HomeMy WebLinkAboutVALLEY VIEW ESTATES #1 BLK 1 LT 13GRE,,[ER ANCHORAGE AREA DOls.;UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCAT, ON ~,'1~.~ ~g LEGALDESCR,PT,ON LI~ gl L/cdl~t U,e..uO
SEPTIC TANK:
DISTANCE
PROM WELL /00
MANUFACTURER--~"~*e=~. MATERIAL
INSIDE WIDTH ~ LIQUID DEPTH
COMPARTMENTS
LIQUID CAPACITY JOOOGALLONS.
-T'l-~- D RAIN FIELD:
DISTANCE FROM WELL I~,0
NUMBER OF LINES_ /
ABSORPTION AREA
I FOUNDATION ~/~ (~ [
DISTANCE BETWEEN LINES
NEAREST LOT LINE
AJ//4 TRENCH
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
L TOTAL LENGTH
~-,.~0 '-- OF LINES
W,DTH,~(~,N. TOTAL EPEECT~VE
DEPTH OF FILTER S 4
MATERIAL BENEATH TILE IN. ABOVE TILE IN.
WELL: - '
NEAREST SEPTIC
BUILDING NEAREST /O~' '
FOUNDATION LOT LINE , SEWER LINE , TANK__
DEPTH DISTANCE FROM:
/~ ~ SEEPAGE /
/~'(''/; SYSTEM
CESSPOOL ~-'--~, OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANC~
INSTALLED BY:
SEWE.R LINE DEPTH: '"'] I '/'O
PIPE MATE RIALr
REMARKS:
DIAGRAM OF SYSTEM
DATE APPROVED. / G.A.A.B.
Form EQ-032
t'iI=IX:i[H.i'i f",IlJH!i~:Ei:F';: Ed::;' E:E[)F~:CK)H:E; .... i:~:
'Ti--IF~ L.IEi',I(3'TH I) I i"ilEi'.,iS )Z ()N :!::iii; 'iHiiE L..L::i'qGTH (]:i'.,i I='I:?:E'i') OF -I'HiE ]"I;?.ENCH (:)1;i:
THE DEPTH !iii:::' f::t 'Ti:;;:L~:NC:?4 OF,: P]Ti" ils THE E:, ]i '.:_:;TFff.,E:I~}i: BETb.!EEN THE SLII:;;'.I='I=ICE] (:)!=' THE{
EiF::(;ILJND FIND THE' E;:f']'l"'i!;)hl Ol:;' 'THE Ei:;:.::Cfq'v'Frl"]:Ol'~ (:[N FE;ET).
TilEI:~rE ]:S NCi :~;iET !4]:D1-H i:::'i::iJ:~: 'i'f;]:E;NCHES.
-t"HIE GiI:;?.Fi'v'E;L li:)l~:l::"l'l-'! ;!::~E; THE HIN;I;I"IUIq DIEPTH OF' GRf::I',/tE! E',ETI.,.i!:EEi",i 'FHIE CtI..Ft'Ft:::II.L. i::-']:PE
RNI') 'THE E:ErfTOI'1 OF THIE E!:.::E;FI'v'¢Tf'Z[CIN ,;;ZN F!EfZ'T').
h'! ]: I'..I Jii'iLit'i [:, :i: STf::!i',!C.aiZ Blii{'l !,.IIEEi',I f::l !,.I!EL.L FI?-.IIZ) FIN'?' ON-E; )Z TIE SEi],iI:IGE: D ;1: ::~;F:'(:;d~;f::lL :!ii;'.r'STE';t"t :[ ~;
:L~%i:.t F'!:!!:E't" i::'CIt:;~: FI t='I:a:];VFITE H!ELL (')t;~: ;:;i:E~l;i~ F'EET F'Eh~;~: FI I:::'UtE',L.H;; I.,.IEL[
'.i!;F:'E;C:;(F']JE:F:t"I'~.I:3i'-,If~; FIND CON::~-;TI~:UE:T];Eii",I [) Z( FII}iF;~'.f::li'l'_:ii;
;[ h!:iii;TF:!!_ L.F!'i' :i: ESi.
S; ;!: dii".!ED:
(3L. Ei;I'-,f 141::!!;~:I;)[..IE
" ~Q
GED, ECHNI CAL ~ DEVEL.v PMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694 2774 or 688 2280
R~sell O~ster Earl Ellis
688-2280
694-2774 S0IL LOG Land Development
Soils ~- Foundations
Perfomed for: Name: ~X~
Mailing Address:
Legal Description: k._~<~ x~
Depth (feet)
So11 Charactertsttc~
0
2
,w
10__
11__
12, _
Ground Water Encountered:
Yes No_~,.~
If yes, what depth~
Proposed Installation:
Comments: '-~'~,~
Seepage Ptt._~Drain Field~
Performed by: Date:_
DIE;F'RR"t'f'iENT OF HERL.TH Fff..!D ENVt,q'.C~NMEN'T'F!L
~...~ k-~ L. E_ F" E.-'2: F;:--".: ~--'iI ]J::
i::ii':'F'L.: C:l::it'-4'r GI.~.[-:t",I F:I
L.(]CFiT :[ CIi",I E:.
E:, ! H ]
L.::L::: [~:J. VFILL. E?T~ VIEW '- ...... F" ....
i'i):N:(HUI"i [:,]:S'i-FtNCE BETWEEN FI WELL AND FIN's' Oiq-SITE
::!.OO FE:ZE'I" FOR I::I F'RI',/RTE b.iEL. L OR'. ;7OG:~ FEET FOR'. A F'LIE',L..ZO
WECL_i.. L.OC:S F~FE'.E ~'.E:iZ]I..I]:R'.ED FIND f,It..IS-[ ~EIP: t::ETUE'.NEE) TO THE: DEF'FIf::-i't'"IE:NT b~]:"l"HZbl :~::O DAY'.:
OF THE: WELL COhlF'L.E:TZON.
SF'[::C ]: F ]: C:f~'l- ]: (:)NS AND C:C~NSTi::UCT Z ON D Z laEi[~'.Eil"lS ~'.[: F~',,,'A ~ L_FIBLE -['O :[ I',I:E;UE;:E F'I::CIF'E~'.
i 6iSTFiL. L.I:~'i" l
I CERT]:FY THFI'['
3..: ]: F:IP1 I::FI["IlLIFII~: 14ITH THE I~:EQU]:I;~:Ef"IEN'TS FOR'. (]N-SI'TE SEI.qERS AND WE:I._I~..S FI'-::; SET
F'(:l~.'."['~.~ [~:ITI "['["l[E MLII",I:[C]:PFIL]:TY OF
2:: :[ i.'.i]:I-.L. INSTAM.-. TH-F: SYSTEM ]:i'"1 F:ICCOI:'.E:'ANCE WI'TH T'HE: CODES.
I::IF'FL..:f~C:I~N-[' ~3~..EN IR I-'.IFIF:~:[:'LE
(. k i V E D
DRILLING LOG
Well Owner ~ J' '''~" Ergrdle Use of We]l
Location (address o~: Township, Range, Section, if known; or distance main road
Lotz 13 ?"
_~_oc~. 'J. Valley V J l (~,z
Size of easing. 6" Depth of Hole 15 0 feet Cased to 2 6.8 feet
Static water level ~. U ft. (71~15b.~) (below) land surface. Finish of w~l] (check one)
Screen ( ); Perforated ( ).
N/A
Describe screen or perforation
Well pumping test at 4 gallons per (~{') (minute) for. 1 hours with
of drawdown [rom static level.
open end ×~ );
Date of completion 5 / 2 G / 7 ?
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 :TO_ 2 Ca~ ±n,~ s tiekup
2 ITO_ J. 6 Silty gravol; cobbly
ll~] TO_ 48 Bedrock, gray
/~L; TO_ 50 Bedrock. !igt~r brox,m
5() TO 3.2:5 Bedrock, dark gray
.2~ .... .To_-L5O' .edroc~,. gray; water seaps in spora~::Lc ~raci:~rcu
through~o. Bt
TO
.TO_
TO
.TO_
TO
TO_
TO_
TO
2 -- STATE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
05052158 HAA#
1. GENERAL INFORMATION
Complete legal description Lot 13, Block 1 , Valley View Estates #1
Location (site address or'directions) 26034 Wild£1ower Circle
Property owner
Mailing address
Stuart Gilbert
P.O. Box 771747
Day phone 694-7112
Eagle River, AK 99577
Lending agency.
Mailing address
Day phone
Agent Cindy Wilson/Partners
Address 11940 Business Blvd. , Eaqle River
Unless otherwise requested, HAA will be held for pickup.
3
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
NOTE:
Day phone 694-4994
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.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
x
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
NOTE:
72~325 (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.
Name of Firm Anderson Enqineering
Phone 563-7155
Address p.o_ Bow ~4~77~ Anchoraqe¢ AK 99524
Engineer's signature ~ ~ ~¢t~¢)~--% Date ¢//~/¢/7
DHHS SIGNATURE
..~.--~
'/ Approved for 1 ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the fo[lowing 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 mst tut ons n order to sat sfy certa n 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.
72-025 (Re¥.1/91) Back MOA~,21
Legal Description:
A. WELL DATA
MuniciPality of Anchorage /~J~
DEPARTMENT OF HEALTH & HUMAN SERVICES R E C E IV
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-~4~¢42 9 1997
Health Authority Approval Checklist Municipal ty of Anchorage
Dept. Health & Human Serv cas
05052158
Lot 13, Block 1
Valley View Estates #1
Parcel I.D.:
Well type Individual If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Y Date completed
Total depth 50 ' Cased to 26.8 '
Sanitary seal (Y/N) Y
5/26/77
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
9/8/97
~4.9'
32"
Y (See note)
g.p.m. 1.5 g.p.m.
Other bacteria
Mike Anderson
Date of test
Static water level
Well production 4
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: 9 / 1 7 / 97
B. SEPTIC/HOLDING TANK DATA
FROM WELL LOG
5/26/77
20'
Nitrate .279
Collected by:
Date installed 6/24/97 Tanksize I ,000 Number of Compartments 2 Ceanouts(Y/N). Y
Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N
Date of Pumping 9 / 10/97 Pumper · JR ' s Pumping
Soil rating (g.p.d./fF or ft2/bdrm) 125
36" Gravel thickness below pipe
Monitoring Tube present (Y/N) Y
Results (Pass/Fail) Pass
45
380
C. ABSORPTION FIELD DATA
.Date install.ed .6/2, 4/77
Length 32 ' Width
Effective absorption area 448
Date of adequacy test 9 / 9 / 97
Fluid depth in absorption field before test (in,);
Fluid depth 25" (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
N
System type Deep trench
84" Total depth 201"
__ Depression over field (Y/N) N
For 3 bedrooms
Immediately after 560~a1. wateradded (in.): 71"
Absorption rate = >2,000 g.p.d.
If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
NONE ON THE LOT
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
108'
>108'
None
>75'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation > 25 ' Property line > 1 00 '
Water main/service line > 50 ' Surface water/drainage None
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
On adjacent lots
On adjacent lots > 200 '
Public sewer manhole/cleanout
Lift station None
Property line > 100 '
Surface water None
Curtain drain None
"Pump off" level at*
>200'
None
>150'
Absorption field 7
Wells on adjacent lots
Building foundation > 25 '
Water main/service line > 50 '
Driveway, parking/vehicle storage area 10 ~
Wells on adjacent lots > 200 ~
F. ENGINEER'S CERTIFICATION
in conformance with MOA HAA guidelines in effect on this date.
Engineer's Name Michael E. Anderson, P.E.
Date 9/25/97
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTIt
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date ~//~
Legal Description (inclu~de lot, block, subdivision, section, towu~shi, p, ra~e?.
Location (address or directions)
(b) Applicants Name ~ £~ ~c;~ ~ Telephone'- Home~ZX~m'gfusfness
Ap~licant s Address - '
(d) Lending Institution
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f).. Mail the HAA to the following address:
Type of Residence
Stngle-Family.~
Number-of Bedrooms
Multi-Family~
Other (describe)
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 the legality and status.
4. Sewage Disposal
0nsite/~ Public ~--~ Community ~--~ Holding Tank ~--~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page'l of 2]
98-6I-L
t~.Aoadd~ ~tMH(I:.77 ' 9
ae
F~2NICIPALITY OF ANCHORAGE (MOA)
Well Classificati~n~,C~ If A, B, c~ C, D.E.C. Approved(Y/N)
Well Log P~esent (~) ~ Date ComPleted ~-7_(~ -V '7 Yield
Total Depth /~ Cased to Z ~ / Depth of G~outing. -- ~¢' 3
Static Water Level ~ Pump Set At
Casing Height Above Ground ~ / ' sanitary Seal on Casing (Y/N)
Electrical Wi~ing in Conduit (Y/N) K Depression A~ound ~llhead (Y/N)
Separation Distances f~c~ Well:
To Septic/Holding Tank on Lot /~)~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot-~/~' ; On Adjoining Lots ¢- / ~o'
To Nearest Public Sewe~ Line ~-/~0' TO Nearest Public Se~r
Cleancut/Manhole ~-/~' . To Nearest Sewe~ Service Line on LOt ~
Wate~ Sample Collected By ~--~ ; Date
Wate~ Sample Test P~sults // 7~¢/~
C~ttt~nts
B. SEPTIC/HOLDING TANK DATA
Date Installed ~- ~77 Size /ooo~r
Standpipes (Y/N) ~ Aid-tight Caps (Y/N) /
Depression ove~ Tank (Y/N) A~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) A~; .; for
Holding Tank High-Water Alarm (Y/N) A~ /cc Temporal%; Holding Tank Permit (Y/N)
Separation Distances f~cm SeDtic/Holding Tank:
To Water-Supply Well /O F ~
To P~ope~ty Line ~- / O'
To ~ter Main/Service Line
Cou=se ~-/OO
No. of C~,~8zrtments
Foundation Cleanout (Y/N)
To Building Foundation ~ ~
To Disposal Field ~"
TO Stream, Pond, Lake, c~r Major D~ainage
Comments
[Page 1 of 2]
Receipt #
Date Paid:
Amount:
/¢
2~15-84 .
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date .Installed ~ _ -j_%L - ~ ?
Width of Field 3 (b~' F-
Depression over Field (Y/N) ~/
Type of System Design
Length of Field 3 2- ~
Depth of Field /~ '
Gravel Bed Thickness 7 '
Standpipes P~esent (Y/N)
Date of Last Adequacf Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To ~ater-Supply Well ~-/aodP~ To lh?operty Line
To Building Foundation .-~ ~/O ! To Existing or Abandoned System on
Lot /L///~ ; On Adjoining Lots 7= /~ O '
To Water Main/Service Line -~0 ! To Cutbank(if present)
To Stream/Pond/Lake/o~ Major ETainage Course ~-/~
To D~iveway, Parking Area, or Vehicle Storage Area
Co~nts
D. LI~T STATION - ATp ~-- ~'5~/~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comnents
Dinmnsions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Meets MOA
** Check Permitted Bedroc~ Rating Against HAA Pequest
I certify that I have checked, verified, or conformed to all MOA :H3~ Gu~del,~
on the dat9 of. this, inspection. ' /, ' :'. ,' ~,i~!~. 'l
Signed ~ Date ?
KB1/d5/s
[Page 2 of 2]
2-15-84
SEP-~5-1997 09:1~ CT6E ESI ANCHORAGE 9075~15J01 P.O~OJ
CT&E Eltvironmen~al Services Ino_
CT&E Re/.//
Clle~t Name
Project Name///
Client &le ID
Matrix
Ordered By
PWSID
Sample Remarks:
9756~2001
A~dcrson ~'u~cri~g
Lot 13, BI, Valley View l~s£ 1
Lt 13, BI, Valley View tlst #I
Drinldm, Water
Client
Printed Date/Time 00/24/97 18:57
Collected Date/Time 09117/97 19:00
Received Date/Time 09/18/97 14:00
Technical Director: Stephen C. Ede
Results
PUL UnltS Method
Allowable Prep Ana[ys|s
Limits Dete Date Init
Nitrate-N
Totat CoLifora
O.gO
0.100 A',g/L EPA 300.0 10 max
coL/lOOmL SHt8 92228
~9/18/97 OeP
SEP-25-1997 09:16 CT&E ES I RNCHOR¢IGE 90?5615301 P, 03/03
Zt~__- CT&E Environmental· Services Inc,
Drinking Water Analysis Report for Total C°litomi Bacteria 2oo w. Po..r o,~,,
An,'ho~age, AK 9951~-1605
RIbID IffSTRtfC'I'IoN.~ ON REg'gR.~£...gIDE ,BEFORE CO££ECT'I:YG ..q.4MP££ Tel: [907) 50Z-2343
Fax: (907) 551-5301
TO BE ~OMPL£TED B¥"~",~IqORATORY
_~s$i$ ;ho~ ~is Water SAMPLE to
~ S~ple ~er 30 hou~ old, msul~ may
~m~e t~ long in ~si~; s~ple should
n~ be ~v~48 hou~ eld at enamlnadon
D MM~MUG
' N~rof~lonie~lO0 mi.
.
. BA~I'ERIOLOGICAL WATER A~ALYSIS RECORO
TOTAL P.03
MEMORANDUM
RECEIVED
DATE:
TO:
FROM:
September 26, 1997
Donna Mears, MOA- DHHS
Mike Anderson, P.E. ~ ~
SEP 29 1997
Municipality of Anchorage
Oept. Health & Human Services
SUBJECT: Lot 13, Block 1, Valley View Estates No. 1 Subdivision
Certificate of Health Authority Approval'
Attached is the revised application for a Health Authority Approval for the subject lot. The water
sample was retaken on September 17, 1997, by myself. The data has been entered on the checklist
form. In addition, the owner has sealed the wire entrance into the well head. He has also encased
the wiring in conduit to the ground level. Once the new house is constructed all wiring from the
well will be encased in conduit.
Hopefully this will resolve all problems with issuance of the Certificate of Health Authority
Approval. Please let me know if you have additional questions.
NORTHERN TESTING LABORATORIES;INC.
2505 FAIRBANKS ST.
ANCHORAGE, ALASKA 99503
g07-277-8378
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
PRIVATE WATER SYSTEM
NAME
/
MailingAAddress
Ciiy State ~ Zip Code
SAMPLE DATE:[!~ Phone
· Day Year
Purchase Order No.
SAMPLE TYPE:
[] ,'~outine
[] Special Purpose
[] Check Sample (for original contaminated
sample with lab reference no.
Sample Time
/. o. Location Collected
[] Treated Water
[]XLIntreatedVV~ter
~['aboratolry Ref. No.
2
3
10
Signature of Representative
FOR LABOi~ORY USE ONLY
TO BE COMPIL~D BY LABORATORY
Received at: /~] Anch, [] Fbks.
Date Received ~/O~//
Time Received ~) ~'~
Next Sample Due
COMMENTS:
,._~ATISFACTORY _
UNSATISFACTORY
RESAMPLE
OTHER BACTERIA
TOO NUMEROUS
TO COUNT
U
R
OB
TNTC
Direct Verification Final
Count LSB BGB Result* Comments
*N~...~ot~liform Colonies per 100 mis.
Reportedlb~y / ]
Date (~)c~ 2-
Time
~nstru¢:ting Engineers
~01 Bu6dy Werner Drive
] :borage, Alaska 99518
Date Arrived: 8/05/87
Time Arrived: 0930
Date Sampled: 8/04/87
Time Sampled: 1500
Date Completed: 8/07/8?
)urce: IIose Bib L13, Bi, Valley View
~nlple ID#: A080587-2
~ra~neter Unit Resu]. t ADEC MCCg
[ trate-N mg/L 0. i7 10
Carol J. Garrison, Vice--President
g MGC = Maxi~uum Coataminant Concentration
Quality Control Report
Client: Constructing Eng).neero
ID~i: A080587-,.2
Listed below are quality control assurance reference samples with a known
concentr'ation prior to analysis. The acceptable limits represent
a 96~ confidence interval established by the Environmental Protection
Agency or by our laboratory through repetitive analyses of the
reference sample. The reference samples indicated below were analyzed
at the same time as your sample~ ensuring the accura6y of your results.
Samplei Farameter Unit ResuIt Acceptable Li~J.t
EPA WS378-6 Nitrate-N mg/L 0.99 0.84 - 1.02
LLINI
(below) ~ surface. ]Pi~l,~ o~ wd~lt (el~..k,,,,-) '~
~ . CHE, MICAL & GEOLOGICAL LABORATORIES 6F ALASKA, INC.
·274-3364 5633 B Street
n na ysis
z,,- ......... -,~ Dri ki ter A I Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
I.D. NO.
Water System Name Phone No
Mailing Address
City State Zip Co~e
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
I
I
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analvsis shows ires Water SAMPLE to be:
· ~ Satisfactory
3 Unsatisfactory
[] Samole too long in transit; sample should
~)ot De over 48 hours cio at examination
to indicate reliable results. Please sene
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
[] Membrane Filter
Lab Ref. No.
['
Result* Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
~resumpt lye 1Omi ]Omi /Omi 1omi 1Omi 1.0mi O.lml
24 Hours
Date
825"L"STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M. SU-LVAN,
DEPARTMEN [' OF HEALTtl AND ENVItRONMEN'¥AL PROTECTION
October 3, 1980
Glen A./Judy Wardle
Box 1341
Anchorage, Alaska 99510
Subj%ct: Lot 13 Block 1 Valley View Estates Subdivision #1
Approval for your individual sewer and water facilities
cannot be granted until the following items have been
completed: .
~/(11~/ The water analysis report be delivered to this department
from Chem Lab, 5633 B Street, for our review.
.~ .~'(~.) The septic tank pumped with a receipt submitted to
~~there are any further questions, please call this department at 264-4720. '
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Sandy Hartmann
% Marston Real Estate
2804 West Northern Lights Boulevard
99503
~~~"~ ~-~, .,.J~UNICIPALITY OF ANCHORAGF~..:---~ C.~c~/c~z/~
~~ DEPARTM~~ ~F HEALTH AND ENVIRONME~ ~ PROTECTION
,~ ~ 825 L Street~ Anchorage, A].as~a 99501~,~ ,,~.,,~ ")
Time
Date
Insp
Date Received:
_Au__u_g~_~t 19_~ 1977
Time
Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
p
LeDding Institution Request: Alaska Bank of Commerce
Mailing Address: Pouch 7-012 99509 Phone: 279-5641
Property Owner:
Mailing Address:
Glen A./Judy Wardle
Post Office Box 1341
99510
Phone:
277-1239
Legal Description: Lot 13 Block 1 Valley View Estates Subdivision
Single Family Residence: (x)
Multiple Family Residence: (
Number of Bedrooms:
Number of Bedrooms:
Well System:
Permit #
Construction
Individual well (x) Conm%unity/Pubiic System )
Depth of We]_l Well Log on File
Bacteria], Analysis
Sewage Disposal System:
Permit #
Septic Tan]< Size
Absorption Area
On--.site System (x) Public Utility
Installed 1977 Installer
Soils Rate Material
( )
'7.
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Absorption Area
Absorption Area
to Nearest Lot Line
])epartment of Health and Envir. onmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 13 Block 1 Vall.e_y__Vi.e_~E_~.tates ~ubdj_u~_~ion
.~,ffaaavit: Attached: ( } Attached:
Disapproved: Date:
Department Worksheet:
279-2511, ext. 224, 225 ?~!~',.,~'IW,!i<~,',~ I~,,~],~]IoN
~quest for Approval of Individual Sewer and W~'~j.~ja~ties
Property Owner:
Mailing Address:
2. Name of Buyer:
Mailing Address
o
Lending Institution:
Mailing Address:
Phone:
Phone:
4. Realtor/Agent:
Mailing Address:
Phone:
5 Legal Description: ~o't l? ~ I~ ~/~J/~,L~[(~~ A~¥~'~ ~, ~-
Street Location:
6. Single Family Residence: (~- Number of Bedrooms: / __
Multiple Family Residence: ( ) Number of Bedrooms:
7 o
Water Supply: *Individual Well (~
If Individual Well, well depth
If Community System, name of system
Public/Community System ( )
Sewage Disposal System: On-site System ( ) Public System
If On-site System, date of installation: __' /~-~ __
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
ALASK~'~°ARTMENT OF H, EALTH AND SOCIAL S--~'-'~ES
DIVISION OF PUBLIC HEALTH
Lab. No.
BACTERIOLOGICAL WATER ANALYSIS
Office
PLEASE MAIL RESULTS TO:
1
NAME (~4 \ ~ ~'-N} /-i~l\~ [~ ~
~'ITY_
ZIP CODE~~'-* [ ~
Sample collected by.
Phone No.
Specific place of collection .... ~ ..... ~ ~-. ~ L'~
REASON FOR SAMPLE SUBMISSION:
[] ~lness suspected
[] Health Regulated Establishment
;[~ Other ~,Y';:': :-:'.~. ~--~.i~.~.!~,~
WATER SAMPLE SOURCE
[] Well Type of casing
[] Improved (Enclosed, Covered ) Spring
[] Surface (Reservoir, stream, lake)
[] Holding Tank
[] Other
Analysis shows.this WATER ~AMPLE tp be:
L~/Satisfectory
[] Unsatisfactory
[] Questionable [] submit other sample
[] Sample too long in transit ~o indicate reliable results.
Sample should no~ be over 48 hours old at time of
examinati~)n.
[] Bottle broken or leaked in transit.
[] Other
SANITARIAN'S REMARKS
Sanitarian's Signature:
~READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD
· Time Received. P.m, Lab. No,
Presumptive :' ~' lOml lOml 1Omi lOml lOml 1.Omi 0.1mi
24 Hours
48 Hours
EMB
J
~ DATE RECEIVED
' &~_ " INSPECTION APPOINTMENTS ~
TIME TIME TIME /
DATE DATE DATE
INSPECTOR INSPECTOR~(~. ~ (~ INSPECTOR q ~
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~[~'~OHMEHTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION SEP 2 9 1980
Te,ephone 2.-..20 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES'
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER I PHONE
MAI LING ADDR ESS'
PROPERTY RESIDENT (I} different from above) PHONE
MAILING ADDRESS
3. LENDING INSTITUTION ] PHONE
MAILING ADDRESS
PHONE
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four
{~ SINGLE FAMILY []~ Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
{~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[i~ INDIVIDUAL/ON-SITE** \°t-~'~ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTI LITY
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
~ StNGLE FAMILY [] ONE --E~] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY ,~ ~-),~L~
-E~] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY _q- o'~ (~--~ '~ (~(
Connection Verified LOG RECEIVED ~'~ - 3 --'~ ~ ' ~ ~.
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
~ I NDIVI DUAL/ON -SITE DATE INSTALLED
E~] PUBLIC UTILITY f,~
Connection Verified _ i NSTALLER ·
E~Septic Tank or []Holding Tank
Size: [0~0 If Tank is homemade SOILS RATING
give dimensions: \
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank A~so~rea~ Sewer Line I Nearest Lot Line
WELL TO: J
Absorption Area to nearest Lot Line
5. COMMENTS
~ APPROVED FOR '~ BEDROOMS
[~CONDITIONAL APPROVAL (letter(~ust accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)