HomeMy WebLinkAboutVALHALLA #1 BLK 3 LT 18Valhalla
Block
Lot 18
#015-212-01
MUNICIPALITY 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
LOCATION
I Well ~ Absorption a ea
it¥ in~g lions Inside 10ngth
cai ~.~'l~ ~ IF HOMEMADE: ~
DISTANCE TO
Well Dwelling
DISTANCE TO: ~¢~,¢%~ Foundation__ ~])-- ,
li,~6,~ L~&~/a~%d th of lines
of tile to finish Fade tile
Len§th Width Depth
Nearest I~t_Jin~ O
Trench wid~J
PHONE .~ NEW
NO. OF ~ROOMS
Liquid d e.l~,_t I~
PERMIT NO.
in gallons
PERMIT NO.(~ ~ ~ ~ ,- )
PERMIT NO.
Type of crib
TO:
Well
Nearest lot line
~/~,,~/~)_~ Depth Driller Distance to lot line
Building foundation Sewer line Septic tank
DISTANCE TO;
on area
Absorption area(s)
OTHER
PIPE MATERIALS
SOl L TESY RATI~G~
INSTALLER
REMARKS
APPROVED
DATE LEGAL
72-0 l~'Rev. 3/78) /]
Department f Health and Environmenta ~rotection
825 ~ Street, ~chorage, AK. ~9501 ....
264-4720 r~
R TT N P RM T
- ~ WELL AND/~ ON-SITE SEWER PERMIT ~l~>[ .
Applicant: ~-~f/?~. "'-J~-~' ~:>/~: ' Mailing Address: ~/~S :
Legal Description: :~'7-,/~ ::? : Z(~ Lot Size:
Type of Soili~sorption System Is:
Trench: ~ Drainfield: Seepage Bed: Holding Tank:
aroom,, So Z ':
The Required Size of the Soil ~sorption System Is:
DEPTH ~ LENGTH ~ . GRAVEL DEPTH ,.:~1 WIDTH
Tnt length dizension 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 ~nd
the bottom of the excavation(in feet). There is ~o set width for trenches.
The gravel depth is the minim~ depth of gr~vel between the outfall pipe and
the botto~ of the excavation(in feet).
* * REQUIRED SEPTIC~-~OL-94-N~) TANK SIZE = /~ GALLONS * *
Per~it ~pplic~nt has the responsibilit~ to inform this dep~rtment during the
installation inspections of ~ny wells adjaoent to this propsrty ~nd the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any ~ystem without final inspection ~nd approval by this dep~rtment
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams ara
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site
the~resideDce is remodeled to
SigneR: Applicant /'
and walls as
sewer system may require enlargement if
include more that~ 3:)edrooms.
Issued by:
SWP/024(1/81)
S
&
S
~ [IZ5 OLD SEWARD HWY.
ENGINEERS, INC. ANCHORAGE, ALASKA 99503
,349 - 6561
S(}ILSI.()(; VI H(;()I AII(}~ I~ SI
2
( .... 3
4
5
6
9
I0
~2
~5
~9
2O
COMMENTS
IF YES, AT WHAT
DEPTH)
JOHN E. SWAN!
1834-E
w1maz
n®x 1309, STAlm H®LTE A ANCUORAGEv ALASKA 99502
944-7714
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF O0
00
DRILLED AT THE RATE OF "23.PER FOOT.
344-9000 7>3-''415
PROPERTY OWNER
LOCATION OF WELL SITE 1"n'. soy. I)a-M&4L
DRILLER n %'n^-0- r-i0-(rq
WELL LOG:
0---_7<.
Seue'.c L
01--_7n� f,L�.t[4 CO2h/!n_ rrlf`GI7C'�_o CIS,(!_^7±�AI. t7C7t;fiL?'(".PILLCL�.
7n-•--:'0' Haat_.. L'Yt .:. I1^!i,)UjvC cacorAe ri,LtaUG!.e to(l1LG{'-!xm, d L6hr4 n to 10 '1
X11.11 r. 1n ./oE t a_° woll.(tk, jt4 nCi'-aco .FnCf!i1,iR.(! a���. 11(i-�: `,aL?.� 11,01JeU(m.,a rood ne,)7, !ILtll.o
1/. p1u.?.2 �.)h.au ld be , n -t' l.Lesl 4 ,"eet a,P,P
Ca"I't a h,i Lunn.: 'p3.00 r„e;i ;baa 80 ;Cees: :;`18,40.00
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 1 0 O0
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
SERVICE CHARGE 0 F I V,% PER MONTH WILL BE ASSESSED 'ON- PAST DUE ACCOUNTS.
Municipality of Anchorage
Development Services Department
BUilding Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 01 5-21 2-01
1. GENERAL INFORMATION
Complete legal description VALHALLA #1
COSA # O
ExpiratiOn Date:
BLOCK 3, LOT 18
Location (site address) 441 0 Traverse Way, Anchorage, AK 9951 6
Current Property owner(s) MICHAEL & LISA INSALACO
Day phone
Mailing address
441 0 Traverse Way, Anchorage, AK 9951 6
Lending agency ,
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3.~ ~PE OF WATER SUPPLY:
~': . individual Well:
· ~i: IndividUal wa.t~:~ Storage
.~ .Community Ciass __ Well
P'ublic water'System
4
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site [~
[] Individual Holding Tank []
[] Community On-site E~]
[] Public Sewer j-~
The MuniciPality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ArcTerra Consulting, Inc. Phone 868-3792
Address 20441 PTARI~IlGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH I~1. DUFFUS Date 07/15/2011
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies onlY to the conditions as of the day tested. The flow
and absorption rates may change due to subsurface conditions that may not be observed from the Surface,
changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the
water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
~/ Approved for /..?L
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
"7-2-
B,
Municipality of Anchorage
Development Services DePartment
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Valhalla #1, Block 3, Lot 18
A. WELL DATA
Well type PRIVATE
Date completed 6/1 5/83
Total depth 80 fl.
Parcel ID: 01 5-Z1Z-01
Date of test
Static water level ff.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform ~_~colonies/lOOmL Nitrate O~ ~},.~ mg/L
Arsenic: ND rng/I Date of sample: 7/7/Z01 1
SEPTIC/HOLDING TANK DATA
IfA, B, or C provide PWSID # __
Sanitary seal (Y/N) Y
Casedto 80 f.
FROM WELL LOG
1 2/1 7/85*
65.8*
6.6*
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24 in.
AT INSPECTION
7/8/2011
64 ft.
5,6 g.p.m.
Collected by: 'ArcTerra
Tank Type/Material Se.bric/Steel Date installed 6/1 5/83 Tank size 1 ZS0 gal.
Number of Compartments ~_ Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
High water alarm (Y/N) N Date of pumping 7/8/11 Pumper'A+
C. ABSORPTION FIELD DATA
Date installed 6/1 5/83 Soil rating (g.p.d./ft2 or ff~/bdrm) 349
Length 146' ft. Width3ff. Gravel below pipe 5 ft. Total depth g ff.
Eft. absorption area 1460 ft2 Monitoring tube Y Depression over field N__
Date of adequacy test 7/8/201 1 Results (Pass/Fail) PASS
Fluid depth in absorption field before test O in. Water added 600 gal. New depth Oin.
Elapsed Time: O min. Final fluid depth O in. Absorption rate >= 600+
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date __
D. MFT STATION
System type Deep Trench
For 4 bedrooms
g.p.d.
Date installed NA
"Pump on" level at __
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at __
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septictank/liff station on lot 100'+
Absorption field on lot 100'+
Public sewer main 75'+
Sewer/septic service line ZS'+
Animal containment areas 50'+
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & cimuit requirements?
On adjacent lots 1 00'+
On adjacent lots 1 00'+
Public sewer manhole/cleanout. 1 00'+
Holding tank 100'+
Manure/animal excrete storage areas 1 00'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main 1 0'+ Water service line 1 0'+
Wells on adjacent lots 1 00'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 1 0'+ Building foundation 1 O'+
Water Service line 1 0'+ Surface water 1 00'+
Curtain drain 50'+ Wells on adjacent lots 100'+
COMMENTS
Absorption field 5'+
Surface water 100'+
Water main 10'+
Driveway, parking/vehicle storage 10'+
G=
ENGINEER'S CERTIFICATION
I certify that t have determined through field inspections and
review of Municipal records that the above systems are .in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 07/1 5/2011
COSA Fee $490.00
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SGS Reft# 1112999001
Client Name ArcTerra Engineering and Surveying Printed Date/Time 07/15/2011 10:11
Project Name/# Valhalla #1 BLK 3 L18 Collected Date/Time 07/07/2011 13:40
Client Sample ID Valhalla #1 BLK 3 L18 Received Date/Time 07/07/2011 16:05
Matrix Drinking Water Technical Director Stephen C. Ede
Sample Remarks:
4500NO3-F - Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements.
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/11/11 07/12/11 NRB
Waters Department
TotalNitrate/Nitrite-N 0.935 0. I00 mg/L SM20 4500NO3-F B (<10) 07/08/11 AYC
Microbiology Laboratory
E. Coil Negative I 100mL SM20 9223B A 07/07/11 CR
Total Coliform Nel~ative I 100mL SM20 9223B A 07/07/11 CR
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 01~;-212-01
1.
GENERAL INFORMATION
Complete legal description
Location (site address)
COSA #
Expiration Date:
VALHALLA #1 BLOCK 3: LOT 1 8
Current Property owner(s)Terr¥ & Dehorn Hill
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
Dayphone34~916 ~
4410 Tr~ver~eWay: Anchorage: AK 99~1 ~
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the
transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal
and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site
Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well
and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one
year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or
a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
4. 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, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for
this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all
applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ArcTerra Engineering & gun/eying: Inc. Phone~__
Address ~_0441 PTARMIGAN I~LVD.: FAGLF RIVER: AK 99~;77
Engineer's Printed Name KENNETH M. DIJFFIlg
Date
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations.
The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from
the surface, changes inland use, local soil charactedstcs, groundwater levels that may fluctuate dudng the
year and the water usage of the family being served by the system. The operational life of all well and
septic systems are subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function safisfactoP/for current or future
occupants or ~n ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Valhalla #1. Block 3. Lot 18
A. WELL DATA
Well type pRIVATE
If A, B, or C provide PWSID #
Date completed 6/1S/8;~ Sanitary seal (Y/N) Y
Total depth 80 ft.
Cased te ...~L0-~*
FROM WELL LOG
Date of test
Static water level B S. B * ft.
Well production 6,6' gp.m.
Ce
Parcel ID: -~
Well Log (Y/N) Y
Wires propedy protected (WN)Y
Casing height (above ground) 24 in.
AT INSPECTION
8/1/07
64 ft.
5.6 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100mL Nitrate ._].~IL Other bacteda 0 colonies/100 mL
Arsenic: ND mg/I Date of sample: 8/1/07 Collected by: ArcTerra
SEPTIC/HOLDING TANK DATA
Tank Type/Material_~~ Date installed 6/1S/83 Tank size ~ gal.
Length 146' ft. Width 3 ft.
Eft. absorption ama 1460 ft2
Date of adequacy test 8/1/07
Number of Co~partmenteZ Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
High water alarm (Y/N) N ' Date of pumping 7/Z3/07 Pumper McDonalds
ABSORPTION FIELD DATA ' :~
Date installed~S0i! rating (g.p.d./ft; or ~/bdrm) 349 System type ~
Gravel below pipe 5 ft. Total depth 9 ff.
Monitoring tube Y Depression over field N
Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test_l_ in. Water added_EzL gat. New depth .]_in.
Elapsed Time:_]. min. Final fluid depth_L in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date .....
D, UFT STATION
Date installed NA
'Pump on' level at
Datum
E.
Size in gallons
in. 'Pump off' level at
Cycles tasted
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/tiE station on lot ! 00'+
Absorption field on lot 100'+
Public sewer main 7~"~
Sewer/septic service line
Animal containment areas SO'-I-
Property line 1 O'+
Water Service line 1 O'+
Curtain drain 50'+
F. COMMENTS
Manhole/A_,~ce__ss (Y/N).
High water alarm level at in.
Meets alarm & circuit requirement?
On adjacent lots 1 0 0' +
On adjacent lots 1 0 0' +
Public sewer manhole/cleanout I 0 0 ' +
Holding tank I 0 0' +
Manure/animal excrete storage areas 1 0 0 ' +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~;'-i' Property line ~ ' -I- Absorption field ~ ' +
Water main 10'+ Water service line ! 0'+ Surtacewater 100'.i.
Wells on adjacent lots 1
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 10'+ Water main 1 0 ' +
Surface water 1 0 0 ' + Driveway, parking/vehicle storage 1 0 ' +
Wells on adjacent lots 1 0 0 ' +
*Well flow data from orevious test
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems ate in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Pdnted Name KENNETH M. DUFFU~
Data 08/2Z/2007
COSA Fee $430.00
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
VENTS
7.8' '~o.2'
TRAVERSE L/AY
S89'59'58"E
60.00'
S89'59'19"E
o~J 50.2'
~ WELL
38.0'
~ 2'x5'
EXISTING b FP CANT
~ HOUSE
,38,0' CANT ~--
,, · k~VY//,~; --- 6'~15'
CO ~,. ' DECK
'X
x.
x ~ 6'x5.3'
Lx--x--x x xl DECK
160.00'
I--11
ANCIlORAGE RECORDING DISTRICT
ASBUILT OF:
VALIIALLA SUBDIVISION
ADDITION NO. 1
LOT 18 BLOCK 3 PLAT ~
SURVEY CERTIFICATION: I, John L. Schuller, have conducted a
physical s u n'c~J of this property as shown on this drawing and that the
unprovcments siluatcd thereon ar~ within thc pmpcr~ lines and no
encroachments exist other than noted. Under no c~cums',ance should
any information on this drawing bc used for conslmcfion of fences
s~'uclurcs, improvements, or for establishing bound-w/ incs.
EXCLUSION NOTES:It is the owners respons~ility to dcterminc
the existence of any easements, covenants, or restrictions which
do not appear on thc recorded subdivision plat.
AUG 23, 2007 1'--50'
07--069 s 2736 0705/17
SGS Ref.#
Client Name
Project Name/#
Client Sample ID
Matriz
107377400 I
ArcTerra Engineering and Surveying
4410 Traverse Valhalla I B3 L 18
4410 Traverse Valhalla I B3LI8
Drinking: Water
All Dare,Times are Alaska Standard Time
Printed Date/Time 08/13/2007 10:13
Collected Date/Time 08/01/2007 I his
Received Date/Time 08/01/2007 12:15
Technical Director Stenhen C. £de
· PWSID 0
Sample Remarks:
Allowable Prep Analysls
Pararnctcr Resulls PQL Unils Mcthod Containcr ID Limils Dale Dale Init
Metals b~ ICP/MS
Arscnic
ND 5.00 ug/L EP200.8 C (<10) 08/06/07 08/10/07 TK
Waters Department
Total NitratedNitritc-N
1.63 0.100 mg/L SM20 4500NO3-F B (<10) 08/02/07 JDS
14ic robiol oc/y Labora toz'~'
TotalColiform 0 col/100mL SM209222B A (<1) 08/01/07 SDP
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
�5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
Chemlab Ref.* :93.0581-9 REPORT of ANALYSIS
Client Sample ID :L18 B3 VALHALLA S/D
Matrix : WATER
Client Name :S & S ENGINEERING
Ordered By :RAY
Project Name
Project*
PWSID :UA
Sample ROUTINE SAMPLE COLLECTED BY: S.S.
Remarks:
Collected :02/11/93 0 19:45 his.
Received :02/12/93 6 16:00 hrs.
WORK Order :63135
Report Completed :02/15/93
Technical Director:: TE H EDE
Released 8y G�
QC
Allowable
Parameter Results Qual.
--------------------------------------------------------------------------------------------------
Units
Method
Limits
NITRATE-N 0.41
mg/l
EPA 353.2/300.0
10
' =
See Special Instructions Above UA = Unavailable
See Sample Remarks Above NA = Not Analyzed
U = Undetected, Reported value is the practical quantification limit. IT = Less Than
D = Secondary dilution. /�±�+ GT = Greater Than
rZON SGS Member of the SGS Group (Socidtd Generale de Surveillance)
Extract Analysis
Date Date Init
02/15/93 02/15/93 LIN
3
e _
ueortronr
CIAL TESTING & ENGINEERING CO. AK DIV
'MICAL & GEOLOGICAL LABORATORY
TELEPHONE (907) 562-2343
5633 B Street
Anchorage, Alaska 99518.
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
❑ PUBLIC WATER SYSTEM I.D. #
KPRIVATE WATER SYSTEM
Name — 5 & S ENGINEERING Phone No.
17034 Eagle River Loop Road No. 204
Ea ver, a RIM Alaska 9U77
Marling Address
SAMPLE DATE:
Mo.
Day
Year
SAMPLE TYPE:
,wRoutine
LI Check Sample (for routine sample
with lab ref. no.
)
❑ Treated Water
❑ Special Purpose
❑ Untreated Water
SAMPLE Time . Collected
No. LOCATION Collected By
LST l 3 VIM14(U4 5/D I 15 .5!"
21 I
3
4 1 I
5 1 I
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
❑ Unsatisfactory
❑ Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received Z.
Time Received f6eoa
Analytical Method: Membrane Filter
` No. of colonies/100 mi.
Lab Ref. No. Result* Analyst
�t3.o58 / FM czl
/0 m
I I m
m
m
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter: Direct Count
Verification: LSB
Fecal Coliform
BGB
0
Coliform/100 ml
Final Membrane Filter Res""ul��ts pCollform/100 ml
Reported By Uc� Date 3 / 3
TNTC = Too Numerous To Count Time: a.m.
OB = Other Bacteria p.m.
PART ONE OF TWO
VN SGS Merr REMAINDER TO FOLLOW
MUNICIPALITY OF ANCIIORAGE
DEPAR"I'~TflEN"i' OF 14EALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONfJI[-:NTAL HEAL'CH
CEIYrlFiCAIE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON SITE SEWER AND WATEFI FACII_ITY
264-4720
Application Date
GENERAl.. INFOR~/IATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Ledatjpn (¢ddress,O.r,directions
b) ..A~plicant Name:~)~; ¢~:7/~ Telephone: Nome ~;~ ;~/ Business
c '/~ppli¢~nt, is ~heck one: ILei~ding Institution ~J;
Buyer
Other
(explain);
(d) _end ngld¢titu i~¢i. ~ Telephone
(e) Real Estate Company and Agent
Address ..............
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single-Family'~ Multi-Fanlily ~ Other
Number of Bedrooms
WATER SUPPLY
Individual Well%~ Community L~ Public
Note: If community well system, must l~ave written confirmation from the State Department of Environmental Conservation
attesting to the legality and statue.
SEWAGE DISPOSAL
Onsite~4~. Public [~ Community L'L-J -{olding Tank E3
Note: If community well system, must have written confirmation from the State Department of Environraental Conservation
attesting to the legatity and status.
Page 1 of 2 72-025 (11~84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCN, D~ ~ A AN[) INFOR~AIlON
As certified by my seal affixed hereto aed as el the validation date shown below, I verily that my investigatioe of this Health
Authority Approval shews that the on-sile water supply and/or wastewaler disposal system is sale, iunctional and adequate
~or the number of bedrooms and type of structure indicated herein. I lurther verity that based on the information obtained
from the Municipality el Anchorage files and from my investigatioe and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipa~ and State codes, ordinances, and regulations in effect oe
the date el this inspection.
N~rne of Firm __ ---- .... It ............... Telephone __ ._-..: ............
DHEP APPROVAL
Approved for -/--Lz-L~-C.~ bedrooms
Approved 7,~-- Disappr~?d
Terms of Conditional Approval
CAUTION
The Muncipality of AnchoFage DepaFtment el Health and Environmentat Protection (DHEP) issues Health Authority
Approval certificates based solely upon tile FepFesentations given in paragraph .5 above by an independent pFofessional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DIqEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or ornissions in the
professional engineer's work.
Page 2 of 2
72-025 ( I I/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
gN a,^uw oF ^"C"O ' r HECK.ST - FE.RUARY
D~,'r. OF HEAL~. & 264-4720
ENVIRON~[NTAL PROTECTION
gEC & 91985 Legal Description: Z0~/¢
WELL DATA
RECEIVED
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ '-/-5'"~- °¢~ Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing~'~)N)
Depression Around Wellhead (Y~
Well Classification
Well Log Present(~N)
Total Depth ~?d / Cased to ~ z
Static Water Level ~') ~b~.~'
Casing Height Above Ground
Electrical Wiring in Condui~/~Y~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
/
To Nearest Public Sewer Line
Cleanout/Manhole
; On Adjoining Lots /dz~
; On Adjoining Lots
__ To Nearest Public Sewer //.
To Nearest Sewer Service Line on Lot
;Date
Water Sample Collected by
Water Sample Test Results
Comments~ ~'
B. SEPTIC/HOLDING TANK DATA
Datelnstalled ~'-/~'%'~"'~ Size t~¢~
Standpipe~;N) __ Air-tight Cap~) Foundation Cleanouk~,)
Depression over Tank (Y.~..~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) /J///~ ; for
Holding Tank High-Water Alarm (Y/N) ,6J/~ Temporary Holding Tank
Separation Distances from Septic/Holding Tank:
To Water-Supply Well / ~'" /
To Prop.ert¢ Linde
To Water Main/SerVice Line
Course ~'~
Comments :'
P~ge 1'of 2"
To Building Foundation
To Disposal Field
Per mit:/N)A~,~-
To Stream, Pond, Lake, or Major Drainage
72-026¢1/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field .2 /
Square Feet of Absorption Area /¢¢'O
Depression over Field ('~N~
Results of Last Adequacy Test //~')~'z///~'/~¢~
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot W///¢
To Water Main/Service Line /-/'/I¢
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field /z/
Depth of Field ~ /
Gravel Bed Thickness -~ /
Standpipes Present(~N)
Date of Last Adequacy Test /~-
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots - ~¢
To Cutbank (if present)
Comments
D. LIFT STATION /// //
'~'~D ate--lr~,.s~ II e d
Size in Gallons~'-----~.
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
-' - ~ Vent (Y/N)
-~-'~-P_~m~ping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request ** -- .
I certify t hat I J~a.¥~h~ed¢ veri~?d, or conformed to all MOCCan~HAA guidelines in effect on the date of this inspection.
Signedcompany ~ / MOA No.
Page 2 of 2
72-026 (H/84)
ALASKA eFIUIROIq ethTAL cOrlTROL $ RUICe$, II'lC.
~nqineePinq ~, ~nuironmcnlol ~lUdie$
CRAIG JONES/VISTA REALTY
4410 TRAVERSE WAY
ANCHORAGE ALSAKA
99516
SELLER-WAYNE COGGINS
12/19/85
CRAIG JONES/VISTA REALTY
4410 TRAVERSE WAY
ANCHORAGE ALSAKA
99516
50828
LEGAL:VALHALLA BLOCK 3 LOT 18
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE-12/17/85
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF I460 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 921 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
4 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 4 BEDROOM HOUSE.
THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 12/18/85 .
FLOW TEST ON WELL
WELL FLOW DATE-12/17/85
A FLOW TEST WAS PERFORMED ON THE WELL. 921
PUMPED AT A RATE OF 6.6 GPM OVER A DURATION OF
THE DRAWDOWN WAS . 1 ' WITH A RECOVERY TIME OF 5
AND THE STATIC WATER LEVEL WAS 65.8 FEET.
THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME.
GALLONS OF WATER WAS
2.3 HOURS.
MINUTES
1200 ~Uesl 33rd r~ucnue, $uii¢ ~' Anchov~q¢, Alosko 99503'(907) 561-5040
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER.
[] I I t I t I I
~"PRIVATE WATER SYSTEM
Name ,~ Phone NO.
/" ? l: / ? ? ~'''
Mailing Address
/9/:/ __ ,4:
City State
Mo. Day Year
Zip Code
SAMPLE TYPE:
~;~. Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
Treated Water
Untreated Water
SAMPLE Time Collected
NO. LOCATION Collected
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~ Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received 6~ ",
Time Received /'%
Analytical Method: Membrane Filter
* No. of colonies/lO0 mi.
Lab Ref. No. Result*
Analyst
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter: Direct Count
Co[Iform/100ml
Verification: LTB
Final Membrane Filter Result~/ ~
'rNTC = Too Numberous To Count
8GB
_ Collformll00ml
Date
Time: //_2'-~.~ a,m.
OB = Other Bacteria
ALASKA ENVIROr =.NTAL
CONTROL SERVI(.,,.5, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
CHECKEO BY
SCALE / :M¢~'~
OATE
DATE
Property Owrer
Mailing Address
Buyer
Address
Lending Institubon /?.? (, /-'4 //~¢/' /
Address ~/'¢~/¢:?~'~ ¢,' t~:£ ~/ * ¢* y' ' //// Zip Code
Address Zip Code
APPLI~ NT FILLS OUT UPPER HA' ONLY
Phone
Legal Description ~_.~) ~/~
S~ree~ Lo°at,o. Z/~://0
"rype of Residence
'~;:~- Single Family
~ Multiple Family
q Other
No. ct Bedrooms
Water Supply
'~.lndividual ATTACH WELL LOG, A well Icg is required for all wells drilled since June 1975.
? Community For wells drilled prior to that date, give well depth (attach icg if available).
[ ' Public Utility
Sewer Disposal
~, Individual Year Individual Inslalled: . .
~ Public Utility When Connected to Public Utility: .......
~ Doldin9 Tank
NOTE: 1HE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFOBE~PROCESSING CAN BE INITIATED.
Date Date Date
Inspoctor Inspeolor
Time
inspector
Field Notes:
( ~PP~]O V E D BEDROOMS
( ) DISAPPROVED
( ) CONDITLONA/L APPROVAL*
D ATE ~//'~/,~"~'¢~. ~
Inspector
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTEC J'ION
AUG 23
___RECEIVED
'CONDITIONS OF APPROVAL
Date S~wer Installed
Well ro Absorption Area
Well to Tank
Well Log Received
Septic Ta~lk Size