HomeMy WebLinkAboutT15N R1W SEC 18 LT 146A
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Diviaion
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ~)..'.'.~'" /
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
Address
Phone(s) J Perm~t No. ' JNo bf Bedrooms WELL
LEGAL DESCRIPTION
Lot Block ~
j~A ~ FOUNDATION
Township, Range, Section
Aa-BUILT DIAGRAM (Show location o~ well, septic system, prope~y ~ines, foundation,
~ ~ ~k'~ , ~k~ driveway, water ~odies, etc.)
~ANKS ~
~ SEPTIC ~A ~ HOLDING
/ TYPE OF SYSTE~
Depth to pipe bottom from Total depth from origina$ grade ~tJ J~ I OJ
FT FT
Number of lines ~ FT ~ )~
SoiJ rating Pipe materi~l
Inst~Jler ~ O J J~ Date ifls(aJled ~ ~J, ~
WELLS ' '
~ PRIVATE ~ OTHER (Identify}~
FT
Installer )ate Installed:
I ' ~ ~ NG ' certify Ihal Ibis Inspe~ion was pedormed according Io ali
72-013 (3/85)
13Y lii!:l',lI3IIqlEE];:~,, :If::'
FOR ¢:~
L Clil !::N t:1::: ¥ I 1B:~ ! ~:
t(::)i"!l! by t.h~.', I"h.~n:ic:il;;*a].;i.l'..'y (;:)t ~.)lr'li:::hCil".:;'~.gli:~ (l"ll;J¢.~) arid
::!; ,, ! b~ :i I :! i'.~(dll,)r'e I(::~ a'~ ] I I'IC)~,~ ,:*l'l(::t S(,a'l:x.:~ (::il ~:,~ :! ,~!~[~h:a r'
SCALE
N
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFI
LEGAL DESCRIPTION:
1
2
3-
4-
5-
6-
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Township, Range,
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
DEPTH?
Depth to Waler After
Monitoring?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ AND FT
COMMENTS
...... ,~RING
5 & ~ ~'~"'. '~iver Loop Road No. 204 ~/)///~ __
PERFORMED BY: 17034 Eagte_~.__;._ -;-.~?;' 2~./.~ '~ ~'--~--CERTIFY THAT THIS_TEST WAS PERFORMED IN
Eagle River, ~'" .... ~' {///'- /
ACCORDANCE WITH A].L STATE AND MUNICIPAL GUIDELIII~S IN.E~FECT ON THIS DATE. DATE:
72-008 (Rev. 4/85) / /
.VIUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage. Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LEGAL DESCBIPTION
LOCATION
OISTANCETO: ]Wel,~/~,lAbs°rpti°narea~O ' Dwelling~o ' PERMIT
~~ Manu'actur"r ~~ Ma'~rial ~ "°' °' c°moartm"nts
C}q. ~ gallons IF HOME,DE: Inside length Width Liquid depth
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z ~ Manufacturer Materi~l Liquid capacity in gallons
Q Wel,~/~ Found~i~ Nea~s~t~ine PERMIT NO.
~ DISTANCE TO:
No. oflines / Length of each line Tota~n~of lines Tren~ rth Distance between ,ines
-- inches
~ !~ Top of tile to finish grade ¢, Material beneath '~e,,O Total effective absorption area
inches
Length Width Depth PERMIT NO.
~ ~ Type o¢ crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s~
~ DISTANCE TO:
OTHER
PIPE ATERIALS
SOl L TES~ATI NG
INSTALLER
APPROVED DATE LEGAL ~ ~ /
72-013 (Rev, 3/78)
PERMIT NO.
MUI'-I Z C 1' pAL 1' TY OF ANCHORAGE
DEPARTMENT ~ALTH AND ENVIRONMENTAL '~-~"ECTION
825 'L. _.rREET, ANCHORAGE, AK.
2~4-4720
ON--S I TE SEWER PER£4 I T
780~5~ )
APPLICANT
LOCATION
LEGAL
CHUCK BRYANT
BEVERLY DRIVE
Li4~ SEC 18 TiSN RiW
BOX 129 EAGLE RIVER
LOT SIZE
54450 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL RATING <SQ FT?BR>= 90
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= 12 LEN(~TH= ~i GRAVEL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION <IN FEET>.
RE(~U I RED SEPT I C TANK S I ZE= ~L250 GAL/_ONS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT ~URING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE~
------ TWO ( ~ > INSPECT IONS ARE REnU I RED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL 8Y THIS
DEPARTMENT WILL 8E SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE WELD OR
i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I T EXP I RES DECEMBER
I CERTIFY THAT
l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BV THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
/__~
APPLICANT CHUCK BRYANT
ISSUED ...............
[~SOI LS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99602 276-2221
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
DATE PERFORMED:
SLOPE SITE PLAN
8
9
10
11
12
13-
14-
15-
16-
17
18
19-
20-
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
0
p
E
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND FT
COMMENTS
72-008 (7/76)
OEF::'AF:~I'MEIq]" OF: HIEAL FI'I AND E!]xIVIF:~ONMENI'AL,
:!. ~.1,6'- ?.0 () 0
,.~..l:( D].V.I ,.~:1 (}ti,, NA I.~OT: 146A
c~l:::l... I L (~1,1. L o TOWHSH I P: .I,,.. N I .Al,IL I ....].W
ii ,, 2.5A I.~::~U. F:: I ~. ti', ACI::;;I]!]~:D
/or!..h by tI'ie:, Fh..u"l:Lc:i. pa]:Lty c)~' AnchoPage (MOA) and Ll"ie State oI Alaska.
;:~, :t: v, ci].l :insLa~t:l Lhc.::> ~i!iy~i~'~:.~?~ll ;~1"1 ac:c:or'danc:e w:Lth ali MOA ccx::le~ a~d regt. k;laLic:)ns~,
alid :i.~ comp:l:i, anc:~r~, ~i'Kh k:.he cles:Lgr~ c:;r':i, te~':La c)~ th:is per'm:i.t,,
:3,, ! ~:i.:I..L adhel'e 'Lo a:L~J. MC)A and Stat,:.~:~ ot f,~:laska r'equ:i.r'ements for' th~z~ se'l. bach:
d'Ls'[:.anc':c:'~,~ [i"om oily (~.>,).~:is'~':~l"~i;;~ w~.:~,~t:]., w,~'~'.(~.>)t,~o.'l'.(~.~>l" Cl:ir~I::H::)~[ih~:L ~y~'~:.(~.:,r~i C:)l" p~d::~l:i.c
At::"F:'I.. ]: C;AN'I": I"IIE:I:r(B W I E'I' Z
%%
1(~o
WATER WELL RECORD,
STATE OF ALASKA
DEPARTMENT OF NATURAl RESOURE$
Division of Geologicol 6 Ceophyslcol
Anchora~( l~+6A ~Wo,__ o,__o,- 18 sE] wE]
.~I-Ic~]DISTANCE ANO DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Herb
Feet Below 4, WELL DEPTH: (II,gl) 5. DATE OF COMPLETION:
ha~p~ Krey , , 55 67 O T.,, w.. ~ mb,,; , , ,
$~d ~ gravel ~d H20 67 69 a. cAs,.s= O'h'~" ~ W.,...' ' '"
~ Equipment
F'ERM I T NO.
DEI::'FII:;?.Ti'"IENT 01- HEFILTH F:IND EN',/iRONMENTF:IL F'~e. OfEC:TION
IL,,..ll IF_'-"£ IL._ IL .... IF':::' lEE IF~ I1'.11 3: T*
I=lF- I,- I,.. ]. _.Hi',! I
L 0 CI:::IT ]: ON
LF::EiF:IL
P'IiNIHUH I.:,I:~2;"Flat'.,!CE E:E'¥t.,.IEEI'.,I R 1.4EL. L RN[:, RN"r' ON-5;iTE SEt.,.IFIGE D]:SPOSI:::IL 2T,¥1i.:.;"FEM IS
i. OO F:'EET FOR F:I PRI'¢RTE klELL O1;~. 2Ct0 FEET FOR FI F'UBLIC klELL.
t.,.IELL LOG':~;; F:II;:{E I:~E6!U;[RE[:' RND HUST BE RETURNED TO THE DEPFIRTHENT I.'.IITH];N :']:0 DFt"¢S
OF' THE 1.4ELL COMF'LETION.
OTHER REC!UIREHENTS HR'T' RPF"L'¢. SPECIFICF¥1"IONS F:IND CONS'T'RLICTION DII:~r.3RRMS RRE
F¢,,,'F:IILFIE:LE TO IN~;URE PI:~:OF:'ER IN~;TFILLRTION.
I
::L:
FORTH 8'¢ '1"HE MUNICIPFILIT¥ OF FINCHOf;~F:IGE.
2: I I.,.lII.J_ IHSTRLL THE ':i.:,'¢STEM tN FICC. ORDRNCE klITH THE CODES.
S I '-':iNED~: frtl:: F L :[ CFINT
.... ' ......... ' ...... ~' ................................ r__r' .................................... 7 ..... ' ................
;[ '-",=' IJI:.L:' B'T'_~ "
A & L DRILLING COMPANY
BOX97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588
OWNER OF LAND
ADDRESS ~
LEGAL DESCRIPTION~
DATE-Started .~/5/? ~:~
PERMIT NUMSER _ 7 ~'~O 4'/~
!
DEPTH OF WELL
STAT,¢ LEVEL OF WATER FT.
DRAW DOWN FT, _ /OD
GALS. PeR HR / ~ O
e~NDOF CAS~ ~0
KIND OF FORMATION:
From O .Ft. to
From~ Ft. to
From ~:} Ft. to
From ,~. ~' Ft. to~_
From .~/ Ft. to~,~Ft. ~'-~,~Z] X~ g ~'t'~ From
From 4~rt. to 7i rt.~g~n~om.~
From. 71 FI. to /2~ Ft. ~OSro,Ua rro~
rroml3o Ft. to /J.] Ft.~g~Z~/<~ From
From/33 Ft. to ~7 rt~ ~[~~ From
From,~7 Ft. to_O~g--Ft. ~ C/~ From
Fro~ ~ ~ Ft. to_~Ft. ~ 0 J'~ From~
From.__Ft. to___Ft.
From Ft. to Ft.
From Ft. to___ __Ft
From__ Ft. to .Ft.
From__ _ _Ft. to
Ft. to Ft.
Ft. to Ft.
FI. to Ft.
Ft. to____Ft.
Ft. to Ft.
_ Ft. to __Ft.._
Ft. to ___Ft.
From__ Ft. to __Ft.
From __Ft. to Ft.
From _. Ft. to_ Ft.
From__ Ft. to~ FI.
From Ft. to Ft.
From__.Ft. to Ft.
From__ FI. to Ft.
From__.Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From_ Ft. to Ft.
MISCL. INFORMATION:
DRILLER'S N AU E _/~'~-~ ~
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 146A; Section 18; T15N; R1W
Location (address or directions)
19015 Beverly Drive, Eaqle River, Alaska
(b) Property owner Herb & Barbara White Telephone: (home) 688 ~0848~ Business
Mailing Address P.O. Box 770649, Eaqle River, Alaska 99577
(c) Lending Institution Seattle Mortqaqe Telephone
Mailing Address ATTENTION: Dick Dolman
(d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER - virglnia Kohfield
Address ~ Cent~rf~ld Drive, ,quite 201, Eagl~ River, Alaska 99577
Telephone 694-4200
(e) Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING/694-2979
17034 Eagle River Loop Road, Suite 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family F~ Number of bedrooms 4
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 E~ 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 (R,,. 7/B,) Page 1 of 2
5, ENGINEERING FIRiVl 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 affect on the date of this inspection.
Name of Firm Telephone ~¢z/~,.-,-~ ~,,~ ,~
Address 1703~ E~lo ~:~" ..... ~"
Eagle River, ~"~' ..... 517 ~ ~
Date -
6, DHHS APPROVAL
Approvedfor.-~c~ ~ edroomsby
Approved /~' 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 Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
A. WELL D~'""~A
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
Well Classification "~,,.LDi~.i ~D',~"L..
Well Log Present (~N) ~ Date Completed ~.- ~-~L~
Total Depth 1¢ct~ Cased to '~Ipt~' Depth of Grouting
Static Water Level '~"') ~
Casing Height Above Ground
Electrical Wiring in Conduit~N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Pump Set At
Sanitary Seal on Casing i~/'N) V
Depression Around Wellhead (YI~
If A, B, C, D.E.C. Approved (Y/N)
Yield
; On Adjoining Lots
~,~1:)~'~'- ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed~ Size ~--~
Standpipes (~/N) '~ Air-tight Caps
Depression over Tank (Y/I~
Pumping/Maintenance Contact on File (Y/N) I~/~
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/I ICLD',,%'C TANK:
To Water-Supply Well \ (~"~'
To Property Line 'to
To Water Main/Service Line ~.E)~
No. of Compartments '7-
\/ Foundation Cleanout ~N)
Date Last Pumped ~
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ,~- la-
To Disposal Field '~--~ '~'
To Stream, Pond, Lake or Major Drainage Course \ G c, ~.-~'
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness /-,'
Statndpipes Present ~N)
Date of Last Adequacy Test
Square Feet of Absortion Area 7(~L)-
Depression over Field (Y/~
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ~ LbO
To Building Foundation \E)~''~
Lot ' ~'
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line ~,~ '~'
To.F.,~e~,,er Abandoned System on
; On Adjoining Lots
To Cutback (if present)
.-~..~ D '~..~--
Comments
D. LIFT STATION
Dimensions
Manhole/Access (Y/N)
TH iegsthedWfS:: r Ala rm Level at~ ~~ -"'""~~ Vent (~Cycles during Adequacy T~st'
Meets MO~Y/ )
Co~~
**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
inspection.
S & S ENGINEERING
Signed
17034 Eagle I~lver Loop Road No. 204
Company ~?..~ Ri~a~*: Alaska
Date ~Z ~
Receipt No.
Date of Payment
Amount: $
72-026 (Rev 7/88) Back
q'- 19-qc
Receipt NO. ,~)
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
ANALYSIS REPORT BY SABLE for Work Order # 26672 Date Report P~inted: AUG 31 90 ~ 13:24
Client Sample ID:LI46 "A" SEC1S T15N R1W
PWSID :UA
Collected AUG 22 90 @ 15:00
Receives AUG 23 98 ~ 13:55
P[esezved with :AS REQUIRED
Client Name : S & S ENGINEERING
Client Acct : SNSENGP
P.O.~ NONE RECEIVED
Req #
Ordered By : R. SHARER
Analysis Completed :AUG 30 90
Special
Instruct:
Send Reports to:
I)S & S ENGINEERING
2)
Chemlab Rei ~: 903209 Lab Smpl ID: I Matrix: WATER
Allowable
Pa~amete~ Tested Result Units Method Limits
VOL AROMATIC/UNSAY ORGANICS n/a n/a EPA 503.1
BENZENE ND(1.O) ppb EPAS03.1
BROMOBENZENE ND(1.O) ppb EPAS03.1
n-BUTYLBENZENE ND(1.O) ppb EPAS03.!
sce-BUTYLBENZENE ND(1.O) ppb EPA603.1
text-BUTYLBENZENE ND(1.O) ppb EPAS03.1
CHLOROBENZENE ND(1.O) ppb EPA503,1
2-CHLOROTOLUENE ND(1.O) ppb EPA603.1
4-CHLOROTOLUENE ND(i.O) ppb EPA603.1
1,2-DICSLOROBENZENE ND(1.O) ppb EPAS03.1
1,3-DICRLOROBENZENE ND(1.O) ppb EPAS03.i
1,4-DICRLOROBENZENE ND(1.O) ppb EPA503.1
ETHYLBENZENE RD(i.O) ppb EPAS03.1
HEXACHLOROBUTADIENE ND(1.O) ppb EPA503.1
ISOPROPYLBENZENE ND(1.O) ppb EPA503.1
4-ISOPROPYLTOLUENE ND[i.O) ppb EPAS03.I
NAPHTHALENE ND(1.O) ppb EPAS03.1
n-PROPYLBENZENE ND(i.O) ppb EPAS03.i
STYRENE ND(1.O) ppb EPAR03.1
TETRACHLOROETHYLENE ND(1.O) ppb EPAS03.1
TOLUENE ND(I.O) ppb EPA603.1
1,2,3-TRICHLOROBENZENE RD(1.O) ppb EPAS03.1
1,2,4-TRICHLOROBENZENE ND(1.O) ppb EPAS03.1
TRICHLOROETHYLENE ND(1.O) ppb EPAS03~i
1,2,4-TRIMETHYLBENZENE ND(1.O) ppb EPAS03.1
1,3,5-TRIMETHYLBENZENE ND(1.O) ppb EPAS03.1
o-XYLENE ND(1.O) ppb EPA603.1
m & p XYLENE ND(I.O) ppb EPA603.1
n/a
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907)562-2343
FEDERAL TAX I.D. #92-0040440
ANALYSIS RSPORT EY SAMPLE £or Work Ozdex # 26617 Date Report Erlntod~ AUG 27 90 ~ 10:31
Client Sample ID:Li46A SECi$ T15N R1W
PWSID :UA
Collected AUG 21 90 ~ 18:30 hrs.
Received AUG 22 90 ~ 13:30 hrs,
Preserved with :AS REQUIRED
Client Name : S & S ENGINEERING
Client Aect : SNSENGP
P,O.# NONE RECEIVED
Req #
Ordered By : R. SNAFER
Analysis Completed :AUG 24 90 Send Reports to:
Laboratory Supex~o~ :STE?EP_~HPHSN C. EDE 1)S & S ENGINEERING
Rel.ased Ey: ~ ~Z~ 2)
Special
Instruct:
Chemlab Ref {: 903176 Lab Smpl ID: 1 Matxix: WATER
Allowable
NITRATE-N 2.8 mg/1 EPA 353.2 10
Sample ROUTINE SA~4PLE.
Remarks: SAMPLE COLLECTED BY RD$.
i Tests Ps[formed See Special Instructions Above UA-Unavailable
ND- None Detected "See Sample Remarks Above
HA- Not Analyzed LT-Less Than, GT-Greater Than
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
A~.,~orage, Alaska 99518
Drink ng Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
PUBUC WATER SYSTEM I.D.# [ I I I I I I
PRIVATE WATER SYSTEM
Name
Mailing Address
Phone No.
S & S ENGINEERING
17034 E~gle River Loop ROad No. 204
Eagle River, Alaska
City State
Mo. Day Year
Zip Code
SAMPLE TYPE:
~' Routine
[] Check Sample (for routine sample
with lab rel. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
3 I J
"I J
Time Collected
Collected(~.~ _~
TO BE COMPLETED BY LABORATORY
SatiS shows this Water SAMPLE to be:
isfactory
[] Unsatisfactory
[~ Sample too tong in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special deltvery mail
Date Received ~ - ~ '~(~
Time Received /~-~ ~'(~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Analyst
90.3176 ~...~,
Result*
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
BACTERIOLOGICAL WATER ANALYSIS RECORD ~'~LC~/~
Membrane Filter:. Direct Count O Collform/100ml
Verification: LTl3 BGB___
Final Membrane Filter Results Collform/100ml
Reported
Time: / ~'~'~'~'~'~'~'~'~'~ 7D a.m.
TNTC = Too Numberous To Count
OB = Other Bacteria
PART ONE; OF TWO
EMAINDER TO FOLLOW
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Properly Owner
Mailing Address
Telephone: Home ~ ~'¢ - 0~¢~'7~ Business
(c)
(d)
Lending Institution ('~-~ ~-v'O.~'~' Telephone
Mailing Address cJ'O(9° ':P~ ~1~ ~ J~ ~ ~
Real Estate Company and Agent ~ioCi~'~ ~C.%~
Address ~ ~ ~ ~ '~ ~C[ ~ ~/~C~ Z.~O
Telephone % ~¢ - ~¢~ ¢
(e)
Mail the HAA to the followina address: or; Check here~,~f hold for pick up,
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family ~
Number of Bedrooms
WATER SUPPLY
Individual Well,~ Community [] Public []
Note: If corn m unity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite ~ Public [] Community [] Holding
Tank
Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 trey 8/861 fronl
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/er
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-- --(-:~O~Jc' ~1 ~Y5 ...~'I ~ Telephone
Date J~-t ~ ~% ¢~Z
DHHS APPROVAL
Approved for '~'"~'~ C'"'~ bedrooms By ~6~-~.~
Approved ~ Disapproved
Conditional
Terms of Conditional Approval
CAUTION
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 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,
Page 2 of 2 72-025 IRev 8/861 Back
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
A, WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth ~ ~ rCased
Static Water Level '.~ O '
Casing Height Above Ground
Electrical Wiring in Conduit IY/N)
If A. B, C. D.E.C. Approvea (Y/N)
Date
Completed
Yield
Depth of Grouting /~ ~
Pump Set At
V
Sanitary Sea~ on Casing (Y/N) /
Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorpuon Field on Lot
To Nearest Public Sewer Line
Cleanout/Manho~e ~ /
Water Sample Collecte(J by
Water Sample Test Results
-/-' / O O
: On Adjoining LOtS
'~'/~30~ : On Adjo~mng Lots
To Nearest Public Sewer
To Nearest Sewer Serwce Line on Lot 'Y' ;~"~-
Date
Comments
B. SEPTIC/HOLDING TANK DATA
Size
Date Installed
Standpipes (Y/N) ~' Air-tight Caps {Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line 'f' ~' ~ ~
To Water Main/Service Line Course '74 / O~) r
No. of Comoartments
Foundation Cleanout (Y/N)
Date Last Pumpeo '~" ~' ~ ~
for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
¢./ZO /
To Stream. Pond. Lake. or Malor Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ - 7 ~
Width of Field '~ '
Square Feet of Absorpnon Area
Depression over Field (Y/N)
Results of Last Adequacy Test /~'~'ff ~'~'~
Separation Distance from Absorption Field:
· -/-/O O
To Water-Supply Wel
To'Building Foundation 4~, 0
To Water Main/Service L~ne ¢- ~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present [Y/N)
Date of La~sLAdequacy Test
74,,..- ¢
To Property Line
To Existing or Abandoned Syster~ on
: On Adjoining Lots '~' ~ 0 '
To Cutbank (if present) ?3--
Comments
D. LIFT STATION
os ~....~ D~menslons
Manhole/Access, [Y/N)
'Pump On" Level at ~~ "Pump Off" Level at
H~ h Water Alarm Level at ~ ~ . ,
'g
~ Clcles d~;in Ade uac Test. Meets
Tested for ~ ' y ' g q y MOA
Electrical Codes (Y/N) ~ ....
Corn ment~.._ ~
"Check Permitted Bedroom Rating Agmnst HAA Request *' * -
I certify t.~t I~ve/~l~e~ keri, verified or conformed to ~11 MOA and HAA g uidelines in effect on the date of this i nscectlon.
Signed ~1//~'/'~J//~¢'"'"-' Date Jug.c_.., ~o ( ¢ ~7
Company ~H5~ ~q¢~ ~OMOA No,
Date of Pay mere ~ ~
A~ount: $ /O~' CO
a'7-o z--3
Q IAI333
Page 2 of 2
/96I Z NI ii
NORTHERN TESTING LABORATORIES, INC.
2505 FAIRBANKS ST.
ANCHORAGE, ALASKA 99503
907-277-8378
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
ATE WATER SYSTEM
SAMPLE DATE:
Mo, Day
S~AM._~T-.Y.E PE:
L~,PCo u t in e
[] Special Purpose
Purchase Order No.
[] Check Sample (for original contaminated
sample with lab reference no.
3
Zip Code
[] Treated Water
~ed Water
)
Collected by /Laboratory Ref. No.
8
9
TO BE COMPleTED/BY LABORATORY
Received at:/~ Anch. [] Fbks.
Date Received
Time Received //',..~/~,'~/'"
Next Sample Due
COMMENTS:
SATISFACTORY
UNSATISFACTORY U
RESAMPLE R
OTHER BACTERIA OB
TOO NUMEROUS TNTC
TO COUNT
*No. of Total Coliform Colonies per 100 mis.
Date
Time
NORTHERN TESTING LABORATORIES, INC.
600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479-3115
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378
Constructing Engineers
9601 Buddy Werner Drive
Anchorage, Alaska 99616
Date Arrived: 6/16/87
Time Arrived: 1515
Date Sampled: 6/16/87
Time Sampled: -
Date Completed: 6/17/87
Source: Hose Bib - Herb White Res.
Sample ID#: A061687-5
Parameter Unit Result ADEC MCC
Nitrate-N mg/L 3.0 10
========================================================~.--~-- ~/~ ~- ~ --- ...... ==
Carol J. Garrison, Vice-President
* MCC = Maximum Contaminant Concentration
NORTHERN TESTING LABORATORIES, INC.
600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479-3115
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277.8378
Quality Control Report
Client: Constructing Engineers
ID#: A061687-5
Listed below are quality control assurance reference samples with a known
concentration prior to analysis. The acceptable limits represent
a 9§~ 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 accuracy of your results.
Sample# Parameter Unit Result Acceptable Limit
EPA WS378-6 Nitrate-N mg/L 0.99 0.84 - 1.02
===========================================================================
/
LEGEND: As-BUILT suRVEY
G Iron Pipe SC~O 1"
o 5~oOI Pin
~ S~tvo.i Hub Q T~
[ hereby certify that a survey of Lot .~ ~.
_Subdivision w~s m~de ~o~ ~ ,, _ ~nd
that the improvement~ situated d~ereon are within the property
and do not ovedo9 or encroach on the property lying adjacent thoreto,
thor no improvements on property lyln9 ~djacent thereto encroacl~ on
the premises in question ~nd that there are no roadways, transmission
lines or oth~r visible easements on s~Jd!property except as ~ndlcated
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME T~ME TIME
DATE DATE DATE
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HE,'~L¥,I &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL F,,,)I'ECTtON
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
DIRECTIONS= Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for procassin§.
1, PROPERTYOWNER I PHONE
PROPERTY RESIDENT (if different from above) ~ ~' ' PHONE
MAILING ADDRESS
3, ~.ENDING INSTITUTION PHONE
MAILING ADDRESS
4, REALTOR/AGENT ~ /' PHONE
'MAI~II~IG ADDJ~ESE - o
5. LEGAL DESCRIPTION
~ SINGLE FAMILY
~ MULTIPLE FAMILY
7, WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON'SITE
[] PUBLIC UTILITY
NUMBER OF~BEDROOMS
[] One ~l~ Four
[] Two [] Five
[] Three [] Six
[] Other
ATTACH WELL LOG. A weh log is required for all wells drilled
s nce June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
/YZ/' YEA, C -S,TE SYSTEM WAS ,NSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [~] FiVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] NDIVIDUAL/ON-SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: I~.~'O If Tank is homemade ' SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)