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SPRING HILLS ESTATES BLK 2 LT 6
Springhill Estates Block 2 Lot 6 #015-051-65 IP �l�111 "I'll •• S-i'r1l'E Department of Environmental �_ � �,� Conservation �� ALAS DIVISION OF ENVIRONMENTAL HEALTH }� - _ ___ Drinking Water Program GOVERNOR BILL WALKER �`r_�, 555 Cordova Street Q+}SZ ' Anchorage,Alaska 99501 Main:907.269.3076 Fax: 907.269.7650 thomas.brannan@alaska.gov February 16, 2017 File:Alaska Children's Services Mr.Jeffery Garness, P.E.,M.S. PWSID: 210312 Garness Engineering Group,Ltd. Class: Non-Transient Non-Community 3701 East Tudor Rd., Suite 101 Source: Groundwater Anchorage,AK 99507 Re: AK Child and Family—Spring Hill Estates Block 2 Lot 6 Source-Septic Separation Distance Waiver Dear Mr. Gayness: On February 2,2017, this office received your submittal requesting a reduction of the State's minimum separation distance between a Public Water System (PWS) drinking water source and a potential source of contamination.This letter approves the requested reduction in the State's minimum separation distance requirement from 200' to 191' between the drinking water well serving the AK Child and Family (AKC&F) PWS and an existing septic system drainfield serving Spring Hill Estates Block 2 Lot 6 (SHE B2 L6) as detailed below. Waiver Determination The septic system serving SHE B2 L6 consists of a 1,500 gallon septic tank and drainfield and was completed in January 2006. At that time it was believed that the potable water service was provided to AKC&F by Anchorage Water&Wastewater Unity;a subsequent Sanitary Survey for the AKC&F PWS by Garneess Engineering Group discovered the subject encroachment.At its nearest the septic system and its associated appurtenances are 191' from the well serving the AKC&F PWS.This well was completed in August of 1965,and consists a 12"casing extending to a depth of 22'6" below ground surface (BGS),a 8" casing continuing to 249' BGS, and continuing with a 6" casing terminating at 286' 8"with a screened interval at 263'to 280'BGS. The well penetrates intermittent lenses of sand, silts,gravels, clays, and mixes thereof,with a static water level of 187'BGS reported in 1965. The following additional items were taken into consideration as part of this waiver approval: 1. From December 2006 to December 2016, source water sampling results for combined nitrate-nitrite or nitrate concentration rose from 1.61 mg/1 to 3.28 mg/l.This suggests that the well is minimally influenced by septic system exfiltration,decomposition of organic matter in soils, and/or erosion of natural deposits which can be typical in the lower hill side of the Anchorage Bowl,despite this combined nitrate-nitrite and/or nitrate concentrations remain well below the 10 mg/L Maximum Contaminant Level (MCL)/MCL Goal; 2. From January 2000 to February 2016,Total Coliform Rule sampling for total coliform(TC) and e. coli(EC) found one TC positive event in April 2007,two TC positive events on July 2012, and no EC positive events; 3. Surface topography and conditions between the subject well and encroachment is generally shallow towards the well and heavily vegetated;and 4. The well accesses a presumed confined/semi-confined aquifer. 1 Mr.Jeffery Garness,P.E. 2 February 16,2017 Based on an evaluation of the available information and in accordance with the State's Drinking Water Regulations, 18 AAC 80, a Separation Distance Waiver for the encroachment detailed herein is issued. Limitations and Appeal Process Any changes, constructed or natural, that affect the conditions to which this approval was granted will void this approval. This approval does not imply the granting of additional authorizations,nor obligate any federal, state, or local regulatory body to grant required authorizations.This is not an approval of omissions or oversights by this office or noncompliance with any applicable regulation. The Department's approval does not guarantee correctness of the functional design or waiver the owner's responsibility for continued compliance with State regulations. Any person who disagrees with this decision may request by mail, e-mail,or facsimile an informal review in accordance with 18 AAC 15.185 or an adjudicatory hearing in accordance with 18 AAC 15.195-15.340. Informal review requests must be delivered to Division Director within 15 days of receipt of this decision. Adjudicatory hearing requests must be delivered to the Commissioner within 30 days of this decision, otherwise,the right to appeal is waived. For more information,visit www.dec.state.ak.us/comxnish/ReviewGuidauce.htm. If you have any questions regarding this plan review please do not hesitate to contact me. Sincerely, T.W. B , '.I.i'. Engineering Associate I Cc.: Rosey Brown AK Child&Family 1709 South Bragaw St. Anchorage,AK 99507 170216_Alaska Children's Sc reices—Spring Hill Estates 132 1,6 SourcC Septic_210312_WA.docx Municipality of Anchorage .� Development Services Department Building Safety Division i Onsite Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ek.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW060009 PID Number. 015-051-65 Name:ROBERTATKINSON Wastewater System: ❑ New ■ Upgrade Address: 9420 SPRING HILL DRIVE • ANCHORAGE, AK 99507 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 529-8625 4 ■Deep Trench 0 Shallow Trench CI Bed 0Mound 0Other LEGAL DESCRIPTION SOY Ra": 0.6 Tolal Dpth rram erlg+ gado. 11 MAX cPa/sa. R rt. Block: Lot: Subdivision: Depth to pie bo ham orlp" grad.: crow depth beneath pipe: 2 6 SPRING HILL EST. SEE DWG. rt. 7 r, Township: Range: Section: ri added above odgN Bade: Craw lenath: — — — SEE DWG. n. 72 rt WELL: ❑ New ❑ Upgrade crow .;doth: 2.5 NU at we: 1 a.lehc. Mlw.n — rt pt Gaenccotion Phrate. &e.c): Total Depth: Caned To: Tatal absorption area:pie m01Mal: rt 1008 sae rt. 0 3034/ F-810/ SCH 40 PVC orwr: wed: stow water Lew: "aw.. GEG, Ltd. OaN YNt 1725-27/2006 nerd. Pump Set AL Ca" tteght Aeare Gro red. TANK CPY R R SEPARATION DISTANCES Cl septic 0Holding ■S.T.E.P. 0Other To Septic Tank Absorption Feld Lift Station Holding Tank c/prlvote seer linea NaMoct"re .. ANCHORAGE TANK Capndty In gaeone: 1500 From Well 100'+ 100'+ 100'+ — 25't a STEEL Names a 2 eanpw m w: Surface water 100'+ 100'+ 100'+ — — LIFT STATION Lot Une 5'+ 10'+ 5'+ — — Size N gaone: 1500 wmWpc .. ANCHORAGE TANK ORENCO SYSTEMS Foundation 5'+ 10'+ 5'+ — — en Neel M: at Nes at: "h water a a: 42" 42" 46" Curtain Drain NONE KNOWN Pomp Nate a N : aecb+m Inpeetiaw Wamwo bre /20 OSI 05 MH MOA Remarks: BENCH MARK erb Oeecdpt : THE OLD SEPTIC TANK WAS FILLED WITH CONCRETE. BOTTOM OF SIDING NEAR POINT "B" AuunW ENw : 100.00 n ENOINEE S SEAL �4 A. 00o Op 47 51/Ls•— GEG, Ltd. Inspections performed ormed bY: Dates: 1st A I .............. 2nd �•'•amess:' 3rd QO'P a �O Development Services Department Approval�� 06 -7953 �4p4 Reviewed and approved by: A Dote: 13 ! _DA .e �c�000 Op "gra (R.. 13/01) O.CE �f,,,;ooa`oo OOO�O�p PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: — SW060009 015-051-65 NEW DBL2 NEW 1500 GALLON S.T.E.P. TANK r/ DUAL OUTLETS EXISTING GRAINFIELD TO BE USED AS A RESERVE SITE � I / / / / / EXISTING i 4 BEDROOM HOUSE r �/ I / GARNESS ENGINEERING GROUP, Ltd. p;'�: CONSULTANTS d GENERAL CONTRACTORS Q•••••• • • • ......•••• ... 3M1 L N0011 11G`U. WI[ 101 • M*W"- Nt (M9)S 32Q• w•.,w..... 4,mn O PREPARED FOR:PHONE NUMBER: PACE NUMBER: ROBERT ATKINSON 529-8625 2 OF 3�QOp 1 ey A. ess: LEGAL DESCRIPTION: DRAWN BY: . % �C� -7 53 • �' SPRING HILL ESTATES SUBDIVISION; LOT 61 BLOCK 2, C.J.G.��'��.s 1/3!Q. oo� TYPE OF WORK: UATE: ��QOd4Op�ODoa AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 1/30/2006 IRw. 0L05) A I B C STI 48.5 10.3 - ST2 45.6 14.7 - MH 44.5 16.8 - DBL1 - 12.2 54.2 DBL2 - 12.2 55.7 MTI - 33.9 49.8 MT2 - 94.0 43.4 I / / / / / EXISTING i 4 BEDROOM HOUSE r �/ I / GARNESS ENGINEERING GROUP, Ltd. p;'�: CONSULTANTS d GENERAL CONTRACTORS Q•••••• • • • ......•••• ... 3M1 L N0011 11G`U. WI[ 101 • M*W"- Nt (M9)S 32Q• w•.,w..... 4,mn O PREPARED FOR:PHONE NUMBER: PACE NUMBER: ROBERT ATKINSON 529-8625 2 OF 3�QOp 1 ey A. ess: LEGAL DESCRIPTION: DRAWN BY: . % �C� -7 53 • �' SPRING HILL ESTATES SUBDIVISION; LOT 61 BLOCK 2, C.J.G.��'��.s 1/3!Q. oo� TYPE OF WORK: UATE: ��QOd4Op�ODoa AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 1/30/2006 IRw. 0L05) PERMITNUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW0 - SW060009 015--051-65 FINAL GRADE - 99.21+ 5T1 ST2 MH TOP OF TANK � TOP OF TANK / AT INLET - 95.21 AT OUTLET - 95.21 TH/I INVERT OF BUNG AT INLET . 94.83 THE DISTRIBUTION UNE IS 1.25 INCH PVC w/ 1/4 INCH HOLES SPACED 29 INCHES ON CENTER (30 HOLES TOTAL) NEW 1500 GALLON S.T.E.P. TANK FINAL GRADE 93.84+ FABRIC PIPE (AVG.) BOTTOM OF TRENCH - 83.57 (AVG.) �--8— RELATIVE ELEVATION OF BOTTOM OF TESTHOLE - 77.57 (TEST HOLE DRY) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 3 GENERAL CONTRACTORS M L UOC11 FAML l 101 • 010"WL Mt N00) • M101L (F YM37-411• • FAY ()0)}V " • `0S11C w. Maws PREPARED FOR: PHONE NUMBER: PACE NUMBER: V ROBERT ATKINSON 529-8625 1 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: SPRING HILL ESTATES SUBDIVISION; LOT 6. BLOCK 2, C.J.G. TYPE OF WORK: DATE: PROFILE AS -BUILT DRAWING OF SEPTIC UPGRADE 1/30/2006 (Re, 01105) h•.:Yt ..... 858,' -7953 From +19078308507 Tu• San 31 05:20:40 2006 INSPECTION REPORT Page 1 of 1 MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 4700 SOUTH BRAGAW INSPECTION INFORMATION &HELP: 343-7982 INSPECTION: VOICE 343-8300 INSPECTION: FAX (907)249-7777 www.muni.orgrBSD/Inspectlons.cfm NAME: not given PERMIT#: 08-7132 COMPANY: INSPECT DATE: 1/31/2008 AM PHONE#: 350-0339 PHONE#: 250-1100 PHONE#: 250- /72/ ADDRESS: 9420 SPRING HILL DR LOT 8 BLOCK 2 SUBDIVISION: SPRING HILLS ESTATES GRID #: SW2436 COMMENTS or DIRECTIONS lift station TYPE OF INSPECTION: Other Electrical COMMENTS: (FORINSPECTORUSE ONY) l Y' ^ 1 ) A"'p 'k ' j PRIMED NAME "1 DATE: MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jan 24, 2006 Expiration Date: Jan 24, 2007 Permit Number: SW060009 Parcel ID: 015-051-65 Legal Description: SPRING HILLS ESTATES BLK 2 LT 6 Design Engineer: 0855 Garness Engineering Group, LTD Site Address: 009420 SPRING HILL DR Owner Name: ROBERT ATKINSON Lot Size: 48682 SO. FT. Owner Address: 9420 SPRING HILLS DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99507-4371 This permit is for the construction of: ❑Q Disposal Field Q✓ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By. Municipality of Anchorage • Development Services Department j Building Safety Division. On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.sk.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. INC;- oil - 1105 Permit Number Property owner(s) ROBERT ATKINSON Day phone 529-8625 Mailing address (1) Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd.) LOT 6. BLOCK 2. SPRINGHILL ESTATES SUBDIVISION Legal description (Section, Township & Range) N/A Lot Size 41 e Acre q.F Number of Bedrooms 4 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and Is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit Fees: 41so 'Ca 4 Date of Payment: VI'di o10 Waiver Fees: Date of Payment: Receipt Number. 't Ggt-0 Receipt Number. 1524 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS January 17,2006 Municipality of Anchorage Development Service Department On -Site Water &: Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 Ref.• Proposed Septic Upgrade for Spring Hills Estates Subdivision; Lot 6, Block 2, To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgraded. We are proposing to install a new 1500 gallon S.T.E.P. tank and a deep trench type drainfield. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography around the proposed drainfield is relatively flat. In short, there are no slope concerns. 5. WAIVER REQUEST: We request a waiver from the required 14 foot setback between the proposed drainfield and the existing drainfield to 10 feet. The existing drainfield is to be used as a reserve site and both drainfields will never be in service simultaneously. In addition, the average topography around the drainfields is relatively flat. We feel there will be minimal lateral migration of effluent between the two drainfields. In short, we are unaware of any adverse impacts with the granting of this waiver. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: garnessengineering.com We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. NOVE. Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7 page constnhction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: gamessengineering.com i SPRING HILLS EST. S/D LOT 3. BLOCK 2, \ C�2 \ / // ROPOSED SEPTIC UPGRADE SPRING HILLS EST. S/D\ / / / (SEE DESIGN PACE 2 OF 2) LOT 4, BLOCK 2, / SEER?AC SPRING HILLS EST. S/D / EEAALOT S. BLOCK 2. 1 N2, 6"--e 'L9R(NO CONCERN) / Lj-�.ba�4Vr�.`� �� XISTINC SEPTIC SYSTEM I I \ I I \\ II iI t V / SPRING HILLS EST. S/D I LOT S. BLOCK 1, i 1 / ��C \ -..D v \ GARNESS ENGINEERING GROUP Ltd. off: CONSULTANTS b GENERAL CONTRACTORS e.., 3M1 t f11DOR Iq.O, fAF 101 • NCwONfE. Mt N'A1 . hgMF "7) IT • W b 3x 32" PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 ROBERT ATKINSON 529-8625 1 OF 2 QOy LEGAL DESCRIPTION: DRAWN BY: ° SPRING HILL ESTATES S/D: LOT 6, BLOCK 2, C•J•G TYPE OF WORK: OATS: SITE PLAN FOR SEPTIC SYSTEM UPGRADE 1/16/2006 \ 4 BEDROOM \ HOUSE SPRING HILLS EST. S/D LOT 4, BLOCK 1, A. GOr;�ss. (R". 011m) I/I, /,> L' I IIS^ I I / SPRING HILLS EST. S/D I LOT S. BLOCK 1, i 1 / ��C \ -..D v \ GARNESS ENGINEERING GROUP Ltd. off: CONSULTANTS b GENERAL CONTRACTORS e.., 3M1 t f11DOR Iq.O, fAF 101 • NCwONfE. Mt N'A1 . hgMF "7) IT • W b 3x 32" PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 ROBERT ATKINSON 529-8625 1 OF 2 QOy LEGAL DESCRIPTION: DRAWN BY: ° SPRING HILL ESTATES S/D: LOT 6, BLOCK 2, C•J•G TYPE OF WORK: OATS: SITE PLAN FOR SEPTIC SYSTEM UPGRADE 1/16/2006 \ 4 BEDROOM \ HOUSE SPRING HILLS EST. S/D LOT 4, BLOCK 1, A. GOr;�ss. (R". 011m) I/I, /,> L' APPROXIMATE LOCATION OF UTILITIES --,, PROPOSED DRAINFIELD. THE DISTRIBUTION LINE IS TO BE 1.25 INCH PVC WITH 1/4 INCH HOLES SPACED 29 INCHES ON CENTER (30 HOLES TOTAL)— EXISTING SEPTIC TANK TO BE COMPLETELY 3ANDONED PER UPC BY EXISTING DRAJNFIELD TO BE USED AS A RESERVE SITE. — NUMBER OF BEDROOMS;4 GALLONS PER DAY (GPD): 600 PERCOLATION RATE/S: 30 MIN./INCH PROPOSED APPLICATION RATE:0.6 MINIMUM DRAJNFIELD SO.Fr.: TOM DRAfNFIELD DESIGN, MAXIMUM DEPTHAS FEET WIDTH: 2.5 FEET LENGTH;72 FEET M.OA APPROVED SAND FILTER: N/A EFFECTIVE: 7 FEET REDUCTION FACTOR: NIA ACTUAL SOTT.: 1008 T GEG. UdM A I PAGE SPECIFICATION N . ...... LETTER THAT PERTAINS TO THIS DESIGN. TOOBTAIN A COPY OF THE LETTER CONTACT CEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER. WELL DRILLER. CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND ONDMONS OUTLINED. EXIST NG 4 BEDROpLv HOUSE .... . 0 C INSTALL FOVNWTION CLEANOUT. PLUMBING I CRAWLSPACE 5 TO BE PROPOSED 1500 RE—ROUTED. STATION w/ DUAL OUTLETS NOTE: THE CONTRACTOR �( / / SHALL HAVE THE WEST LOT LINE AND THE 100' WELL RADIUS FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CC .....• .. I. ..... ......... ini L 101 - NICHOR.M W / (07)337- ll.. rM I PREPARED FOR: PHONE NUMBER: PACE NUMBER' ..... I . ... ..... ...... ' J . ROBERT ATKINSON 529-8625 2 OF 2 .*P - If ey CE—* amess.- -- LEGAL DESCRIPTION: DRAWN BY: . 1 -.1. 17 -- DATE: SPRING HILL ESTATES SUBDIVISION; LOT 6, BLOCK 2, C.J.G. N'p TYPE OF WORK: rofessto DESIGN OF PROPOSED SEPTIC SYSTEM UPGRADE 1/17/2006 (Re, 0IJD5) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 7 8 9 10 11�I�IIYI GMIXED W/ SM 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: SPRING HILL ESTATES S/D; LOT 6. BLOCK 2, PERFORMED FOR: ROBERT ATKINSON DAT. DEPTH zzzz 1/17/2006 (feet) c_c_ TEST HOLE 1 EPnC AR� 3:30 zzzz ==== FILL SOIL CLASSIFICATIONS 2 ===Z 3 3 ___= it+! GP ML ---= ORGANICS GM CL 4 /SM GC OL 4 5' II °• •°• : SW MH j=:ZZZILOAM 5 00SP CH 6• SM : OH 6 SC 7 8 9 10 11�I�IIYI GMIXED W/ SM 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE SEEP m 12' 1/10/2006 DRY 1/13/2006 DRY 1/17/2006 • ' i — 1 DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 1/11/2006 1 3:00 N • ' i — EPnC AR� 3:30 30 5' 1' 3 r, — 6' — 4 4:00 30 5' II 5 4:00 — 6• — 6 4:30 30 5• 1• 1 r / \ ! �SGLE- 100' DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 1/11/2006 1 3:00 — 6' — 2 3:30 30 5' 1' 3 3:30 — 6' — 4 4:00 30 5' 1' 5 4:00 — 6• — 6 4:30 30 5• 1• 19 I PERCOLATION RATE 30 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.0 FT. AND 5.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE, FERMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: - ----- ----- ----- MUNICIPALITY OF ANCHORAGE //� (% DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION �^ ~ 82.5 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT — NAME PHONE u- VCW f P1�1-in �D l fatflYj 335211 ❑UPGRADE MAILING ADDRESS 130 Y 8•-93S'r Vef.i �AS_e IS •7`t.2m gs,LUw LEGAL DESCRIPTION—— ei LOCATION NO. OF BEDROOMS Well Ahsorption area Dwelling PERMIT NL]. 1 DISTANCE TO: _ pIU'1– i� 9 hp7" U Y W Q I Manufacturer hGnD �L ,�a� IL Material No. of compartments S� Liq. capacity in al Ions IF HO EMADE: Inside length Width Liquid depth �_—map DISTANCE TO: Well —� — --- Dwelling -- PERMIT NO. 02 - h Manufacturer Material Liquid capacity in gallons O wzU4 I zw 71WAell Foundation DISTANCE TO:1'+G� h f1 fJ� �'1 No.oflinestenyth of each line Total length o iges, Nearest lot line `LO Trench width PERMJT NO. �� " o y- 0 wN�r-Y•I.'rrc 6+--H Distance between lines .S :> 6 "yZ inches F Top of tile to finish Materia eneath tile Total effective absorption ary a grade ,/[ '- e ga O / ,S— %O inches ,�,j Irl Length Width Depth — -- PERMIT NO. Lu a. oQ. H Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line r Class — Depth Driller Distance to lot line PERMIT NO. r Lu DISTANCE TO: Buildiny foundation Sewer line - Septic tank---^ Absorption area(3) OTHER U-7-11.1 L ly do -fr, /ot ca -ye s PIPE MATERIALS SOI L TEST RATING INSTALLER REMARKS p�,Mrh 6u Iled -Ar L= 31. 77. — A h61 0 Moir ST 0Y 0z51- T 1 0 S3i � APPROVED — — DATE LEGAL — -- M`4 2d 149I —LG —�w g 2 S'p ,,',/ , �// 7i1/ �s iafPS J 72-013 (Rev. 3178) Qn 4. T -]F *- " 10F:7 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET: ANCHORAGE, AK, +9501 264-4720 ��e &' & -..... X 7' E := [` 0•• I *z t4 E '' L_ L_ PERMIT NO: DATE ISSUED: DATE CLOSED: APPLICANT: ADDRESS: CONTACT PHONE LEGAL DESCRIP LOT SIZE: 840308 HAND WRITTEN 03/22/84 r'8} 04r�:i.l••7,: s4 MCLIN CONTRACTORS BOX .--O3 ANCHORAGE, AK 99504 33-1'.x'94 SUBDIVISION: 'SPRING HILLS ESTATES LOT: 6 BLOCK: 2 SECTION: 15 TOWNSHIP: 12N RANGE: 3W 48682 (SQ. FT. OR ACRES) I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH 1=_Y THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS. HND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL: WASTEWATER DISPOSAL SYSTEM OR PUBLIC: SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF A LIFT 'STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES: THEN <1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AC:—E UILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT: AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED APPLICANT: MCLIN CONTRACTORS DATE: ISSUED BY DATE: MUNICIPALITY OF ANCHORAGE Department Health and Environmenta' 'rotection 825 L Street, Anchorage, AK. X9501. / �C) 2.64-•4720�O Permit V # ee HANDWRITTEN PERMIT # -- -/W/EEyyLL ANDA& ON-SITE SEWER PERMIT //�� Applicant: /,/?C[�/� ( rJ3� _ Mailing Address:.�L?"rY,33 ieA66 J _ Location: �r �y Phone YN�umber : 33,_?- /a % y Legal Description: j�lp--�����YLJ�G�e��,2'�L7O Lot Size: Type of Soil Absorption System Is: j/old/ 1?3a �---` SPti/$J Trench: _ Drainfield: _ _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: -S� _ Soil Rating (sq. ft/br) The Required Required Size of the Soil Absorption System Is: DEPTH �� LENGTH -31 GRAVVE1, DEPTH ^, WIDTTHHI/S 3� The length dimension is the lengt� J® of the trench or dr iTffield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel. between the outfall pipe and the bottom of the excavation(in feet). # # REQUIRED SEPTIC(HOLDING) TANK SIZE_ _SaQ _ GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjagent to this property and the number of residences that the well will serve. ' * *. * TWOM INSPECTIONS AIRE REQUIRED # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 23+ # # # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that. 3 bedrooms. Signed: z`_ /}�— Issued by: licantG° Date: FI/ ^------ SWP/024 (1/81) / 2 I X %L 601' SOILS LOG MUNICIPALITY OF ANCHORAGE 19, 4 PERCOLATION • X11 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIONTEST �E 825 L. Street, Anchorage, Alaska 99501 2644720 \- —' SOILS LOG — PERCOLATION TEST PERFORMED FOR: I t LI n CojJ , 1"6r ,. DATE PERFORMED: LEGAL DESCRIPTION: S P0 4 it Lcf 6 131v L le p /1 57 fJ O 2 �- . SLOPE SITE PLAN FJEP TIF} 1 J 2 5 Sr.n�l ii I's �Kmrc$t S �o•-� 8 9 r�r 10 U 11 12 — 13 c V;5 12-5 II 'h 14 15 — 16-- Sud - 17 �ht br Ch L s•(f 18 19 20 / L` A / 1` WAS GROUND WATER L ENCOUNTERED? O P IF YES, AT WHAT E DEPTH? P " d,',- ner,_ bio% j H OREM Date Gross Net Depth to Net so Time IN' Water Drop — ININ 3 9 y 9 NMIjIN (6 - /n ae ,yo ID/ !! �.v 31 - 5y - 1b21 milliIN00 /027 ti -L3 _ �) 2- 5- 33 rcn oli of IINN mmmmim MENJ , Reading Date Gross Net Depth to Net Time Time Water Drop — 3 9 y 9 (6 - /n ae ,yo ID/ !! �.v 31 - 5y - 1b21 /027 ti -L3 _ �) 2- 5- 33 rcn oli of PERCOLATION RATE `� (minutes/inch) 3 )/� TEST IT BE/TWEEN 3— FT AND e-- FT •�J PERFORMED BY: Uwr"'—_CERTIFIED BY: 72-008 (6/79) M --W DRILLING, Inc. P.O. Box 10-378 ^ 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING, LOG �1`!L.:n�OI1 Conetruci;,:fo;:, :L' ^_e. Well Owner_ EIL.- 1111. of Wel :7oc:caC'.c Location (address of: Township, Range, Section, if known; or distance main road----__— 1,ot 6 awcl; ? ,r,ilvz. ITLI*L,,_____,_ __—__ _ -Size of casing___—Depth of I-lole—---feet Casedto_L_(( —feet Static water level_ % 29 --f t. (&13ei've) (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( ). Describe screen or perforation—.—!';�t,�—_—___ � y`°` RAGE Well pumping test �� gallons per (h2ll1:) (minute) for_L�RtxtdTwR�1L1 —tea. of drawdown frim static level D° L O. HE, ENVIROW!v;ENUaL PROTECTION Date of completiat_ f17'r1—t%:?nt�t __` N�� 2 q�Q WELL 1.00 Depth infeet from _�—_..�.�._-..�._._.—_"—__—_�_��.��� ground surface Give details of formations penetrated, size of material, color and hardness --' I TO (6__ _ Botrel ^also 1_Grn=e-1,.. ne�OIE'dLLTY�1tNCHORAGE DEP'L Of HEALTH & _(6 =�0 1jY O'F11i 1j11, GP:.�tpi ENVIRONVENTAL PROTECTION _TTO__ .— — _—.— -----_— 13C !mn :1.00 :?^:.;y Lla.),'h;/ Gi•�,tiC)- NOV 6 �18� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw SL art P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us ✓ (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 01,5- 081- (o5 1. GENERAL INFORMATION k.. 46. COSA# 04 D032, Expiration Date: 4-30—OG Complete legal description SPRING HILL ESTATES SUBDIVISION- LOT 6, BLOCK 2, ❑ 'Public Water System ❑ Location (site address or directions) 9420 SPRING HILL DRIVE' • ANCHORAGE, AK 99507 Current Property owners) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ROBERT ATKINSON Dayphone 529-8625 9420 SPRING HILL DRIVE • ANCHORAGE, AK 99507 STEVE CAVIN w/ PRUDENTIAL VISTA Day phone Day phone 762-58873 3801 CENTERPOINT DRIVE • ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well . . ' E Individual Water Storage ❑ Community Class Well ❑ 'Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. 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 Certificate of On -Site Systems 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 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG. LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with 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 ofthe system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there 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 benerit of the ownerlisted above. Any reliance upon or use of this report by any otherperson or party is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for —I/--- bedrooms. Disapproved. 337-6179 Date 1131 & Conditional approval for bedrooms, with the I1lowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory V Arsenic Advisory Manitenance Agreements Supplemental Engineers Reort Other ON ON-SITE.c WATER AND ATFR PROGRAM •:• By: //45�- l ! r Original Certificate Date: tR••. iwil Municipality of Anchorage • ~' Development Services Department ; Building Safety Division Orn -Site Water 6 Wastewater Program 47W South Bragew St. P.O. Box 196650 Anchorage, AK 99519MM www.ci.enchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SPRING HILL ESTATES S/D• LOT _6.B2,Parcel ID: 0 15' A. WELL DATA Well type MAIE If A, B, or C provide PWSID# N/A Well Log (YM) YES Date completed 4/2/1984 Sanitary seal (YIN) YES Total depth 253 ft. Cased to 251 ft. FROM WELL LOG Date of test 4/2/1984 Static water Ievei 220 ft. Well production 8 g.p.m. WATER SAMPLE RESULTS: Coliform 0 oolonies/100 mi. Nitrate 1.28 mg./L. Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 12/30/2005 210 ft. 9.2 g.p.m. Other bacteria 0 colonies/100 ml. Arsenic: <5.0 ug./L. Date of sample: t 2 27 2005 Collected by: GEG, Ltd. B. SEPTICIHOLDING TANK DATA Tank TypelMaterial S T.E.P./STEEL Date installed 1/25-27/2006 Tank size 1500 gal. Number of Compartments E Cieanouts (YIN) YES Foundation deanout (Y/N) YES Depression over tank (YM) NO High water alarm (YIN) YES Date of pumping NEW Pumper C. ABSORPTION FIELD DATA 0./ 1/25-27/2006 ® 110 system TRENCH Date installed 3/26/fsa4 Soil rating p.d. r tm _ yste 1YPe Length 72/53 ft. Width 2.5/3-3.5 ft. Gravel below pipe 7/9 ft. 1008/ YES Depression over field NO Total depth IL -0j, 3.3 ft. Eff. absorption area 954 ft, De Monitoring tube _ D Data of adequacy test NEW Results (Pass/Fail) — For 4 bedrooms Fluid depth in absorption field before test = in. Water added =gal. New depth =in. Elapsed Time: = min. Final fluid depth = In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM 8 type) — If yes, give date — D. UFT STATION Date installed 1/25-27/06 Size in gallons 1500 Manhole/Acoess (YIN) YES "Pump on" level at42 in. "Pump off' level at 42 in. High water alarm level at 46 in. Datum BOTTOM OF TANK Cycles tested NEW Meets alar & circuitYES requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout - N/A Holding tank N/A Animal containment areas 50'+ Manurelanimai excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, partring/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. Receipt Number QOO-Vq (Rev. 12/01) wain of raymeni _ Receipt Number �T CU W Cl) (L C:) (I' C7 a 2 11 ` �SNt S \o ?�4 n FT n N_ ASPHALT ASPHALT DCCK 13 i G. OJ � OL �/ e 4� STA. RT yU 4 -I- 60000�ppp0 OF'A�gJ;no 0:A 9 LH ...........................0 ............. SHANE A. HOLT : O s- LS -6914 � O�ocoo4- ROUP, Ltd. GARI`7E5SSFa,NGI so wR, coNIRA °�- TudLTr RE"`t' Suite 101 3701 E. Alaska 9g50g 3246 j337--6179 FAX:( w.game�°sLnecring.eam I 7 P\ 1 NOTE I AS SHOWN ON CITY GRID MENT NOT VERIFIED BY AS OF THIS DATE FOR THE HIFORMATIDN HEREON R PDR INC USE Of FENDING JHSTITUTtDNSI S NOT TO 8E TO SHOT/ ANY IONNG AO BEM "THE ORA ELE IMPROVEMENT$ SITUATED THERC01 EXISTING STRUCTURES AND PUTTED LOT ONES OR EASWENTS AND 6 MOT TO BE USED fOR POSITIONING ADDNIO THE VIADC RECORDING DISTRICT, ALASKA AND DT STRUCTURES OR FEMCCUNES. WITHIN THE PROPERTY LINES AND THAT NO VIS: EASEMENTS OP RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SNO" HEREON. ENCROACHMENTS CXIST OTHER THAN NOTED. NOTE; ANY RHCCLMES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY L 4E ATED AT ANCHORAGE, ALASKA THIS 20TH---_ OR LOCATE STRUCTURES. DAY OF JANUARY____ 2COG--_ ANY PAVING SHOWN MAY BC APPROXIMATE DUC TO SNOW CONDITIONS. HOLT LAND SURVEYING 10003, FB 121-40,46,42 Tn A4lS-5513 AS -BUILT SURVEY n _ SCALE 1' = 40' ti ✓J I HEREBY CERTIFY THAT C HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLDVINO DESCRIBCD PROPERTY. V LDT 6, BLCCK 2. SPRING HILL SUB. THE HIFORMATIDN HEREON R PDR INC USE Of FENDING JHSTITUTtDNSI S NOT TO 8E TO SHOT/ ANY IONNG AO BEM "THE ORA ELE IMPROVEMENT$ SITUATED THERC01 EXISTING STRUCTURES AND PUTTED LOT ONES OR EASWENTS AND 6 MOT TO BE USED fOR POSITIONING ADDNIO THE VIADC RECORDING DISTRICT, ALASKA AND DT STRUCTURES OR FEMCCUNES. WITHIN THE PROPERTY LINES AND THAT NO VIS: EASEMENTS OP RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SNO" HEREON. ENCROACHMENTS CXIST OTHER THAN NOTED. NOTE; ANY RHCCLMES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY L 4E ATED AT ANCHORAGE, ALASKA THIS 20TH---_ OR LOCATE STRUCTURES. DAY OF JANUARY____ 2COG--_ ANY PAVING SHOWN MAY BC APPROXIMATE DUC TO SNOW CONDITIONS. HOLT LAND SURVEYING 10003, FB 121-40,46,42 Tn A4lS-5513 01-11-06 10:47 FROM-CUE ESI, SCS ENV SERVICES —Sw SGS RCL# 1058329001 Clirnt Name Gamess Engineering Group. Ltd. Project Namel# Spring Hills Est Lot 6 Block 2 Client Sample 1D Spring Hills Est Lot 6 Block 2 Matrix Drinking Water PWSID 0 Sample Remarks: 9075615301 T-411 P.02/04 F-333 All DAIes/17mes are Alaska Standard Time Printed Date/Time 01/09/2006 8:10 Collected Date/Pliant 1227/2005 10:30 Recelred Date/time 1227/2005 11:16 Technical Director Stepben C. Ede Allowable Prep Anwysts Parameter Results POL Units Me" Contzina ID Limits Date Date Init Nitrate -N 128 0.)D0 mg/L L•PA353.2 B (-101 1228/05 JC Metals by ICP/NLS Arsenic 5.00 U 5.D0 Microbiology Laboratory Total Coliform 0 ug/L EP200.8 C 1229105 01/04/06 SCL col/100ml. SNUO9222D A (o—I) 1227/05 TLF 01-I1-06 10:48 FROM -CRE ESI, SCS ENV SERVICES 9075615301 V MV SGS/CTBE ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria REPO INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTWG SAMPLE MUST BE COMPLETED BY WATER SUPPLIER rLIC WATER SYSTEM ID# PRNATE IaAT FR SYSTEM Send Resuhs CI. Send Ytvoce SAMPLE COLLECTION: r� w.. i..r..✓f ..r r V�iar Data: l- • JLQ� um o.r V. Tim: 2 T-411 P.03/04 F-333 ANCHORAGE, ALASKA 99518 Tei: 907-582-2343 Fax 907.581.5301 Lab Rd No i105e329 qg. 0 SandFe fta- 0SeM Invoke SAMPLE TYPE: VRoutine 13 Treated Water Q Repeat Sample 13 Untreated Water (refer to lad no. 1 ❑ Special Purpose Transported v (/ to Lab By, Qf Same as collector Other: TO BE COMPLETED BY LABORATORY Sample Raeeiving: Date: jam' _ ❑Sampe.rersohousod ❑ RUSH SAMPLE Time: Ci (6P Results may be unresable Temp: -v ❑ 48 HMW Phone p: Delivery Method: G F Rare tons Fax#' Received Byy �— ......................................................................................................... Bacteriological Water Analysis Record: Analysis Began: i2 /1 Analyst: T� Anatyli" Method: MembraneFllter MMO-MUG (PIA) Reported By: —� gnakee MMO-MUG (PIA) RESULTS: Total Cokform: E. Col MEMBRANE M ER RESULTS: Dired Cant Coloniesn00mL Venficatiat .................................... LZSA�10EC:NCFBK JUN' Sem to client Phoned [3 Faxed Q Datarrtnc Spoke vvlth• t+aerua . LTB j�—Satisfactory ❑Unsatisfactory - TMre.TMN1.I ftc� Datamme: ��,P/o /TZ:3e oe.m.s..«r Forth # FW- 0053 12/17103 1WsoslnasolVWK_GmupData\PubidDOCUMENT\FORMSapprove&LdI Form 121703.xis 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. S .(,) 1)1 HAALZ1-1— 1. GENERAL INFORMATION Complete legal description Location (site address or directions) _ 3 U-0 S Property owner%_��i (�%'� ` L�� G ,� Day phone 97 le - :P-o-tti _ Mailing address AS e_') I 4,w 14Ixb r "1 .1 —� Lending agency )> " V,9 ( Day phone Mailing address -- Agent L 92 Day phone —2-7 1, - �LO-o i Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. 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. 4. 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. 11 72-025 (Rev. 1/91) Front MOA 921 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. Name of Firm�� �ji Yr kU� � _ Phone Address 3 �/ 5 Q>-6 n Engineer's signature 6. DHHS SIGNATURE LApproved for bedrooms. Disapproved. Conditional approval for Additional Comments Date bedrooms, with the following stipulations: By: Date 7— /22- f 2 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 h i the professional engineer's work. 72-025 (Bay. 1/91) Back MOA 421 W Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL. CHECKLIS'r Legal Description: /'! i 4 Parcel I.D. 0_O A. Well Data Well type R� if A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed 412- S `�—_Drlller _ g --1X/ Total depth ,2 3 ,Cased to � — ,// t1 Casing height .�� /L Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Wires properly protected (Y/N) FROM WELL LOG `//z/8 4 --g.p.m. AT INSPECTION (p a y19:3 ,0/D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1;35 P ; On adjacent lots Absorption field on lot 1 G ' ; On adjacent lots -- -�, / r3 +3 Public sewer main ��< —_Public sewer manhole/cleanout Sewer service line i Petroleum tank I v & u WATER SAMPLE RESULTS: ;C1 rrt r1r1 Coliform Nitrate 0A01, Other bacteria Date of sample: -`� Collected by: _ 177^'s B. SEPTIC/HOLDING TANK DATA Date installed 3V� /3 / Tank size 15 Com_ Compartments Cleanouts (Y/N) __Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) rY,/"\ Alarm tested (Y/N) Date of pumping (, I-9 9 3 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot )3,- _On adjacent lots > rem Foundation To property line � 2-U _Absorption field Surface water/drainage Nioovle, Water main/service line i -L-0 72-026(3/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons_ Vent(Y/N) _ N n til ti High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 3� l0 `B �/ Soil rating (GPD/Ft2) System type 12ur��i Length 5 3 Width 3 v Gravel thickness 9 Total depth 1 �2 J Total absorption area R 5)V Cleanout present (Y/N)JDepression over field (Y/N) N / Date of adequacy test 101AY/ R'3, Results (pass/fail) ice' for i� Bedrooms Water level in absorption field before test 14— After test Peroxide treatment (past 12 months) (Y/N) 14 o If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots > y lJ l-) Property line o20 To building foundation To existing or abandoned system on lot N On adjacent lots 1 5-0 Cutbank r%w� Water main/service line t D Surface water t) vt-2 Driveway, parking/vehicle storage area _711-0 Curtain drain y E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effe&t on the date of this inspection. HAA Fee $ / -70 `rte Date of Payment Receipt Number 7-4/ 7�� cz D s T 72-026 (3/83)' Back Waiver Fee $ Date of Payment Receipt Number SINCE 1900 CI It 7 I [L I,f 1I) Ito f . 1 IF (,lit?IIL Rallip i -c Pia 1, c i N. Cliel)L' Kine tro'lec1: Name! l'r. o'} e ctli 1'G1£; COMMERCIAL TESTING & ENGINEERING CO. �1�� .��-�'✓ s Fo CHEMICAL, & GEOLOG.ICAL LABORATORY y��anooenronr TELEPHONE (907) 562-2343 5633 S Street Anchorage, Alaska 99513 Drinking Water Analysis Report for 'f otal Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. # C�� PRIVATE WATER SYSTEM Addross cny SAMPLE DATE: Md =1Z Mo. Day Year SAMP TYPE: Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Special Purpose TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old aj examination ziPcoao to indicate reliable results. jPlease send new sample via special delji, ery mail. i Date Received✓ Time Received t� i ❑ Yeated Water kYUntreated Water I SAMPLE Time Collected No. LOCATION jq Collected Ely 1 L L. A � mol -V11 266r, 111 � �`�n p1 _ T4) 21 3-- JI 4 f I. READ INSTRUCTIONS Membrane i BEFORE Verification COLLECTING SAMPLE Analytical Method: Membrane Filter No. of colonies/100 ml Lab Ref. No. Result' Analyst FFII 93.2980 FT _ IL� m IL II J I�I m BACTERIOLOGICAL WATER ANALYSIS RECORD Filter: Direct Count LSB Fecal Coliform Confirmation _ Final Membrane F!M Results Reported By TNTC = Too Numerous To Count' OB = Other Bacteria (ZAE3 S Member of the SGS Group Coliform/100 ml BGB q Coliform/100 ml _ Date 6 n m PART ONE OF TWO REMAINDER TO FOLLOW ` MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ONSITE SEWER AND WATER FACILITY 264-4720 Application Date /0-'/- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) rz 3Lj '- — Location (address or directions) (b) Applicant Name __JS _('(7A,of _ — Telephone: Home - Business Applicant Address C'�p ---Af Y, c,, : & Ak _`7 y Su '} -,----- (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address.---- -- ---- ----------- ----- Telephone :�`_• r�'�' tel, / 2. TYPE OF RESIDENCE Single-Family)4 Multi -Family ❑ Other—, - Number of Bedrooms — /h' 3. WATER SUPPLY .. Individual Well A Community ❑ Public ❑ 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�l Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, roust have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDINU INSPECTIONS, TESTS, FILE SEARCH, DA r A 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. ECS 5-6 Name of f=irm _—� —.� __----__— Telephone __f— ---� Address ---------------- Date _ _ /O_- 9` 13 5------- --------�-— cue �.,..��•,raSyBs•. cffooa 000aa o oo�u000m o00 0 n �ogs%�eleu ougo caul rv� a tproy C. Reid, j/ o 4� ��Na I No, 22fe7•E �o". 6. DHEP APPROVAL �n til. J 9 /�� .... �i `L•'` _ Approved for s_1zLL�_ bedrooms by�—��.�.�.,�_,-''� Date Approved —/ _—.—.__ Disapprovt� _— C0nditio5l Terms of Conditional Approval CAUTION The Municipality 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 riot responsible for errors or omissions in the j professional engineer's work. Page 2 of 2 72-025 (Nnn) MUNICIPALITY OF ANCHORAGE (MftCIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA)DEPT. Or HEALTH & CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 Legal Description: -S pi -r„1) H)AS 9 7, Z-( 7lzkla3�.1 A. WELL DATA Well Classification _ rrvuit If A, B, C, D.E.C. Approved (Y/N) - Well Log Present A) - Date Completed 9- 1 89- Yield Total Depth 2- s 3 _ Cased to 25) ° Depth of Grouting N1 Static Water Level Pump Set At — N Casing Height Above Ground 1—_ ti ' — Sanitary Seal on CasinT �N) .— Electrical Wiring in Conduitdlti) Depression Around Wellhead (Y/� Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots/°u= To Nearest Edge of Absorption Field on Lot !2 ti ° ; On Adjoining Lots /O011 To Nearest Public Sewer Line .— ^ NI 1 To Nearest Public Sewer Cleanout/Manhole �� t� To Nearest Sewer Service Line on Lot Water Sample Collected by Va_ Date £35 Water Sample Test Results -L' 'C6-'/ _ Comments B. SEPTIC/HOLDING TANK DATA 01 m Date Installed 3 '?'`I -Size y - No. of Compartments Standpipes) _ Air -tight Capsb�) — Foundation Cleanou&/N) Depression over Tank (Y/y Date Last Pumped 9 Pumping/Maintenance Contract on File (Y/N) i for N a - Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N). Separation Distances from Septic/Holding Tank: i To Water -Supply Well - // U ''— — To Building Foundation To Property Line 2U To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course !00_ - Comments Page 1 of 2 72-626(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata do R //— Type of System Design Date Installed 3- '2 6" R Y Length of Field Width of Field -3 - s Depth of Field Gravel Bed Thickness Square Feet of Absorption Area ! 5 `f D Standpipes Present1)N) Depression over Field (Y/61 Date of Last Adequacy Test . Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 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 D. LIFT STATION Date 7r x,,/ To Property Line — 'z0 To Existing or Abandoned System on On Adjoining Lots 3c To Cutbank (if present) Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at �' "Pump Off' Level -at High Water Alarm Level at Tested for Electrical Codes (Y/N) nt (Y/N) during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify thha�at;I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed %//U `h -- Date 0y_ Company iiECS MOA No.ST 8 q p —7 /� �t(�/1'<"i e•*n�oj�p3p Rpt egp�lli Receipt No. Date of Payment �D //— �S S>>R d g 1 ,- Amount:$ CFO mw °�' 4t@� %va+Ie� �y C. Reid, No. 2251•E Page 2 of 2 72-02e (11/84) f�tY \NOEPINpF :z4 CHEMICAL & GE :OGICAL LABORATORIES F 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 TO BE COMPLETED BY LABORATORY WATER SYSTEM: L-1J_� (") See It on back Analysis shows this Water SAMPLE to be: I.D. NO. 9.Satisfactory ❑ Unsatisfactory Water System Name E-7 -G� Phone No. ❑ Sample too long in transit; sample should not be over 30 hours old at examination to Mailing Address Indicate reliable results: Please'send new-- —. sample via special delivery mail. ��. _—__-- City State Zip Code C© Z 5 C 3 �il Date Received SAMPLE DATE: —D Mo. Day Year Time Received = _ SAMPLE TYPE: Analytical Method: ❑ Routine C) Chock Sample (for routine sample ❑ Fermentation Tube with lab ref. no._— ❑ Treated Water Membrane Filter ❑ Special Purpose El Untreated Water SAMPLE NO. LOCATION Collected Collected y� Lab Ref. No. Result* Artal at ek 3 L -- J _- _ L--� QI --_ 4 L - -- J �- _ L- --I Q7 s L_-- ----J -- - L -_el ED �- "Noof colonies/ E00 ml. of No. of Positive Pomona 06.1220 ib1 BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. toes READ INSTRUCTIONS, Membrane Filter. Direct Count _ Collform/100ml Verification: LTB_ --BGB r -- BEFORE Final Membrane Filter Reeulle _—��--_— „�� C Reported 7""'C��_Date_=� _ Collform1100ml C - �S By_� ' v Time: a.m. s COLLECTING SAMPLE p.m. TNTC _ Too Numerous To Count MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) L� 6 641i f -5',`W 1IUCr L�_ 2 iL.) 3Gc1 SES _, 6— r Location (address or direcpions) (b) Applicants Name vE1_1 Telephone - Home Business3i,66•3724'- Applicants Address 1p4.3o :�j!j�cj' JVD('. A-li 9 d% (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer [:�j ; Other [:] (explain); _ (d) Lending Institution Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single-Familyl<�l Multi -Family F:::� Other (describe Number of Bedrooms GL� 3. Water Supply Individual Well y Community E:] Public M 9 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 E:j Community Holding Tank E::j 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] i,� 6�- ,-f: L L s 5. 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 regula- tions in effect on the date of this inspection. Name of Firmt/ rte( Address /l OG ltiI Date .Yd g •� .�_.__.Y�. �W -- (ENGINEER SEAL) 6. DHEP Approval Approved for bedrooms By Approved Disapproved W_ Terms of Conditional Approval. CAUTION Conditional Telephone _-57�/- O<<r7 Ory/ 4 Q���G�Oa oQeoo aopo `��G1a �T g7� o° ao sf—'1{f vy63oo A it Gy C. Reid, Jr. No. 2457E .:v THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAI. PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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. REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTInICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DREP SEAL) RR4/ej/DIB [Page 2 of 2] 7-19-84 MUNICIPALITY Of A'r;Cli„iJ Dear. MUNICIPALITY OF ANCHORAGE (MOA) NOV 2 1984 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 1e F C, A. WELL DATA Legal Description: -:.�.�i �y��, rC� ,--� Well Classification If A, B, or C, D.E.C. Approved(Y/N) 0/4 —_ Well Log Present /N) �_ Date Completed1112L-4 Yield Total Depth J _Q� Cased to:.'_5 /.(a —_ Depth of Grout ing_LL1k,,,e,.., � Static Water Isvel_ --(;”"�_ Pump Set At ----- �;�'� Casing Height Above Ground _—_� Sanitary Seal on Casing 4rL,� Electrical Wiring in Conduit Z 2—M) --Depression Around Wellhead (Y^ Separation Distances from Well: To, Septic/Holding Tank on Lot _>wa �/� On Adjoining Lots To Nearest Edge of Absorption Field on Lot >itid CL) ; On Adjoining Lots_:-' 013� To Nearest Public Sewer Line �`1��j To Nearest Public Sewer Cleancut/Manhole`�Vln, To Nearest Sewer Service Line on Lot t) WaterSample Collected By _'yJG _; Date_ Water Sample Test Results Comments_L&stt_ B. SEPTIC/HOLDING TANK DATA Date Installed �Size /Spy No. of Compartments 2 - Standpipes 2lm) __ Air -tight Caps */N) —_ Foundation Cleanout Q(N) Depression over Tank _(Y 7 — Date Last Pumped Pumping/Maintenance Contract on File (Y/N) HA- : for _"IA Holding Tank High -Water Alarm (Y(N) �')I.A- Temporary Holding Tank Permit (Y/N) NIA- Separation Distances from Septic/Holding Tank: To Water -Supply 6+e11 `%'LvO— To Building Foundation (I U) _ To Property Line 6 To Disposal Field ri' _-- To Water Main/Service Line u— To Stream, Pond, Lake, or Major Drainage Course Comments ,ntidil.2r d<.,'0.2, ns✓t_ a s - Receipt # Date Paid: Amount: [Page 1 of 21 . 2-15-84 L (e t3 2. Jp2ry C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /104 Type of System Design'T�,e,f, Date Installed 3/w,( Length of Field Q3 _ Width of Field 3-35_y Depth of Field Izi Gravel Bed Thickness Square Feet of Absorption Area 4-152qltl� Standpipes Present g% ) Depression over Field (Y& Date of Last Adequacy Test '01A Results of Last Adequacy Test 0(p Separation Distance from Absorption Field: To Water -Supply G\bll yloo'' O To Property Line _ac) To Building Foundation 2 ql To Existing or Abandoned System on Lot N(A- On Adjoining Lots 730 i (''_ To Water Main/Service Lire rile- To Cutbank(if present) AJ To Stream/Pond/Lake/or Major Drainage Course (A, To Driveway, Parking Area, or Vehicle Storage Area COmTentS pal" 6�..SZk' U7 D. LIFT STATION Date Installed )U(A, Dimensions Size in Gallons 'ki Manhole/Access _(YIN) "Pump Ch1" Level at ✓lj(/t "Pump Off" "Level at High Water Alarm Level at P(X Vent (Y/N)_ rUl_ Tested for vJ(A, Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(YM) A)I A _ Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conforrred to all MOA HAA Guice on the date of this inspection. Signed aL L Date c 3C Ccmpa /7FG i �iri� MOA No. 51 <t Grp KBl/d5/s (Page 2 of 21 in effect 2-15-84 4 k uy? CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL. CENTER 5633 B Street II, ) Drinking Water Analysis Report for Total Coliforin Bacteria 5 READ INSTRUCTIONS _BEFORE_ .No. of colomer/100 ml or No. of Po1Nw pon.om 08,1220(b) BACTERIOLOGICAL WATER ANALYSIS RECORD Row. 1953 Membrane Filler. Direct Count Verification: LTB Collform1100ml Final Membrane Filter Results Collform1100ml Reported By -- I _ Date Time: A.M. COLLECTING SAMPLEi p.m. TNTC= Too Numerous To Count 1'0 BE COMPLETED 6 WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: ('1 See It on back An lysis shows this Water SAMPLE to be: I.D. NO. o4 ' Satisfactory —_ C3 Unsatisfactory Water System Name I Phone No. CI Sample too long in transit; sample should not be over 30 hours old at examination to Mailing Address i indicate reliable results. Please send new sample via special delivery mail. Data Received City State Zip Code C I ti I CL I�I�Ir (� _1'Zp/rte SAMPLE DATE: Mo. Day Year Timo Received SAMPLE TYPE: d Analytical Method: G' Routlne ❑`Check Sample (for routine sample with lab ref. no.----) O Treated Water 1:1 Fermentation Tube Mambrane Filter O Special Purpose 4 Untreated Water SAMPLE pC. YI - � O L(o ii L S��A I S I -f t_lC Collected Collected _ Ely Lab Ref. No. Result' Analyst i I ? S, pG i A 1 — _ z--- 3 �— —� -- -- --� EE --- �- -----� --- ,- 1--J EE --- 5 READ INSTRUCTIONS _BEFORE_ .No. of colomer/100 ml or No. of Po1Nw pon.om 08,1220(b) BACTERIOLOGICAL WATER ANALYSIS RECORD Row. 1953 Membrane Filler. Direct Count Verification: LTB Collform1100ml Final Membrane Filter Results Collform1100ml Reported By -- I _ Date Time: A.M. COLLECTING SAMPLEi p.m. TNTC= Too Numerous To Count