETED BY WATER SUPPLIER ~, PRIVATE WATER SYSI'EM Mailing Address Phone No. $ & $ ENGINEERING l'~rtgle Rivor, A ~sN~ 99~';27 City Slate SAMPLE DA'YE: F~T~I F-~-j F~i] Mo. Day Year SAMPLE TYPE: ¢'~ Routine Check Sample (for routine sarnpla with lab ref. no, E] Special Purpose Zip Code ) [] Treated Water ~ Untreated Water SAMPLE ' Time Collected NO. LOCATION Collected 3 I I 4 I .J 5 L I TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE be: /~atisfactory to [~ Unsatisfactory BI Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sarnple via special delivery mail. Date Received ____~2~/ _ Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* Analyst EFJ El-2 I-T-] BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count Verification: I. TB Final Membrane Filter Results TNTC = Too Numerous To Count OB = Other Bacteria BGB _Coliform/lO0 mi Coliform/100 mi Date Time: ,/~--~.~ )~ _ a,m. p.m. DATE-~ ECEIVED INSPECTION APPOINTMENTS TIME TIME TIME -DATE f -DATE DATE DEPT. OF I lcALIvl~ -- MUNICIPALITY OF ANCHORAGE ENVIRC)NMENI'AL PkOTECTION  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street- Anchorage, Alaska .~501 D E ~ ~ 0 19~9 ENVI RON~ENTAL SANITATION DI VISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) d~ys for processing., j PROPE ~Y~WNER P~OPERTY RESIDENT (If different from ~bove) g PHONE 2. BUYER MAI LING ADDRESS ~ ~ PHONE~ 4, REALTOR/A~ENT MAILING ADDRESS 6. TYPE OF RE~IDENO'E NUMBER O F ~B E D R O O,]~I,S~- I~/SINGLE FAMILY [] One J~' Four [] [] Two BI Five [] MULTIPLE FAMILY ~ Three ~ Six ~ INDIVIDUAL* *ATTACH WELLLOG. Awel Iog 's required for al welts dri led Other [] COMMUNITY [] PUBLIC UTILITY 8, SEWAGE DISPOSAL SYSTEM ~'/I N DI VI DUA L/ON.SiTE~ [] PUBLIC UTILITY since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ~~/I--AR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [~] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED ~ERMIT NUMBER 3. SEWAGE DISPOSAL SYSTEM E] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified _ INSTALLER E~Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank IAbsorption Area Sewer Line [ Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~'A'~ROV ED FOR :'~ BEDROOMS [] CONDITIO/N~L APPROVAL (letter must accompany certificate) __? DISAPP,R~/ED DATE ,, ~) ~,~/--' 'Y .~..~ BY / -.~ ~- ~ (~)..r~ ? gEOLOgiCAL I. P.O. BOX 4-1276 4649 BUlkiNESS P^RK BLVD, ANCHORAGE, ALASKA Drinking Water Analysis Report for Total Colifdrm Bacteria TO BE COMPLETED BY WATER SUPPLIER city ,*'~ State zip Code Mo. Day ,:.. Year SAMPLE TYPE: [] Routine [] Check Sample (for routine samp'ie with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION Time Collected Collected By //' e.,¢' TELEPHONE (g07) 279-4014 LABORATORY: NAME ADDRESS Date Received Time Received CITY Analytical Method: [] Fermentation Tube ~/~. Membrane Filter LAb Ref. No. Result* Analyst I F-Fq I FFq 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAM PLF Form No. 18-310 (3.78) Date Collected ~ S~rce P'¢esumpt Ive _ 24 Hours 48 Hours ~onflrmatory 24 Hours 48 Hours ' Multiple Tube Report: __ 10mi Tubes Positive/Total ]0mi Portions Membrane Filter: Direct Count Collform/100ml Verification: LTB Final Membrane Fllter..J~esul.~,~k L"~.~ ----Coliform/1OOml Time: ,/ ~/~ d'~ a,m, ~3.rrl. TO BE COMPLETED BY LABORATORY