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HomeMy WebLinkAboutT12N R3W SEC 27 LT 20T ZN, R3W, Section Lot 20 #018-092-01 Municipality of Anchorage Page 1 of. 5 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alosko 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000139 PID Number: 018-092-01 Name:BRUCE & KlM BAISCH Wastewater Systerrl: [] New · Upgrade 13621 ELMORE ANCH., AK 99516 ABSORPTION FIELD No. of Bedrooms: Ph°ne:(907) 545--0822 4 DDeep Trench nShollow Trench IBed nUound BOther LEGAL DESCRIPTION *2.0 aPb/sq. 20 - - .78-1.4 ABOVE 5.5 - 4.0  ~ ~ 360 se. ~ ~M D-303~/F-810 SEPA~TION DISTANCES ~ s.pu= ~ .o~.~ · S.T.~.~. T=nk Re~d StoUon T=nk ~ u... ANCHORAGE TANK 1500 Well 100'+ 100'+ 100% - 25'+ STEEL 2 su,=c~ ~oo'+ ~oo'+ ~oo'+ - - LIFT STATION Water Lot 5'+ 10'+ 5'+ - - 1500J ANCHORAGE TANK/ORENCO SYSTEMS Line 'Pump on' .~., a' rPum~ off' .ev., ob IHrgh water a'a~,. Foundation 5'+ 10'+ 5'+ - - TIMER ACTIVATED ~ NONE KNOWN 20 OSI 05 HHF M.O.A. Drain I I ~emarks: * THIS iS AN INNOVATIVE BO~OMLESS - BENCH MARK INTERMI~ENT SAND FILTER (ISF) SYSTEM TOP OF MANHOLE LID · * 2.07 OF M.O.A. APPROVED SAND FILTER ADDED I~,,~,d 2nd 0/9-12/00 Depa.ment of Health and Human Se~ices approval ~.....}; ....... ...~ Reviewed and approved by:~~Do~e:~ PE..~ .U.BER~ AS--BUILT DRAWING P^ROE' ,D SWO00139 018-092-01 ^ B j ST1 41.6 77.9 m'3 /~NEW BO'I-rOM LESS ST2 48.4 85.6 ~t ~ ~4 / INTERM]~ENT SAND fiLTer ~ MT~ 97.4 123.0 ~ , ~2 NEW 1500 GALLON S.T.E.P. TANK ~ Z INSUreD / 4 BE PREPPED FOR: PHONE HUMBER: PAGE NUMBER: BRUCE A KlM BAISCH (907) 545-0822 2 OF 5 AS-BUILT Of SEPTIC SYSTEM UPGRADE (BOTTOMLESS ISf) "*"' """"* A S- B U IL T D R A WI N SWO00139 .- FlJq/¢, i27,Al7~ - 100,06 - I00.~ ~'l - I00.~? 511 / 51'2 ^'*"' - x,,,,*~M"'--'- ,, - _- ~-~w,~oo ~or~ ~ .............. Af MT 7 fINAL ~ - 104,24' - IC)4,~OMT / \ / 12' / DA~: ~/~/~ooo ~S~ WATER & WASTEWATER J.W.M. ~&~;" ..~.~. · ....... .,~...,: ...... ~EV~V F0a: ~HONE UUU~Ea: PA~E NUU~E~:~ g ~{'9''"?'"¥'"~ 9RUCE AND KlM 9AISCH (907) 345-0822 3 0F 3 Ea~ 0ESC~IPIION: LOT 20; S[CT~ON 27, T~2N, ~W ~h;q,.l'..~. ........ "~ PROFILE AS-BUILT OF SEPTIC SYSTE~ UPGRADE (BOTTOMLESS ISF) MUNICIPALITY OF ANCHORAGE Depa~lment cf Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000139 Legal Description: T12N R3W SEC 27 LT 20 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Bruce & Klm Baisch Owner Address: 13621 Elmore Road Total Bedrooms: 4 Anchorage, AK 99516- Site Address: 013621 136TH AVE E Lot Size: 54450 SQ. FT. Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field k~ septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: ALASI{A WATER & WASTEWATER May 17, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Sen,ices On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Septic System Upgrade for Lot 20; Section 27, T12N, R3W (Bottomless Intermittent Sand Filter - ISF) To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The existing septic system consists of a 1250 gallon septic tank and a deep trench type drainfield. The existing drainfield is surcharged and is believed to be encroaching groundwater and must be upgraded. We are proposing that a 1500 gallon S.T.E.P. tank and a innovative Bottomless Intermittent Sand Filter (ISF) system be installed. Comments regarding the proposed upgrade are summarized as follows: 1. GENERAL: A test holes was excavated on the north of the existing septic system to determine an area suitable for a septic system upgrade. Groundwater is believed to be shallow and consistent over most of the property. Given the limited area around the test hole and the setbacks from the existing septic system, it is our opinion that a Bottomless ISF system is the most viable option. 2. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layers are a GW material to a depth of 2.0 feet and than the soils transitions to a SW/SM to SM material to a depth of 6 feet. At 6 feet, the soils transitions to a SM/GM material to the depth of 11 feet (bottom of test hole). Groundwater was encountered during the excavation of the test hole at 11 feet. The monitoring tube was checked on 5/3/00 and found water to be at 5.2 feet; on 5/9/00 and found water to be at 5.0 feet; and also on 5/15/00 and found water to be at 4.8 feet. A percolation test was performed between the depth of 2.0 feet to 2.5 feet which had a percolation rate ot'<5 minute/inch. It is our opinion that due to the overall appearance of the soils, a conventional application rate of 0.8 gallons/day/ft2 would apply. 6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 - Ph: (907)337-6179 N Fax: (907)338-3246 3. DRAINFIELD DESIGN: Bottomless Intermittent Sand Filter (ISF) a. Percolation Rate: <5 minutes/inch b. Allowable Application Rate for ISF: 2.0 gallons/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 300 ft2 f. Effective Depth below pressure pipes: 2.5+ inches g. Width: 12 feet h. Length: 30 feet. i. Effective absorption area = 360 1l2 j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank". 1. Sand Material: In accordance with M.O.A. latest standards m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the #8 sieve. We are proposing to excavate down to a depth of 2.5 feet (maximum - at any point), place a minimum of 6 inches of sand, install the air supply line, and cover it with L5 feet of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 4. SURFACE WATERS: There is no surface water withinfiffl00 foot of the the proposed septic system upgrade. 5. TOPOGRAPHY: As can be seen on the attached topography site plan, there are no slope concerns. 6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Onsite Services office (5th floor, 9th & L St.). 7. CLOSING: I am open to any suggestions from your department, which would be an improvement to the proposed design. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179. Thank ye for your assistance. 3arness, P.E., M.S. 6901 Debarr Road, Suite 2B N Anchorage, AK 99504 ~ Ph: (907)337-6179 N Fax: (907)338-3246 I LOT 2, BLOCK 2, ~ { LOT 1, BLOCK 2, OLSON HEIGHTS S/D I Ii OLSON HEIGHTS , ~ ~ C~p~c DE ARMOUN S/D ] I I ,,.j x/ /i I [ \ I I I \ I /I I DE ~MOUN S/D 0,~ NO ENCROACHME~ CONCERNS ~l~ ~ PROPOSED SEPTIC UPG~DE NO ENCROACHMENT CONCERNS ....................... ~ I I~ ' I LOT 11, ] ~ --- DE ~ou. S/D , 5/17/2000 tVATER & WASTEWATER ,' PREPPED FOR PHONE NUMBER: PAGE NUMBER: ~j N ~ . ~.[.~ ~..;....~ BRUCE & KlM BAISCH (907) 345-0822 1 OF 5 LOT 20; SECTION 27, T12N, RSW SITE P~N FOR SEPTIC SYSTEM UPGRADE (BOTTOMLESS ISf) SHED EXISTING SEPTIC TANK AND DRAINHELD TO BE ABANDONED C T.% PROPOSED BO'i-rOMLESS INTERMITTENT SAND FILTER, EXCAVATE a BED THAT IS 2.5 FOOT DEEP MAXIMUM BY 12 FEET WIDE BY 30 FEET LONG, SEE ATTACHED DETAIL AND PROFILE (PAGE 5 OF FOR CONSTRUCT]ON AND REQUIREMENTS. (SEE AIR INSULATED / / BEDROOM HouSE 10' LfflLi'[Y EASEMENT 1500 GALLON S.T.E.P. TANK DATE: 5/17/2000 BY: J.L.M. A1,ASICA_ WATER & WASTEWATER sc~, . CONSULTANTS, INC.,: ....... 1" = $0' PHONE NUMBER: BRUCE &: KlM BAISCH (907) 345-0822 LEGAL DESCRIPTION: LOT 20; SECTION 27, T12N, RSW OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE (BOTT0btLESS ISV) PAGE NUMBER: 20F5 -7953 4 PlA. MONIf~IM~ ~ PI~ blN~ PROM ~ ¢~P ~g PI¢~I~ON FIF~ PLAN VIEW / . 5/17/2000 ~ ....~ ....... ........... - CONSULTANTS, INC.~': ........ ' ~ 1" = 20'~~ ................ J ......... LOT 20; SECTION 27, T~2N, RSW DETAIL OF BOTTOMLESS INTERMITTENT SANF FILTER (ISr) ALASKA ~/ATER & '¢/ASTE~/ATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK. 99504- PHONE (907) 357-6179 * FAX (907) 338-5246 [SOIL LOG - PERCOLATION TESTI LEGAL DESCRIPTION: LOT 20; SECTION 27, T12N, R3W PERFORMED FOR: BRUCE AND KlM BAISCH DATE PERFORMED: 5/2/00 ORGANICS I TEST HOLE #11 GW SW/SM TO SM SM/GM SOIL CLASSIFICATIONS OR HL CL OL MH CH OH SC DEPTH TO DATE GROUNDWATER 11' 5/2/00 5.2' 5/3/00 5.0' 5/9/00 4.8' 5/~5/00 DATE READING CLOCK TIME 5/15/00 - PRESOAKED PERK HOLE FOR 4+ HOURS PRIOR TO TEST 2 3 5 6 NET TIME WATER LEVEL (MINUTES) READING 50 MIN. 0" 6~ 30 MIN. 0" 30 MIN. 0" NET DROP (INCHES) PERCOLATION RATE <5 (HIN./INCH) TEST RUN BETWEEN 2.0 ,~T.. AN, I)~L~ FROM 2' TO 6' TO VISUALLY APPEAR~ T~//~/~T~5~/~ COMHENTS: SOILS PERFORMED BY A~SKA.WATER ~ WASTEWATER I, THiS WAS PERFORUCD I¢ ACCORDANCE WiTH ALL ST~/A~'¢UNIC~ IPERC. HOLE DIA. 6" (INCHES) .5 FT. N./INCH PERCOLATION RATE. -- , CERTIFY THAT 3UIDELINES IN EFFECT ON THIS PROPERTY OWNER MAINTENANCE AGREEMENT ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated c;~-_~k~ ,,tiff ,200~ i~ made between the Municipality of Anchorage Department of Health ~nd Human Services (DHHS) and the property owner(s) of This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owner(s) agree to the following: The property owner(s) will have an annual inspection of the system performed by a registered professional engineer. This inspection shall verify that all effluent and air pumps, timers, and alarms are functioning as designed. Any deficiencies shall be corrected and the engineer's statement that the system is functioning as designed shall be filed annually with the DHHS. erty'O~vner Name Property Owner Name (Notarize Here) State of ~ Judicial District ~ I~ SS. On this~'~day of t/~ in the year cflO~q O, before me, the undersigned notary p~.blic, per. ksonalty appeared: ~/A/~ ~,4/-qC-/-/ __ known to me to be the person(s) whose name(s) is/are subseribex1 to the within instrament and aclmowledged that he/she/tlxey executed the same for the purposes therein contained. In wit..~ss whereof, I hereunto set my hand and offigMseal, c ~ ~ -~ (No,[4ry P~bli¢ (s, ignatu, re) (Nota.,'y's printed name) My~ comroissioa expires: MUNIC~I~pA£1TY'OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES On-Site Services Transmittal Sheet TO: The attached paperwork has been reviewed for the following reason(s): and is being returned __Discrepancy in legal description and/or owner name· __ Discrepancy in number of bedroroms. ~nature and/or stamp missing on -- Show measured distances to sewers/wells, curtain drains and streams within 200 feet of proposed system. Replacement disposal site not shown and/or tested. Calculation error in design. Show locations of all soils, percolation or water table tests. Pro~ed system too deep for soil'test submitted. To.D'~graphic information missing or inadequate. N~rrative missing or inadequate. Additional soil/perc test needed. Sand filter requirements not satisfied. Water monitoring results missing or inadequate because Incomplete; missing Well log required. Water sample unacceptable Other Please supply ,the necessary info'rmation and re-submit your ~-' ~ request. ~our cooperation is appreciated. ', [ ~r r -Revrie~e . r LEA VE THIS FORMA TTACHED TO PAPERWORK : ~' /203-rev. r4/93 Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 018-092-01 GENERAL INFORMAl.ION Complete legal description T12N. R3W. SEC 27: LOT 20 Location (site address ordimctions) 15621 ELMORE ANCH.. AK 99516 Property owner BRUCE &: KlM BAISOH Mailing address 13621 E'LMORE ROAD Lending agency Mailing address Day phone~.~ASm/~gZ~ ANCHORAGE. AK 99516 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup· NUMBER OF BEDROOMS: 4 TYPE OF .WATER SUPPLY; Individual well XXX Community well Public water NOTE: · ' n If community well system, prowde wntte confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWAI'ER DISPOSAL: Individual on-site Holding Tank Community on-site Public sewer NOTE: xxx If community wastewater system, provide written confirmation from State ADEC lng to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #2i Computer Version INote; Alaska. Water. and Wastewater Consultants, Inc,. shall be paid $3770.00 at, or pnor to, ctosing for the engineering services providecL 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 base( on the information obtained from the Municipality of Anchorage files and from my investigation and ins ~ction, the on-site water supply and/or wastawater disposal system is in compliance with all Municipa, ~nd State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ALASKA WA'T"'ER &/~ kS'~¢~C/'A' ;R CONSULTANTS, INC. Phone (907) 337-6179 Address 6901 DEBARR F[/OADJS~I'~Ii/2EI~N(: ORAGE. ALASKA 99504 Engineer's Signature ~, ~ ~J,~ ~ -~ Date In conducting this evaluation, AWWC, Tn~/ a-~e~ !~ to pro"'~de a thorough, conscientious engineering analysis of the system In accordance with ADEC and fV~OA pH~ ~ Guidelines & Regulations. The repotted results described the performance of the system under the cdnditions~bncountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local eoils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or patty Is not authorized, nor will it confer any legal right whatecever. 6. DHHS SIGNATURE Approved for Disapproved Conditional approval for bedrooms bedrooms, with the following stipulations: Additional Comments By: Date 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 pumhasers 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. 1/91) Back MOA #21 Computer Vemlon Municipality of Anchorage .... ~25 "L" Street, Rm 502 ~chom~e, Alaska 9950~ (907) ~3~[Nlg Health Authority Approval Checklist Legal Description: T12N, R3W, SECTION 27; LOT 20 Parcel I.D.: A. WELL DATA 018-092-01 Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A 7/11/82 Casing height(above gmund) 29" Wimspmperiypmtected(Y/N) YES Log present (Y/N) YES Date completed Total depth. 200' Cased to 200' Sanitary seal (Y/N). YES Date of test Static water level Well production 5.0 WATER SAMPLE RESULTS: Coliform 0 Date of sample: 6/19/00 B. SEPTIC/HOLDING TANK DATA FROM WELL LOG 7/11/82 NOT STATED Nitrate ATINSPECTION 4/4/00 132 g.p.m. 6.7 g.p.m. ~.32 m.q/L Other bacteria 0 Collected by: A.W.W.C., INC. Date installed 6/8-13/00 Foundation cleanout (Y/N). Date of Pumping. NEW C. ABSORPTION FIELD DATA Date installed 6/8-13/00 Length 30' Width Tank size 1500 Number of Compartments 2 Cleanouts (Y/N) YES Depression (y/N) NO High water alarm (Y/N) YES Pumper YES * TO TOP OF SAND FILTER (FROM FINAL GRADE) Soil ratin~r ft2Jbdrm) 2.0 System type. BO'FrOMLESS ISF 12' Gravel thickness below pipe 0.24' Total depth *2.92'-3.48' Effective absorption area 360 SQ. FI'. MonitoringTubeprasent(y/N) YES Depressionoverfield(Y/N). NO Date of adequacy test NEW Results (Pass/Fail). For 4 Bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): __ Fluid depth (ins) Minutes later: Absorption rate = Peroxide treatment (past 12 months) (Y/N) If yes, give date 72026 (Rev. 3/96)* Computer Version D, LIFT STATION Date installed 6/8-13/00 Manhole/Access (Y/N) YES High water alarm level at* 46" Cycles tested NEW Size in gallons TIMER "Pump on" level at* ACTIVATED *Datum BO'FFOM OF TANK 1500 TIMER "Pump off" level at*, ACTIVATED 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 tine 1 oo'+. N/A 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10'+ Surface water/drainage 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation. 10'+ Surface water 100'+ Curtain drain NONE KNOWN I certify that I h,a~ ~(fl'th~u field inspections and review of Municipal r~cor~ ~J/th.~Yabo~e systems are in conformance with ,hi. date. Signature I. .,44/ / \ I -//1' Engineer's NaiVeb /._ JEFFREY A, GARNESS Data ~? z~ Absorption field 5'+ .Wells on adjacent lots 100'+ Water main/service line 10'4- Driveway, parking/vehicle storage area 10'+ Wells on adjacent lots 100% ,~'~' OF ...... HAA Fee $ Date of Payment Receipt Number 72-026 (Rev, 3/98)* Computer Version Waiver Fee $ Date of Payment Receipt Number 06-Z6-00 16:45 FROM-CTE ENVIRONMENTAL Zt~ml~, CT&E Environmental Services Inc. 5615301 T-608 P.02/03 F-813 CT&E Ref,# Client Name Project Name/~ Client Sampi~ Matrix Ordered By PW$1D S~p[e gem~ks: 1003161001 AK WaIer & WasT£water Consulmn~ lbo. TI2 NR3W Soc 27 Lo120 TI2 NR3W S~c 27 Lot 20 Drinkiug Wav:r Client PO# Printed Date/~ime 06/23/2000 18:00 Collected Date/Tim= 06/19/2000 8:30 Received Date/Time 06119/2000 12:15 Technical Director~ Stephen C~ Erie Released ~/~~ ~ Prep AnaLysts 1.32 fl.5O0 m~l/L EPA 300.0 10 max 06/19/00 SCL 0 cot/1001~ iN10 9222B 06/19/00 KAP FROM-CTE ENVIRONMENTAL 5615301 T-608 P.03/03 F-813 CT&E Environmental Services Inc. Laboratory Division ~ 200 W. Potter Dove Dri_~king Water Analysis Report for Total Coliform Bacteria Am:horace. AK 998~8-~ 60S Tel: (907) S62-2343 ~[ER TO BE COMPLETED BY LABORATORY Ai~alysis shows this Water SAMPLE to be: n PUBLIC WATER sySTEM I.D. # I I' I ,:! I I J SAMPLE DATE: ~ Month SAMPLE TYPE:  Ro,qine ~ Repeat Sample (for routine sam[lie with lab ref. no. --) [] Special Purpose SAMPLE LOCATION Day Year Q Treated Water I~ Untreated Water Time Coll~ted Collected By [] Unsansfa~o~Y [] Sartq~le over 30 hoists old, results may be unrohable ~am~le t~ long in ~ansi[, sample should not b~ OV~ 48 hoB~ o[d a~ ex~tnaIIO~ ~ mdica~ reliable ~su[~. Ple~ se~d n~w sample via Time A~al~lc~ Method; ~cmb~c - ~* ~MUG · Humbe~ofcolom~lO0 mL R~suIt* Analyst teh Fbk$ Jun [] Foxed Client unread of unsatisfactory results: Phalli SpQke~tm Foxed D~: Time. BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG R~ult: Total Colifam Membrane Filter: Dh,~t Coun~ ~) Verification: LTB BGB Fgal Coliform Confirmation Final Memb~ne Filter ~ul~ ~ Colonii:mtlO~ mi COLIFIRIVi _ Coliform/tOO mi Tim. ~(,~'~ hfs Ij~~ Member of tile SGS Group I~e!~ GfJilarille ¢~a Surveillance) ENVIRONMENTAL FACILITIES IN AI.ASKA. CALIFORNIA, FLORIDA. ILLINOIS;. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY. OHIO. wEST VIRGINIA 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 NAME ;\1 ~ l PHONE [~NEW MAILING DDRESS . - .~. LEGAL DESCRIPTION -- ~ ~ ~ . v - - ~ ~[~ ~' ~-- W;~' ~)'~ (~ ../ Absorption area ~ L iM~'nc~;;; i;;; n g al I ° "s IF HOME.DE: ns de length Manufacturer Liquid capacity in gallons DISTANCE TO: Iwe'' Len thoO each line- Top of tile to finish grade (.¢.. F Width Foundation ~.. (~ f Total len~t~ o] lines Material beneath tile Depth Length Materia] [Nearest I~t line,c. 7, Trench width ' .~'~'in ch es ~'~ inches P ~M, IT NO. Distance between lines .~. Total effectl e absorption area PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area I Well Building foundation Nearest lot llne DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOl L TEST RATING IN ;TALLER , ~. t REMARKS APPROVED DATE LEGAL 1~-/,f-F,z. TI L Al 72-013 (Rev, 3/78) PERMIT NO. ( DEPARTMENT b,- HEALTH AND ENVIRONMENTAL ,,ROTECTION 825 'L' STREET, RNCHORROE~ BK. 99501 264-4720 C~--SITE SE~EF: PER~4 IT APPLICANT LOCATION LEGAL MORELL FAIR Ti2NR~W S. 27 L20 BOX t006~ S STN 995ii ~45-t25t LOT SIZE 999999 SQUARE FEET TYPe OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS; [)EF"TH: 9 LEr~iGTH: 50 u.] R FI'-,~ E L DEPTH: 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R 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 GRBVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). RE,..~L! I F-:ED SEPT I I_-: TAr-Il---;: S I ZE: ~1_250 GFtLLO~-4S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TI4Cu (2) I r~SPE~DTIOr-~S ARE REQLIIRED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVRTE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS ?5 FEET. OTHER REQUIREMENTS WRY APPLY. SPECIFICRTIONS AND CONSTRUCTION DIAGRAMS ARE RVRILABLE TO INSURE PROPER INSTALLATION. PERM I T E;'~P I RES DEC:EI"IBER 7_~:I... 198FJ I CERTIFY THAT l: IRM FAMILIAR WITH THE REOUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. :,~IGNED' APPLICANT MORELL FAIR ISSUED BY ..... $~_~____DRTE .... V4. 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: J%~fJ~rC~[ ~'~O~ DATE PERFORMED: LEGAL DESCRIPTION: 'T ~'~ ~ ~ ,~V' S ~v~ ~JDJ~ ~.O SP~C~J~ ~' 2 3 8 SLOPE SITE PLAN 1' ~ 3~f, 5' 10 13 14 15 16 17 18 19. 2O WAS GROUND WATER S ENCOUNTERED? ~)~ L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: (/~t-C-~'.n; ~v'~3 $ CERTIFIED BY: (minutes/inch) FT AND -- FT DATE: 72-008 (6/79) TYPE 0F SOIL RB.:,uRFTIEN _,~_,TEM I:,. TREN_.H MRXIMUM NUMBER OF E,E[.ROoM_, = 4 ,..:,t,.. FT,/BR) = SOIL RRTING ""':~ THE REQUIRED SIZE OF THE SOIL RBSORPTION _,T_TEfl IS: C, EF"TI-t= 1~3 LE~"~GTH= --%2 GRR'..-'E L [:,EF'TH: 6 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET), THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRYRTION (IN FEET). '_'L ,..~. ~, ~--' F:E:]:.!Li ~ F-:E[:" SEPT ][ C: TI-31'-.II--':: S I ZE: ' "-': :'--'~ PERMIT RPPLICRNT HRS THE RESPONSIBILITV TO INFORM THIS DEPRRTMENT DURING THE INSTFILLRTION INSPECTIONS OF RNV WELLS RDJRCENT TO THIS PROPERTV RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TI-~O (~Z) I ~-~SPEISTIO~'~S RRE RE:Z/I_IIRE[) BBCKFILLING OF BNV SYSTEM WITHOUT FINAL INSPECTION BND RPPROVBL 8V THIS DEPBRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN ~ WELL 8ND BNV ON _,ITE SEWRGE DI~FO~BL z~z, TEM IS t00 FEET FOR B PRIVBTE WELL OR ±50 TO 200 FEET FROM B PUBLIC WELL DEPENDING UPON THE TVPE OF PUBLIC WELL. MINIMUM DISTBNCE FROM B PRIVRTE WELL TO B PRIVBTE SEWER LINE IS 25 FEET BND TO R COMMUNITV SEWER LINE IS 75 FEET. WELL LOGS BRE REQUIRED BND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 20 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MR¥ RPPL¥, SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PER~"I T T E:~-:F" I RES DEC:EI'dE:EF-: 2~:..-1 .. ::L~8~_-_-_-3 I CERTIFV THRT .1: I RM FRMILIRR WITH THE REQUIREMENTS FOR. ON-SITE _,EWER_ RND WELLS RS SET FORTH BV THE MUNICIPRLITV OF RNCHORRGE. ,~.. ~¢_-TEfl IN RCCORDRNCE WITH THE CODES. '~" ~ WZLL [NSTRLL THE '-' '- ~:: ~ UNDER_TRND THRT THE ON-S[TE _,EWER _V_TEM MRV R. EQU~RE ENLRRGEHENT RE'~ZDENFE ~S REMODELED TO ~NCLIIDE MORE THRN 4 BEDROOMS. S I GNED: ............ RPF'L I CRNT MORELL FyF/ iSSUE[' B ~~¢~Z~ ZL ~- - -~ ..... ' ............... 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION December 31~ 1980 Morrell Fair Post Office Box 10-063 Anchorage, Alaska 99511 Permit ~ 800421 Subject: T12N R3W Section 27 Lot 20 A permit issued by this department for well and/or sewer system has expired as of this date. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, // ~ Senior Environmental ~p~cialist LNB/ljw enc: Copy of Permit SWP/057 : PERHIT NO. [)EPRRTf'IENT r_), IEflLTH FIN[) ENVIRONMEIqTRL. [ .TECTiON -"L"' ..., i [4.LE F., Idf,!L.F~_ F(I- .~E., RK. RF:'PLICRNT MORELL FRIR E:O::.'-,' :LE~EI6]~ SO. ':2.,TR. ]:44 LOCFrT tON ELHORE ST LEGFIL i_2['_'~ S27 T:I.2N R%q4 SM LOT SIZE 5,'&:'l.E;I}il SC!UFtI:i~E I::EET TVPE OF SOIl.. RBSORBT!ON SY'STEM IS: TRENC:H MFI',:<IMUi',i NUMBER OF [gEDROOMS = 4 SOIL RR'FING ,::SC! F'T/'E:R)= J..2{] T'HE RE:QLIIRED SIZE OF THE SOIL aBSORPTION S'¢S]"EM IX: E::. EE F:' '"F" ~-~ .... :':L. ~ L_ F,.EE I"-4 E]:i -F E.-; ..... ~t- ;;;t ~:Z~ F:. F~ ../E2~ ~ ....E), E: E::~' 'T ~---~ ..... THE LENGTH [:,If'IENSION IX 'THE LENGTH (IN FEET) OF THE TRENCH OR DRRII'-4FZEI..D. THE DEP'rH OF R TRENCH OR F'ZT IS TRE DZSTRI'.,ICE BETIqEEN THE SLIRFRC:E OF THE GROtJND RND THE BOTTOM OF' TFIE E',,<CRVF:Fr):oN <IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE F3RR',,,'EL DEPTH t:5 THE MINIMUM [:'EF'TH OF GRFIVEI.. BETWEEN THE OUTFRI..L P!F'E FIND THE BOTTOM OF THE EXC:RVRTZON (IN FEE"F). I::'ERHIT I-':tPPI..ICRNT FiRS THE RESPONS!E:):LIT'¢ 'FO INFORM THIS DEF'RRTHEI'.,IT DURING ]"fie I. NSTI:::II..LRTION INSPEC]'IONS OF RN"r' t'.IEL. LS FIDJFtCENT TO THiS F't:i:C~F'ERT'T' FIND THE NI_IHBER OF RESt[:'ENCES TF'IFiT THE kiEL. l_ WILL SER',,,'E. BRCKF'tL. LZNG OF RNM SYSTEH 14tTHOUT F'INRL INSPECTION FIND RPF'F,i:O?'RI... F.:~'.r' THIS DEPF:IRTMENT l,lILt., E:E SUBJECT 'TO PROSECUTION. MINIMUM DISTRNCE BE'THEEN R I.,.!EL..I_ RI'.4D RN'¢ ON-SITE SEI.,.IRGE DZ[SF'OSRL SY'_'STEM !S Z88 FEET FOR R F'RIVRTE 14ELt...~ :15E~ TO 2EI8 FEET FROM R PUBL]:C 14ELL DEPENDING UPO!'.,I THE T"r'PE OF F'UBI...IC: 14EI..t._. P.IELL. LOGS RRE REC!UIRED RN[:' MUST 8E RETURNED 1"0 THE DEF'FIRTMENT OF ]'HE I.,IEI_L. COMPLETION. OTHER REQUIREHENTS HFI'.? flPF'L"r'. SPEC:tFICRTIONS RND COf',ISTRUCT:(ON D:(FIGI;'.I:aM'5 RRE R',,,'RtL. RBLE TO INSURE PROPER INSTRLLRTION. I CERTIF'¢ THRT d.: I RM FRHZLIRR klI'T["l 'F!4E REgUIREMENT$ FOR ON-~'.:!TE SEWERS RND 1.4EI..LS RS SE]' FORTH B'¢ THE HUNICIF'RL. IT'¢ OF RNCHORRGE. 2: )'. k!ZI_L !NSTRM_. THE S"r'STEM IN RCCORDFINCE N~'FH THE COPES. ]~: I UNDERS't"RND 'THRT THE ON-'SITE SEWER S'¢STEM MF:Ik' REb]LIZRE Ef',IL. FIRGEMEI'qT IF: THE RE%~E:,ENCE ~S REMOE)ELED TO INCLUE:,E MORE THRN ,4 E:EDROOMS. 2; ! GNED: FIPPL I C:RNT HOREL. L F'R~R P RmT NO. TYPE OF SOIL RBSORBTION SYSTEM MRXIMUM NUMBER OF BEDROOMS = ~' ~OIL RRTING THE REQUIRED SIZE OF THE SOIL RBSORPTION_%"c~_.TEH I_~'. MLIN I C'I PRL I T'-r' IDF R~,L--:HEIE:RI3E DEPRRTi'/-"hT OF HERLTH RI'.ID ENVlRL-~NM'. ~RL PROTECTIOH 8 ~...5 "L' PERPl I T STREET, RNCHORROE, Fi:.{. 99501 CII"M--S l' TE [>EF'TH= /~) LEI",.II3TH= ¢¢'~ I3t~:R'..-"EL [:'EPTH= ¢ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIEED. THE DEPTH OF R TRENCH, OR PIT IS THE DISTRNCE BETWEEN ]'HE SLIRFRCE OF THE GROUND Rt.,ID THE BOTTOM, OF THE ErCH~RTI_N" -" F; (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRBk,'EL DEPTH IS THE MINIMLIM DEPTH OF GRR',,,'EL E:ETWEEN THE OUTFRLL PIPE Bt'iD THE BOTTOM OF THE EXCRVRTION (IN FEET). E:EI~L! I REC, --~.E F'T I g--: TRI"~JF( S I ZE= /,~ ~--/~) IBRLLt.~31"-J"-- PERMIT FIPPLICFINT HRS THE RESF'OhlSIBILITY TO INFORM THIS DEPRRTMENT DURING INSTRLLRTION INSPEC:TIONS OF RNY WELLS BDJRE:ENT TO THIS F'ROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TF]I] ( 2 .':, 'I 1"4'-----,PECT I F-I 1"-4_c, FIRE R E E-;-.! LI I F4EC, 6HL. KFILLINLi OF RNY _¢STEM WITHOUT FtNRL INSPECTION RHD RF'PROVRL BY THIS DEPRRTMEHT HILF BE SUBJECT TO PF;;:I]SECUTION. THE F'E F-:I'.I I T EXF' I F.'ES C, EC:EI~-IE:E F.: Z-': 1 .. 197'_=,. I CERTIFY THRT i: IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWER'--'; RND WELLS RS SET FORTH BM THE MUNICIPRLITY OF RHCHORRGE. 2: I HILL INSTRLL THE SYSTEM IN RCCORDRNCE HITH THE L':OC, ES. g: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM WRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO IHCJ..UDE MORE THRH 8 DEDROOMS. Applicant - t,Ilt.,IIML;M DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS ~08 FEET FOR R PRIVRTE WELL; OR 250 TO 20¢ FEET FROM R PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS RRE REQUIRED RNC, rtUST BE RETURNED TO THE [:,EPRRTHENT WITHIN 30 DRYS OF THE WELL COMPLETION. EITHER REQUIREMENTS WRY RF'PLY. SF'ECIFICRTIONS RND COHSTRLICTION DIRGRRMS RRE BVBILRBLE TO INSURE PROPER INSTRLLRTION. 825 "L." STREET ANCitORAGE, ALASI(A 99501 (907) 264-4t 1 I December 31, 1979 Morell Fair Post Office Bo:{ 10-063 £outh Station Anchorage, Alaska 99511 Permit ~ 790103 Subject: T12N R3W Section 27 Lot 20 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to'this department to document the installation date. If an enginee~ has inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please contact this office at 264-4720. Sincerely, Senior LNB/ljw enc: Copy of Permit Performed For Leaal This 2204 Cleveland Anchorage, Alaska 99503 ~,~ Performed ¢/~0/P~ ~escription: Lot~Block Subd i vi s i on SW7~ ~aT, W/~ ~. ~9~. ~ ~orm Re~orts Soils Loq~ Percolation Test Soil Characteristics Perth Feet 14 --~ 16-- 18-- 20-- Was 6round Water Encountered? Yes, At what Denth? jo_ Readinq Date Gross Time Net Time Depth to H20 Net Droo Percolation Rate Hinute Proposed Installation: Seeaaae Pit Den. th of Inlet Depth To Test Performed By Drain Field Bottom Of Pit Or Trench ZO w. E 61 3-5 LOT SURVEY CERTIFICATION Lot ~z::~, Block --- Ar~a - -- Sq. Ft. Plat File No.' :Zoning District LEGEND: {~Bmss Cop Mo~umee~ Iron Pipe Steel Pin Survey Hub ~ Tack Anchorage Recording District, Alaska REVISIONS ~_ DATE .,-" '~ ~ ~ ,k . . ~ . . . ..... .~,~. __~,,_.-~. ,i~,~ ........... · ~ -~,:~ .... ~~ F~[~~'- ~=:: ~= ~---:~--:~ ....... _ _~_::. ~ ...... ~,.~j~ .... .~:~. ~__~ ~~~ ~.~_~::~, _~.~.::,~,.~_______..~.__~j This well is producing gallon?--~water per hour. INVOI~ SR BOX 668, BOGARD RD. ' , PALMER, ALASKA 99645 TELEPHONE 745A0,~ I ~- ~ · SALESMAN lot I~tk ,subT/.,~Z l.) p__,~ELL LOG ,.. ,M N 'DRILLING Set pump ?~'~,~-- feet. '-14 114 ' 214 PLEASE PAY FROM THIS iNVOICE /"~,., pe, toot AMOUN? '~ DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 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) Property Owner ,/1~ :~,~'~ .,/¢~/~'~--¢*;;q~i~)~one: Horpe ;2¢:~'i--~//~'' Business Mailing Address -~ ¢ "¢o' ,,,,%'¢ //2 ~/ /, 7.¢/,-¢ / .-- w~ ~ (C) Lendinglnstituti0n ~¢/~J ~ '/ Telephone Mailing Address '¢~/~ ~/~-~ (d) Real Estate Company and Agent ~ ~ ~ Address (e) Telephone Mail the HAA to the followina address: or: Check here ,~if hold for pick up. List contact p~erson and dayphone number below. TYPE OF RESIDENCE Single-Famiiy~ Number of Bedrooms 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. SEWAGE DISPOSAL Onsite'~ 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 1 of 2 72-025 trey 8/861 Fronl leUO!SSejo~d aq~ u! suo!ss!Luo ~o sJoJ~a ~o~ elq!suodseJ ~ou s! e6e~oqouv jo ,9,!led!e!un!~ eq/'panss! s! eleo!j!~eo e eJoleq ehep eZAleUe Jo suogoadsu! honpuoo leu op SHHQ jo seaAOldU]=l 'shue~ueJ!nbeJ e~ehs pue leJap@j u!ehJeo AJs!hes oh JepJo u! suo!~nh!hsu! 5u!puel J!eqi pue seLu oq jo sJeseqoJnd oh Asepno3 e sa s!qh seep SH HQ eqJ_ 'e~SelV jo e~,ahS eqh u! p@Je;s!SeJ Jeau!6ua leUO!SSehoJd ~uepuedepu! ua Aq e^oqe S qdaJl~aJed u! ua^!8 suoRehueseJdeJ eqi uodn Aluo peseq s@~eo!b!peo la^oJddv /qpoqhnv qhleeH senss! (SHHO) see!^JeS uagunH pue qhlaeH Jo huaLupadeo ebaJoqouv Jo Ah!lad!e!un!hl eq.L NOI-LI'I¥O '9 · uo!~sadsu[ S!LI1 bO m, ep uo loabbe u! suo!halnSaJ pue 'seoueu!pJo 'aepo3 e~el9 pu~ lad!o!uniN lie qh!M eaue!ldLuoo u[ s! LUe~sA~ laaods!p Jo/pue Xlddns Ja~a~ eh!s-uo eq:l 'uo!~aedau! pua uo!laS!:~se^u! ALU LUOJb pue sel!J @SeJoqeu¥ ,!o Al!led!o!un!AI eqi LuoJb peu!elqo uo!~eLuJolu! eql uo peseq ha~l Alpc^ ~eq~anb I 'u!eJeq pe~eo!pu! eJn~nJls Io edA~ pua suJoo]peq bo JeqLunu eqh Job e:!anbepe pua leUO!:!auni 'abas s! ua e:!s/,s i~sods!p JeleN~e~,se~ Jo/pua ,~lddns Jele~ el!s-uo eqi leLI] s~oqe le^o~dd'¢ Alpoq~n¥ qhleeH s!qh ~o uo!leD!hse^u! ALU leqh Abpe^ I '~olaq u~o~s e~ap uo!haP!la^ aqi bo sa pue o~eJeq pex!jje leas ALU Xq Pa!b!PeO SV NOI,L¥1N~IOJNI (]NV ¥,L¥(] 'HOi:I¥=I~ =1'114 'S.LLS=I,L 'SNOI.LO=IclSNI 9Nl(]l^OtJcl IN~I:I !DNIU~NIgN=I '9 MUNICIPALITY OF ANCH?~'~gE ENVIRONMENTAL SERVICES L ,$1OI~IUNICIPAMTY OF ~NOHO~GE (~g~ HEALTH AUTHORITY APPROVAL (HAA) 22 ]988 CHECKLIST- FEBRUARY 1984 264-4720 RECEIVED Legal Desoription: ~ WELL DATA Well Classification Well Log Present,N) Total Depth ~ Static Water Level (~ Casing Height Above Ground Electrical Wiring in ConduJt~N) Separation Distances from Well: ~),~/v''/~¢~'' If.A, B, C, D.E.C. Approved (Y/N) Date Comfpleted ~"%/'/~ ~¢'~'" Yield //z/,~'/Cased to ~ Depth of PumpGr°utingset At '~'~'~' ! Sanitary Seal on CasingS) Depression Around Wellhead (Y8 To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ~/~r Water Sample Collected by ,"~'~-~' Water Sample Test Results Comments (~.)~Z. ~ /~] "~ ~'T"'~¢/~///¢' ; On Adjoining Lots /O~ ~ ; On Adjoining Lots /~'~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDiNG TANK DATA Date Installed Standpipes bN} Air-tight Caps ~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /O~ //¢¢¢¢¢ To Property Line /0 To Water Main/Service Line Course /~'~ Size /~'~'~ NO. of Compartments Foundation Cleanout~l) Date Last Pumped ~-/~"~'~' · '~/J~ ;for Temporary Holding Tank Permit (Y/N) '~/,~ To Building Foundation To Disposal Field ~'~ ~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /O~/~' Width of Field '~"'"'"~'" Square Feet of Absorption Area Depression over Field (Y~). Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~:~O /./'- To Building Foundation '¢~ · Lot To Water Main/Service Line 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(~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 /,, Dimensions Manhole/Access (Y/N) "Pump On" Level at ~ "Pump Off" Level at High Water Alarm Level at %__ Vent (Y/N) _ Tested for ~g Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~ Comments ~~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I.~ch~,G~e~., ~/~r?ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~t.... ~4,~/,/-,~---- Date Company "/~'~'/~ MOA ~o, Receipt No. /~ ~(0~ Date of Payment ~ - ~ ~- ~ /70, ~ Amount: $ Page 2 of 2 72-026 (11184) 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 -C c~ ~.. --01 HAA# GENERAL INFORMATION Complete legal description Location (site address or directions) ~ 4-5,'-- ~6.s' 7~ ~,~ Property owner :[~,-~z~ ~ ~S,'~- ~PP~ ~ Day phone ' Mailing address ~ - 0 6o Y.- ~-~-o4-~c~- /3.~ c~l. ,z~E. Lending agency Mailing address /.2 [~ Day phone Agent /d i/'~ Day phone Address /w/cc Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ' Z~r TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. ,'h" '.', ~, NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 {Rev. 1/91) Front MOA~21 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 Anchdrage 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. Alaska Water ,~ Name of Firm w~;~waterServ~oes /// Phone 847.!.A~roP~iog e D~-,q Address /Knc/~/~ 995~ ¢// / EngineeYs signature ~ bedrooms. DHHS SIGNATURE X Approved for ~37-bl7~ Date 8,//*~, Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto 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. MUNICIPALITY OF ANCH?3GE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage R E C E I V E DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825%" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist Legal Description: A. WELL DATA Parcel I.D.: 018 - O~/Z If A, B, or C, attach ADEC letter. ADEC water system number Well type Log present (Y/N) x./~__~ Date completed Total depth Sanitary seal (Y/N) ~ ~_~c~ Casing height (above ground) >7. Wires properly protected (Y/N) x~,~_~ ~ Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform FROM WELL LOG z AT INSPECTION >6, g.p.~ : ~: g.p.m. Nitrate *q~ ~f~ Other bacteria ~ Dateofsample: ~/~/~ ~'~ D Collected by: ~)~ SE~ICmOLD~G TANK DATA ~- - Date installed i* }~/~ Ta~ size IgC* Nmber ofCompanmen~ ~ Cle~outs (Y~ N~S~ Foundation cleanout ff~) ~ Depression ff~ N D High water al~ ff~ ~/~ Dateofmumping ~'7~/9~ Pumper o~ ~0~Y ~ ~ I~ ~)~,~ I ABSOR~ION~LDDATA '~ ~ lO ~ Datems 11 O t6 ~ 2 2 I~O m e ~ : I oi, Len~h ~ Width ~ O Gravel t~c~ess below pipe : ~ ~ To~ depth ~ M ~-~: ~ Effective abso~tion area ~ Mo~toring Tube present~~e~ Depression over field ~ N O Dateofadequa~test 7J;~*& Results~ass~l) ~ For * be~ooms ~ ~luid depth in abso,fion field before test (in.); ¢ I~ediately~er[~°~fl. wateradded (in.): ~ t~ ~Fluid depth ~ (ins.) Minutes later: I~ O Abso~tion rate = ~ ~ OO .g.p.d. Peroxide treatment (past 12 months) (Y~ ~o~N If yes, give date ~ ~"'~tze iu gallons Mauhole/Access (Y/N) ~lat* "Pump off' level at* E. SEPARATION DISTANCES Septic/holding taak on lot Absorption field on lot Public sewer maiu Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: 100' I,,-r~-~ t~?.'7*~f ~'~.~. l~?llgF~'~ I Iq~ ~ OU adjacent lots ~o~ I~ ~z; Ou adjacent lots NI /~ Public sewer manhole/cleanout SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building fouudatiou 4-0 ~ Property line 40 * ff ~x'~'~%sorption field Water main/service line '~' t 0 Surface water/drainage ~'l oo Wells on adjacent lots 1~gq. ~'D='~POrm~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 40 ~¢e(~ ~va~ Water main/semce line / / Surface water ~ } OO Driveway, parking/vehicle storage area / Curtain drain DC.-.~v;q 4¢' % Wells on adjacent lots Property line ,~0 (~' F. ENGINEER'S CERTIFICATION// 4t 2%4 l certify that l ha/w~e4~tined/th~u ~ei{ inspections and review of Municipal recordss "~ in conformanc/withI~A t1~ gp~tel#tes in effect on this date. ,. iff ~ Signature ~/?~-( ~ ~ ~ ~ ~.~,,~, Engineer s Nanle ~-~ ~. ~ Date o1//-/~ ~t ~".,. · ~'~x~~ ........................................................................................................ HAA Fee $ .,~&~7) ,- Date of Payment r/' /~,~ Receipt Number XD,~q C /~ ¢~' ) / Rev. 8/95 OSS: haa,wk.doc Waiver Fee $ Date of Pay~nent Receipt Number At a ka Wa er & WalslteWalaer 8471 Brookridge Drive ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers July 31, 1996 Municipality of Anchorage Dept. Health & Human Services Division of Environmental Services On-Site Services Section P.O Box 196650 Anchorage, Alaska 99519-6650 Ref~ HAA for Well and Septic Evaluation for T12N, R3W, Sec 27, Lot 20. 13621 East 136th Ave. To whom it may concern: The subject property is served by a private well and septic system. The well and septic were initially tested on 7/9/96, and the septic system was found to be inadequate. A copy of the original report to the homeowner is attached. Clean-outs were installed at the beginning and end of the trench, and a new monitoring tube was installed (A Plus Home Services). According to the homeowner, the drainrock only had about 12 inches of water in it when the monitoring tube was installed. The system was jet cleaned (Old McDonalds Pumping) on 7/17/96, and retested on 7/18/96. The results are summarized as follows: WELL TEST (7/9/96): The static water level in the well was determined to be 136 feet below the top of the casing. Water was pumped at a rate of 6.15 gpm for a total of 98 minutes (603 gallons). During that period, the maximum drawdown was 14 feet. The well recovered completely in less than 30 nfinutes. Based upon this data, it was determined that the well is adequate for a 4 bedroom house (600 gpd)J WATER ANAYLYIS: Water samples were taken from the kitchen sink on 7/1/96. The sample tested positive for coliform bacteria, and negative for fecal coliform bacteria. The well was chlorinated~ and retested for coliform on 7/19/96. It tested negative for bacteria. The 7/9/96 sample tested .892 mg/1 for nitrates (10 mg/1 is the allowable limit). SEPTIC SYSTEM TEST: The sump was dry on the morning of 7/18/96. One-thousand & six-hundred gallons of water was introduced into the end clean-out, over a period of approximately 90 minutes. I then waited 30 minutes for the liquid level to stabilize ( 58 inches). This corresponds to 27.6 gallons per inch. During the initial 20 minutes of recovery, the level dropped 4.5 inches (124 gallons). The monitoring tube was completely dry 24 hours later. Based upon the data, the system was deemed to be adequate for a four bedroom house (600 gallons per day). NOTE: The adequacy of a septic system ia' influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance ([requency of septic tank pumping, usage of biological additives), condition of drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the ,pecific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the future performance of this well or septic system SEPTIC TANK: The existing septic tank is approximately 14 years old. The condition of it is unknown. In short, the engineer makes no warrantee regarding the future life of the septic tank. FOUNDATION DRAIN: There is a foundation drain, with a sump pump located near the northeast corner of the house. The separation distance from the absorption trench to the drain is approximately 45 feet. I assume the drain/pump was installed to remove water around the foundation during spring break-up. Based upon the soils test data for Lot 12, R3W, Sec 27, Lot 21 (lot immediately to the south), groundwater was encountered at 6 feet below the ground surface on 8/17/90. According to the soils log (8/11/82) for my clients lot, no groundwater was encountered to a depth of 13 feet. The actual depth to groundwater, during spring conditions, is unknown. CLOSING: If you have any questions, please contact me at 337-6179, or on my pager at 1-800-481-1162. Thank you(for the business. Sincerely,/} .~ ~ Owner/Consultant Brad Price Second Inspection.wps A\[alska Wa ;elr & Was ;¢wa ;¢r 8471 Brookridge Drive N Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers July 14, 1996 Brad Price 13621 East 136th Ave. Anchorage, Alaska 99516 Ret Well and Septic Evaluation for T12N, R3W, Sec 27, Lot 20. 13621 East 136th Ave. Dear Brad: Per your request, I tested the subject well and septic system on 7/9/96. The results are summarized as follows: WELL TEST: The static water level in the well was determined to be 136 feet below the top of the casing. Water was pumped at a rate of 6.15 gpm for a total of 98 minutes (603 gallons). During that period, the maximum drawdown was 14 feet. The well recovered completely in less than 30 minutes. Based upon this data, it is was determined that the well is adequate for a 4 bedroom house (600 gpd). WATER ANAYLYIS: Water samples were taken from the kitchen sink on 7/1/96. The sample tested positive for coliform bacteria, and negative for fecal coliform bacteria. In order to meet Municipal standards, it must test negative for any bacteria. It is my recommendation that you chlorinate the well, and we retest it. The samples tested .892 mg/1 for nitrates (10 mg/l is the allowable limit). SEPTIC SYSTEM TEST: According to the septic system as-built records oa file at the municipality, the trench has an effective depth (drainrock depth below the perforated pipe) of 60 inches. During my site visit, I note that the sump (white pipe at end of trench) only extended 30 inches below the perforated pipe. In short, the sump doesn't go to the bottom of the drainrock. The initial liquid depth in the sump was 21 inches (51 inches above bottom of drainrock?)~ Water was introduced into the sump at a rate of 6.08 gpm, for a total of 86 minutes (523 gallons). The liquid level in the sump rose 12 inches (almost submerging the drainpipe), which corresponds to 43.6 gallons/inch. Water did not back-up into the septic tank. The recovery of the system was monitored periodically for 160 minutes~ and then approximately 24 hours later. Based upon the data it appears that the trench is only capable of absorbing 485 gallons per day. A four bedroom house must be capable of absorbing 600 gallons per day. In short, your septic system is inadequate. As we discussed on the phone, it may be possible to jet clean your system & chemically treat it, however, this would require the installation of clean-out just past the septic tank. In addition, it would be beneficial to have a clean-out at the end of the trench (where the white pipe is). It is my recommendation that the sump be converted to a clean-out, and a new monitoring tube be installed to the bottom of the drainrock. Once the clean-outs are in you could jet clean the system, and then treat it with a drainfield cleaner such as "Septiclear". Whether this will rejuvenate your system is uncertain, but it may be worth a try, considering the cost of a new system. If you have any questions, please contact me at 337-6179, Thank you for the business. Sincerely,/~ Owne !Consultant or on my pager at 1-800-481-1162. Brad Price Initial Inspection.wps HOME SEHVICES, liNC. 12216 Wilderness Road Anchorage, Alaska 99516 345- 1890 CUSTOMER Brad Price INVOICE N° P.O. Block Lot DATE DESCRIPTION Install DOUble Cl~out .~ t~ and at thc ~'ad of drainfield, install new monitening tube To replsce invoice ffi1705 REMARKs TOTAL $ Gallons __ Sel~tic __ Leach Area __ Holding Tank .__ Standpipes [] PROBLEM AREA -- CALL FOR MORE INFORMATION [] NEEDS TO BE DONE AGAIN IN 6 MONTHS [] Good Shape [] sludge buildup on bottom [] Jim cap missing or [] Cut standpipe to 1' above ground needs replacinq [] Floater on lop [] Needs Septictrine ._TIJL-24-1_g96 08:11 FF,'OM FT RICH HATCHERY TO ,338~,246 P.Oi Anchorage Recording District~ Alosko .L,.E.~END '' ~ I~o~ or Aluminum cal~ed monument UAL ,.~- 0 Ir~ pipe ~Or rebut reoove~d. ~ ~x~ hub&t~ reoovered · ~/8".X ~"' rebgr ~et this ~utve~ ' CT&E Ref.# Client Sample ID Matrlx CT&E Environmental Services Inc. Laboratory Division ~jj~-j,~,~,~-~-~e~J~'~'J~'~'J~ Laboratory Analysis Report 962~7.962677001 136~1 Elmore Road/Ktn Sink Drinking Water Collected Date 07/01/96 Technical Director: Stephen C, Ede Smnple Rmnarks: Nitrate-N Nitrite-N Results QC PQL Units Method Qual 0.910 0.100 mg/L ~PA 353.2 0.100 U 0.100 mg/L EPA 353.2 0 0 co[/100mL SM18 9222B tntc ob w/o co[i Allowable Prep Analysis [nit Limits Date Date 07/02/96 ESC 07/02/96 ESC 07/02/96 YAV U - Undetected .T - Less than GT - Greater man D - Secondary Dilution J - Below the calibration range 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tek (907} 562-2343 Fax: [907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA, ILLINOIS, MARYLAND. MICHIGAN, MISSOURI. NEW JERSEY. OHIO. WEST VIRGINIA 07/22/96 10:38 CT&E ESI RNCHORRBE ~ 9073383246 N0.297 . CT&E Environmental Services Inc. . Drinking Water Analysis Report for Total Coliform Bacteria 200 w, Anchorage, AK ~9518-15C, RE',4.D .[;\'STRUCT.[O,VS 03' REFER~E S~DE B£FO.R.E COL /' ECTLVG S.4.'ffPLE ~el: (907~ S,-~¥ [PLE DATE: SAMPLE TYPE: Routine Repeat Sample (for routine sam plo with lab re[ no, .) n Special Purpose Day Year SAS'~ LE LOCATION (g~,2 I ~04ofa~. .~ Untceatgd Water Time Collected Collected B>' 12' ~/ ~ F~x: (907) 581,5301 II TO SE Cr~MPL~TED BY L.-(BOR_~.TOR\ ' .~na[?'sis shows ~i~ Wa~r $,~MPLE ~o ~ Sample ov;r 30 hour~ b¢ unreliable Sample too Iohg an; be over 4S hours o{~ at examinariorx to indlcaN reliable re*uRs. Please $¢nd Da;e Received Time Received Analysis Began Ann ,,q ¢~ Method: ,~'J'"Membrane Filter 0 bIMO-MUO ' Number oFcolonie$i 100 mi, ! ,,h RnF, N'O, ResuI¢ Anal?' - Sear Io A, DiE.C. Fh~ ,J,Jn Client notified 0f unsatlshe/0D' results: Dale; Tim~: BACTERIOLOGICAL WATER .42~'ALYSIS RECORD MMO-,.',~'G Result:· Total Coliform Mom ~rane Filtey:. Direct Count ' Varifi~atlon: LTB BGB , Fatal Coliform Confirmation ReportedBy . ~',- Date )RILLING; CO~ /Ak CHEMICAL & GEOLOGICAL LABORATORIES OF AL~KA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Wozk Order t 7136 Date Report P~inted: JUN 13 88 ~ 11:16 Client Sample ID:L20, T12N, N3W, SEC. 27 PWSID :UA Collected JUN 7 88 ~ 17:55 h~. NocelYed JUN 8 88 @ 16:00 PreEerYed with :COOL 4 DEG. C Client Name : AgCS Client Acer : AKECSNP P.O.t NONE REC'D Neq ~ O~de~ed By : Analysis Completed :JUN 10 88 Send Reports to: Laboratory Superrep :STEPHEN 0. EDE 1)AECS Nelea,.d ET: ~~ ~ 2) Special Instruct: Chemlab Nef ~: 1333 Lab Smpl IO: 1 Matrix: ~ater Allowable ParameteI Tested Result/Units Method Limits NITNATE-N 0.75 rag/1 EPA 353.2 10 Sample ROUTINg SAMPLE Remarks: SAMPLE COLLECTED BY A. ~EIN 1 Test~ Pezfo~med See Spoclal Instructions Above UA-Unavailable ND- None Detected *' See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-Greater Than 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 [] PUBLIC WATERSYSTEMI.D.# I I I I I I I ~ PRIVATE WATER SYSTEM Name ./] Phone No. Mailing Address City Slate Zip Code Mo. Day Year SAMPLE TYPE: "~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose Treated Water Untreated Water SAMPLE NO. LOCATION 2 I I 3 I I 4 I Time Collected Collected By TO BE COMPLETED BY LABORATORY sasis shows this Water SAMPLE to be: tisfactory [] 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 ~0- ~ Time Received .J~'~ '~ Analytical Method: Membrane Filter * No. of colonies/100 Lab Ref, No. Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter:. Direct Count Verification: LTB Final Membrane Fj, Iter Re,,sults i Reported By~..._~ ~~_ ~ PAF~T ! OF 2 TNTC = Too Numberous To!Count OB = Other Bacteria BGB ~:,~ Date Time: Coilformll00ml Coilformll00ml P~EMA1NDER TO FOLLOW AppLI('~':NT FILLS OUT UPPER HA, ' ONLY ~'-'~--- Address ~ (% ~ ~, Zip Code Sewe[ Disposal ] J ~vidual Year Individual Installed: ~.~ ~ ~ ~ ;~. ~- ~'~t~z ~' ¥ I(~ ~,~ Time Time Time Time Date Date Date Date Inspector inspector Inspector Inspector ( ) OONDITIONAL APPROVAL~ Soils Rating Date ~wer Installed Well To Absorption Area /~, Well Log Received CHEMICAL & GEO OGICAL LABORATORIES (IF ALASKA, INC. /~~ ' TELEPHONE (907)562-2343 ANCHORAGE56331NDUSTRIALB Street CENTER Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Water System Name SAMPLE DATE: ~ (*) See h on beck I.D. No. / Phone N~ ~ .~ I-~0 State Zip C~ Day Year SAMPLE TYPE: ~ Routine [] Check Sample (for routine sample with lab ref. no, E] Special Purpose ) [] Treated Water ~ Untreated Water SAMPLE NO. LOCATION 3 [ J 4 I J Time 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 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received ~-.- ! 7- <~'f T~ms Rece,ved 0 ~(~ Analytical Method: [] Fermentation Tube ~L.Membrane Filter Lab Ref. No, Result* Analyst I I [-i-] I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE O6-1220 (b) Rev. 197S BACTER IO LOG ICAL WATER ANALYSIS RECORD Multiple Tube Report= Membrane Filter= Dlre~t Count Date T,m.' 1%-© © ""~ ALASKA e EJIROIqmeFITAL COI]TROL SeHulCeS, ~n§in¢~rin§ g ~n~ir~nmenl~l $1utlies February 20, 1984 Depaztment of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99501 Attn: Robbie Robinson Dear Robbie: On February 17, 1984, I inspected the sewer system and well located on LOt 20, Section 27 T12N Subdivision. At that time a water sample was taken and the results are attached. Ail the standpipes were capped~ above ground, and in good condition. The well is located 102' from the sewer system. The well has a sanitary seal and the wires are encased in conduit. The casing stands 2' above the ground surface. The ground is graded away from the well. Sincerely, Jim Green Geotechnical Engineer JG/cad Approved by: 1200 UJest 33rtl Aucnu¢. Suite B.AncHo~'a§e, Alask, 99503~,(907) ~'1-5040