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HomeMy WebLinkAboutUPPER EAGLE RIVER ESTATES BLK 2 LT 2A I I GRE ANCHORAGE AREA BOR ,r "H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM DISTANCE ~ ,, FROM WELL/<~) MANUFACTURER'~ f~'~ /~1'C''~ MATERIAL ~/~:~ / NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH __ LIQUID CAPACITY / ~ ~'{~) GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER __ LINING MATERIA YD~;~ CRIB SIZE: BUILDING FOUNDATION 7D/ OR WIDTH ~'~, DIAMETER NEAREST LOT LINE __ ADDITIONAL ABSORPTION LENGTHZ~, DEPTH /~ I DEPTH /~' DISTANCE FROM: WELL /~'/ ABSORPTION AREA (WALL AREA) SQ. FT. WELL: BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED. NEAREST SEWER LINE REMARKS DEPTH ,/ SEPTIC TANK DISTANCE FROM: SEEPAGE ~- SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAL:/?// DIAGRAM OF SYSTEM LOT SLOPE: REMARKS: Form NO. EO~Oal LOG OF DR~tI'NG 'by A 8' L OWNER OF LAND .~O&./,.,6/...~..~ ............................. DEPTH OF 'WELL ._l.--.L...---~ ................... ~----~-~. ................. ~,, ~2~~..f._~..4_..~.~c.~....4 STATIC LEVEL OF WATER ~ ................. ......... ~.._-~,~ ~'~ 4',"~'~ 4~ Down F~. ~ ' WELL SITE ~ ~ ~ ......................................... DRAW ................................................................ __ ...... ............................................... ..... : ............................... ;~ .......... ~ .............. ~ ''ATE--END= ~" /.~ 7.&...-.'...£~.~.~-'-~-'--~0--.;~*'~ ~:I.~ OF ~A~IN~ --...~.--.~ .................................................  IND OF FORMATION: .~ . . /FROM O FT. TO .~_ ........ FT.----~-:-U---=-'---4-~-~-'-° = FROM ........................ FT. TO ........................ ~ ............................... I ............................ - -- &~ ~ ' FROM.....-.L~-' .............. FT. TO.....-/--~-' .............. FT;.~.../~._~....~..J...~.d~. r ~.~FROM ........................ FT. TO ........................ FT ............................... ~') ~' ---- ~_ '/~ d~ ¢J'~'~'~ FROM ........................ FT. TO ........................ FT ............................... FROM......-/-.'-~.-- ........ FT. TO '~ ...... k-r./-&~--.=---; .............. FROM.----~-.~ ........ FT. TO ~'o FT ~/~ ~.4...~ '- ........................... ~"'v-: ......... :: ::'":" ~ FROM ........................ FT. TO ........................ FT ............................... FRoM ~o ~FT To ~"~ ~.~:".6.4,q'"~'FROM ........................ ~. To ........................ FT ............................... ~- ~ - ? - =~l~L~?~.~/..~ FROM ' --- FT. TO ...~:.L; ........ FT ............. :.._...:...t..:.. ~ FT~ TO .~,5 FT,;~,U..: ............ - .................. FROM ........ -~- ..................... .~. : :i :~.::~ :: .: :.., ,--.,,$?.~,¢ 7 CF-," ' ~soM......~..O. ............. ~. TO_.../i~./-:.-.---:-~ST:g--~::--~""'~''~;"~ FROM ........................ FT. TO ........................ ST ........... : ........... :: ..... FROM ........................ FT. TO ........................ FT ............................... FROM ........................ FT. TO ........................ FT .............................. MISCL. INFORMATION: L I I GREATEr ANCHORAGE AREA BOROUGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT pERMIT NO. INSTALLATION LOCATION LEGAL DESCRIPTION SEEPAGE PIT ~ TYPE AND SIZE OF FACILITY TO BE SERVED ~ ' / ' ~/~ FINANOED THROUGH TO BE INSTALLED BY PHONE DRAIN FIELD OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SePTiC TANK '~ j FOUNDATION TO SEEPAGE PIT J ~ ~/ DRAIN FIELD DRAIN fIELD TO NEAREST LOT LINE, WELL TO SEPTIC TANK ~ DRAIN FIELD ,/~) WATEr MAIN TO SEPTIC TANK , SEEPAGE PIT TO R~VER, LAK~, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRiB CROSSING GAP OF EXCAVATION ~ FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST ]RON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. CONFORM TO BOROU~GH REGULATIONS REGARDING INSTALLATION. CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE REA BO OUGH RDINANCE NO. 28-$8 AND THAT THE ABOVE X ¢/ APPLI A.T'SS''NAT'RE . .I GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAl QUALITY Case # 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For t~m S~ll'~m~ Dated P~formed ~-?~ Legal Description: Lot This Form Reports Soils Log ~ Percolation Test Soil Test Must Be Logged To 4' Below Proposed Seepage System Depth Feet 12~ 13~ Soil Characteristics l i Was Ground If Yes, At Water Encountered?_]kJ_O o~ What Depth? 0~ Reading Date Gross Time Net Time DePth to H20 Net Drn Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet ................. Da?th to Bottom of Pit Or Trench Tes i: Performed BY .T_~_ ]~-~-'~t []ate Certified Dale I I ": ~:' P.O. Box ~96650. Anchorage; Alaska 99519-665 . ~ ;~' ' ' -'~--.~CERTiFICATE OF HEALTHAUTHORI~ = ' APPROVA~ FOR A SINGLE FAMILY DWELLING .... pa~el~.O:~ 050-.781-1'2'~:~'~ ....... :~-" :;' -:: ~' ~ :HAA~ ~11~'~ 1.~ GENERAL'I~ORMA~iO~ '~L'~5 "=%'~ ~ ' ~ - :.../~ :=--j.: .... :.~.?.~.~.~:~.~.-~.~:~:~, .;.~;.:-;~..-~-~,-'~, .,~.~ ...... ~ .- ,~ . :_=:.:=.:~j;_c_.~.::_.C~mP~ete,~gald?CZ~.P~ion_ Lo% 2A~B~ck 2 Upper EagIe Individual well Community well 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY' ENGINEER"~:--'-!~/" *.."::. ;..'. :~.i';;.-: As ce~ified by my seal affiXod horoto end'as of the validation date shown ~16w, investigation 'of this Health Authori~ Approval apphcat~on shows lhat the on-s~te water supp y and/or wastewater disposal system is safe, functional and adequate for the num ~er of bedrooms and ~p~ of structuro indicated h~roin. I fu~hor wd¢ that ~as~d on the ~nformafion o~ta~n~d from the Municipali~ of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance ~ith all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection, . ~ ,- Name of Firm ' KND Engineering Phone'-696-5111 : ',' ~ 7Addres~-';;'-204&l:.'Ptawmiean ~lvd Eaole River',' A~'",9~5~'7'?.~ ,:;"~.'; Additional Comments ;r'h:e M~ni~ip~ii~Y-0f Anchorage Department of He,alth and Human ise'rvi',c, le~? (~HHS) i~S' ?i~Apt~r0ve~l Certificates based, only upoh~the ~epre§~ntatJ0hs gi~,~"'in 'p~;~r~ish .5'~bbve 'b~ an in~e'l~e~d~nt profeSSion~ienginee[reglstered in theState of~laska,.~he DHHS does this as a courtesy'to purch?Se'~'~f horn~ and their.'J~nding i~sfitutions in 0rderto satisfY certain federal ~nd State r~'~l-uimments, Empi~y~e~ ~fD~-~'S d~ ~ot ' Cdnd~ct"~h~p~cti0nS''or'analYze ~ata' before a"certificate'is'issaed.'.The Municipality Of Anct~6~a~-IS not ' responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 1/91) Back MOA Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: Lot 2A, Blk2 Upper ER Est ParcelI.D. 050.781-12 A. Well Data Well type ind. Log present (Y/N) Y Total depth 191 Sanitary seal (Y/N) Y FROM WELL LOG 11/10/76 If A, B, or C, attach ADEC letter. ADEC water system number. Date completed 11 /1 0/76 Driller Sill 1 '~van Casedto 'a.~-k- ,c'{'O'+ ~L~asing height Wires properly protected (Y/N) y AT INSPECTION 3/20/95 78' 71 ' 7.0 g.p.m. 3.1 3 + unk nnk Date of test Static water level Well flow Pump level1 ; On adjacent lots 100' + ; On adjacent lots 1 O Q' + SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 95 ! Absorption field on lot 1 ?. 5 ' + Public sewer main N / A Sewer service line 53.1 ' WATER SAMPLE RESULTS: Coliform - 0 - Date of sample: Public sewer manhole/cleanout N / A Petroleum tank N / A Nitrate 1 . 3 9, ,m ~q / 1 3/20195 (,H) 4:/.'5'/'95: ~("©) Collected by: Other bacteria '- 0 - F, Mn B. SEPTIC/HOLDING TANK DATA Date installed 1 q 7 ~' Cleanouts (Y/N) Y High water alarm (Y/N) N / A Date of pumping 3/16/95 Tank size ! 250 Foundation cleanout (Y/N) .. ~ Compartments 1 y Depression (Y/N) Alarm tested (Y/N) N / A Pumper ,lP's Pumping N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 95 ' To property line Sudace water/drainage 30'+ On adjacent lots 100' Absorption field 1 4 ' N/^ 72-026 (3~3)* Front Foundation 43 Water main/service line CONTINUED 9N BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot N / A On adjacent lots D. ABSORPTION FIELD DATA Date installed 9 / 7 3 * Length 28' * Width 28'* Total absorption area 684 s f* Cleanout present (Y/N) Date of adequacy test 3 / 20 / 95 Results (pass/fail) Water level in absorption field before test 48" Peroxide treatment (past 12 months) (Y/N) N · . Information from inspection report SEPARATION DISTANOE FROM ABSORPTION FIELD TO: Well on lot 1 0 0 ' + To building foundation 5 7,5 ' On adjacent lots ~15: ' + Surface water N / ~, N/A Curtain drain Sudace water Soil rating (GPD/Ft2) * 1 5 5 - 2 2 5 $ f / b d )System type S e e p a g ~ p i f. * Gravel thickness 6 ' * Total depth 10 ' * y Depression over field (Y/N) N pass for 3 Bedrooms Aftertest 48" after ?4hnur~ It yes, give date on file w/HHS On adjacent lots 125 ' + Property line 10~' + To existing or abandoned system on lot - - - Cutbank N / A Water main/service line 70 ' + / - Driveway, parking/vehicle storage area 25 ' + / - E. ENGINEER'S CERTIFICATION I cerb'fy that I have checked, verified, or conformed to all MOA and HAA date of this inspect~bn. Signature ~ ' Engineers Name K e n n e t h H, Date · ,5 / ?. / 95 HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)° Back Waiver Fee $ ~ ~.~,.~-~ Date of Payment Receipt Number I I HFIR 24 "95 04:37PH HTL P.1 NORTHERN TESTING LABORATORIES, INC. 3~30 INDUSTRIAL AVENUE FAIRBANKS, ALASKA g9701 (907] 456-3116 - FAX 45~3125 2505 FAIRBANKS STREET ANCHORAGE, AJ. ASKA 99503 (~7} 277-8376 · ,=AX 274-~545 KND Engineering 20441 Ptarmigan Blvd. Eagle River Ak 99577 Attn~ Ken or Dee A136938 Lt 2A B1 2 Upper ER Est's Mosebib - Front of House Water Our Lab #= Location/Project= Your Sample ID: Sample Matrix= Commentsz Lab aeper~ D=te~ 03/24/95 Date Arrived= 03/21/95 Date Sampled= 03/20/95 Time Sampled: ~600 Collected Dye KD * Definitions * B - Below Regulatory Min. H = Above Regulatory Max. g - ~etlmate4 Value M - Matrix InterZerenoe D = Lost to Dil~tion MDL ~ Method Detection Licit Date Date Numbs~ Method Parameter Units Result * MDL Prepared Analysed A136938 EPA 353,3 Nitrste-N mg/1 1.39 0.25 03/22/95 Re~Lange Chemistry Supervisor I I NORTHERN TESTING LABORATORIES INC. 3330 INDUSTRIAL AVENUE 2505 FAIRBANi(S STREET FAIRBANKS, AEASKA 99701 ANCHORAGE, ALASKA 99503 (907} 456-3116, FAX 456 3125 (907) 277-8378 · FAX 274 9645 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA KND Engineering 20441 Ptarmigan Blvd Eagle River, Ak 99577 Public Water System I.D.# Date Received: Date Analyzed: Date Reported: Next Sample Due: 04/05/95 Time Received: 14:30 04/05/95 Time Analyzed: 14:30 04/06/95 Time Reported: 18:03 Phone No. Purchase Order No. Collected by: KND Sample Type: Check/Repeat Sample for previous sample Sample Method of Analysis: Membrane Filtration Comments: S : U = POS = ND : TNTC: CG : HSM : SA -- Old = Comments: R = NT : Satisfactory Unsatisfactory Positive Test Result None Detected Too Numerous To Count (>200 Colonies) Confluent Growth Heavy Sediment Masking, Results May Not Be Reliable Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Sample Age >48 Hours, Too Old For Analysis Resample Required No Test * # Colonies/lO0 ml ** # Colonies/mi Sample Sample Total* Fecal* Other* HPC** Location Date Time Lab# Coliform Coliform Bacteria Result Comments 1 Raven St. Lt 2A Blk 2 04/05/95 14:00 AB5899 0 ND ND NT S Juli~/~h.~e.~fer ._~ .v ~- Envi~hmental Analyst ~ I I Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 17, 1995 Kenneth M. Duffus, P.E. KND Engineering 20441 Ptarmigan Boulevard Eagle River, Alaska 99577 Subject: Waiver Request for Lot 2A Block 2 Upper Eagle River Estates Waiver Request 9WR950015, PID ~050-781-12, HA950163 Dear Mr. Duffus: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are a private well to the septic tank on property of 95 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services Program ljm:~6 MUNICIPALITY OF ANCHORAGe Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR950015 ' PID# 050-781-12 HA# HA950163 Permit # Date Received: May 5, 1995 Legal Description: Lot 2A Block]2 Upper Eagle River Estates Engineer: Kenneth M. Duffus, P.E. 20441 Ptarmigan Boulevard, Eagle River, Alaska 99577 Applicant: Wayne & Janet Kuyendall Waiver Requested: Private' well to septic tank on property of 95 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: Waiver List 3. Other: is Granted: Conditions or Date: ~---/~-- ~- Rec ~: 00867/2709 Amount: ~ELL ~, EL. L D~T,9. - I r 2~ i 2B 3A 3B ~121 ~ 2021~ 20~9 20~21 RAVEN DR. 20028 '20il2 2(~136 20230 20324 9707 20227 20~2~ PTARMIGAN 20300 TR B FRIDERICK H~HN HOt~ESTE.4D RAVEN WOO0 ELEMENTARY SCHOOL , 9500 9439 KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 May 4, 1995 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 ATTN: Dan Roth REF: Lot 2A, Block 2, Upper Eagle River Estates Well to Septic Tank Waiver Request Dear Mr. Roth: On March 20, 1995, my associates and I performed a well flow and adequacy test on systems serving the subject lot. Although both systems were found entirely adequate, we found during our measurement verification that the septic tank was less than 100 feet from the well. A later survey confirmed our measurements. From records in your files, it was determined that the original well drilled (documented in 1973) to serve this residence was allocated to the new Lot 2B at the time of subdivision in 1975. A second well was then drilled (also by Sullivan) to serve Lot 2A as noted by the well log dated 11/10/76. This well is on the north side of the dwelling. Subsequently a Health Authority Approval was granted for Lot 2A; the engineer providing information indicated that a proper separation existed. Through the survey we find that the first cleanout on the septic tank is 96.6' from the well. Assuming that the end of the tank is approximately 1.5' closer to the well, the septic tank is 95' from the well. We are therefore requesting a waiver of 5'. The well log indicates the presence of clay in the first 15 feet, then a hardpan with boulders for the next 20 feet. From 35 to 80 feet clay is again present. The well depth is at 101 feet. Our nitrate sample yielded a reading of 1.39 mg/liter. The sewer system lies on the southern portion of the lot and is separated from the well by the house foundation. From the septic tank the lot begins to slope gently to the south, away from the well and dwelling. In addition, the soils information for the system indicates a layer of moderately tight material underlain by silty sands to 12 feet. No bedrock or groundwater was found. REF: Lot 2A, Block 2, Upper Eagle River Estates Well to Septic Tank Waiver Request May 4, 1995 Page 2 of 2 In compliance with 18 AAC 80.020 and 18 AAC 72.021(a), I have addressed geological conditions for this request and have assigned the following number values: Distance from sewage system bottom to groundwater Soil sorbtion below the sewage system Soil permeability below the system Water table gradient Horizontal separation 5.69 4.50 2.28 2.90 2.86 TOTAL: 18.23 Based on these values and my evaluation, I feel that the possibility for contamination of this well is fairly remote. Your prompt attention to this request is appreciated and if you have any questions, please contact me at 696-6111. Respectfully submitted, enclosures: Certificate of Health Authority Approval Health Authority Approval Checklist Site Plan Water Test Results AND THAT NO ENCROACh INDICATED. IT IS "tHr OWNE~ TO DETERMINE T EASEMENT~, COVENAN'r WHICH DO NOT A~PEAR VISION PLAT. UNDER N: ANy DATA HEREON BE U OF FENCE LINES) OR ARy LINES. ASBUILT-NO C__O~N~s S~ET THIS._DATE. "~''~''~""'~'~~~"-- ~ HERESy CERTIFY .THAT I HAVE ~ FOLLOWING Dc~ .... ~. VEYED THE ~E EXI~TEN~ OF ANY ~RID~ S OR RESTRICTIONs . ~ THE EE~D~ ~1- - 'R E~LISH NQ ~ND- DRAWN~ ~MOCIATEs LAND SURVEYING 694_082~9 ~.:.. ......... ..... ~ ~ , . MUNCPALTYOFANCH0 AGE .- .~_-'/';~ . , . ........ · ','-:' ' ~ -' ;:'~? ~- -~ . :.'~ DEPARTMENT OF HEALTH & HUMANSERVICES ~ , .'./~}~ '. :. ~. Division of Environmental Se~ices _' ...?. ,.~, : .: _..., ~ -,'. - On-SiteSe~icesSection _. - ~. , . ' ' . .. ~ :' PO Box196650 Anchorage Alaska "" '-:-':,' ~:-~ '~ -...' -:.-. ,-~-:.'L~ , :: 343-4744 ' ~; -~-~"~.'~' -,~'e' ~ ....~..~,. _~ -. , CERTIF CATE OF HEALTH AUTHORI~, ~ .............. .,... ...... .~,,.. ~... APPROVAL FOR A SINGLE FAMILYDWELEING ~ ~- - 1..,GENERAL INFORMATION:~;-~ ~ .-- ~ - · ~ - , ~;. ' · ~- ~'~-?--;:-~:'---:<c~::vL~ ~-~,.;/~( ";~-'~_~~ · ~ . ~ . · .:~, . ~'"'%"v"~' ~ . _ -~ : " --,-, '¢ ation site address 0¢dir 2 ~//~- . - 5;:: ..'-STATEMENT OF INSPECTION BY E ER. ' . '" ~' ?' AS certified by my seal affixed hereto and as of the validation date shown below, I verity 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 m~~inves{igation'~irid inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and state Codes, ordinances, and regulat, i~ns in effect on the date of this inspection. - , -.' . . :: .~ ?:{: ?: :- :.:.?~':;;!.. ~_!.~.-.,, :~.: ..:. ..... :.._. ?. .. .':,.: ., .:. ,-...... :..' ?'.: ,~:,, :.-.'!- ' Address 2~::~,-/-./.~1'." ~-7[-o.:J.,~z.~,~.,. "~./~/~,: : .~. ~.::' ' ' :' E~gin~s:~i~nature''~' ~ ~-: Date / Approval Certificates biased only upon the representations given in paragraph $ above by an independent professional engineer registered in the State of Alaska. The DHHSdoes thisasa Courtesyto pumhasers of homes and their lending institutions in order to satisfy certain federal and state requiremen'm. 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 profess!onal engineer"s work. Health Authority Approval Checklist Legal Description: /'-/' 2,4-~ Z~F!~, /_.~.- z~::. ~. Parcel I.D.: MUNICIPALITY OF A NCHO P.A~ Municipality of Anchorage ENVIRONMENTAL SERVICES DIV~I~;f~J".~\ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division S£P 1 1 1996 825 L Street, Room 502 * Anchorage, Alaska 99501 · (907) 343-4744 RECEIVED If A, B, or C, attach ADEC letter. ADEC water system number A. WELL DATA Well type -~{~ ' Log present (Y/N) y Date completed' Total depth / D / Cased to zC(Z2 / '¢ Sanitary seal (Y/N) \/ FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Date of test //~' ! o ~ ~' ~, ?,/2-,c:, /'~ ~' Static water level ~ `~ / '7 / /' Well production 7'. o g.p.m. '~' / ~ ~'' / ~-// Y g.p.m. WATER SAMPLE RESULTS: Coliform ~ Date of sample: Nitrate /. z¢ ¥~ ~//__. Other bacteria Collected by: ,~ N' ~ E,~.G . B. SEPTIC/HOLDING TANK DATA Date installed / ~ ? ~' Tank size Foundation cleanout (Y/N) ~/ Date of Pumping ~'-~ 2~- '~ 5' / ~- "--Z) Number of Compartments / Cleanouts (Y/N).__ Depression (Y/N) /t// High water a arm (Y/N). Pumper '-,7'-/4/.5 C. ABSORPTION FIELD DATA Date installed ~/'7 ~ Length ~' ~ / Width 2-~' f Gravel thickness below pipe Effective absorption· area ~ ~ 5/ ~ Monitoring Tube present (Y/N) Date of adequacy test '~/';~'/~'~"'- Results (Pass/Fail) Fluid depth in absorption field before test (in.); Fluid depth /7/ ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Soil rating (g.p.d./fF or fF/bdrm)/,5'-$-~_ z~' System type ~-~7~ ~-~ /-~7/~ ~ / Total depth '/~ / · Depression over field (Y/N) ~ For ' ~ bedrooms Immediately after~/gal, water added (in,): ~ ~' Absorption rate ' ~.5"~) Y- = _g.p.d. If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION ' Date installed _ _ _ Manhole/Access (Y/N) ..~Puffip on" level at* "Pump off" level at* High water alarm level a~ *Datum E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot / Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ,/ z~ / .z Property line / ~/¢" Absorption field / Water main/service line / o ' f-- Surface water/drainage '/~' o / ~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ~' ~ E) ENGINEER'S CERTIFICATION / certify that I have determined thru field inspections and review of Municipal recj~,,.~f't~e ~w,.~t~ns are in conformance with MOA HAA guidelines in effect on this date. ~" Signature . Engineer's Name ~ ~ HAA Fee $. ~:~F-~) . ~ Date of Payment Receipt Number ,~::~,~'/d~' C(::~..~J 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number P.$ ANCHORAOF ,¢,i.ASI(A Ug51~ (9 7) 340.i008 ,' FAX 849-1016 8dl 'b :,~ 'HOON 8-REF I Report Date: 08/07/96 Date Arrived, 08/0~/96 Date Sampled: 08/01/96 Time Sampled~ 1000 Collected By: MDL = Method De~ection Limit Our Lab #: F1641~4 Location/Project: Your Sample ID~ L2 A/B2 Upper ER Estates Sample Matrix: Wate~ comments: Mosebib by ~arage. B = Bslow Regulatory Min. g = ~ovm Rmgulato<y Max. Date Date ~ab# Method ParaMeter Unlbs Results * ................... T ............................ 2272 .... ~,4~ o.o~ o~/o2/~ FZ641~4 EPA ~00.0 ~trats-~ MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2Al Block 2; Upper EaRle River Estates Location (address or directions) 20136 Raven Drive~ Ea~le River, Alaska 99577 (b) Property owner ~tc_~k:: (!SA F_~./f. Telephone: (home) CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING (~') ~C'b- -'1C---, I - I '~ HAA# Mailing Address P.O.Box !9~!3 (c) Lending institution Telephone Mailing Address Business (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here)~, if hold for pick up.) List contact person and day phone number below: _~ & F~ ~.N~INEERING 17034 Eagle Ri'cer Loop Road NO. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family [~X 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 ~ to ~ O~ed le^oAddv leUO!l!puo,'9 to swJo.L euoqdole.L OWeN · uo!~oedsu! slq], jo e~ep aq~ uo ~oejle u[ suo!~elnbe~ pue 'sooueu!pJo 'sepoo pue led!o!un!AI lie q]!M aoUe!ldwoo u! s! we~sAs lesods!p je],eMe]seM Jo/pue Alddns Je~eM e~!s-uo oq~ 'uo!]oodsu! puc uol]e6Rse^u! 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Approved {Y/N) Well Log Present (Y/N) ~ Date Completed ~ Yield Total Depth ~ Cased to ~Depth of Grouting Static Water Level ~ ~ ~ Pump Set At ~ ~ Casing Height Above Ground ( ~ u Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~ O0 ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot / ~O ~ ; On Adjoining Lots To Nearest Public Sewer Line ~/~ To Nearest Public SeWer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~ ~ / ~ Water Sample Collected by. ~ +~ ~1,¢~¢'~ ;DateV/// Water Sample Test Hesults ~ ~ ~_~ r ~ ~ ~ Comments B. SEPTIC/HOLDING TANK DATA Date nsta ed --~-"~. -~ Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ,/,~ ~-O No. of Compartments ~ Air-tight Caps (Y/N) ~/ Foundation Cleanout (Y/N) Y /~/ DateLast Pumped ~//0 / 87 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: /~/~ ; for '~ " Temporary Holding Tank Permit (Y/N) ~/~ To Building Foundation TO Disposal Field To Water-Supply Well [ O0 / ~ To Property Line c,~ O To Water Main/Service Line / (~ ~ -~ To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~,~p~' ~'¢'--~/ Width of Field _ Square Feet of Absortion Area Depression over Field (Y/N) Type of System Design Length of Field Depth of Field / Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test / To Property Line ,:~ C, / To Existing or Abandoned System on Results of Last Adequacy Test _~.~,~l.~ .~..¢~,"~£~ / SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /~ ~ / To Building Foundation To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ; On Adjoining Lots _~O / "~ To Cutback (if present) D, LIFT STATION Date Installed ~ Dimensions ,S,,ize in Gallo ns~.~j~ Manhole/Access(Y/N) 'Pump On" Level at r,%,_ "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 all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ & $ ENGINEERtNG 17034 Eagle River Loop Road 1~1o, Company - I-'~'-'cr ~.t.,.~, 99577 Date ,?. ,~ ~-~? MeAde. Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7188) Back Page 2 of 2 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE £or Work Order ~ 14753 Date Report Printed: 30L 13 89 @ 14:50 Client Sample ID:L2A E2 UPPER EAGLE RIVER PNSID :UA Collected 3UL lO 89 ~ hrs. Received JUL 11 89 @ 16:45 hrs. Preserved with :AS REQUIRED Client Name : Client Acct: SNSENGP P.O.$ NONE REC'D Req $ Ordered By Analysis Completed :JUL 12 89 Send Reports to: Laboratory Supervis9r :~TEPHEN C. EDE 1)5 & S ENGR Released By, .,. Special ;' Chemlab Re£ #: 6223 Lab Smpl ID: 3 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 0.58 mg/1 EPA 353.2 lO Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. Tests Performed ' See Special Instructions Above UA=Unavailable None Detected *' See Sample gemrks Above Not Analyzed LT=Lese Than, GT=Greatez Than