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Home My WebLink AboutBRUIN PARK BLK 5 LT 5Bruin Pork Lot 5 Block 5 #016-101-23 ~I~'--~II~K /'Al~lq,,.,l'lq~/K/'Aq~.~~' /~KI~/,A DidK~/V'"rl HEALTH DEPARTMENT 327 EAG'~.E ST. ANCHORAGE, ALASKA 99501 2'/9-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION ,,~,~.,/~ SEPTIC TANK: ADDRESS ~ PHONE~ LEGAL DESCRIPTION~ ~,~_~_ NUMBER OF DISTANCE FROM WELL ?~-I MATERIAL COMPARTMEN.TS L.o~,,~ CA,:',,C,,,' 5 ~ ~*L~O~S..S.~~, -- --" ~~ '7,~ L,~U.~ INSIDE WIDTH~DEPTH . . SEEPAGE SYSTEM: NEAREST LOT LINE ~ ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL ~ , FOUNDATION · , NEAREST LOT LINE TOTAL LENGTH OF LINES ii-i, TGrT~L :-FFf~VE ABSORPTION AREA SQ. FT, LENGTH OF EACH LINE DEPTH: TOP ~'F TILE TO FINISH GRADE WELL ('7~ ,,~'~.~ : TYP E-~(---J- ~ DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE LOT LINE DEPTH /q2''''( ' DISTANCE FROM ..... WATER ,BUILDING FOUNDATION SAMPLE , NEAREST NEAREST SEPT,C '7 .~ / SEEPAGE /,~ ' OTHER , SEWER LINE ~'/~ , TANK , SYSTEM ,, "J·"-' , CESSPOOL '"""""- SOURCES DIAGRAM OF SYSTEM DISTANCES: DATE APPROVED HEALTH- ,~,U T~ORITY ~ GAAB-H D-2 GREATEr 327 Eagle St. ANCHORAGE AREA HEALTH DEPARTMENT Anchorage, Alaska 99501 )ROUGH 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME 0F APPLICANT RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS , SEEPAGE PIT , DRAIN FIELD , OTHER TO BE INSTALLED BY [-! ANTICIPATED DATE OF COMPLETION MAILING ADDRESS. ~f:)~'¥~ [-/) ~ ~/~ '-" ~-~"-' ' , ~'N E NQ.-~-~, ~5 ~- LOCATION OF INSTALLATION ~ ~ ~/ i ~-_ BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS . ~f~, ' ~ ~ - , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT Tg 8E SERVED ~f'-~ ~ f"__Z__ · SEPTIC TANK SIZE /c'~''~ ~7') TYPE'""¢~".'""-"-~"'-7'SEEPAGE AREA DISTANCES: 4o- / I certify that I am familiar with the requirements .... ~ .z~ . '. ¢' ~ :- Df Greater Anchorage Area B~arougl>.Ordinance No.~28-61~ and that the above described system is in accordance with said code. /-/, ; '2'" Certified Well For..~J~.~.~....~.a..h..o...~...e..Y......~......F..?....a.~..~...1..~ ..,..~...h...o....~...1...rl..~.~ ~ ........... .-. ............................. Location....LO.~;.,.,..~.,... J~l.~.~k....~.,..,~ .~..~1J,.12.. ,.~...a..~t.~ .............................................. Date Comple~d..._6..-..~..4..-..7..~. ....... [ ................................................................................... Depth of wen ......... .~..~..,,.F..~.C,~...,..i....,::: ........ '.....~; .......................................................... Size of casing ......6....Inc. h ............................ i ................... i ................................................ Distance to water ...... :.,.:~.~..~..F..~. .................................................................................. Distance to water while"pump}~g::::;.::..:....J[.~,~[i.F..~..~iji:.i:j.i./L.i.....i....a~' rate of ................. ..2...4..0.. ......................... gallons per hour. Description of Formation' from to Clay: Sand&Gravel '.,i B~n.'~..Soft 0 42. , .Clay, Sand.~GraVel r ' [' 'Gr,e7.' Soft 42 50 Cla.v, Sand&Gravel ',.'.. Br..n.- Soft 50 60 Clay Sandt~Gravel "- Grey.' Soft 60 79 Sand .& Gravel. G~ey~W&;~h !qa~e'..~ 79 81 Cla.y, San~&Gravel O.reY.:..~M~d.. 81 -' 132 ,, , , .~,~ ~ ~-~¥: ~ .~. .., .... :.. . .;. ~, .~.~ .~ ~ . FOSS DRILLING 1336 INOBA PH. 279.2849 ANCHORAGE, ALASKA 99501 advise you to attach this certificate to your deed. Municipality of Anchorage Department ol Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 Parcel I.D. 016-101-23 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING NAA# Expiration Date: Lot 5, Block 5, Bruin Park Subdivision Location (site address or directions) 11131 Polar Drive Current Property owner(s) David Ogden Day phone 349-5516 Mailing addressPO Box 113271, Anchorage,AK 99511 Lending agency Mailing address Day phone Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: ~4./~- ~'M-~.-~ NUMBER OF BEDROOMS: 4 ~/&~/~ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on propedies served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates 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. 72-025 ~Rev. 01/00~' 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 based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 ail applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address $ & $ ENGINEERING 170~!,= Rive~' Loop Road No, 204 Eagle River, Alasl(a 99577 Phone Engineer's Printed Name Robert C. Cowan DHHS SIGNATURE /-~ Approved for ~ bedrooms. Disapproved. Conditional approval for Date ~. -*, -.~,~4~ ¢~ ~:~ ..¢,. ~, ...... ;.,..,.~ ~.-,~ .................... bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: j / - .?-. i - O '¢ Original Certificate Date: Reissue Date: 75-025 (Rev 01 001' '" 'Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 %" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I.-oT .5' l~,,~c,~c 5- r3/~,, ,¢ /~/r,,'~,c $ /~2 A. WELL DATA Well type P/¢/v//-~-~ If A, B, or C provide PWSID # Date completed 4/'t¥//'~7' Sanitary seal y~- r Total depth I 3 ~ ft Cased to ¥o-~ ft FROM WELL LOG Date of test ~, /3~¥/7 ,/ Static water level ~ <~ ft Well production "/ g.p.m WATER SAMPLE RESULTS: Coliform O colonies/100 mi Date of sample: ~]t;~/ oo B. SEPTIC/HOLDING TANK DATA Taqk;Type/Material ~..,~,~c ¢/ 5~'~c Date i~stalled ~-/q/'7o Tank size cl~e,an0uts Y~5 Foundation cleanout ~ate of pumping ~/17/oo Nitrate O,~ mg/I Collected by: Parcel I.D.: Well Log Wires properly protected __ Casing height (above ground) AT INSPECTION ft g.p.m Other bacteria o colonies/100 mi $ & $ ENGINEERING 17034 Ea~j~e ~iver Loop Road No. 20~. Eagle River, Alaska 9957Z gal Number of Compartments ~ Depression over tank ~o High water alarm Pumper in. System type ft C. ABSORPTION FIELD DATA Date installed 4-/"r/7 o Soil rating (g.p.d./ft2 or ft2/bdrm) U/~ Length 3¢] ft Width ~ '7 ft Gravel below pipe Total depth ~ 0 fl Effective absorption area z/~¢~; f¢ Monitoring tubeY~J Date of adequacy test ~¢/I 3/0 o Results ~Fail) -p~,.r3 __ Depression over field ,'~ o For L/ bedrooms Fluid depth in absorption field before test ~ ' I ~/,/' in Water added ~; o ,¢ gal. New depth,,¢ ¢' Y,~ in. Elapsed Time: ..30 min Final fluid depth 5- '3/,/~ in Absorption rate >=. 6o O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~'o ~L ~ ,' ~ ~ ,,~ .If yes, give date ~ 72-026 (Rev. 01/00)* LIFT STATION Date inst~ led Size in gallons ~~b~-e/Acc~ss "Pump on I~vel at i~ in High water alarm level at __ in Datum ~ Cycles tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot } ~ o ~ ~ Absorption field on lot /'o ~ '-~- Public sewer main Sewer/septic service line ~,-.~ ' On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank zv/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LO']' TO: Building foundation D,~' '-~¢- Property line ) ~ Water main N'/,~ Water service line Drainage N/4 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ 0 ~'~ g ~'° ~ Iing foundation :30 -~- Water main Water Service line 10 ' -/- ' Curtain drain t,,,~,,v/~ ~',,,o~ ~ Absorption field Surface water Surface water Wells on adjacent lots Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name ~0,"J&,~' Date ~/I-~ HAA Fee $ ~___~'~ . Date of Payment Receipt Number Waiver Fee $ Date of Payment ~'~ Receipt Number 72-026 (Rev. 01/00)' 08-16-00 01:$$ FROM-CTE ENVIRONMENTAL $615301 T-722 P.02/02 F-65~ zt~." CT &E ER vi ronmen tn I Se w ices Inc. ~mTo~ Division r~--~~~~~~~-- 200 W po';xer Drive )rinking Water Analysis Report foi' Total Coliform Bactedar~,.A"c"°"""~oTi s62.2~4a~K .~s~e.~s.s RE.4D INSTRL CTIONS ON ~VE~E SlDK gEFO~ COLLECTING SAMPLE Fax (~71 561-5301 , MLST BE COMPLETED BY wATER SUPPLIER TO BE C,~MPLETED BY LABOrATOrY ' ~ pUSLICW:'s-TERSYSTEMLD'# II11 Ill fl~ PRIVATE WATER SYSTEM SAMPLE DATE: Month SAMPLE TYPE: ~ Routine Repeat. Sample (for rouffn, saml~l* with Inh ref. no, ) Day year O Tr~u~ Wa~r ~ Unla~ated Wa~r sAMPLE LOCATION Tim Collteml Colletted By Ana~)slS Shows this ~azer SAMPLE co =e: Sans Pacmry CI - Uno.factory Q S~Ie ov~ 30 hau~ o1~ r~ul~ may S~ ~ long m ~mg smpte should ~[ ~ ov~ 48 hou~ old ag ex~l~a~o~ n~ ~le ~a s~al ~liv~ mad. TI~ ~lv~ Alfl~al M~; ~emb~e F~ 1OO4G41 O mi. ResulT* Analys~ Jun [] Faxe~ Seat lo A O.&C, Aneh Fblc~ Cilcnz nodfled of uusalisfac~ory resul=: SpoVa md~ It~CrEIIIOLOGICAL WATER ANALYSIS RECORO - Coltmrmtlfl~ mi TIm.~[ ,(-ff~, hr~ ENVIRONMENTAL FACILITIES IN ALASKa. CALIFORNUL FLORIDA. iLLINOIS. MARYLAND. MICHIGAN. MISSOIJRL NEW JERSEY. OHIO. WEST VIRGINIA FRO~-CTE ENVIROND~NTAL 5615301 CT&E Environmental Services Inc. Laboratory Division 200 W. Potter Drive Anchorage, AK 9!J518 Tel: (907) 562-23~3 Fax' (907) 561-5501 T-TZZ P.OI/OZ F-SST CT&E Ref. ~: Cl[ent Name: Project Name Client Sample ID: Matnx 1004641001 S & S Engineering n/a L5 B5 Bruin Pad( S/D Drinking Water PWSID n/a Sample RemarKs: Client POw: n/a Printecl Date/Time: 08115100 00:00 Collected Datefrim~=. 08113/00 13:45 Received Date/T~m,;: 08114100 11:34 Tecllmcal D~rec~or. ~tephen E~ie Released By: ~~~ ~_~. Parameter Results PQu unim ^llowaule Peep Analysis Metllocl L~mit= Data Date In~t To~al Coliform (MF) 0 coUlOOml SM9222B 08114100 KAp Nitrate 0.5 U 0 5 mglL EPA 300 10.0 08/14/00 SCL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-47'44 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~__~\L~ -,- 1, GENERAL INFORMATION Complete legal description Lot 5; Block 5; Bruin Park Subdivision Location (site address or directions) 11131 Polar Drive Anchorage, AK Property owner Mailing address Lending agency Mailing address Pat Ogden P.O. Box 113271 Anchoraqe, AK Day phone 99511 562-2425 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4t TYPE OF WATER SUPPLY: 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 Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev 1/91) Fronl MOA ~21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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 17U;~4 u. agle River Loop ~cad No. Add ress Eagle River, AJaska 99577 Engineer's signature - _ · Phone DHHS SIGNATURE Approved for '~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date [ - &' ' ~'~' 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. 72~)25 (Rev 1t91) Back MOA #21 Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICE~ E (~ E IV E DI Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) ~4~'z~41996 ........ Municipality o1Ancl~orage Health Authority Approval I;lleCKIl$/Dept. Health ~. Human Services Legal Description: ~.o T ~ 6 ~-oc~c ~'- ~v,,., P4,e~ 5'/O Parcel I.D.: A. WELL DATA Well type P ,~ , v ,~ r ~_ Log present (~N) "/~ $ Total depth I '5 ~L Sanitary seal (~N) ¥ ~: 5 If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ / ~ ¥ / '; '/ Cased to /4 o ~- Casing height (above ground) Wires properly protected (~/N) )' ~ ~' Date of test Static water level FROM WELL LOG r~/~-,~/'~,~ AT INSPECTION ! ! ¥. O g.p.m. '5.5/ Well production g.p.m. WATER SAMPLE RESULTS: Coliform O Date of sample: ~' / ~' / ~/~ B. SEPTIC/HOLDING TANK DATA Date installed ~ / ~//7~ Tank size Foundation cleanout (Y/~ , o Date of Pumping ~//~/' w (, Nitrate Depression (Y/~ Pumper '~ + /Y4~ ~ Other bacteria S & S ENGINEERING Collected by: ~7034 Eagle River Leap Road No. 2{)4 Eagle River, Alaska 99577 Number of Compartments ~- Cleanouts (~/N) /,, o High water alarm (Y/~). ,v 0 C. ABSORPTION FIELD DATA Date installed .,c- / fi' / ? o I Length 3. t Width Effective absorption area q 5'(~ ~ Date of adequacy test ~" / ~ ~ [ ~t ~, Fluid depth in absorption field before test (in.); Fluid depth 3/7 (ins) Minutes later: Soil rating (g.p.d./fF or fF/bdrm) System type C~, _~ / / Gravel thickness below pipe (~ Total depth ~ e Monitoring Tube present ~N) Y~ Depression over field (Y,~ Results ~Fail) to ~ £~ For , ~ Immediately after ~/¥o gal. water added (in.): Absorption rate = ~ o 0 '+- .g.p.d. bedrooms ~/10 !' Peroxide treatment (past 12months) (Y/N) /vo,v~. ~,~ ~,,v If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed, Manhole/Access (:Y/N)' "Pump on" te~j~'~''/ High water alarm level at* Cycl~ Size in gallons E. SEPARATION DISTANCES "Pump off" level at* R SEPARATION DISTANCES FROM WELL ON LOT TO: ~holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line / 00 / /o0 On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: t Foundation t~/A r, oa,~ l~o~.,~. Propertyline - ~ *~ ' Absorption field Water main/service line ~0 '~ /oo -/- ?0o /oo Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line O (. ,~-e= ~ , ~u dng foundation ~ / 8 Water main/sewice line Surface water /0 o r + Driveway, parking/vehicle storage area Curtain drain P~ ~ ( K ~ ~ ~ Wells on adjacent lots /oo ~ ENGINEER'S CERTIFICATION I certeS/that I have cloterminod thru field lnspections and review of Muntctpal record~JO~ a~o~ ~.~.~ ~_.~ are in conformanc~~?AA ~ in effect on this date. Signature Engineer's Name ~'d~ ~ Date ~- / ~o / q ~ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~05×15×96 15:02 CT&E ESI ANCHORAGE ~ 90?6941211 N0.250 Q05 CT&E Environmental Services Inc. Laboratory Division -:_:_- *_*_:::i ::__ --- __ · ~ ___:::Jl ..... L ....... J Laboratory Analysis Report CT&E Ref.# Clleut Sample ID Matrix PWSID 0 Sample REmarks: 961652.96 [652001 L5 B5 Bruin Park S/D [0 l Drinking Water Collected Date 05/08/96 Technical Director: Stephen C. Ede Released By_o'~---~_~,~. ,~~~ Nitrate-N Total Coliform Results ac Pal ~uet Units Method 0~I08/96 TAV 0.100 U 0.100 mg/L EPA 353.2 0 0 cot/1OOmL $N18 9~2~g (DC) U · Undetected LT - Less than GT - Greater than 0 - secondary Oitut{on J ' getow the catfbration rang 200 W. Potter Drive, Anchorage, AK 99518-1605 --Tel: (907)562-2343 Fax: (907) 561-5301 3180 Pager Road, Fairbanks, AK 89709-5471 -- Tel: (907) 474,8§56 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 15:02 CT&E ESI ANCHORAGE ~ 90?6941211 N0.250 Q04 CT&E Environmental Services Inc. L a b o r a t o ry D i v is i o n ~~'.~',~t.~'~rtt~r~,:~r.~t'.~'~J~(j.~j~c~,'~ Drinking Water Analysis Report for Total Coliform Bacteria 200 w, ,o,e. Or, ye Anchorage, AK 9951 8~1 605 R£AD iIVSTRUCTION$ O:Y JCEl"EJ~E SIDE ~EFOI~, COLL£CTIIYG StdMt'£E Tek (907) 582.2343 MUST B£ CO~PLI~TSD BY WATZR SUPPLIER" ?UBLICWATF, R$¥$TEblI.D,# L--I '1, 1""1 [ I PRIVATE WATER $YSTgM S^MPLI~ DAT~: Month SAMPLE TYPE: Routine 0 Repeat Sample (for routine sample with lab reft no. ) 1~ Special Purpose SAI~[PLE LOCATIO~ Day Year Treated Water Untreated Water Time Collected Collected By ;ax: (907) 561-5301 ~0 BE coMPLeTED BY'L-ABSORbS, TORY Analysis shows this Water SA2vIPLE to be: Satisfacto~ UnsadsfKto~ O Simple over 30 hours old, results may be unrelisble Sample too Ions in transit; sample should not be over 48 hours old at examlnafion Io indicate reliable results, please send new ,ampl~ via special ddive~ mai[. Date Received Time Received Analysis Began Analytical ~ethod: ,J~Mcmbrane Fiber [3 MMO-MUG * Number orcolonics/loo ml. · Lab Ref. No. Result* Sent [o A,U.~-.~.. ~. Fbks Analyst Jun [~ raxed Client notified of unsatisfactory results: Plloned Spoke with Faxcd Date: Time; BACTERIOLOGICAL WATER ANALYSIS RECORD MhlO-MUG Result: Total Coliform Membrane Filter: Direct Count · Verification; LTB Fecal Coliform Confirmation £. ¢oli ~ Colonies/lO0 mi BGB COLIFIRM 7'.VrC' - T,,' ,¥,~m¢,,,u~' :r. Com~enls: FinaIMcmbrane Filter Re I~s Reported By ' ~ Rick Mystrom, Mayor MtmicipaliD of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 June 7,1996 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Eagle River, Alaska 99577 Subject: Waiver Request for Lot 5 Block 5 Bruin Park Subdivision Waiver Request #WR960019, PID #016-101-23, HA960189 Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between the on-site wastewater system (leachfield) and the property line has been approved. The approved separation distance is 4 feet from the leachfield to the north property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. If there are further concerns or questions, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-site Services DJR/ljm:Ogden MUNICIPALITY OF ANCHORAG~ ' Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR% WR960019 PID% 016-10~-23 HA~ HA960189 Permit Date Received: May 21, 1996 . Legal Description: . Lot 5 Block ~..Br~in Park Engineer: Robert C. Cowan, P.E.,~ S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River, 99577 Applicant: David M & Patricia A. Ogden Waiver Requested: Lot line of leachfield and the north DroDertv line of~feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special COnditions: 3. Other: Waiver is Granted: ~. Waiver is NOT Granted: List Conditions or Reasons for above.. By: ~ Name'of Reviewer Date Rec %: %01876/8687 Amount: $115.00 Date Paid: 5-21-96 ROBER'r C. COWAN, RE. ROBERT A. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN May 20, 1996 CIVIL ENGINEERS (907) 694-2979 R E C E IV E D MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 MAY 2. 1 1996 Municipality of Ancnorag. e Dept. Health & Human Services REFERENCE: Lot 5; Block 5; Bruin Park Subdivision Request you issue a Health Authority Approval on the referenced property and grant a waiver for the horizontal separation distance between the leachfield and the north property line (along Polar Drive) at zero feet. Monitoring tube for crib is 4 ft. from property line and aerial extent of the crib is unknown. We do not anticipate any adverse effect on the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION 1996 RECEIVED 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 3330 'GREATER ANCHORAGE ARE/', BOROUGH Department of Environmental Quality "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspection: CMRO VA FHA CONV Property Owner: Mailing Address: ~--~)~R ~o~ 1~2[ ~Q~'O~ Da7 Phone~/~--/O~2. Name of Buyer: Mailing Address: Name of Lending Institution: Mailing Address: Name of Realtor or Agent: Mailing Address:~O ~ ~-i~ Das Phone Phone Legal Description: Location: Type of Facility to be i nspected:/l~o~,'~. /-/o~.No. B.drmls. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well j~.~ ~]~. Sewage Disposal'System Type .~of S~stem: Public Utility If Individual, date of installation Individual (on-site) Page 2 of two pages - Re~ Legal Description ;t for Approval of Individual ,~ :r & Water Facilities Comments Approved ~' ~7,~)o~~ Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough,. Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true a'nd accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)