HomeMy WebLinkAboutSPERSTAD #2 BLK 5 LT 14
MUNICIPALITY OF ANCHORAGE
DE tTMENT OF HEALTH AND HUMAN SER .ES
Environmental Health Division
825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
Phone(s) TPerm~t No ' No el Bedrooms
LE6AL DESCRIPTION
Lot
Township. Range. SeCllOt/
;2/.J L~] 5~',~- Z~) $,
TANKS
~' SEPTIC ~ HOLDING
TYPE OF SYSTEM
~TRENCH [] BED ~ W. DRAIN ~ OTHER
FI
/'2, o
FI
'7,(¢ FT ~, o
Total absorp,,, ........ ¢~¢'~ SO FT '4-J.~~ FT
WELLS
~' PRIVATE [] OTHER fldentifv)
Classd~catton (ix. El,C) 1 oral Deplh Cased to
IDaO[te Inslalled: ~'~ ~--~
.5~- '2 ~
REMARKS:
DISTANCES
SEPTIC ABSORPTION
TANK FIELD WELL
WELL
LOT LINE ,4.5- ~ ,/~ -z~ %
=
FOUNDATION
AS-BUILT DIAGRAM (Show Iocahon el well sephc system, p~operly hnes. Ioundahon.
dnvuway, water bodies, elc 1
Scale: / ,','z_-:
Inspections Performed by:
1212 cf,,
Mririicipal and Stats guidelines ill effect 0n Ibis
Health Depadmen, Approval:
72-0~ 3 ~3/85)
,a ,~GHOFIA~E, ALASKA 99502&650
~907) ~6.-4111
DEPARTMENT OF HEALTH & HUMAN
January i0, 1986
TO: Permit Applicant
Subject: Permit # 850707 ~"
Lot 14 Block ~ Sperstad Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspected the.installation of the on-site sewer system
the original as-built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
i:)EI='(:fl::~THE]gT I]F [',E~(,~i/FH ~;:'d',}'.) E:N',; :l: I::~I]NME:NT~d_ F'Fd::JrFi:l:::'l" I
9 ~:;! ',5:
2, ~ 4..., .g. ?' 2 C!
]: alii (';~,~m:i, ] :i.~'~n" e~:i.t,h 'ILN(.:.!) Pe!qLlJ. P~;:.!mE)n'hEi f'OP On--E~:i.'L(:~.t ~iii~L'~E2P~i and ~,~E.?], :t.s ~:'H~i E~;i:..)'[',.
~'~::mt.l"l t::)y 'Ltr'~e IdLu'~i~:il:~],:~'Ly O{' ~ne:l'H:)l"aE~c-~:.) (Id(](:~) and
2. I w:i. ll :i.r~e~d'..a~.l 'l',,l'~e~ ~;yed:E~m :i.n acc:c)r'daric:'e ~:i.'Lt"~ all 1~1(](.:~ c:od(.:::,s and PegL~:l, at.:i, oi"~s~,
and in c:Oml:)].:i, aric:~;~ ~,~J.'Lh 'Lhe~ ch.~s:i.c~n E:l":i.'L(~.H"i~l 0~' t.h:J.s~ t::)er, m:i.'L,
::~,, :1: w:i. ll adhE~H".(.;~ Lo ~tl:l. l~[::)(~ au'id St. at.~:'.~ o~' ('~lasl.::a r'eqL&i,~eme.)nt.s t'nr' t. he
c:l:i.~s'Lar~ceE~ {'l:em ~':tliy (e).::i.f~'l:.il'lE~ L,gE:?':I.i~, ~;~a~L(.:~)~'3(~'~..{.:,~'l~ diEi~po~a:l. ~,y~s:L(~nl [::~1' i::~Ld:~:l, ic:
~:i(~.)i.,J~:.)r'a(iN:~, s'yErlt.{~mi cml 'l'..l'lJ.~; of any a(::l.jac;{,.:~n'l:, oP near'l:)y :t.o'l:.,,
any t!~l'l ]. ail' {:,~i'~.)IIIE3FI~', W J, ]. ], I'" En::ll..I :i. I"E'i q'~i['l add :i. t. J. (::)l']a ], I::)i::~l"ili i ~',,
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
No,
PERFORMED FOR:
DATE PERFORMED:
Range, S ectio n :--~.2~t,._~
SITE PLAN
LEGAL D E S C R I PTt O N: __--~¢.~/'¢.~'~
2
3
4
7
8
~0
~2
14
15
'17,
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Deplh to Water Alter
Monitoring? Dale:
Reading Date Gross Net Depth to Net
Time Time Water Drop
2O
PERCOLATION RATE
TEST RUN BETWEEN
COMMENTS ,/""~,,~ ¢',~ ~ ',
J'~/~ (mLnutes/inch) PERC HOLE DIAMETER __
' FTAND __FT
PERFORMED BY:. , ,~ ~ ;,: : ,t ' ; ;rx '~ 2 ' '::~ :i i CERTIFY THAT THIS TEST WAS PERFORMED IN
f'i:. 'W:": ~ ;!
ACCORDANCE WITH ALL STAT'E ,~&l¢) MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
~ ..... ,
DRAWN OY DATE RECERTIFICATI~ DATES
WEST DIMOND BLVD ~ 1495 ~c~g;
ANCHORAGE~ ALASKA 99~0~ ~'=30'
ORIO CN[CK'ED BY PROJECT ~MBER/NAM[
(90T) 349-5552 (907)349-6075 2832 RD
~, ~ ~ THOMAS W SPERST~ SUBD
L8
N
I
~1' OCrJ~' /
BY DATE R EC£RTIFICATIOH
RD
GLOBAL ENTERPRISES
1200 WEST DIMOND 8LVD # 1495
ANCHORAGE, AL ASK A 99502
(907} :549-5552 (907):~49-6075
2832 RD
E
LOT I
TYP
PROJECT MJMBER/N AME
L8
! heret~y certt/y the foI[puing'd~scrzb*:d property, bOL_~. ..... I~I~ck ~
THOMAS W SPERST~ SUBD
M-W DRILLING, Inc.
P.O. Box i 10378 · 10330 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
~6--] 74
DRILLING LOG
Well Owner CLARK, JOHN
Use of Well Domest t c
Location (address of: Township, Range, Section, if known; or distance main road
Lot 14, Block 5 Sperstad Subd. fi2 - Anchorage
Size of casing. 6' .Depth of Hole
Static water level. 55 ft. ~
Screen ( ); Perforated (
g 3 feet Cased to. 93 feet
(below) land surface. Finish of well (cheek one) open end
).
Describe ser6en or perforation
Well pumping test at lO gallons
of drawdown from static level,
Date of ?mpletion.. Ma~y 20, 1986
Depth in feet from
ground surface
2 . ..C_a.%tn_q.. s.,ttckup_
3 _ :0tganlgS,,
56 .... ~!.!.tY Bravel
:?sil lay
89 "Silty gravel
93
0 _'I'0_
£ TO
3 TO
3:q .TO
56 TO
7 ~ _TO
(}9 _TO
.TO.__
(minute) for. 1, hours with 100~
WELL LOG
Give details of formations penetrated, size of material, color and hardness
,,Water beartnq sand
_TO
TO
TO
__ _TO
--__TO
.TO.
NWWA Certified Contractor
3--CONTRACTOR
);
ft.
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
1. GENERAL INFORMATION
Complete legal description
HR
-?
Location (site address or directions)
Property owner
Mailing address
Lending agency .
Mailing address
Agent No~ ~ -
Address
Day phone
Day phone
Day phone
Unless otherWise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: ~f
3. TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
e
Public water '
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system. , . ,,. ./,,..., / ,,
,,~3)~ ,,"'
" '" - ' ~' ;', '
,. ,)?) ,,
' 1/' , k~ ,,..
Public sewer "-.i ? -~')~¢?I,,c,-,
If community wastewater system, provide written confirmation from State ADEC .
attesting to the legality and status of system. : ' ' '
NOTE:
72-025 (Rev. 1/91) Front MOA #21
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.
Name of Firm
Address
Engin~¢s signature ~~ ~.
Phone 3 q,.~"'- ~-.~-.~
Date to / z¢'/') g'
DHHS SIGNATURE
X Approved for Z¢
Disapproved.
Conditional approval for
bedrooms.
., ,%... .......
bedrooms, with the following stipulations:
Additional Comments
Date
}?~ ~.,T,he Qf ,A6chorage Department of Health and Human Serv ces (DHHS) issues Health Author
",,,Approval Ce-rtifica,~s"based only upon the representations g yen n paragraph 5 above by an ndependent
pr.o.f;~ .s~ij'ooal engineer registered in the State of Alaska. The DHHS does th~s as a courtesy to purchasers of homes
an~l'their'.l'~ding in'stitutions 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 w0rk..::t?':~, :; ,.. !,':~.: ~.~. }:,: .: · · ' ':
. ,-' "-:"~-',:~'~.:.-J'L' ' ' ' ' : ,'~ ,: .. : .::: -' ' ,'.b''''':''' ! .". -: ..
"72-O25(P. ev.I/g1) ~ack MOAI¢21 ,.. . : ' .
· · i'.:::"i' :"' ' '
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: I¥/,'T ~ £'/,)er.r/r,,~ ~ ~ Parcel I.D.
A, Well Data
Well type ~' r-; o, ¢/' e.
Log present (Y/N) 'r'
Total depth ,,9..~ '
Sanitary seal (Y/N)
If A, B. or C, attach ADEC letter. ADEC water system number
Date completed s-/~o / ~0"' Driller /"/
Cased to 9 3' Casing height
'r' Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot I o 3 '
Absorption field on lot ~ o,9 '
Public sewer main > t oo'
Sewer service line > ~,~-'
.g.p.m.
AT INSPECTION
; On adjacent lots > l oo'
Public sewer manhole/cleanout > e co
Petroleum tank 1'4 o,) ¢ ..~.e ~,.,)
WATER SAMPLE RESULTS:
Z Nitrate
Coliform
l oo
Date of sample: Io/¥/9't/ Io./Iz./9~{~ Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Tank size t ?_,5-0 ~,~/ Compartments
Foundation cleanout (Y/N) y Depression (Y/N)
(~. A-. Alarm tested (Y/N) N,
Oateofpumping N. A. / I-H~os p one'er-¢on_~r¢ch;-,,~Pumper N./,.
k~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
N
Well(s) on lot I O.~ ' On adjacent lots > Ioo' Foundation 8_9 '
To properly line */,5-~ Absorption field ,.¢- ' Water main/service line > ~L~'-'
Surface water/drainage ;> ~ o o,
72-026 (3/g3)' 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 DISTANCE FROM LIFT STATION TO:
On adjacent lots
Soil rating (GPD/FF)
Gravel thickness
Well on lot
D. ABSORPTION FIELD DATA
Date installed 5-/ ! ~ / ~(5'~
Length 3 9 J Width
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Total absorption area ~' ~'/ c~' Cleanout present (Y/N)
Date of adequacy test N ,A-. ( I-/~-.r~ /'~,~/- Results (pass/fail)
Water level in absorption field before t/est --
Peroxide treatment (past 12 months) (Y/N) N
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I
On adjacent lots
To building foundation
On adjacent tots ~
Surface water '>
Curtain drain
E. ENGINEER'S CERTIFICATION
Sudace water
15-o ~ II?~r~ System type
~ ' Total depth
Depression over field (Y/N)
for
After test
If yes, give date
N
Bedrooms
· * Property line I ~ '
To existing or abandoned system on lot N' ~,
Cutbank N,/1-. Water main/service line :> 'a~-'
Driveway, parking/vehicle storage area 8'
I ce~'fy that I have checked, verified, or conformed to all MOA and HAA
date of this inspect~bn.
Signature ~--'.,,"/~ ~ ~
Engineer's Name
Date
THEODOR~ F, MOORE
CE-3589
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
CT&E Ref.//
Client Sample ID
Matrix
Commercial Testing & Engineering Co.
Environmental Laboratory Services ~z×~~~~/~
LABORATORY ANALYSIS REPORT
94.5083-1
L14 BLK5 THOMAS W SPERSTAD S/D//2
WATER
Client Name FLATfOP TECI~qlCAL SRV WORK Order 82691
Ordered By TED MOORE Printed Date 10/07/94 ~21:56 tu's.
Project Name Collected Date 10/04/94 ~12:00 hrs.
Project// Received Date 10/04/94 @ 13:30 lu's.
PWSID UA
Technical Director
Released By:
STEPHEN C. EDE
Smnple Remarks: RO~ SAMPLECOLLECTED BY: T. F. MOORE.
Parameter
Qc Allowable Ext. Anal
Results Qual Units Method Limits Date Date
Init
Nitrate-N
0.10 U mg/L EPA 353.2/300.0 10
10/05/94 MCE
* See Special h~structions Above
** See Sample Remarks Above
U = Undetected, Repoded value is the practical quantification limit.
D = Seconchry dilution.
UA = Unavailable
NA = Not ga~alyzed
I~= Less 2hah
GT = Ch'eat er qllan
5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
Arc/J:
COMMERCIAL TESTING &
ENVIRONMENTAL LABORATORY SERVICES
~;~ I¢~-~ ¢-~'--- __ '~
ENGINEERING CO.
Drinking Water Analysis Rep out £0r Total Coliform B a6teria 5633 8 STREET
ANCHORAGE, AK 99518
READ I]¥,~TRUCT]'OI¥,~ 01¥ JC. EV~;'2'~,~ ,~[D~7. ]~,EFORJ~' COLLL¢CTIIVG ,~,/JJ~iIDL~ TEL: (907) 582-2343
FAX: (907) 561-5301
MUST BE COMPLET,Ep BY WATER SUPPL~IER,
PRIVATE WATER SYSTEM
Send Invoice
Send
1' ax humber
~ SendResults 0 Sendlnvoice
Company Name Contact n,..m¢
SAMPLE DATE:
S AM~PLE TYPE:
~ Routine
Month Day Year
~ Repeat Sample (for routine sample
with lab ref. no. )
· ~ Special Purpose
SAMPLE LOCATION
l_oh 1~ 61t~$:,
Treated Water
Untreated Water
Time Collected
Collected By
~; 3omn -T-F ~
TO BE COMPLETED BY LABORATORY
Analysis shows thJ. s Water SAMPLE to be:
~ Satisfactory
[] Unsatisfactory
[] Sample over 30 hmrrs old, results may
be unreliable
[] Sampte too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable resutts. Please send
new sample via special delivery mail.
Date Received
Time Received
Analysis Began
Analytical Method: cB~'Membrane Filter
[] MMO-MUG
* Number of colonies/100 mi.
Lab Ref. No. Result*
}
Sent to A.D.E,C. ~ Fbks Jun
D ,e: tctt t% ,me:
Client notified of unsatisfactoo' results:
[]
Phoned Spoke ,Mth
Analyst
Date: Time:
Faxcd
[]
Faxcd
ComJnents:
BACTERIOLOGICAL WATER ANALYSIS RECORD
M;MO-IVIUG Result: Total Coliform
Membrane Filter: Direct Count
Verification: LTB
Fecal Coliform Confirmation
Final Membrane Filter R[sul#
Reported By /'~ !/(//~
BGB
E. Coli
(~ Colonies/1 O0 mi
COLIFORM
Date . /d- t"~ ,'~ ¢- Time
/
Coliform/lO0 ml
I~ '5/U : hr,
"'
Member of ,he SCS Group (Soci~t~ G~nsrale de Surveillance)
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
(b)
Applicant Name L )z~.~ ,4 ~_~/,~t.x-'~ Telephone: Home "-- Business
Applicant Address ,,,~,-~///22--~c;z -.'"~'"'"~-,~%- -'4f".'.'.'.'.'.'.~- .~.~)'~"'2~
Applicant is (check one): Lending Institution []; Owner/builderj~.; Buyer []; Other [] (explain);
~(c)
~d) Lending Institution
Address
Real Estate Company and Agent
Address
Telephone
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family [~ Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Well ¢~ Community [] Public []
Individual
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite~[[/ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11,84)
ENGINEERING FIRMPROVIDli iNSPECTIONS, TESTS, FILE SEARCH, D, -~ 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 ~
Telephone
Engineer's Seal
DHEP APPROVAL
Approved for "~'"'"" ~f'~ bedrooms by 2~¢>~ /"~-' '"~~
Approved // Disapproved Conditional
Date
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOAI
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: '/
~ .I~ ~'~-~ ~ TA'~
Well Classification
Well Log Present (Y/N)
Total Depth ~ 7~
Static Water Level
Casing Height Above Ground ~ /
Electrical Wiring in Conduit (Y/N) Y'
Separation Distances from Well:
To~olding Tank on Lot / Z) ~. ~-
To Nearest Edge of Absorption Field on Lot /Z~,--~'-
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
FNVIRONMENTAL PROTECTION
.!i. Jt. 1 41986
EIV ED
pA/u/P'r'/.~ if A, B, C, D.E.C. Approved (Y/N)
~ Date Completed .¢"- :2-0 .-- ~ (.. Yield
Cased to
'¢ ~' Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead
; On Adjoining Lots
; On Adjoining Lots ¢~,..,~_.~
To Nearest Public Sewer Line ~ To Nearest Public Sewer
Cleanout/Manhole -~ To Nearest Sewer Service Line on Lot
Water Sam pie Collected by //'~/,~ ~'~ ~ ~ ,,-, ; Date '7-
Water Sample Test Results _
Comments
B. SE~?~.~OLDING TANK DATA
Date Installed ~4-%/~-)~ Size
Standpipes (Y/N) '~ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances frol~'pii~/Holding Tank:
To Water-Supply Well /O
To Property Line ¢'i~
To Water Main/Service Line g)'-.'~,"- /~"
No. of Compartments ~
Foundation Cleanout (Y/N)
Date Last Pumped //.~z,~,'
--~---- ; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Course
comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed .,:~"~/'~-- ~'
Width of Field ~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test "'---
Separation Distance from Absorption Field:
To Water-Supply Well ,/~'o
To Building Foundation "~
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field '-~ ¢)
Depth of Field ,/Z.
Gravel Bed Thickness ~
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~'--
To Cutbank (if present)
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 during Adequacy Test. Meets MOA
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 date of this inspection.
Signed//_~/'~~,,~--~--~ Date '"~
Co m pany ?¢,g~'~
Receipt No.
Date of Payment
Amount: $
MOA No.
Page 2 of 2
Engineer's Seal
72-026 (11/84)
NORi'HERN TESTING LABORATORIES, INC,
600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479-3115
6957 OLD SEWARD HIGHWAY, SUITE 101 ANCHORAGE, ALASKA 99518 907-349-8623
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
~BLIC WATER SYSTEM I.D. #
PRIVATE WATER SYSTEM
. NAME
Mailing Address
City State
SAMPLE DATE: '.~ ~ ?)'g Phone ,~'~<~-~fi'~
Mo, Day Year
Purchase Order No.
SAMPLE TYPE:
[~F~o~tine [] Treated Water
[] Special Purpose [] Untreated Water
[] Check Sample (for original contaminated
sample with lab reference no. )
Sample Time
,~:N o, Location Collected Collected by
2
3
4
5
6
7
8
9
Zip Code
~,/4Labo~atory Ref, No.
Signature of Representative
FOR LABiRATORY USE ONLY
TO BE COMPLETED BY LABORATORY
Received at: ~' Anch. [] Fbks.
Date Received
Time Received /5
Next Sample Due
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DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN BISTRICT OFFICE
437 'E' STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
February 3, 1987
Global Enterprises
ATTN: Roger O. Goodman
PO Box 1.12207
Anchorage, Alaska 99511
SUBJECT: Waiver Horizontal Separation between Well and Septic
System, Lot 14, Block 5 & Lot %, Block 4
THOMAS W. SPERSTAD SUBDIVISION Addition ~2, Anchorage
8721-WA-027
Dear llr. Goodman:
The Department has reviewed the subject waiver request and
hereby waives the horizontal separation between the well and
septic system to 108 feet. This waiver is only valid for the
present existing multi-family structures on Lot 5, Block 4,
effective as of the date of this issuance.
If you have any questions or need further assistance, ptease
contact me at the Anchorage/Western District Office.
Sincer'ely,
Hichael P. Lewis
Environmental Engineer
HPL:pkk
u,xicipahcYo
Anchorage
P.O. B', 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264.-~¢1>1~× 4720
TONY KNOWLES,
MAYOFf
DEPARTMENT OF HEALTH & HUMAN SERVICES
July 8, 1986
John Clark
P.O. Box 110741
Anchroage, Alaska
99511
Subject: Lot 14 Block 5 Sperstad Snbdivision #2
Dear Mr. Clark:
It has come to the attention of this department that the septic system
on the subject lot has been installed within the 150 foot setback required
to a Class "C" or community well. Apparently a well to the west of the
septic system on the subject lot serves more than a single family dwelling.
This department cannot approve this system until this issue is resolved.
Please contact this office as soon as possible to resolve this matter.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site services
SSM/ljw
Roger Goodman
Robert Schilling
Global Enterprises
1200 West Dimond Blvd #1495
Anchorage, Alaska 99502
/v unicipahtYo
Anchorage
P.O. BY., 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
June 23, 1986
John Clark
P.O. Box 110741
Anchorage, Alaska 99511
Subject: Lot 14 Block 5 Sperstad Subdivision #2
On-site Well Permit #860127 - Issued May 14, 1986
On May 20, 1986, The Anchorage Assembly approved a new ordinance
regulating on-site wastewater disposal systems (septic systems).
Ail septic systems constructed after the effective date of this
ordinance are subject to the provisions of this ordinance.
Our records show that you currently hold a permit for the installation
of a septic system. We strongly urge that you contact this office
prior to constructing your system. Any changes in the code that could
impact the construction requirements of your septic system will be
identified and brought to your attention. Please contact the
Environmental Services Division at 264-4720.
Thank you for your cooperation.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/SSM/ljw
0