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Home My WebLink AboutLAKE HILL ACRES #1 LT 27 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 J Name Address Phone(s) Permit NO. LEGAL DESCRIPTION WELL LOT LINE ,,~'~J FOUNDATION Lot Township, Range, Section TANK'S · ,'~EPTIC [] HOLDING Material Capacity in gallons No. of Compadments TYPE OF SYSTEM [] TRENCH ..J~'~BED [] W. DRAIN [] OTHER Depth to pipe bottom from Total depth from original grade original grade ~)' ~ FT / ,~:~:~ ET Fill added above original grade Gravel depth beneath pipe ~ ,~"-FT ~ '~"~FT Gravel length ~ravel width Total absorption area [ c~\~ SO ET Distance between lines ~_.~tFT Pipe material Date Installed WELLS <~r~RIVATE [] OTHER ~ldenlifv) Classification (A,B,C) J Total Depth Cased to '~'/C, ~j~ h_~ (_~ FT FT Installer J Date Installed: REMARKS: DISTANCES SEPTIC ABSORPTION WELL TANK FIELD AS-BUILT DIAGRAM (Show location of well, septic system, property lines, Ioundation. driveway, water bodies, etc.) S & S ENGINEERING I 17034 Ea~Je Ri~er L~ Roa~ ~t~ ~,,. ca,fy that this inspection was perlormed according to Munici~ ~l~J gUld[llnes in e~ect on ~dat~ % H*alth D*padm~nt ~ppro~l iq tJ N I C Z I:::' A L I T ¥ 0 I;::' A iq ii:; H 0 R A G D~;,pa~'tmen'L c~-,"' I...leal{h & i...I ~m,'.~,c, Set-vi. ecs ii~;'..?.~:JJ; L I::;'ILp(~.:,,:~:~'I'... ~::tf'i~.::l'r'.,(::ii~(.i~,'.~.:~'~ A].ast-::.a 99.501 :3.4.;:5"'"4'720 F' E R M :[ 'T' r:::'ap c e ]. 11: cl:051'"~052-':36 Lo'L l....egal:: Subd:i. vi~i:i, cin: I....AK[:C HILL A[]RE:S :~:I. I....ot~ Sect :i. on ~ 3 ]"ob~nsl'iip: !5N Range: !....or Size ;;:*.3 :!.8:]; (sq,, t"l'..,, of act. es) ~l<~.)'( }};ei::Jl'~CJi:3ili~i',] 'l"h:J.S F'er'mit.~ 3 Total Capac:ity: 3 B loc k: () SEF'TIC 't',/..~lxif:::~ M:i. nimum ":.o'~ a'l septic: 'l:.ank :: al: ac :i.'Ly: t, ()()C~ gal ].ons~ Eac:l"i ~iept.:i.c tank must have '~ . .... s~,..4.~ ~. :i.c 'Lanl.:: (s) < Zl., 0 I .'.,; ~. {.. J. P [el[~ .I. TO BIE :[ IqSTAI....L. li~:C :I: N ACCOF;~'DANCE W I '['H ENG ]: t~]iEIER ' S MOI..IND ).)liES I GN ,, IxlI::IT :1: F:' Y DHH S P R ]: OR ]"0 AL.L I N S PE C T I ,".IN S ,, E: X :!: !Jill- :i: NG SIEE!:;:'A f':')[ii: P :I: T MI.,IS T ]!:',E F:'ROI::'ERL. Y AB(:'~N:t)Oi',IED,, ]'H]:S F:'IEFi'.MiT iS ]:SSUE:D FOR TIdE E:X]:STING 3 )i':di!i:DR!]OM S :I: NGL. Iiii: FAM :!: I....Y RES I D!iii:NCE ONL. Y z, AIqD E XI:::' I RES ON 1:~:."./:31/89 ~ ]: CERT:!:F'Y T'HAT~. _t~ :I: am l'am:i, il. iap ,.-~cit. h 'Lhe Pequir,):..h'nents i'(::)p on-.si, re sewer'~ arid ~.~el:l.s as fopth I:)y the Mun:i.c:i. pa].ity o{' Anchor. age (MOA) and the Sta'Le o{' A].aska,, ;[~,, ]] ~i:i.].]. :[.i"Hi~ita].:[ thE, system in accor'darice with all MOA codes and arid iri colnl::it:i~:tJ"lc~ l~it.l] the des:i.~ln cp~.'Lep~.a o{' this :~ ]: J~J.].]. aclhEm(.z.) t.c) al:L MCiA and State o{ A].aska peqLtir~ements {c:H'~ the set. l::)ac:k d :ist,:a. nc:~es [' pc:,m ai']y ~.)x ist :[ng ~:.)]. ]. ~, v~astewat, er' d J. sj::iosa], system c:)l'~ pub 1 sewerage s'ys't, em on this or any adjacer~'L of nearby :l.o'L,, 4, I under, stand Chat this peJ-mit, is valid f'or. a maximum c:~f' 3 bedPooms,, al. so under~sCand that the capac:ity (]~' 'Lhe total system :i.s 3 k)(.z.:,dr'c)c~ms anti ariy ~n].aPgemei'Y~.. w:i.].]. P[.)cjL(iP(,~:, ar'l acldJ.'~.iorta]. .... ....... .............. ~~~ .................................. SCALE ' * SCALE PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~'~'~"~'1 [~'t ~',¢'~. [")f'l [.,.*L.. Township, Range, Section: ~ "~1 SLOPE SITE PLAN 1 3- 4 5 7 8 WAS GROUND WATER ~.~ ENCOUNTERED? IF YES, AT WHAT DEPTH? ~ ,~ ~ ~eplh to Water A~f~ ~ ~ ' '~ / ~ ~ I I I I I I I I I I ~onilorino~ [ ~/~al.: ~-~o -~ I I I I I I I I I I 11 Gross Net Depth to Net Reading Date Time Time Water Drop ,~ ~ ~ ~ ~/~' ,/~" 14 15 16 17 18 19 20 PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT PERFORMED B~: -~ ' - f / I /~~ __ _ CERTIFY THA~ T~ TEST W~S PERFORMED IN ANCHORAGE AREA Em ' 'UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELl. INSIDE LENGTH · MANUFACTURER ~'~"' '~'""t~ MATERIAL INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS ~.- LIQUID CAPACITY /OOO GALLONS. SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL BUILDING FOUNDATION ADDITIONAL ABSORPTION DIAMETER tt'~I OR WlDTH'7.,If, LENGTH'7--Ir, DEPTH CRIB SIZE: DIAMETER <~ DEPTH c~l DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE__ ABSORPTION AREA (WALL AREA) SQ. FT. WELL: TYPE BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST LOT LINE SEWER LINE OTHER SOURCES DISAPPROVED REMARKS DEPTH ~-J~O' ' DISTANCE FROM: SEPTIC SEEPAGE /~,O ~ TANK ~'(,~) ' f' SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE; , DIAGRAM OF SYSTEM DATE ~7/i~'/"~ c/ APPROVEI~' ~j G.A,A.B. Russell 694-2774 Civil Engin~sfing Soiis ~ Foundations 0 ,9 E ~'fvGINEERING ,9 DEVELOYMENT CO. Performed for: Name: Legal Description: Depth (feet) 0 Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 333-5240 SOIL LOG Mailing Address: Ear/Ellis 333-5240 Surveying Land Development Tel. No. ~c~_.-~ Soil Characteristics 6 7 8 9 10 11 Ground Water Encountered: Yes Proposed Installation: Seepage Pit__ Comments: ~ Performed by: __ No ~'If yes, what depth__ v/~Drain Field Date: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 27 Lake Hill Acres #I Location (site address or directions) 24508 Reese Road EAGLE R~FER AK 99577 Property owner Mailing address Lending agencY Mailing address '~-~,-qg.- t"~/~-c'C~._,,,&% Day phone 278-2776 C/O l_~y Lu~.db.~-ERA PROFESSIONAL REAL ESTATE 2702 GambOl Anchorage, AK Day phone Agent Larry Luedke/ERA PROFESSIONAL R.,E., Address 2702 Gambx~l Anehoraqe! AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: NOTE: Day phone 278-2776 XXX Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. XXX TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 99503 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/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. S & S ENGINEERING - Name of Firm 17034 Eagle River L~p Road No. 204 Eagle River, Address : .-"/ / EngineeCs signature ,-~~ ./ Phone Date Approved. for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ~ ~/~.~-oZ~ Date By: / The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type Log present (Y~ Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~-~- \~-I~- Driller Cased to ~_c~ k--- Casing height Wires properly protected ~/N) ~" Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION ~ g.p.m. ,~0¢ ,'Z.'~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ Absorption field on lot \ Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~] .. ~ ~'J'"7~' Tank size \ Cleanouts ~/N) -,[ Foundation cleanout~N) High water a arm (Y~L~. Date of pumping Pumper Collected by: Other bacteria ~'~ S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99~577 Compartments Depression ,(Y~) Alarm tested (WN) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~. ~ ~, t~c, To property line ~ c> \ ~ Surface wateddrainage On adjacent lots Absorption field Foundation L,,~-- { Water main/service line 72-026 (3/93)* Front CONTINUED' ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DIS~OM LIFT STATION TO: Walton lot On adjacent lots Manufacturer Manhole/Access (Y/N) / / "P~evel at Surface water D. ABSORPTION FIELD DATA Date installed Length ~ Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y~I-~ Soil rating (GPD/Ft2) Width ~ L,, ~ Gravel thickness Cleanout present~N) System type Total depth Depression over field (Y~ for After test ~ If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ ~ ~ t ~- On adjacent lots ~, c, c, \ '~- Property line To building foundation L~ "~ ~ To existing or abandoned system on lot On adjacent lots Surface water Curtain drain ~ ~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effect, Engineer's Nam~e~'~.~!N_b.bR I N? . 1703.~'~Eagle River Loop Road Date Eagle River, Alaska / / 'inspection. HAA Fee $ /7'¢ Date of Payment ~ --,,Z ~ ~<~ Receipt Number f,~L/Z~Z//~'("~.,'~L'-),~ ? 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number 17:40 CT~E EN[JIRONHENTAL LAE~ SERUICES NO. 405 ~EC COMIVIERCIALTESTING & ENGINEERING CO. ENVIRONt',,,IENTAL LABORATORY SERVICES ......... R~FORT of ANALYSIS Cheml~b Ref.~ :93.2979-1 Client Sample tD :L27 LAKE HILL ACRES ~l 'Matrix ~WATER 56:33 8 STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: {907) 561-530~, Client Name ~S & S ENGIN~ING WORK Order :67566 Ordered By :P~Y ReF~rt Completed :06/28/~3 Project Name : Collected :06/22/9~ @ 13:00 hi Received :06/23/93 @ 13:00 hr ProJect~ Technical Director:STEP~:N_~C. Released By : ~'* . Sample Remarks: ROUTINE SA~IPL~ CO[~LECTED BY: PJ~Y, QC Allowable Ext.. Anal Parameter Results Qual Unit~ Method Limits Date Date Nitrate-N 0.4t m~/~ ~PA 353.2/300~0 10 06/25 * See Special Instructions Above UA = Unavait~le ** See $~mple Remark~ Abov~ NA ~ Not Analyzed U = Undetected, Reported value is the practical quantification limit. ~ ~ ~ess Than D ~ Secondary dilution. G~ = Greater Than 19:39 CT~E ENVIRONHENTAL LAB SERUICES HO. 405 QE~.' CHEMICAL & GEOLOGICAL ~BO~TORY TEL~.PHONE (907) 562-2543 5&3@ B @treat Anchorage, Alaska Drinking Water An,~lysis Report for Total Coliform Bacteda 'FO BE COMPLETED BY WATER SUPPLIE-R r f- , i--~ 0 PUBLIC WATER SYSTEM I.D./4L._,.I. I . I I L__J $!kP~tlVAT~ WAT~. SYSTEM TO BE COMPLETED BY LABORATORY Ar, aiysis snows this Water SAMPLE to be: /'~.f~$ atisf act cry [] Unsatisfactory [] Sample 1¢o long i¢, transit; ~ample should not ~ over 20 hod~s old ~t ex~mination to ~ndicate reliable resuks. Please ~end new ~ample vi~ s~c]¢! delive~ maid. SAMPLE DATE: SAMPLE TYPE: ~ Routine [] Check Sample (for to.dna 8ample wlih lab ret. no. [] Spe¢t~l Purpose ,m,_; Untreated Watw T!me Received ..... Analytical M.e.thod: M~mb~nne Filter No. c! co:onie~,'100 mi, Ansly~.~ A n ~ t-- ~x "'"Z-~'~'9 ~ C~ BACTERIOLOGICAL WATER ANALYSIS RECORD 'REA D'] N~r'RUCTt ON8'"'- [ Mernbr;l~e Filler~ DIre~l Count BEFORE V~rlfle~tlen: LSa Feb..si Coliform Confirmation COLLECTING SAMPLE ~ln~ Membrane Filler Resull~ Re,tied By_~/ ~" TNTC = Too Numerou9 To Count Ooltform/lO0 mi CoIIformJt 00 mi Time: ~C~':) e.m. OB = Other Bacteria PART lINE OF TWO MUNICIPALITY OF ANCHORAGE ~) DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES ~.,,~.~. ~j_,~ CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUB.MITTAL). (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 27; Block 1; Lake Hill Acres ~1 February 9, 1988 Location (address or directions) Property Owner Alaska ~ous±ncj Telephone: Home Business Mailing Address 1400 West Benson, Anchorage, ALaska (~33601) Lending Institution Gold Dome Rainier Telephone Mailing Address Real Estate Company and Agent JACK WHITE COMPANY/Lynda Banner Address 10928 Eagle River Road, Eagle River, Alaska 99577 Telephone 694-5500 (b) (c) (d) (e) Mailthe HAAtothefollowinaaddress:or:Checkhere [],ifholdforpickup. Listcontactpersonand day phonenumberbelow. S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 ordered by Lynda Banner TYPE OF RESIDENCE Single-Family IX] 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 Onsite E~ Public I-1 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 72-025 IRev 8/86~ Front 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 $ & $ E~,~,,~,;r.~R;~,~C, Telephone Address 17034 Eagle RiYer Loop Road Ne. 204 Eagle River, Alaska 9957~, ~_~ I c~ ~ ~ Date Approved for .'7"~/"%¢-'*/~'~).~ bedrooms by ~:///~/ ..-/'/- -'(~/¢'~¢×~'~ Approved c~ ../~ Disapproved Conditional Terms of Conditional Approval /.¢,¢/, 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 th is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/86) Back MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAG/~EALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTION FEB 2 2 1988 WE''.*TA RECEIVED Well Classification ~ i.--~ \ ~\ ~,.5 264-4744 Legal Description: If A, B. C, D.E.C. Approved (Y/N) rS/¢''- Well Log Present (Y/,~) Total Depth \ t~\ ~ -~ Cased to Static Water Level ~ ~1, / Casing Height Above Ground Electrical Wiring in ConduitS) Separation Distances from Well: Date Completed ( _')~--~, Yield /'3f'c~J¢ Depth of Grouting Pump Set At ~ I~5~ Sanitary Seal on Casing (:~,N) "~ y Depression Around Wellhead (Y~). ' To Septic/I-l'oNtm~ Tank on Lot ~,~ ; On Adjoining Lots To Nearest Edge of Absorption Field on ~_ot \~::::~ J"J¢' ' , On Adjoining Lots To Nearest Public Sewer Line t,~ F~//'/~' To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Water Sample Collected by~--~'~'~'r~ _~,r-~¢'~:::~i'-~; Date Water Sample Test Results ~//~.~ ~--~ ~- .//~--~.~...---~ fT~.*.-(~ ~ Comments 7~ ~ ~ ~'~' L.~4-.. ~ ~ ~ B. SEPTIC/I~ TANK DATA Date Installed Standpipes I~N) 7 Air-tight Caps Depression over Tank (Yd~J) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from SepticR'fe~g Tank: To Water-Supply Well ~, ~ ' To Property Line ~. ~ To Water Main/Service Line Course ~. ~I:~'P )~' Comments "~'~'~ ""/~'t~ '-7~["Size I O~;:)c:::) No. of Compartments 7 Foundation Cleanout ~N) i._.%//~ate Last Pumped ; for - Temporary Holding Tank Permit (Y/N) Y To Building Foundation '. ' ~'r)~=:~ !'~-'- To Dispd§~l Field To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026 fRev 8/861 Front ABSORPTION FIELD DATA To Water-Supply Well To Building Foundation Lot '"~/,A, To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Soils Rating in Absorption Strata ~,~'~'~/-~ ~ "'z"~ype of System Design Date Installed ~ _ \~ _.../,¢¢ Length of Field ~ Width of Field "'~1 I t Depth of Field \ Gravel Bed Thickness kc, Square Feet of Absorption Area ~'~(_.~,¢r~. ¢~' Standpipes Preseni~) ~/" Depression over Field (Y¢~) ~ Date of Last Adequacy Test '~" - \~ ~:~-~ Results of Last Adequacy Test '~/¢~"¢~ ~-~¢'~-~ -- ~ Separation Distance from Absorption Field: ~, ¢::::-c:::, I &_ To Property Line ~, ~ I To Existing or Abandoned System on ; On Adjoining Lots "2-2<:2) I''~r To Cutbank (if present) "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) cles during Adequacy Test. Meets MOA ** Checl~ Permitted Bedroom Rating Against HAA Request ** ~ I certify tha{ I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Si~ned S & S ENGINEERING ~ .... Date 17034 Eagle River Leep R~ad No. 204 Company .. ; . ~72' MOA No. Receipt No. ,,/ Date of Payment Amount: $ Page 2 of 2 72 026 (Rev 81861 Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 5215 Date Report Printed: FEE 18 88 @ 14:41 Client Sample ID:L27, E1 LAKE HILL ACRES PWSID :UA Collected FEE 15 88 @ 15:00 hrs. Received FEB 16 88 @ 12:30 hrs. Preserved with :HONE Client Hame : S ~ S ENGINEERING Client Acct : SNSENGP P.O.$ VERBAL Req # Ordered By : Analyeie Completed :FEB 17 88 Send Reports to: Laboxatozy Supervisor :STEPHEN C. EDE 1)S & S ENGINEERING Released By , -..~ O~ ~ 2) Special Instruct: Chemlab Ref #: 9119 Lab Smpl ID: 1 Matrix: Water Allowable Parameter Tested Result/Units Method Limits NITRATE-N 0.17 mg/1 EPA 353.2 lO MUNICtPALI'5' OF ANCHO~I~ DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION FEB 2 2 ~88 RECEIVED Sample ROUTINE SAMPLE Remarks: Tests Performed ' See Special Instructions Above UA=Unavailable None Detected "See Sample Remarks Above Not Analyzed LT=Less Than, GT=Gzeater Than ACHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHO~NE (907) 562-2343 5633 B Street .! i! Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ~RIVATE WATER SYSTEM Name Phone No. S & S ENGINEERING · ~O-~,~ E. agie ~,i*¢er Loop Road No, ~ Mailing AddJress - --* Eagle River, Alaska ~577. City , State Mo. Day Year SAMPLE TYPE: ~,~--Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose SAMPLE NO. LOCATION Zip Code _) [] Treated Water [] Untreated Water 4 l Time Collected Collected By ..... OF 'HEAL-Tt"i-& ENVIRON1ENTAL PROTECTION Ft B 2 2 1988 RECEIVED TO BE COMPLETED BY LABORATORY sYatiS shows this Water SAMPLE to be: isfactory [] Un'satisfactory [] Sampletoo 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 icg-, Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* J Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC = OB = Membrane Filter: Direct Count Verification: LTD Final Membrane F~lt~s Reported By ,,,/.~_~.~---~.~' ~"~- Too Numberous To Count Other Bacteria PART Coilform/100ml BGB C~) Coilformll00ml ~ate ~'~//~ 7 Time: /'-~-~)~ .a.m. 1 OF [ ~MAINDER TO FOLLOW .~ D*,; J2 RECEIVED INSPECTIQN APPOINTMENTS TIME TIME TIME INSPECTOR INSPECTOR I NSPECTOR~,,) ~, ~ ...... ~r ANCHO~A~ D~PT. OF HEALTH &. MUNICIPALITY OF ANCHORAGE ~NVIRONMENTAL P~OTECTION 825 L Street-Anchorage, Alaska 99501 [~'IOV 3 0 !98i ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C E l V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Comptete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ~ PHONE I MAI LING ADDRESS .. ~O~UT ~ .HONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other~ ~, SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [~ Three [] Six 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY *ATTACH WELL LOG. Awell Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY ! q '~ L/ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79} --~ ~ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] iNDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] I NDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or []HoldingTank Size: .If Tank is homemade give dimensions: NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES WELL TO: [] OTHER Absorption Area to nearest Lot Line Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line 5. COMMENTS DATE ~:~'~ APP ROV ED FOR ~.~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED Fk.~/ BY/F( ALASKA e UlR0 menTAL CONTROL SeRUlCe$, Inc. 12/1/91 L~M~N KING 209 W DIMOND BLVD ANCHORAGE AK 99502 SELLER - RON ELIOT BUYER- SUBDIVISION-LAKE HILL ACRES #1 BLOCK- LOT-27 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 504 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 300 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 12/1/81 SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 3 BEDROOM HOUSE. 1000 IS ADEQUATE FOR