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HomeMy WebLinkAboutTANAINA VALLEY LT 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Add~ess ~,,,~,,, ~ TANK FIELD WELL Pl~one(s) Permi, NO~ C~OO~ ~ of Bedrooa, s WELL I~fA ~[ALLEv FOUNDATION Township, Range, Section AS-BUILT DIAGRAM (Show Iocabon gl well, septic system, property lines, Ioundation~ TANK8 _ Manulacturer CapacUy in gallons Meterial NO of Compadments TYPE OF SYSTEM ~ TRENCH ~ BED ~ W, DRAIN ~ OTHER original g~ade ~ FT ~ FT Fill added above original grade Gravel depth beneath pipe ~ FT ~ FT ~a' absorplio, area D~8,~nce be,ween lines ~: '~5 //~ SO FT L WELLS ~ PRIVATE ~ OTHER (Identify) REMARKS: InspecSons Pedormed by: Municipal and Slale guidelines I. effect on Ibis dale' I/~ J ~ ¢ , , , Heallh Depadment Approval: . Date: ::,. 72-013 (3/85) M kl IA I C I F> A I.... I '[' Y (] F:' A N C I"1 [] R A G I!:~ Depa['tmen'L c~t Flealtl'~ & Humarl Set. vices 8,'..::'.[~:; I. S-t.l-(~:~c~-L, Ar"rc:hclr, al.:.l(..:.!~, A:l.a!_=fl.::a 995011. ::f!;43-~q;/-¢'i:~O' 0 N .... S ]: T E S Iii: IAI liE[ R P E R M I T t:::'e[,mJ.t Numbel' .' 890()C)9 Dal'.~a I !i!~!i~(~:el:.!: () :1./,'.2.6 Name: DENAI...I ,':!~UPF:'[..Y :I:NC,, (/IqCI~IOF:/CaGIE, Al< 995:1.~] Day F'hone: 3/.I. 9 '.-[!10 14 F:'ar' i::: e 1 I d ::() J :1.'-'05:1 "' 76 IciL L ~!l..ja :t. II SuI::)I::I :i. v :i !'i~ :i on :: f'ANA ]i NA VALLEY I..ot'. ~I 1 ~::~ 11::~l::: k [ Sect ~ on :~ 4 Townsh :i. p II 12!ff,I Ranl~.:le ,", 4W I..o'~' S:ixi~:, :5:]7:11 (sq. fl:.. c~" a¢::P~':~,s) Max )::h:~dr'c)c, ril!:~: I"h:i.s Pel".m:i'l:.~ 4. 1"ora:l. Cal:~a¢::b'Ly~ 4 DI.:?I:rLI"I 'Lo 'fop c)F s,:-.~l:)'L:i.c tank(s) < 4,() '1"11 I S I:!'ERI"!]:T :[ S A RE ]:SSUE C)F liiXI::':I:RED PERM ]:T 880206 :!: CERTIF:'Y I]..IA'I'~ 1., :1: am ['am:i].:bal' ,,,~:i.'l:.h 't:.l",ex, I"~:,,)qLlJ. P6)IfI(.,gr'yI:,E~ [or'tl~ by 'Lhe Mtu'liCil:la].:kCy o[ ArH::hc:mage (MOA) and 't:.l"te State of' A:l. asl.::a~ ~:'., :1: ~:i:l] :i.n~FLal]. t'.116~ system in ac:c:cn-danc:e w;['t.h ali MOA c:c~ch~s and r'egu].at:i, cins, and J.l'~ (::c)ffll::i].iarlc:lx, ~J.'Lh Lhe design cr'i't'.er':ia :}~,, I ~,,~:i.].]. a(;:ll~(..)l-~'.) 't.o all MOA and S'La'[.(.,:~ (]~' Alaska i"~:~qLiJl'em(:)r]L~ ~'CH" '[.l"~e sca'I, bac:k unicip lity of nchora ¢ Department of Health and Human Services Tom Fink, 525 %" Street Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 Denali Supply, Inc. 7021 Driftwood Place Anchorage, Alaska 99518 Subject: Lot 1 Tanaina Valley Subdivision Permit ~880206, PID #011-051-76 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1988. P~rmits 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 this Department for close the permit. the well, a well log needs to be sent to documentation of the installation and to 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. When applying for a new permit, the fees are: $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, Daniel J. Roth Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit I:'1:! F< I!:BI[:~ ! NI:i!:IEF/S L)ES 1 [:)lq .( NST{~I..I... ~() ' JIF 5 ' M :1: DE 'YF;I!i:I~.K:;I'I 14:1:1 H /1. ' Gl ,h"f,,&il Y"I¢~X :1: PILIIq [:)IEF' III 8 ' ,, Ixll3 I' ]:F: Y ]:)I'll I!iil F:'F,: ~: (:]1::~: I'l::t [i;~:~1]:',1't Z N!BF"IEE', I' tii X I :' .I I d:i;~i'~ I: I:;[:1'< I',[ F:Y Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:. ~/~f~x/~ /~/ I,,//J~',/~ DATE PERFOI LEGAL DESCRIPTION: A' / I ~_~ ~! 2 4 5 6 7- 8- 9- 10- 11 12 13 14 15 16 17. 19- 20- COMMENTS Township, Range, Section: ,~//',~/. / (7/// S LOP E SITE Pt_AN WAS GROUND WATER I;NCOUNTER ED? IF YES. AT WHAT DEPTH? tl i Date Gro~ Na~ I nePth to Net Reading z ~ ~ /3" /,, :~ /,~ 7 f z" I" ,I zo ? M" /,, ~- T.~ / /~" /' _ fi:oB 4.7¢ PERCOLATION RATE TEST RUN BETWEEN 7 .. [mmutes/~ncn) PERC HOLE DIAMETER ..~ /' / ,I ~ ~::l './ /? / ~ /,. ~ PERFORMED BY: . :'~) /ge)~/;-///OdJ~?',/ I 4')'~'j'/)&'[' L--~ /~/JJ~J'0/~IcERTiFY THAT THIS TEST WAS PERFORMED IN 0 d. ?_1 I ;5 UJ :3 16 ? ~0~ if. 8 14 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. ~ GENERAL INFORMATION Complete legal description '1' I Location (site address or directions) Property owner ~'~/2 ~TE..h,x,]~,~-~ Dayphone Mailing address ~ L~ Lending agency ~[~¢~ Agent ~L ~OO%~% Day phone Address Z~ ~~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA s~.uat.u LUOO leUO!l.!ppv :suo!l.,elndp, s 6U!MOIJOj eLI~. q~,!M 'SLUOOJpeq 'SLuooJpaq JOJ. leAOJdd,e leUO!l!puoo 'peAoJddes!a .loJ. pa^o.Jddv % ,I:in.LYN~DIS SHHO '9 'uo!l. oadsu! s!q~. jo al,,ep alp, uo loaJJa u! suo!lelnSeJ pu,e 'seou,eu!p.Jo 'sapoo al,elS pu,e led!o!unbl II,e LII!M aou,e!ldLuoo u! S! UJa~,S,~S lesods!p .JaleMelSeM .~o/pu,e/~lddns .le:l,eM el!S-UO aLi:J 'uo!~.oedsu! pu,e uoR,e~iSaAU! ,~LU UJO.JJ. pue Sel!,L e6eJoqouv ,to Xl.!led!olun~ eLl~. LUOJ~L pau!eiqo uo!l.,euJJoJu] alii UO paseq l.,eql. ~J!JaA Jaq:lJ nj. I 'u!a.,ali paieo!pu! aJ nlon..l~.s ,to edXl pue suJooJpaq J.O .Jaqtunu alii .IOJ. e:!.enbape pue leUO!lOunJ. 'at'es s! t.ue~.s,~s i,esods!p .lm,,eMels,eM .Io/pu,e ~lddns Ja!.,eM el!s-uo aLI1. l'eq~. SMOLIS uo!l, eo!ldde leAoJddv ~lpOLp, nv qlleeH ,elL.il. ,to uo!l,eS!l. SeAU! XuJ 1,eqi ~J!JaA I 'MOleq UMOqS e].,ep UOll,ep!l,eA aql JO s,e pu,e o~.e,leq pax!JJe I,eOs ~uJ Xq pe!J.!lJeo sv I:F:I::INIE)N:I A8 NOI..LO::IdSNI 40 J.N:It/~I~/¥/S Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL. CHECKLIST A, Well Data Well type .~.ott~ttt~\%'--~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth ---, Sanitary seal (Y/N) Date completed ~ Driller ~ Cased to -- Casing height Wires properly protected (Y/N) ---" Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/hc[dln0 tank on lot ~oO~ + Absorption field on lot -'"--' Public sewer main ~/-~, Sewer service line W ] ~, FROM WFLL LOG AT INSPECTION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~, WATER SAMPLE RESULTS: Coliform 0 ..,~/' L Date of sample: ~2~.! ~-/ Nitrate O, ~.O ~,,~ / ~, _ Collected by: Other bacteria B. SEPTIC/HeEBiN~ TANK DATA Date installed / -- 2~ ~ ,~.~c~ (~) Tank size ~ 2-. ~' (:~ ® Compartments ?--. Cleanouts (Y/N) ~ ~ Foundation cleanout (Y/N) _ '~' q~ Depression (Y/N) High water alarm (Y/N) ~//(~, Alarm tested (Y/N) ~/,~ Date of pumping \\.. ~,. o~j Pumper /%,¥' \-\Ora, E. ~-~:~'~C~% SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ [ ~- On adjacent lets f-~./~ Foundation I 0 TO property line ~.0~ ~ d~ Absorption field %'~ ~ Water main/service line Sudace water/drainage kl ~.. ~.'V ~ P~'~ ~' 72-026 (3/93)* Fro~t CONTINUED ON BACK PAGE O..,FTSTAT,O. Date installed Size in gallons Vent (Y/N) N / IA' "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer ~/~ Manhole/Access (Y/N) "Pump off" Level at Cycles tested ~ / {~ SEPARATION DISTANCE FROM LiFT STATION TO: Well on lot ~ / ~, On adjaoent lots Surface water D. ABSORPTION FIELD DATA Date installed I ~- ~' -' ~, e~ (~) Soil rating (GPD/FF) IA ~' (~ System type Length ~,~ t ~' Width ~ I <~) Gravel thickness ~-~ ~ ~ Total depth Total absorption area ~.~© F-~ ~' (~Cleanout present (Y/N) "5' q~ Depression over field (Y/N) Date of adequacy test I¢-~ ~. ~ 5 Results (pass/fail) ~'~. for ~ Bedrooms Aftertest ~ Z./1 ~-' ~ If yes, give date'~r'7~'/~-~t Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) .~ q3 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot h-.J/~ On adjacent lots ~ / ~:~ Property line To building foundation ~..~ ~ ~ To existing or abandoned system on lot On adjacent lots ~'[ ~" -t- ~; ~ ~ Cutbank ~ / ~ Water main/se~,ice line Surface water Curtain drain Driveway, parking/vehicle storage area E, ENGINEER'S CERTIFICATION I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature -~-'~'~-~£, '~'~--'~ Engineer's Name Date ~ HAA Fee $ Date of Payment Receipt Number __ Waiver Fee $ Date of Payment Receipt Number 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.# ~_~\ --* ("~-~\-~ '~,t~ HAA# '~ 1. GENERAL INFORMATION Complete legal description LoT I T2,-~A-I/,~/~ Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent ~ Day phone Day phone Day phone Address ~,~¢'~¢-- Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Individual well Community well ¢ Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirmk~l~/4 ?,~uK.,,vJ d-o/d~u~r~14 ~d~,~-~ Phone Address ~o~ ~. ~ ¢ lo~ ~ , A~C~o~A¢¢/ ~ ~01 Engineer's signature ~~ .~ Date Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~725 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo'~- I -f,Z~A I~/&- ~'AL~LE'r SuC'dParcel I.D. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Driller Cased to _Casing height Wires properly protected (Y/N) Date of test FROM WELL LOG AT INSPECTION Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/deN~j tank on lot ~Oo ' fi' (~) Absorption field on lot Public sewer main ~/A Public sewer service line t4/~ g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ,7_~ (_ SEE' A'Ff-A~ther bacteria O Collected by: C.H.I .,~ B. SEPTIC/I:[~2[~2i;I~ TANK DATA Date installed I~ 4- ~cf (~) Tank size 12-~O ~ ¥ 0 Cleanouts (Y/N). Foundation cleanout (Y/N) High water alarm (Y/N) /'4/~, . Alarm tested (Y/N) Date of pumping ' .~.-12--'~/"L. ('S~E ¢-~.~.~?T SEPARATION DIsTANcES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t¢ /~ On adjacent lots f{ /,~' To property line (~o ~ 0.~ Absorption field --~' (~) Surface water/drainage No~C- Ekh0F./'3T (~ 72-026 (Rev. 3/91 ) Front MOA 21 Compartments ~2_ Depression (Y/N) N/,~ Foundation I 0, ~ ' 0 Water main/service line '~.~L ' CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) ~ High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at 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 [- ~-- ~ °i (~ Length ~'O~ Width ~ (~) Total absorption area (oeo (~) Depression over field (Y/N) N (~ Results (pass/fail) ~,~S~ Peroxide treatment.(past 12 months) (Y/N) o~,.4~'¢. I~0~cA~9 HO Soil rating I ~-% Q System type O~Jl Gravelthickness z~-~ (~) Totaldepth Cleanouts present (Y/N) Date of adequacy test ;J-/8 _c/'Z, for 'dr' If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot 5-1 /A. On adjacent lots /,4 /.4.. Propertyline To building foundation 2_'~ ~ (~ i~.,t,+_ To So.~* d3 TO existing or abandoned system on lot On adjacent lotsoTAr~--S ~:/z'~' (~ Cutbank N/,4~. Water main/service line Surface water /q~N E c~gCJ2VgfP (:D Driveway, parking/vehicle storage area Curtain drain ~o~ o6~¢_V'~0 ~ E. ENGINEER'S CERTIFICATION I certify th~ver~d to all MOA and HAA guidelines Date HAA Fee $ / ~ '¢-¢ Waiver Fee: $ Date of ~aymont ~ ~/~ ~ate of ~aymont Receipt Number ~ ~ ~,/2 ~.) Receipt Number 72-026 (Rev, 3/91) B~ck MOA 21 in effect on the date of this inspection. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICA'rE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel i.D. # ~-f'~ \ \ - L-----~ ~ \ ---/LO HAA# I-\ ~ ~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, bl¢~ck, subdivision, section, township, range) Location (address or directions) (b) Propertyowner ,OE~.IAI. I 5uo/gLu ~r~e Mailing Address ?b,2( i~zCl~T.~dO¢z~ ,0,/.... Telephone: (home) ' Business (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone j- (e) Mail the HAA to the following address: (or check here ~, if hOld for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family,S. Number of bedrooms 3. WATER SUPPLY Individual Well [] Community ~ Public [] Note: If community well system, must have written confirmation from the State DePartment of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site,~ 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. 72-025 (Rev. 7/88) Page 1 of 2 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 regulations in effect on the date of this inspection. Name of Firm /~/,,//J ~/7..~ ~ ~J ~--',',J ~. i tJ ~ ~J(., Telephone Date Engineer's Seal 6. DHHS APPROVAl' Approved for Z// Approved ~ bedrooms by Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 M u nicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72q}25 (Rev. 7/88) 8ack Page 2 of 2 . MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: 6 ,I 7-'.4 ~.4 / A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth__Cased to. Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer L. ine To Nearest Sewer Service Line on I.ot Water Sample Collected by Water Sample 'rest Results Comments Date Completed Depth of Grouting If A, B, C, D.E.C, Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed /-,y'-~¢ ? Size Standpipes (Y/N) y Air-tight Caps (Y/N) _ Depression over Tank (Y/N) _/d Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ,4-/,/.4 Temporary Holding Tank Permit (Y/N) Sl--PARATION DISTANCES FROM SEPTIC/HOLDING TANK: No. of Compartments rv Foundation Cleanout (Y/N) Date Last Pumped ^lEYd ; for To Building Foundation To Disposal Field To Water-Supply Well ¢/60' ¢ To Property Line ~/' To Water Main/Service Line "( ~ To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev, 7/88) Front Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /' '/- ~ ~ Width of Field .5' ' Square Feet of Absortion Area (¢ CO Depression over Field (Y/N) ~ Results of Last Adequacy Test ,PASs,-c, Type of System Design Length of Field (co¢ Depth of Field (~' ' Gravel Bed Thickness - "-// Statndpipes Present (Y/N) Date of Last Adequacy Test Y SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot /.)~M~ o~u L~ To Water Main/Service Line To Property Line To Existing or Abandoned System on ; On Adjoining Lots I.~0/ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ,*,)o~6 ~ n 4~g~ To Driveway, Parking Area, or Vehicle Storage Area '~-~' ' Comments ~.~-~,¢~/:)~-?~/k/ ~¢5 ;~',~/~,'¢ /~' .-¢Z2~-~.,//4'~- ~ATION Date I n s~'at-~ed..~ Dimensions Size in Gallons -'"-.--._ Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at High Water Alarm Level at -"~'~ Vent (Y/N) Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to afl MOA and HAA ¢ inspection. Signed :~//~ ~¢ - Company /Cf',//) *L~'L-~O ~ Date ¢'~ &~/~ ~' MOA No. Receipt No. O Date of Payment Amount: $ 72 026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 elines in effect on the date of this Engineer's Seal 12/22/93 10:31 CT&E ENVIRONMENTAL LAB SERVICES -+ 2773177 N0.159 Q02 , OMMERCIAi. TE $TING & ENGINI=.ERINQ CO. ENVIRONMENTAl. LABORATORY SERVICE;~ ~,~cc,,~ REPORT of ANALYSIS Chemlab Ref.~ :93.6772,-1 Client Sample ID :LOT 1, TANAINA VALJ~ SUBD.,6816 ** Matrix Client Name Ordered By Project Name Project~ PWSID :WATER :P~U[Q%N CONS~ ENGR & ASSOC, ~NC :ST~V[ A./GEORG~ W. :214706 Sample Remarks: SAMP[£ CO~EUT~ BY: S.L~ ANDERSON.' ** [~WELL CIRCLE. 5~33 8 STREET . ANCHORAGE, AK 99518 TEL: (80';) 5§2.23d3 WORK Order :74271 Report Completed :12/2i/93 Co].lecte~ ~[2/17/93 @ i4:40 hfs Received ~12/17/9~ @ [5:00 h~s Technical Director:~TEPBEN.C. ED~ , / QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Da~e Init Nitrate-N 0.20 mg/L ~PA 353.2/300.0 lO 12/20 C[%R See Special Instructions Above U~ = Unavailable See Sample Remarks Above NA = Not Analyzed UndetEcted, Reported value is the prac%ical quantification licit, bT = Less Than Secondary dilution. GT = Greater Then ENVIRONMENTAL SERVIOES IN ALASKA, COLORADO. UTAH, iLLINOiS, OHtO, MARy%AND, WEST VIRGINIA. NEW JERSEY, SOUTH CAROLINA D]EPT. OIF ENVIRONMENTAL CONSERV~kTiON ! ANCHORAGE DISTRICT OFFICE / 800 E. DIMOND BLVD., SUITE 3-470 RECEIVE ANCHORAGE, ALASKA 99503 1997_ HPCE February 24, 1992 WALTER J. HIOKEL, GOVERNOR (907) 349-7755 FOR: High - Phukan Consulting Engineers PWSID¢ 214706 My review of the records on file in this office reveals that the Country Lane Estates Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/cf CHEMI ._ iL & GEOLOGICAL IM "' 9RATORY I-~q z~-~ ~ ~ A DIVISION OF COMMERCIAL YES'rING & EN(IINEERINO CO, 5633 B STREET ANCHORAGE, ALASKA 99518 TELIEPHONE (g07) 562-2343 FAX:(907)561.5301 t~tL¥318 RESULT3 fox I~VOlC[ t 51250 ?WglO : 54 Client Met :~IGI1P~ ~ollsct~d ~ f~ 18 92 ! 16;10 h~. ~PO! : ?0! :~0~[ Results O~ltl ~othod Mlowebl~ Llltita ...................... See 3~clal In~tructlon~ 1boYS ~t.Ui~elIebl~ Member el the SOS Group (Soci~l~ GCn~rl31o de Survell,anco) o0o0oooooooooooooooo oooooooooooooooooooo t~:g[ o g-'g o-gg}; [ D~PT. OF ENV]~RON~MENTA1L CONSERV/kT~O ~/NCHOR~CE/~ESTERN DISTRICT OFFICE 3~0~ C STREET, SUZTE ANCHORAGE. ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 OATE: January 24, PWSZD: 214706 To Whom It May Concern: According to the records on file in this office, ESTATES Water System is in compliance with the Drinkinq Water Regulations, the ~OUNTRY LANE State o¢ Alaska Si ncere ] y, VERA E. CRAIG Environmental Field c Drinking Water ep