HomeMy WebLinkAboutSUNSET HILLS WEST BLK 4 LT 2
NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEAl_TH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~ ~1~1~o4 r~DPORADE
LOCATION
MAILING ADDRES
LEGAL DESCRIPTION
NO. %GROOM8
iF HOMEMADE:
PERMIT N~/b~ / 7
No. of co~___~ments
Inside length Liquid depth
Welt Dwelling PERMIT NO,
Material
DISTANCE TO:
We I Foundation
NO./-~ /~ ~'~°f lines ~/Length of eaSily;ct____ Total length of lines
Top of tile to finish grade Material beneath tile
Length Width Depth PERMIT NO,
Type of crib iameter area
Nearest lot line
DISTANCE TO:
Building foundation Nearest lot line
Depth Driller Distance to lot llne
DISTANCE TO: Building foundation Sewer line Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING '"~
[.ERMIT~ (tO .."~./ "7'
bsorption area(s)
APPRO ED
72-013 (l~l~v, 3/78)
DATE LEGAL
DEF'RRTHENT ~. IqERL..TFI RND EN',/IRONHENI'F~L ,
E~;25 "L." S. Tf'REET, RiqCHORFII,3E., RK. 995~Zd.
2E;4-,4720
F'ERIdlT NO. ,:: ,S':1.02i7 )
EL DORFIDO NORTH
HI.:~I'.,IC: O C I.( PL
RF'PL. I C:RIq'T'
LOC:FFF I CIN
LEG[IL
24:;L:.'L E. 8tB'I'H
1_2 B4 SUNSET HILLS NEST
LOT SIZE 15OO¢3 :SQL.IRRIE FEET
TYF'E OF' SOIL RE:$ORPTION SYS'¥EM IS: TRENCH
MRXIMI..Ihl NUMBER OF BE[:,ROOi'"IS := ~ SOIL RRTING <S64 FT/BR::,=
THE REQUIRED SIZE OF THE SOIL.. RBSORF'TION SYSTEM IS;:
TI,YE LENG"I"FI DIMENSION IS THEE LENGTH <IN FEET) OF THE TRENCH OR E:,RFIIF,ffZlEL.[:,.
THE DEPTH OF FI TRENCH OR PIT IS THE [:,IF.,TFINC:E BETHEEN THE SURI,:FIC::E OF' THE
GRC)UN[:, FiND THE BOTTOM OF THE E:XCR',,,'FITION (IN rE:ET).
THERE It'2; NO SET HI[:'TH FOR TP~ENCHEE;.
THE GRFI',,,'EL. [:'EPTH IS THE MINIMUM DEF'TH OF GRFIVE:L E:ETHEEN THE OUTFFtLI._ PIPE
F4N[:' ]'HE: BOTTOM OF THE EXCFrVR'TION (IN FEET).
PERMIT IZlF'PI_If'SFli'.,IT FIgS THE F?.IESPONSIBILI'f'Y TO INFORM 'THIS DEPFIRTMENT DI...IRING TFIE
tNSTRLLRTION INSPECTIONS OF FINY 14EI,..L.'.S FIL':,JRC:ENT TO THIS PROPERTY l,:li'.,l[:, THE
NUMBER OF: I,'4:ESIDENCES TIqFIT THE I-,.IELL I.YILL SEI;:':',?E.
E~FICKF:'ILI_ING Cfi-- laiqY S¥S'rEM HI'FI,-IOI,JT FINRL INSPECTION F~ND
DEPRRTMENT I.,I.ZI...L BE SIJB..fEE.'T TO PROSECUTZON.
FIPF'I;?.O',,¢FIL BY THIS
MII'.,IIMUM ['.,IL-];TRNE:E I..::ETHI,EEN g I,.IEI_L RN[:, FINY OI'.,I.-SITE SEI.4RGE DISPOSFIL SYSTEM IS
J..00 FEET F'OR g PR:['¢FKrE kIEL. I_ 0R ::1..50 TI,] 200 FEET FROM FI PUBLIC HEI_L. DEF'EIqC, II'.,IG
UPON THE TYF'E I,]i.: F'UI,~':LIC HEI_L.
MINIHUM [:,ISTRNCE FROM g F'F~:I'¢RTE I,.IELL TO R F'RIVRTE SE,~4ER. LINE IS 2.5 FEET RNI'::,
TO R COMPIUI'YI],'Y SEI,I,ER LINE IS 75 FEET.
HEL..L LOGS RRE REQUIRED FINI,) MUST BE RETURNEr:, TO THE E:,EF'FIF~rTFIENT HI],'HIN S~O DRYS
OF THE I.YEL.L COi','tPLETION.
OTHER REQUIREMENTS MRY FIPPI...Y. SF'ECIFICRTIONS gNP E:ONSTRUCTION DIFIGRFIMS ARE
F:I',,,'R ILRBLE 'TO INSURE F'ROPER INSTFtLLRTION.
F:'E.] [;~:11-.1 ][ "f" E;::-=:F" % If~:E :~; [::,[:_; C:E I"IE:E::FY..' ~: J .....
I C:ERTIFY THFIT
1: I gM Ff:IMILIRR I-4I"rH THE F?.EC..!UIREHEN],'S~
FOR],'H E:Y THE HI.JNICIPRLITY OF RNCHORRGE.
2.: I .bllLl_ INS;TRLL THE SYSTEH IN RCCOI,;.'.DFINCE 1.4ITI'-I TI,..IE CODES.
3:: I LINDERSTFIN[:, I],-IFIT TI.YE OI'4-SITE SEHER S'¢S'T'EM MRY REQUIRE ENLRRGEF'IENT IF'
RES;IE:,ENCE: IS REI"IODI,ELED TO INIgLLIDE [,lORE THFIIq 3: E~E[:,ROONS.
FIf:'F'L I C:FfNT EL.. DORFI[:,O NORTH
]
FO[,;.'. ON-.SITE SEHERS RN[) HELI_S RS :SE]''
1"HE
V4. 0
MUNICIPALIT~OF ANCHORAGE
DEPARTE/IENT OF HEALTH AND ENVI RONNIEN'rAL PROTECTION ~7~ PERCOLATION
SOILS LOG- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
5
9
SLOPE SITE PLAN
14 - o c-e., o..~
18~
2O
WAS GROUND WATER iS.
ENCOUNTERED? /~(~ ~
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
~ ~ - ?., I,. /0:3o .~;~, 3.0o/ .,~,
· ~ .~-~/
;~3 ~.o'~
(~ II: I-~ ,'0 'Z.,~ / ,14
PERCOLATION RATE L ~"~' (minutes/inch)
TEST RUN BETWEEN~ ~',. FTAND ~ FT
?..,~,~, z'? .~"~ --x. ~ ,.,~r~-'~..~ ~ ~/?~x~¢/,~'~', .
.
CERTIFIED BY: . .
72*008 (6/79)
gETURN TO: Division of BeologJcal and ~ ilcal Surveys
, 3001 Porcupine Drive (Tele~ e~ ?.77-6615)
STATE OF ALASIg~,
DEPARTMENT OF NATURAL RESOURCES
U,S,G,S, Local Uo,
Drilling Permit No.
, -- ~] Industry
~A~ve ~6elou land surface
.... I0, PUHP[NG LEVEL belo~ la~d surface
MUNICIPALITY OF ANCHORAGE iz. GAOUTING: Well Grou~ed: ~ Yes
'~"JJ~Jv~J~W~L P,~U[LCIION -- Material: ~ttea~ ~e~nt [~ Other:
V ~ ~ ~Jet ~0ther:
MUNICIPALITY OF ANCFIORAGE
DEPARTMi"NT 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.# (,\~,--,~()'} .'~,)
1. GENERAL INFORMATION
Complete legaldescription /.eT 2. '~.k' ~
Location (site address or directions) I~l~E~. }L4_N(.;~¢~< ~g
/JNcll.
Property owner ~eN ~8~ Dayphone
Mailing address ~ll~ ~L~NCoCk ~ ~c~ , AK ~ff5
Lending agency ___~'T ~ HO~ ~ Day phone
Agent_ NoN~ Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2, NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well ~
Community well
Public water
If communify well system, provide written confirmation from State ADEC arrest-
ing to the legality and status of system.
TYPE OF WASTEWATER I::)ISPOSAL:
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.
STATEMENT OF INSPECTION BY FNGINEER
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 _ F L l-r"r or* l'g Cl-I S~/C_~ Phone
Address _ 1~53LO ~2¢_~0 ,ST ~N~C~-I, ~t-~ c/¢/~5-_l/~
Engineer's signature ~~ ~ ~ Date I¢/7/9z ''
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) iss[les 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 DH HS 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. 1191) Back MOA/121
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Z,o'[ 2, ~LI4 q, SuN.ce~r t~l/.~.$ 1,¢~T Parcel I.D.
A, WELL DATA
Well type P~i
Log present (Y/N)
Total depth J 80
Sanitary seal (Y/N) __
If A, B, or C, attach ADEC letter.
ADEC water system number _
Date completed (¢/2~//:~1 Driller FOSS
Cased to I ~0 Casing height_lq ¢(
Wires properly protected (Y/N) "//
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
AT INSPFCTION
[ O g.p.m. _ ~ 5,(0
MUNICIPALITY OF ANCHORAGE
[:N'CI~C)NMENTAL SERVICES DIVISION
OCT O 8 1992
_ g.p.m.
REC[!IVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot loc ' d-o ~, o.
Absorption field on lot ~: I L~' ~
Public sewer main ~ le°~
Public sewer service line
; On adjacent lots ~/oo
; On adjacent lots
Public sewer manhole/cleanout >'leo
Petroleum tank
WATER SAMPLE RESULTS:
Coliform O ¢¢,f ~ICOm( __ Nitrate z.. o, lmm' ~/-.~ Other bacteria
Date of sample: c~/2:z/ ~/2 ,, I~'/117 Z Collected by: ~'L,~'FI~P T£Cl/
B, SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N) Y
High water alarm (Y/N) I1,/~,
Date of pumping ¢]/ 8¢~/9 8
_Tank size Ioo0 ~/~L Compartments
Foundation cleanout (Y/N) _ N Depression (Y/N)
Alarm tested (Y/N) N.~.
N
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /o0 ' ~,h~r., ¢ PA_On adjacent lots
To property line ~ 3o Absorption field
Surface water/drainage
~. /OO Foundation
'~ Water main/service line
72-026 (Rev. 3/91) Front MOA 21 CONTINU ED ON BACK PAGE
C. LIFT STATION N, 4-,
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed /-~l'~ff/~l Soil rating !-/s ~"/~¢H
Length ~2 ~ I '
Width ,~ Gravel thickness 7
Total absorption area S ~ ~ ' Cleanouts present (Y/N)
Depression over field (Y/N) ~ Date of adequacy test
Results (pass/fail) ~4S$ for 3
Peroxide treatment (past 12 months) (Y/N) NONE. I(~.~wN OF
System type
Total depth
If yes. give date H.A.
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~'
TO building foundation
On adjacent lots_
Surface water
Curtain drain NON6,
On adjacent lots_ ~/OO Property line
To existing or abandoned system on lot N ,,~,
Cutbank t4,f~, Watermain/serviceline ~ 50
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guideline~e]~C'b__ ~.ff~,.date of this inspection,
Signature %~. ¢~ g' ~ "'~¢--' ~ '* "~' ¢
Date 10/7 / ~ ~ ~... CL- ~5~ · ~,~ .~
HAAFee$ ?~x(~ o ~
Waiver Fee: $
Date of Payment /¢- (~..?~3~ Date of Payment
Receipt Number ,2. ¢7/,/zp/.~ (,¢-(5'~,~ Receipt Number
72-026 (Rev. 3/91) 8ack MOA 21
)NICIPALIT~/ OF ANCHORAGE DEPT OF -EALII-I &
MUN'FCIPALITY OF ANCHORAGE (MOA~NVIR°NM~NTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) A~J~ ~ 0
WELL DATA Legal Description:
Well Classification 1~.~ If A, B, c~ C, D.E.C. Approved(Y/N) ht//er _
Well Log P~.esent .(Y/N) '~ Date Completed ~/~%//~ / Yield__ [ 97m4
Total Depth · ~ ~O _ Cased to ~ ~(2) Depth of Grouting N
Static Water Level ~(D Pump Set At {-)~ ~u-~ _
Casing Height Above Gzround__ ~9 ,I Sanitary Seal on Casing (.Y/N.)...%/--
Electrical Wi~ing in Conduit (Y/N) )F _ Depression Around Wellhead (Y/N)
Separation Distances f=cm Well:
To Septic/q{olding Tank on Lot [ ~ ~ ; On Adjoining Lots IO~
TO Near. st Edge of ~so~ption Field on T~ot__ ~ I,~ ; On Adjoining Lots
To Neap, est Public Se~r Line ~%///~ To Nearest Public Sewer
Cleancut/Manhole ~/A To ~a~zest Sewer ~rvice Lir~ on lot
Ware= S le Collected 7T._¢
water 'S~ple Test ~esults $ ~; ~ ~=4~ ~ ~
Cc~remts
B. SEPTIC/HOLDING TANK DATA
Date Installed ~/~//
Standpipes (Y/N) ~/
Depression eve= Tank .(Y/N)
Size I0 ~) 0 No. of Cc~partu~nts ~
Air-tight Caps (Y/N) / Foundation Cleanout (Y/N) ~
~ Date Laet Pumped '~/I.,~/~. ~
Pu,~oing/Maintenance Contract on File (Y/N)~//~ .; for
Holding Tank High-Wate~ Alarm (Y/N) ~V/l.% Tempo~aL, y Holding Tank Permit (Y/N)
Separation Distances f-~c~ Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course N 0
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Cown~nts
[Page 1 of 2]
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed__~/~/
Width of Field ~
Square Feet of Absorption A~ea
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness 7
Standpipes Ihtesent (Y/N)
Date-of Last Adequacy Test
Separation Distanc~ frcm Absorption Field:
To Water-Supply Well ~ To P~operty Line
To Building Foundati6n
Lot N O
TO Water Main/Service Line
To Stream/Pond/Lake/c~ Major D~ainage Co~mse
To D~iveway, Parking A~ea, c~Vehicle Sto~age A~ea
; On Adjoining Lots ~d) lu
To Cutbank( if present)
To Existing or Abandoned System cn
Co~a~nts
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Ala~mLevel at
Tested for
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
"Purap Off" Level at
Vent (Y/N)
Pum~)ing Cycles du~ing Adequacy Test.
Meets MOA
C~nts
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, o~ conformed to all MOA
on the date of this inspe, ctic~.
si. ed.
Company 'r~k~ ~%;f'k(~ P~ MOA No. ~"
KB1/dS/s
[Page 2 of 2]
2-15-84
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET
ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX:(907)561-5301
ANALYSIS RESULTS for INVOICE # 58695
Chemlab Ref.# 92.5186 Sample # I Matrix: WATER
Client Sample ID
PWSID
Collected
Received
Preeerved with
2/4 SUNSET HILLS WEST REAR HOSE BIB Client Name :FLATTOP TECHIIICAL SRV
UA Client Acct :FLATTOT
SEP 22 92 @ 11:3.5 hrs. BPO# : PO# :NONE RECEIVED
8EP 22 92 ~ 14:30 hrs. Req~ :
AN REQUIRED Ordered By :
Analysl~ Completed : SEP 23 82
Laboratory Nuper~,~PHE~ C. EDE
Send Reports to:
I)FLATTOP TECHI{ICAL 8RV
Parameter Resulte Units Method Allowable Limits
NITRATE-N ND(O.iO) ~g/1 EPA 353.2/300.0 10
Sample ROUTINE SAMPLE COLLECTED BY: CNRIS.
Rer~rks:
i Tests Performed See Special Instructions Above UA=Dnavailable
ND- None Detected '* See Sample Remerks Above
NA- Not Analyzed LT-Less Than. UT-Greater Than
Member of ,ho SGS Group (SO¢'OtO ~.~r~,o cie Surve{Hance)
COMME~
CHI
IAL TESTING & ENGINiEERING CO. AK DIV
~ y
[ICAL & GEOLOGICAL ~LABORATOR
· 't. EPHONE (007) 562-2343 5633 B Street
Anchorage, A~aska 99518.
Drinking Water Analysis Report for Total Coliform. Bacteria
TO BE COMPLETED BY
[] PUBLIC WATER SYSTEM I.D. # I~
'~ PRIVATE WATER SYSTEM
SAMPLE DATE:
Phone No.
Day ~ Year
SAMPLE TYPE:
[~ Routine
Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
SAMPLE
No. LOCATION
4[
) [] Treated Water
'~Untrseted Water
Time Collected
Colleeled By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
/~Satisfa~ory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over :30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received [~ t ] [.~-~-~
Time Received . .I L~,~-"~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No.
I
I
I
Result*
yat
READ iN.~RUCT ONS
BACTERIOLOGICAL WATER ANALYSIS RECORD
BEFORE
COLLECTING SAMPLE
Membrane Filler: Direct Count
Verification= LSB
Fecal Coliform Confirmation
Final Membrane Filter Results
Reported By
TNTC = Too Numerous To Count //
OB = Other Bacteria
BGB
(~ Coliform/lO0 mi
Date
(~llform/lO0 mi
a.m.
p.m.
~ ~'~ Member of the SGS Group (SociOt~ GOn~,rale de Surveillance)
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)
Location (address or directions)
(b) Applicants Name _[y~__~_O_~
Applicants Address
Tele~)hoae - Ilome Business
(c) Applicant is (check one) Lending Institution
i7--7; Other sxplain);
(d) Lending Institution
~]----1" Own er~br~i"id~r [~"
Telephone
Address
(e) Real Estate Co. & Agent
II II
Telephone ~t- '~,
(f) Mail the }~A to the following address:
2..lj_yp_e of Residence
Number of Bedrooms
3. Wa t e r __S _uj)~j~y.
Individual Well ~..~ Community ~[ Public
Note: If community well system, must have written co~firmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage D_~s_~o_0js_a_l-
Onsite ~--_.[ Fublic I-7 Commu. ity ~-~ Holding Tank
Note: If community well system, must 'have written confirmation from the State
Department of Environmental Censervation attesting to the legality and status.
[Page 1 of 2]
5. Engineerin$ Firm Providing Inspections. . .... ~ Tests~ ..... File Search~__D. ata 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 Anthority 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
ordinances, and regula-
system is in compliance with all Municipal and State codes,
tions in effect on the date of this inspection.
Name of Firm T~t~ ~ ~'~_~ ~{~_~.~7
Address
Date
(ENGINEER SEAL)
Telephone
DHEP A~proval
Approved for
Approved _~__
Terms of Conditional Approval
CAUTION
THE I~JNICIPALITY OF ANCHORAGE DEPARTblENT OF IlEAl,TH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HF~ALTlt AUTHORITY APPROVAL CERTIFICATES BASED SOIJ~LY UPON TIlE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY A~I INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THIe. STATE OF ~LASKA. THE DIIEP DOES Tills 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
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIOb&kL ENGINEER'S WORK.
(DttEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19-84
d~ CHEMIGAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
WATER SYSTEM:
Water System Name
Mailing /~fdres$
City
SAMPLE DATE: ~
Mo. Day Year
SAMPLE ~PE:
~Routlne
~ Ghook Oamplo {for rouflno aamplo
wtth lab roL
~ Spoolal
State Zip Code
[] Treated Water
)~Untreated Water
SAMPLE
NO. LOCATION
Time
Collected
Collected
By
saalysis shows this Water SAMPLE to be:
tisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination to
indicate reliable results. Please send new
sample via special delivery mail,
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
~, ~embrane Filter
Lab Ref, No. Result* Analyst
06.1220 (b)
Rev, 1983
BACTERIOLOGICAL WATER ANALYSIS RECORD
[.:lEAD INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter: Direct Count ............. Coilfonn/100ml
Verification: LTB BOB
Final Membrane Filter Results
Reporled
Time:
TNTC== Tee Numerous To Count
Co[Iform/100ml
ANCHORAGE, ALASKA 99501
CONSULTING ENGINEER TELEPHONE: (907) 279-3916
LEONARD HYDE
COLDWELL-BANKER, gACK WHITE CO.
3102 C STREET
ANCHORAGE, ALASKA 99503
AUGUST 20,1984
SEPTIC SYSTEM ADEQUACY
'rEST
LEGAL
LOCATION
OWNER
RESIDENCE
WATER SYSTEM
SEPTIC SYSTEM
DATE OF TEST
TEST PROCEDURE
TEST RESULT
LOT 2, BLOCK 4,SUNSET HILLS WEST
14144 HANCOCK DRIVE
JOHNSON
SINGLE FAMILY, THREE BEDROOMS
ON SITE WELL
FROM MUNICIPAL RECORDS:
TANK: 1000 gal. Greer Steel
ABSORPTION SYSTEM: Deep trench,42 feet
long, 7 feet of rock
ABSORPTION AREA: 588 sq.ft.
SOIL RATING: 175
INSTALLATION DATE: April 1981
8/1!5/84
Dra:i. nfield was charged with water at a steady
flow of 6 gpm. A total of 450 gallons of
water was added no the trench. At the begmn-
ting ef the test the water depth in the sump
was 17 inches. After adding 450 gallons of
water the water depth was 37 inches. 2.5 hours
later the water depth was measured again. At
this time it was 23.5 inches. 320 gallons
of water has been absorbed by the system.
This system meets the requiremen'ts of the
Municipality of Anchorage as of the day the
system was tested. There is no quarantee that
the system will continue to meet these requi-
rements. The operational life of all septic
sysnem depends on the local soil conditions,
groundwater levels that may fluctuate during
the year, and the water usage of the family
being served by the system.
CONSULTING ENGINEER TELEPHONE: (907) 279-3916
LEONARD HYDE
COLDWELL-BANKER, JACK WHITE CO.
3102 C STREET
ANCHORAGE, ALASKA 99503
AUGUST 20,1984
RESIDENTIAL WELL INSPECTION
LEGAL Lot 2 Block 4,Sunset Hills West
LOCATION 14144 Hancock [)rive
OWNER Johnson
TYPE OF WELL
Residential
WELL LOG available Yes
INSTALLATION REQUIREMENTS MET Yes
WELL YIELD FROM WELL LOG 1 gum
DATE OF TEST
August 15, 1984
TEST PROCEDURE
On August 15 the well was pumped at a rate of
6 gpm. for a total time of 75 minutes. A
total of 450 gallons of water was pumped from
The well. The water level in the well was 65
feet below the top of the casing a5 the start
of the ~es~, but could no~ be monitored
during the test due to obstructions in the
well.
TEST FOR COLIFORMS The well water was tested for Coliforms on
August 15, Test was negative.
TEST RESULTS
This well meets all the requirements of the
Municipality in effect on this date. This
assessment of the condition of this well
applies only to the conditions as of this
date. The flow ra~e of the well may change
due 'co subsurface conditions [:hat may not be
observed from the surface, changes in land
use and other factors that may impac~ the
conditions of the aquifer feeding the well.
CHEMICAL & GI~,.~OGICAL LABORATORIES (,.~ ALASKA, INC.
TELEPHONE (907)-279,4014 ANCHORAGE INI)USTRIAL CENTER
/~'~ 274-3364 §633 B St re et
'",X Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATE. SYSTEM: I-II I I I--I
I.D, NO.
Water System Name Phone No.
Mailing Address
City
Mo. Day
SAMPLE TYPE:
[3 Routine
[3 Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
State Zip Code
Year
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
4I J
'rime Collesled
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
' []i. Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
[] Membrane Filter
Lab Ref. No. Result* Analyst
I FT-]
J
J
*No of colonies/100 mi or No. si Positive pol~ions
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLF
06-1220 (b)
Rev.]978
BACTERIOLOGICAL WATER ANALYSIS RECORD
825 "L" STRLET
/',NC}IOIRAGE, ALASKA 99501
{907) 264 4i II
September 10, 1981
Don Mouser
% E1 Dorado North
24].1 East 88th Avenue
Anchorage, Alaska 99502
Subject: Lot 2 Block 4 Sunset Hills West Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following J terns ]lave been
completed:
(1).6 The water analysis report needs to be submitted to
~ ~/7thzs office from the Chem Lab, 5633 B Street,
.... "~J~/ for our review.
m(2),e~A well log submitted to this office for our files
.~/~5~ld review.
(3) The depression around the well casing needs to be
filled in with impervious type soil so that it
slopes away from the casing. This will need to be
re-inspected by this office when it has been completed.
If there are any further questions, please call this office
at 264-.4720.
Sincerely,
James S. Roberts
Associate Environmental Specialist
JSR/ljw
cc: IIome Federal " '
Savings and Loan
535 D Street 99501
DATE
I NSPIE'CTION APPOINTMENTS
INSPECTOR
DATE RECEIVED
TIME
DATE
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH&ENVIRONMENTALPROTECTIOI~EPT OF EALT &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL i'J~OTECTION
ENVIRONMENTAL SANITATION DIVISION SEP ~5 /981
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~I~(~.~ ~1~.'~1~
DIRECTIONS: Complete all parts oil page 1. Incomplete requests will not he processed. Please allow ten (10) days for processing,
AILING ADDRE~
L~ OPERTY R ESI DENT {I f diffe~i~4~m above)
PHONE
PHONE
PHONE
fBUYER
AILING
ADDRESS
,, .
4. REALTOR/AGENT
PHONE
PHONE
MAILING ADDRESS
LEGAL DESC",PT,ON
6, TYPE OF RESIDENCE }-~ , NUMBER OF~BEDROOMS
~"~ ~ One ~ Four
~ SINGLE FAMI L¢~ ~ Two ~ Five
~ MULTIPLE FAMILY ~ Three ~ Six
[] Otner
7. WATER SUPPLY
,~ INDIVIDUAL* ~ ATTACH WELL LOG. Awel Iog is required for a wells drilled
[] COMMUNITY since June t975. For wells orilted orior to that date. give well
[] PUBLIC UTI LITY depth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** ~ (~/ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
E]--~N G L E FAMILY [] ONE E~'~TH R EE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. ~TER SUPPLY
E~ INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~qq'~Dt VI DUAL/ON -SITE
Connection Verified INSTALLER ~ " ~,¢~
Size:~ If Tank is homemade 8OILS RATING
give dimensions:'¢ ' / ~ ~
TYPE OF TANK ~ MANUFACTURE~..~
4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
I
Absorption Area to nearest Lot Line
5. COMMENTS
~ROVED FOR BEDROOMS
~ CONDITIONAL APPROVAL (letter must accompany certificate)
~ DISAPPROVED
72-010 (Rev. 6/79)