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HomeMy WebLinkAboutHIDDEN HILLS BLK 1 LT 33H;I:D D,EN H/:LL5 lock 1 Lo1' 33 Oll-lZl -58 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 -` Page 1 of 3 NOV ON-SITE WASTEWATER INSPECTION REPORT 0 2 2017 Permit Number: OSP171290 PID Number: 011-121-58 Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade Name: Barry Maijala ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 6320 Wooded Circle Anchorage, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Hidden Hills 1 33 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well >100' N/A N/A N/A >25' TANK A Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,250 Gal. Surface Water >100' N/A N/A N/A Material Number of compartments Lot Line >5' N/A N/A N/A Steel 2 NA Foundation >5' N/A N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain Nonel Noted RemarksSand point driven next to trench Pump on level at in. Pump off level at in. High water alarm at in. cleanout for new monitor tube. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank1)30" Tank to b3D3 y Installer drainfield Denali Excavating Drainfield CO/MT b3o3L{ Inspector Mike Anderson BENCH MARK (Assumed elevation) 100.0 ft Inspeection 1s' 10/5/17 10/5/17 Location and description ction 2nd Back Deck 3'd 4th COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date ;:�'`�• m _•�1 0 AV ..•:-p2.01 p.� OP f : lin Date ( f off' 1.01 I Approved JA � . iy fid + c . _ Inspection Report_9-1-12.doc -1A C*4 0 m 0 < 0w LU M ZD C)_J 0 0 0 0 0 F-0 2' LIJ 0 Cl) LJ_ UJ 7�E , F- LU CD w FL 0 0 U_ 00 LO .11 C\j CL z 0 0 9= Z Cl) W n zx LU ry w 0 w I -- co V ZZ -1A C*4 0 m HIDDEN HILLS BLOCK 1 LOT 33 PERMIT # OSP171290 PID # 011-121-58 PROFILE AS -BUILT (NO SCALE) W.6 OPl g��49 TM r9*I Beni n Schiller PF •. CE 12592 •�`�i �l�li�PR0FESSIONP���� • 1/07\fl MUNICIPALITY OF ANCHORAGE On-Site Water& Wastewater Program 5 PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 . _. http:!/www.muni.org/onsite "(ALIA epartment ^'cN 00,6 On-Site Wastewater Disposal System Permit Permit Number: OSP171290 Effective Date: 10/2/2017 Work Type: SepticTank Upgrade Expiration Date: 10/2/2018 Tax Code Number: 01112158000 Site Legal Address: HIDDEN HILLS BLK 1 LT 33 G:2222 Site Mailing Address: 6320 WOODED CIR, Anchorage Owner: MAIJALA BARRY L & SHELA M Lot Size in Sq Ft: 13831 Design Engineer: FORGE ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: / (�(,{,e,�� �/j'Je I Date: /0 - Issued By: ! ���t"p Date: 10 0.7 .20 / 7 MUNICIPALITY OF ANCHORAGE Community Development Department Phon-• •07-34--7904 Development Services Division �`" • .17-3434 7 On-Site Water & Wastewater Program ffros ON-SITE SEWER/WELL PERMIT APPLICATION SEP 27 2011 ti Parcel I.D. 011-121-58 Barry 1& Shela Mai ala 5 8 t Property owner(s) Day phone — Mailing address 6320 Wooded Cir, Anchorage, AK 99502 Site address 6320 Wooded Cir Legal description (Sub'd.. Block & Lot) Hidden Hills, Block 1 Lot 33 Legal description (Township, Range & Section) Lot Size 13,831 Sq. Ft Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: ( all that apply) Absorption Field Initial Single Family (SF) IX] (w/wo ADU) Septic Tank X Upgrade X Duplex (D) I Holding Tank Renewal ❑ Multiple Dwellings ❑ Privy ( I (SF and/or D) Private Well Water Storage f] THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: �} �$ ��" Date of Payment: Receipt Number: /� 0 IL(/ 7 Receipt Number: Permit No. °spa j2 O Waiver No. Permit App__-:•:_.,c; FORGE ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) September 27, 2017 Municipality of Anchorage Development Services Dept- On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Hidden Hills Block 1 Lot 33,6320 Wooded Circle Septic tank replacement permit application Dear On-Site Services Engineer: The septic tank on the above lot has failed, requiring a replacement. The existing home is a 3- bedroom. We are submitting this permit application for the placement of a new septic tank. The attached site plan identifies the location of the existing home, well and septic system, as well as the location of the new septic tank. The drainage pattern in general will not be changed by the construction. The existing tank will be pumped dry and decommissioned per code. It is a 1250-gallon tank, and the homeowner would like to replace it with one of the same size, even though the house is currently a 3-bedroom home. The new tank will then be placed outside the 100' well radius. After the new tank, we will install a double-cleanout and connect into the existing absorption bed. Records indicate the existing tank has insulation over it. If needed due to shallow bury, insulation will be placed above the new tank. If the system is constructed as designed, it will have no adverse impact: • On the wells in the area or those to be constructed in the future. • On existing septic systems in the area or those to be constructed in the future. • On reserve space, either surface or subsurface, on any lots located in the area. • On drainage patterns in the area. The current drainage pattern will be maintained. ,cF,A q1�1 Sincerely, 'c/ .. .•n'... :71, 0 Benjamin Schiller, PE 0i ».l I I LOT 32 100' WELL RADIUS (S5 I 1 :WOODED CIRCLE DECOMMISSION EXISTING HIDDEN HILLS — BLOCK 1 \I„.2 TANKAND ABANDON IN I LOT 33 PLACE / _ _,` •.. REPLACEMIENT 1250—GAL SEPTIC TANK W/ DOUBLE I N. I CLEANOUT T I I �! I ', EXISTING WELL 1 I 1 � _ I 1 3-BDRM HOME r \ \ \il I \\.7 \ DECK LOT 34 LOT 20 \ \ \ \ \ \ NO WELL \ \ EXISTING ABSORPTION \ \— —M TRENCH L \- - _ + -- — — — ^ —. _ \. 10'UTILITY EASEMENT LOT 39 LOT 38 ~ WELL> 100'FROM VIEW NOTE �����%NAN NO SURFACE WATER WITHIN 100'OF THE — OF.. , WELL> 100'FROM VIEW -.0;0.1. • PROPOSED SEPTIC SYSTEM — _ *• IE TH , ••*,• � NO CONFLICTS WITH WELLS OR SEPTIC oo .. •. SYSTEMS ON ADJACENT LOTS LEGEND Benja• Schiller • MT-MONITORING TUBE OA"P •CSE 12592••���A47�� 0 _ 20 — =0 FEET FCO-FOUNDATION CLEANOUT i.V ?ROFESSi` � 1„=20' TH-TEST HOLE \NV CO-CLEANOUT NAME 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 PHONE ' [~NEW MAILING ADDRESS LEGAL DESCRIPTION 13 t H/Qb LOCATION I Wall ~ JAbsorptionarea U ~: DISTANCE TO: I iD0 ~ Z Manufacturer ..... . .-- ~ Liq, capacity in gal ohs Inside length { Z ~ 0 IF HOMEMADE; ~ ~ ~ DISTANCE TO' Well Dwelling -~ Z I ' I ~ ~ [ ' IWell I Foundation ~ I DISTANCE TO: ~I'O~ 7~ ~ndf~'[~ ~'~, ~ ~ ~ I No. of hnes Length of each hne Total length of I nes ~ N ~t~ finisl~ grade Material beneath tile ~ J~g,b Width De~th < ~ I TypB of crib Crib dismeter Orib depth ~ [~ss Depth Driller Dwelling i ~ ~o £. Material ~ _, Width Material Nearest lot line Trench width ~0 inches .~/ inches NO, OFBEDROOMS PERMIT NO. No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. ~1~ ,~ ~) ~ z"Z Distance between lines Total effective absorption area __ PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. A ~sorption area(s) OTHER PiPE MATERIALS .20~i' ~p f'ou? oF SOIL TEST RATING INSTALLER REMARKS Gerry J. Melloff LITY OF ANCH( DEPT, OF HE/,LrH APPROVED DATE LEGAL 72-013 {Rev. 3/78) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I . ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHON ~,~ MAILING ADDRESS ~GAL DESCRIPTION / ~CATION NO. OF BEDROOMS ~ DISTANCE TO: Well / ~d ~' Abs°rpti°n are~ Dwelling~ / PERMIT NO. -' ~ ~ ~anu~acturer Material ~' No, o~ compartments ~ ~ Liq. qapacity in gallons / Inside length Width Liquid depth ~ !~ Z'd IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well t Foundation ~ Nearestlo~line - PERMITNO ~ ~ ~ No. of lines Length of ~ach line Total length of lines Tren.ch width , Distance between lines ~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area I~ Well Building foundatior~ Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~ .~ SOIL TEST RATING INSTALLER REMARKS / 72-013 (Rev, 3/78) F'E'RM I T i',10. I:::IF'I:::'L.. ~ L'::FtNT LOCI::I'I" I OH LEGFIL [)ON HFII',INI::IH L.!::3 :F::l HIE:,B, EN HIL. I...S E:O,'.'.:: i::l..;P]lE~28 IaNCHORF-:IGE 99!~!;:11.::L 34.9.-:l.::L.;P. 4 I....OT SIZE 999999 S6!UI::II::.".I!E FEET "F"r'F'E OF SO~I.... FtE','-:;ORt::"T'[ON S"r':L:;TEM IS: ]"RENCH MFIHIMLIH I',!I.JME:ER OF' BEI.'F.:O01'I:i~: = 3 SOIL. F~:FI]"II'.,IC~ ,::SQ I:"T,-.'Efl~:)= 125 THE F.:EC-.!LIIRE[:, 'ii;IZE OF 'T'HE SOIl_ FtE::'Z.;OF. IPTICfl'.,i S'~.'S'T'EH t'S: THE: !....EHISTH [:, I MEI'-,IS l ON 1:5 'I'HE LENGTH ,:: l I",1 FEET ) 0t::' ]"FIE TRENCH ClR [:,RFI I I",IF ]: El_D. THE DEPTH OF' FI 'T'RENCH OR F'I'F :I:S THE I}ISTI::INCE 8E]"NEEN THE SUF::FFICE OF:' THE GROUN[:, F:INE:, THE BOT]"OM OF' THE E;:.:;CFI'v'FITICIN ,:.'IN FEE]'::,. THERE ]::5 I'..!0 SET t.,I I E:,TH F'OI~: TRE!'.4CHES. THE GRF:IVE:L. L":,EF'TH IS THE I'"ili'.,tIHIJH [:,EI:::'TH OF ISRFIVE:L E:ETI,.IEEN 'I"HIE OIJ]"FFIL. L. F'IF'E: FIN[:, ]"HE E',OTTOM OF THIE EHCFI'v'FIT I ON ,:: ]1. t",1 FEET ). F'ERH I ]" FtPF'I_ I CFIN'T' HI::IS TFIE RESF'ONS 1' B I I....T. 'r'~.' TO I NF'ORM TH t :.:J E:,EF'FIF::TMENT DUE' I NG THE I N:STFIL. LI:~T 101",i I NSPEC:"F I OI",IS 0I::' FII'.,I¥ I.,.IEL. I_S FI[)JFIC'ENT ]"0 TH t. '._:; I:::'ROF'ERT'~.' FINIX:, THE NUI"IE:EI';.: OF R[::.'Stl)ENCES THFIT THE HEL. L. F.IZLL SERVE. ............. T' !MI C)~ .:: 2: 2:, I1 P',,II L'~;; F:" ~FG:: C: -tF _T.. ~C} Ih.,.] '.~i:. IFil IFC: !EZ ]~:E: ~:iZ {~:.~ L.i] ..1:: iRi'.' E-Z I[12 ..................... E',F:K]:KIz' I L.I... t NG OF FIN's' E;'~'S"I"EI'"I H I THOL.IT F I NFIL I I",tSPECT I CP-,I FIN[::, I::tF'F'F.:O',,,'FIL. E:'~' TH 1:5 [:,EF'FtF.:THEI',IT [,.I I L.I.. E:E :E;LIE',JECT 'FO PRO'}.';ECUT I OI"L I"111",111'"tLJM D I STFtI",IC:E E:ETt.,.tEEI'.,I F:I I.,.IEI....I... F:Ii'.,I[:, I:::1t'.,!¥ OI'.,I-S I TE SE'I.,.IFUiiE I} I SF'OSFIL S"r'ST'EM I S ::LC~Z~ F'EET I::'OR I::1 F'f:~:I',,,'FI'I"E: I.,.IEL. L. OF.: :1.5~Z~ TLq 2'.~NEI ,CE:ET FROM FI F'IJE:LIC I.,.IELI_ [:'EPENI}II",IG LtI:::'Ot",I THE T"r'F'E OF F'IJE',L..IL.: HELL_ I"IIi",ItHIJP'I 13'I'.E;]"I'":Ii',ICE FROM F:I PF.'.IVlaTE HEI..i. TO FI F:'F.:I',,,'IaTE :E:E!-,.IER LINE IS 25 FEET Ftt",I[:' TO FI COMMUi",IIT"r' SEt.,.tER L II",IE ]:E:; ?'5 FEET. HELl.. L..OGS FIRE I::,:E(i:!IJtRED FIND MU'ST E:E RETURt",IEI} TO ]tie DI:ZPI":tRTHENT klITHtI",I 3:~EI [.'."F:I"r'S OF ]"HE .WELL C:OHPI....ETIOI",I. OTHEI~: REL::!I...I I F.:E.I~'IEI",ITS MI::'I¥ I::IPPLJ'r'. SF:'EC I F t CF:IT I OI",IS FIN[:' COtqSTF.'.UC:TI ON [:' I FIGI:i:FIi"1S FIRE F:I',,,'F'I I L.t::IE:I_E TO t HSLIF.:E PROPER I I",ISTFII_I..3:IT 101',!. I C E R T I F"r~ 'T H FI 'T :1..: Z FIPI F'FIM t L I FIF~: 141 TH THE REQLI I P. EMENTS I::'C~R 01",t-::51TE SEI.'.IERS FIND I,.IELI....S las L::;E]" FOR T H I'F.~'~" THE i'ILIN I C I PF:IL.. I ]" Y' OF FIt",I(]HORF:IC'iE. 2: I ,t,.!IL..L II",ISTFILL THE ':i';"r'!~;TEM Ii",l FIC:C:OR[:'FII",ICE I.,-!ITH ]'HI"£ CODE:E;. ].: t iJi",t[)ER:E,,TI::II",t[:, THI::IT THE ON-SITE SE.NEF.: 'i:]"r'STEH MS"r' REQUIRE L::NL..FtRGEMENT IF' THE'] RESI[:'EI",tC:E ]:S F.:EMO[)ELE[)TO INCI_LIE:,E t"'IOF.:E THFIN 3 E:EDF..'OOMS. F:li':' P L. I (:: Ft N'I" /I~F~I'.,t I"1 £::11",1 N I::1 H ~ ~'~-Fl'L~/ L_L_..L~/~ "~ /. /, f' PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 6 7 8 9 10 11 13 14 15 16 17 18 19 2O COMMENTS SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTIVlENT OF HEALTH AND ENVIRONMIENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST SLOPE WAS GROUND WATER //~ ENCOUNTERED? IF YES, ATWHAT DEPTH? SITE PLAN ~,/O O f~ ~;/~ Reading Date Gross Net Depth to Net Time Time Water Drop :. PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) FT PERFORMED BY: ~'/~ /',.,- Y ~ /'~:L(..077 -- DATE: 72-008 (6/79) 0 = 36' 7g - 96' 96 ~ lg3 ].£3 - 160' ].60 ~ 170' 17o- 175' Lot 33, B].k 1 - Hi~den ~i]ls Sand GraEel Gravel Da, nd Gravel Glay Gravel Grave]. Fine ,CJilt ~and C ~urso Gravel with water 173' of 6" casing. Bailed lO GPM 30' water in well Ri S W24'1 I "E 86,05' FENCE (APX)� ANCHORAGE RECORDING DISTRICT, ALASKA 9FT TWIR I OF A4 • 4W 49TH o Mr Air JeffelAW"oldi L ot SURVEY I NO, JEFF A. GASTALDI, R.L.S. G RD. ANCHORAGE,KA 99507 1 ff w PHONE 248-5454 on ANCHORAGE RECORDING DISTRICT, ALASKA 9FT TWIR I OF A4 • 4W 49TH o Mr Air JeffelAW"oldi L ot Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. ' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 -oc'// CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-121 -~58 1. GENERAL INFORMATION Expiration Date: / 0" Complete legal description Location (site address or directions) Curr~nt Properly owner(s) JOHN Mailing address 6320 Lending agency Mailing address' Real Estate Agent Mailing address HIDDEN HILLS SUBDIVISION; LOT 3;3, BLOCK 1 6320 WOODED CIRCLE * ANCHORAGE, AK * 99502 &: HELEN ROBERTS Day phone 360-958;5 WOODED CIRCLE * ANCHORAGE, AK * 99502 Day phone DEAN PARKER W/ PRUDENTIAL JACK WHITE Day phone 762-5834 3201 C STREETt SUITE 200 * ANCHORAGE~ AK * 99505 Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 5 3.. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site [] Individual Water Storage E] Individual Holding tank ['-] Community Class Well D Community on-site r"] Public Water System D Public Sewer The Municipality of Anchorage Development Services Depadment (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for propedies served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Cedificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I redly that my investigation, based on procedures outlined in the Health Authodty 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. I further vedfy 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to prOvide a thorOugh, conscientious engineering analysis of the systcm in accordance v~th ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation. distances measured to readily identifiable features. The operational life 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 tl~ere are no hidden defects or encroachments. GEG, Ltd. can therefore not prOvide any warranty orfuture 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 authorfzed, nor v~ll it confer any legal right whatsoever. Phone 337-6179 5. DSD SIGNATURE ~ Approved for ~ bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: . . PROGRAM . Manitenance Agreements Supplemental Engineer's Reort Other (Rev, 12/01) Original Certificate Date: -7- i · '.Municipality of Anchorage i- Development SerVices Department =' ~: i Buildir~g safety Division': · . i~ On-Site Water & Wastewater Program ~ ' ~ ' 4700 South BragawSt. } ' · ~ . ,' P.O. Box 196650 Anchorage. AK 99519-6650 : www.ci.anchorage.ak.us : (907) 343-7904 " HEALTHiAUTHORITY APPROVAL CHEC L: T Legal Descript. ion: HIDDEN HILLS SUBDIVISION; LOT 33~ BLOCK 1 P~cel ID: 011-121-58 A. WELL' DATA ..... .Well type !~ PRIVATE . . If A, B, or C provide PWSID# N/A Well Lgg (Y/N) YES Date isompleted ' 7/8/1984' Sanitary seal Cf/N) YES Wires properly prote~ed Cf/N) YES Total'depth :175 ft. ~Cased to 175 .ft. '" Casing height (above ground) 12+ · iFROM WELL LOG AT INSPECTION :: I~., :~ Date of test ~ . . 7/8/1984 6/17/2004 Static Water level 145 ; ff. . . - - - 1,31 i ft. Well:p'~oduction - , 10 g.p.m. - · - ::4.75,1 g.p.m. WATER SAMPLE RESULTS: colif°rr~''~ colonies/100 mi. ,Nitrat'eOo'l O mg./L: ! Other: b'a~te}ia :(~ colonies/100 mi. C . ' '... : . , Arsenici: [N/A mg.lL. Date of sample: ,6/19/2004 Collected b ~y: GEG~ Ltd. B. SEPTIC/HOLDING TANK DATA .......... Tank~i'~3eiMa~eria~l ' SEPTIC/STEEL. ' Date inStalled 5/,16/1983 -- Tanksize 1250 gal. Number of Compartment's. 2 Cleanouts (yIN) YES Foundati°n Cleanout (Y/N) iYES Depressi0nlover tank (Y/N) NO High w, aterlalarm (Y/N) . N/A ~'Date.o[pu~mping 6/16/2004 ' Pumper CHUGACH PUMPING C. -ABSORPTION FIELD DATA ! ~'BELOW EXISTING CRADEI Date..installed 5/16/1985 Soil rating (g:pi[d,/ft~or~. 125-. S~ste~'t~,pe ' DEEP TRENCH Length "' i, ,30 ~ .ft.:' Width : 2.5 ff. Grovel below pipe 7.0 ft. Totaldepth "'9.21 ft. Eft. absorption area'420 ff~ ,, Monitoring tube YES ,. ?ePression over field NO i '~ 'e 6/i ~ ' For 3 bedrooms Date d quacytest': 7/2004 ;Results (Pass/Fail) PASS Fluid depth in absorption field before test ,43.5 in. ' Water added 455 .g~il., -.,; New depth 60.5 in. Elapsed~Timei .194 min.' Final fluid depth 57.3 in. ' AbsorPtion rhte >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN- i~ If yes, give date - · NEW MT:DRIVEN 6~15/2004 (NO P~EVIOUS MT). MT DOES NOT EXTEND TO ACTUAL BO'FI'OM .: ~i in. D. LIFT STATION · Date installed ""Pump on" level at in, E. SEPARATION DISTANCES size ingallons'~ · ! !- ' .Ma~~; ~ Pump off' In. ' H~gh water alarm level at -----: ~, ;, .~n. Cybles tested ~ ' Meets alarm & circuit requirements?, i: SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ' ' 100'+' 'Absorption field on lot 100'+' ., PubliCseWer main 100'+ Sewer/s,ePtic service line ' 25'+ :· , Holding tank ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT,TO:r ' Building foundation ' 5'+ Water main N/A , Wells 0n;adjacent lots' ,' 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: .' On adjacent Iot~ On adjacent lots Public sewer manhole/cleanout Property line :'~ 5'+ :Absorption field Water service line 10'-!-. Surface water Property line 10'+ Water service line i 0'+ Curtain drain NONE KNOWN ,COMMENTS ' , Building foundation, 1 O'-I- Surface water 100'+ Wells on adjacent lots,"100'+ G. ENGINEER'S CERTIFICATION ' icertify'ti~ai I have determined through field inspections and .: t:oview of Municipal records that the above systems are in ~ ~ . conform~,~co with MOA HAA guidelines in effect on this date. JEFFREY A. GARNESS Engin'eer's Printed Nam.e Date'~,i. . i;:,,, ~ HAA Fee`S: ' .......· ' .' Date Of Payment Receipt NUmber (Rev. 1~01) ~ ~, , ,', ~t':j~ 100'+ lOO'+ - 100'+ i',! Water main Driveway, parkinglvehicle storage Waiver FeeS" ~ Date of Payment: ' '. · i Receipt Number' 06/01/04 T[~ 09:45 FAX 1 907 762 3189 Jack ~hlte Estate · . ~002 I -~¢ALE I '= 30' I~ASEI~ENTS OF ~ECOI?.D, OTHER' THAN THOSE SHOWN ON THE RECORDE0 PLAT, ARE'NO~ :SHOWN HEREON, C/,eCL ~ MUNICIPALITY OF ANCHORAGE ~) / / / ~j-~' ~ DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~(~_ ~ I~¢- OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION fMUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) /-~T ~ ~t~C.~ / /-/tDL;:~¢~ /,f'//J.-~ Cf/CC;::'. / Location (address or directions) WOo p (b) Property Owner FNM~ Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone: Home Telephone Business Telephone - (e) Mail the HAA to the followina address: or: Check heretiC], if hold for pick up. List contact pe~.Ek~nd day phone number below. TYPE OF RESIDENCE Single-Family)~ Number of Bedrooms 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. SEWAGE DISPOSAL ~ Public F-] Community [] Holding Tank Onsite [] 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 72-025 fRev 8/861 Front '>lJOt~ s,J@eu!6u@ leUO!SSatoJd aql u! suoiss!~uo Jo s Jo J Jo Jol alq!suodseJ lou s! eSe~oqouv to ~!ledio!unlAI oqJ. 'ponss! s! aleo!lB~eo e aJolaq elep eZ,~leUe Jo suoBoodsu! 13npuo3 lou ap SHHQ to sao~olduJE] 'SlU@W@J!nb@~ elels pue le~opot u!elJeo ,~lsBes al Jap Jo u! suo!lnl!lsu! t3u!puel J!eql pue sewoq to sJeseqoJnd al ,~sel~noo e se $!ql soap SH HQ eq/'e>lSelV Ia e~elS oqi u! pe~eis!OeJ JaauiSue leUO!SSatoJd luopuadapu! ue /~q e^oqe ~ qde~§eJed u! ua^!~ suo!leluesaJde~ aql uodn ~lUO peseq soleo!liPeo le^oJdd¥ ~lpoq~nv qlleaH sonss! (SHHQ) soo!^JaS ueLunH pue qlleOH ,to luew~JedaQ o6eJoqouv ,to ~liled!a!un~ aql NOl£fl¥'O le^oJddv leUOB!puoo ,to suuJe/ leUOB!puoo pe^oJddes!Q "~¢,~ po^oJdd¥ (~/i~'~¢~"~'~ (~ ~¢AqsuJOOjpoq ~;''TCAOI~ddV JOt pO^oJddv SHHO 'S ,CHORAGE ~s D~vtstoN L~j~NICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) VEI "EOKL'sT- E""uAR¥26.,. ,o8 Legal Description: ~ .~:~,) ~:~.LOC~. [ WELL DATA Well Classification ~2~/¢'z)CT~ If A, B, C, D,E.C. Approved (Y/N) Well Log Present (Y/N) %J~:¢ Date Completed "7/'~/~:)¢ Yield Total Depth j,.~l Cased to ,.~r~- Depth of Grouting Static Water Level I'2,11P~'R f.C~c4""l'~'T~ / Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot + ~)O¢ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole 4- Water Sample Collected by Water Sample Test Results Pump Set At '- Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on .5",~ 4,'~'.£~ o./or ~, Comments B. SEPTIC/HOLDING TANK DATA Datelnstalled ~ll~_/~)'~) Size 1~.-~¢ No. of Compartments '~' Standpipes (Y/N) ~'~-¢ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression over Tank(Y/N)~.O~J .., ,_~. Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well (,O0 To Property Line To Water Main/Service Line -f" Course '~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 fray 886! Front ABSORPTION FIELD DATA ! Soils Rating in Absorption Strata l~ ~ / ~'~1~ ~/ Type of System Design Date Installed ~/t~/~'~ Length of Field Width of Field 30 ~f..¢- Depth of Field / ! ~ Gravel Bed Thickness '~ / Square Feet of Absorption Area 4'~.0 Standpipes Present (Y/N) '"~ Depression over Field (Y/N) ~O Date of Last Adequacy Test Results of Last Adequacy Test ~-T(~"~rC.L,l[-~'"¢ '~--'O¢- ¢'~ Separation Distance from Absorption Field: To Water-Supply Well 109 ~ 4- lO To Property Line To Building Foundation .4-(0 ¢ To Existing or Abandoned System on Lot .4-(Or ; On Adjoining Lots Jr (OI To Water Main/Service Line W lC)f To Cutbank (if present) ~OT- To Stream/Pond/Lake/or Major Drainage Course 'Jr'/~O I To Driveway, Parking Area, or Vehicle Storage Area Jo' Comments LIFT S~TION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify thatA have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date ~/11/ ~ ate of Amount: $ / ~ 0 Page 2 of 2 72-026 fRev 8'86/ Back Client's Name:_ Address: ~-%SE, EPPS & PO~TS P3_20 EAS~ 88 AVSINUE ~I~CIiORAGE, AK 99507 (907) 349-,545]. WATER WELL TEST Block: / ,., Initial Reading on Meter: DRAW DOWN TIME GPM GALLONS VOLUME GALLONS FIELD M~-TER TOTAL MONITOR LEVEL READING Production Rate: ~"~ ---~ GPM 24-Hour Capacity NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST SUITE A ~AIRBANKS. /,L,~SKA 99709 907.479 3115 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907.277-8378 Quality Control Report Client: ID#: Besse, Epps & Ports A021088-1 Listed below are quality control assurance reference samples with a known concentration prior to analysis. The acceptable limits represent a 95% confidence interval established by tile Environmental Protection Agency or by our laboratory through repetitive analyses of the reference sample. The reference samples indicated below were analyzed at the same time as your sample, ensuring the accuracy of your results. Sample # Parameter Unit Result Acceptable Limit EPA 378-12 Nitrate-N mg/L 0.78 0.72 - 0.80 Reported By: /~_~ k.,"k~' -r-¢"------ Date: 2/12/88 = = = = = = = = = = = = = = = = = = = ~--%-~'_/a=- -_4 ~'~ = = = ~--~ =~ = = = = = =-= = = = = = = = = ..... = = = = = ..... = = = -- Carol J. Gaz~ison, Vice-President NORTHERN TESTING LABORATORIES, 600 UNIVERSITY PLAZA %VEST SUITE A FAIRBA"iKS ALASKA 99709 2505 FAIRBANKS STREET At4CHORAGE ALASKA 99503 INC. 907-479-3115 907-277.8378 Besse, Epps, & Ports Date Arrived: 2/10/88 2200 East 88th Avenue Time Arrived: 1302 Anchorage, Alaska 99507 Date Sampled: 2/10/88 Time Sampled: 1220 Attn: Andy Ports Date Completed: 2/12/88 Source: See Below Sample ID#: A021088-1 Hidden Hills Parameter Unit L33,B1 ADEC-MCC* A021088-1 Nitrate-N mg/L <0.10 10 Rep o r t e d B y: _~_~_7c~///~ ~l~-~-~/. 1 ~ ~ /2~_. _..~l..f~'" Date: 2/12/88 == ...... ==== ..... ~ = = = =,~/=.~.,a -z--%--_.p ---= = ~/~ .... == ................. = ............ = ......... Carol J. Garrison, Vice-President * MCC = Maximum Contaminant Concentration NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLA7~, WEST, SUrTE A FAIRBANKS, ALASKA 99709 907-479-3115 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT [] PUBLICWATERSYSTEMI'D'#E I I I ~PRIVATE WATER SYSTEM NAM£ Mailing Address City State SAMPLE DATE: (:~)2 /~) ~ Phone Mo. Day Year Purchase Order No. SAMPLE TYPE: ,~Routine [] Special Purpose [] Treated Water [~ Untreated Water Zip Code [] Check Sample (for original contaminated sample with lab reference no. Sample Time No. Location Collected Collected by 2 3 4 ? 10 Sig nat u re of Representative ~(//~//'~":~/~ / Laboratory Ref. No. FOR LABORATORY USI:- ONLY TO BE COMPLETED BY LABORATORY Received at: ~'Anch. [] Fbks. °ate .eceived _¢-/0 -- Time Received !~ © ~, Next Sample Due COMMENTS: SATI S FACTO RY (~ L,! N SATI S FACTO RY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Verification Final Count LSB BGB Resua *No. of Total Coliform Colonies per 100 mis. Reported by MUNICIPALITY OF ANCHORAGE DIVISION OF ~VIRO~4ENTAL ~'~ALTH DEPARTMENT OF HEAL~ ~D ~]'VIt~N~iENT~ PR~ECII APPLICATI~I ~R HEAL,~q 1. Gene~al Inforr~tion Application Date a) lmgal ~s~'iption (inclu~ lot~ block, subdivision, ~ction, t~ship, range) Applicants Ad.ess // c) Applicant ~s (check d) h_~nding Institution __~ Z-/I ~-/('~ Address .... ~.. OZ2 .... ~3. ~' .Z F (e) ~al zska:e Co~ & Agent: Address Te le phone 2. T_T_T_T_T_T_T_T_T_T~j~~ of Pe. siden~m Number of Bedroon'~ 3. ~%te~ Su~0o].Z. Note: 'If ~.mity ~11 sys'l:em~ must ha~ v~itten <~nfb~tion fr~ the State ~p~nt of Environmental Con~rvation attesting to t~ 'legality ~d status, Is the ~e].l adequate fo~ the n~ber of t~ s~cified in this ~ (Y/~) 4, ~ wag~_!~osfi~' Is t~e wastewater disposal system adequate f~ t~e n~r of ~dz~s (Y/~) [PaGe 1 of 2] 2-15-84 5, .En__g. ineerir~q Finn t~ovi_d_i_ng_..!n~_pections, %%sts, Data and Infornmtion I certify that I have checked, verified, or confo~nned to all F¢DA HAA Guidelines in effect on the date of this inspection. ( ENGINEER SEA/_.) 6. DHEP Approval. Approved fo~____ii~_.~ bedrocm~ App= ore d.,~-[, D:i. sapp~ove d Conditional FI Terms of Conditional Approval The Municipality of Ancho_~age Departrmnt of [~alth and Enviroraa~ntal Protection dces not guarantee t3.~ continued satisfactory Ferformance of the water: supply and/cc the wastewater disposal system. This approval indicates that, as of the validation date sh~,ra above, based on the data and information furnished ~ an e~xJir~e..er' registe~d the State of Alaska, the water supply and wastewater disposal system is safe and ticnal for the number of bedrooms and type. of struct~me indicated° ( F/HEP SF~tL ) 7. Mail the Bl~\ to the follcwing address: KS2/d5/s [Page 2 of 2] 2-15-84 Be MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORA(~I~ DEP'F. OF HEALTH & ENVIRONMENTAL PROTECTION Well Classification Well Log P~esent (Y/N) Total Depth [/$ Static Water Level ! Z / Casing Height Above Ground Electrical Wiring in Conduit (Y/N) .RECEIVED ~//¢(*. r~;4, If A, B, o~ C, D.E.C. Approved(Y/N) y Date C~. leted ~ -, ~ ~ F~ Yield Card to ~ . /~ . ~pth of G~outin~ ~ ~t At ~ ¢~ Sanit~y ~al on Casing (Y~) ~ ~ession ~ound ~l~ead Separation Distances from Well: To Septic/Holding TapJ~ c~ Lot /dd / ¢, ,'; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /O g ~ ; On Adjoining Lots To Nearest Public Sewer Line /¢.~' _ To Nearest Public. Sewer Cleanout/Manhole /V/~ To Nearest Sewer Service Line on Lot Water Sample Collected By ~/~;/ ~l~tl~l~,.'i'~ ; Date Water Sample Test Results Y~.~' K/~, /~,~ ~ ~ ~J6c L~ ~ SEPTIC/HOLDING TANK DATA Date Installed ~-/~-¢93 Size /2¢¢'~ Standpipes (Y/N) /' Air-tigh~ Caps (Y/N) ~ Depression ore= Tank (Y/~_) /~ Date Last Pumped Pumping/Maintenance Contzraet cn File (Y/N) __; for Holding Tank High-Wate= Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances f~om Septic/Holding Tank: To Wate=-Supply Well __ / v~ To P~operty Line 3¢f'' To Water Main/Service Line Course /¢ ~ No. of Cot~artm~nts ~. Foundation Cleanout (Y/N) /~, ~ To Building Foundation ~ To Disposal Field 5~/ To Stream, Pond, Lake, o~ Major D~ainage Con~eQts [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'_ / ~' ~.C,~ ~ Width of Field 3~ r, .,~. Square Feet of Absorption A~ea ~ f. 0 Depression over Field {Y/N)' Results of Last Adequacy Test Separation Distance from Absc~ption Fie~d: To ~ter-Supply Well ~ 0~/ \ To P~operty Line /~ To Building Foundation /V/~ :',~ A To Existing or Abandoned System c~ Lot ~i~- /%/A ; c~ Adjoining Lots '3 d ~ ~' To Water Main/Service Line /~ To Cutbank(if present) To Stream/Pond/Lake/o~ Major D~ainage Couz~se /v /~ To D~iveway, Parking A~ea, o~ Vehicle Sto~age A~ea ~J ~' Co~ents Type of System Design Length of Field ~ ~) Depth of Field // Gravel Bed Thickness ~' / Standpipes P~esent (Y/N) Date ,of Last Adequacy Test /V /% D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. ~ets MOA Coz~nts ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed ~.~ ? ~,~ Company ~ ? ,.7" /~?~gg~ KB1/d5/s Date MOA No. HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUsTRiAL CENTER ' 5633 B Street ,/~f; / ,Drinking Water Analysis Report for Total Coliform Bacteria -t ~ /--o TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: E~I I I J I I(*) see h °n back City SAMPLE DATE: MO, Day ~ Yeer SAMPLE TYPE: [g Routine D Check Sample (for routine sample with lab ref. no ) E] Special Purpose SAMPLE NO. I.D. NO. Water System Name Phone No. Mailing Addra~ '~" [ State Zip Code [] Treated Water [] Untreated Water Time Collected Collected By snalysis 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: [] Formontatlon Tube 1~ Mom~rano FUtor Lab Ref. No. Result* Analyst I F-F-J *No of colome$/100 mi or NO ol Po$itwo portions BACTERIOLOGICAL. WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count Verification: LTB. B~B Final Membrane Filter Results Repoded By r-~-'~ .~~__ Date TNTC= Too Numerous To Count Collformll00ml Collform/100ml APPLI( NT FILLS OUT UPPER HAI ONLY '?' : ]" ': Zip Code ~'"/¢.~? .// Mailing Address ¢,. ,~, ? ,. ,,: Buyer Address Zip Code Lending Institution ~/? ~( ~.~ d?~.~ ' /¢. { :'~ "~/ ,? -'" '"l ..... .*'1 / ;'././ / ,~ ) /,~"?~ Phone ! ,.] t , .-:;' ../.<..~:i ~' //- /::/// / // ...... Address f' ', ,' : · '' -' . · Zip Code '~'~-(; ? Bealty Co. & Agent Phone Address Zip Code Legal Description ,i.._ ¢ 7 -.'.;' / E? /' ./././.¢4_¢" 4.- ./:~'. -.~ ' --"'-.." ' Street Locatio~ ,.~. ¢: ,, . . ,., ,: ,':~ Type of Residence [] Single Family [] Multiple Family ~ Other No. of Bedrooms. / Water Supply [] Individual ATTACH WELL LOG. A well Icg ~s required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg if available). [] Public Utility Sewer Disposal E~ Individual Year Individual Installed: /~': ~ Public Utility When Connected to Public Utilily: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Date Date Date Inspector Inspector Inspector Field Notes: ..... /. . / o Time Date Inspector /~ DEPT. ~%%1'FI ~. ENVIRONMZNTAL PROi'[CfION APPROVED BEDROOMS I,.,..~ISA P PROVE D CONDITIONAL APPROVAL' 'CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed 72.023 (3182) Well To Absorption Area Well to Tank Well Log Received Septic Tank Size CHEMICA£ & GL LOGICAL LABORATORIES 'ALASKA, INC.~ ' TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I.D. NO. Water System Name Phone No. Mailing Address City , State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref, no [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. I ,b 5I Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: E]:'Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 nours old at examination to indicate reliable results. Please send new sam Die. ,~, ,Date; Received Time Received Analytical Method: [] Fermentation Tube _~Membrane Filter Lab Ref, No. Result* Analyst //'2 I.:"'"/'-= "1 ?' . *NO of colonies/100 rr ~r NO of Positive portions READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev, 1978 BACTER IOLOG ICAL WATER ANALYSIS RECORD Dote Collect e(t Source Date Received Time ReCeived ---- o,m, Lib, No, Presumptive 1Omi 1Omi /Omi 1Omi 1Omi 3.,Omi O,lml 24 Houri 48 Houri Confirmatory 24. Houri 48 Houri EMB Broth 24 houri: Multiple Tube Report= Membrane Filter; Direct Count Verification: LTB Final Membrane Filter ReSults '~'- ) ' · . ~:j ~,(.//._ ~,,;~/': Reborted By Broth 48 hours: 3.0mi Tubes Po$1tlve,rTotal 3.0mi Portions Collform/3.00ml BGB Collform/lOOml Tlme~ ,-' :~ ;"? ? ) _a.m. HEMICAL & G~'OLOGICAL LABORATORIES 'or J4LASKA~ INC. ~° ~ TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street ~;;%~y Drinking Water Analysis Report for Total Coliform Bacteria Phone State SAMPLE TYPE: [] ROutine [] Check Sample (for routine sample with lab ref. no ) [] Special Purpose .Treated Water Untreated Water SAMPLE NO. 1 § 06.122.0 (b) Rev, 1983 Time Collected Collected By I TO BE COMPLErED BY LABORATORY Analysis shows this Water SAMPLE to be: ' ~fi~, Satisfactory I-I unsatisfactory r-] 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 mall, {)ate Received Time Received Analytical Method: [] Fermentation Tube [Z~Membrane Filter Lab Ref. No. Result* A_nal~yaj I ~ I ~ L I ~ BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB Final Membrane FIT~~ Reporled By ~' Date Time: __ TNTC = Too Numerous To Count __BGB Collformll00ml Collformll00ml ¢-,/