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HomeMy WebLinkAboutMINK LAKE LT AMink Lake Lot A #05 - :1. 54-47 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Address TANK FIELD WELL Township, Range, Section AS-BUILT DIAGRAM {Show location of well. septic system, propedy lines, foundation. SEPTIC ~ HOLDING Manulact .... Capacity in gallons ~ ~ b~ ~ I ~ TRENCH ~ BED DRAIN ~ OTHER ~,~ Depth to pipe boltom Irom Tolal depth from original grade ~ originalgrade ~ FT ~ FT :ill added above original grade Gravel depth beneath pipe Gravel length Gravel width Total absorption area Distance between lines Number of lines Soil rating Pipe material WELLS RIVATE ~ OTHER (Identifv) REMARKS: 17034 EaRle River L~ Ro 72-013 (3/85) P EE F..' iq ]; T [)-'.-~r1(.;.):P Ach:ir'.(.!~;!~!.~s:', 6?:[0 N,'.']F;:TH .......... ~:., 7 .... 7 :l.,,,,~.? i NFT)I;:IH i:) ,, H ,. 1"i, S ,, F:'F.:,' ]; OR T(] I htfCF'E;CT Z OI",.tS BY ENE~ I NEE,R', I F: F*'.FT'ER EIF:F;,rCE HL-it. ff:;-'.Ei, C¢.~I_1... 543-4.,C, ii:iJ. AND L. EAVE CONS"FF;~UC'I" F:'EF;~: EN(31HE':EFi'.S (4TTF~,CHE:D F~F>F:'FIi::iVED ,0ES .T. GN ,, THZ,"!il I::'IEF;~H ]: 't" EE X F;' ]: F;: E ,':3 12 /::'.!; :1. /EF9 ,qND V~:~I.... ;I: I:) FOR (';~ !3):NGL. E: i"-"f?tHZL.Y Hi]ME, :I: F'Y' ,?rd;q ffi:H~'t.i.].i.:=qp t,,4:L'!'..h t.h~.? i",,.;::qLtiP(~¢,';e)r'It.~; f'cm c~n-si:i.t.e? sc.-~wer~ and f'ort:.h by 'Lhe Hur'~:i.c.i.F~e. lit¥ Qf' Ar',,chor'ag¢.:.* (IdC)A) ,~r'~d 'ir. he ~.~'Lat. e v,~:i.].l ir'~r~,t.,'a].l t. he :-'~y:,~d'.em :i.n ac:¢;Qpcl?:~r;c:6'~ twi{.l",, a~].]. PIE)A c:~d~:~:,!s ;:Hq,;:! PegLI].a;CL;;.CH'"HF,;~ ,'{*I"1C:I :i.i"i c:oriit:~]..i.,z~.r'lce wit. h the cle,:.~:i, gr~ c:i'i,~.er':i.,'.-:~ Qf' this per'mit., will aclher'e t.c:~ all I"l(::)~ arid St. iai'..e of' C:~:La~l.::a reqL~irerner'd'..f~ f'(::}r' tho ~(~:(,'t. back s~;(:m,,~:;,r'age~ ~;ys'~rt..em cn"~ t.h:J.s of ariy adjac:er'it, or n,:aa~f'by a:!,~so Lu"~ch:~H"~st. ar~ci t. hat. t. lqe) caF)a(:::it.y (::~{' t. he:, t, cU:,,a! sy~rLe:m ;i,!s :~; b~clr'c)c)m~;[; and SCALE i Municipality of Anchorage ~' :~,~'~i '~'~ DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 ~F~iF~.'7" SOILS LOG -- PERCOLATION TEST ~.~\ FO R ~~__~;~~ ~ . PERFORMED LEGAL DESCRIPTION: L~C~'. A ~'J[tl.~/.. ~.~.Township, Range, Section: "~'.1.~ SLOPE SITE ~L~,N 1 2 4 5 6 7 8 9 10 WAS GROUND WATER 11 IF YES, AT WHAT DEPTH? 12 Deplh to Water Alter ,,,~ Gross Net Depth to Net Reading Date Time Time Water Drop ,/ 14- 15- 16- 17 18 19 20 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN . FT AND __ FT COMMENTS S & S ENGINEERING /' .......... · ~ / / ~ PERFORMED BY~aola_ alvar~ Alaska 995~ j,/, ,/' / ~ ~ CERTIFY THAT THINEST ....SWA PERF~R..._~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN~ CT ON THIS DATE. DATE: 72-008 (Rev, IN DEPARTMEi~T OF HEALTH 8~ ENVIRONMENTAL PRO'f~'~'tlON ENVIRONMENTAL ENGINEERING DIVISION  825 L Street- Anchorage, Alaska 99501 Telephone 264~4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL DESCRIPTION ~ NO, OF BEDROOMS LOCATION ~/~ ~ ~ D ~ ~ ~~ ~ ~ Dwelling t PERMIT NO. WeH Absorption area DISTANCE TO; //~ / ' _~ I // ~ Material No. of compartments ~ , Manufacturer ~~ ~~ ~ Inside length Width Liquid depth Liq, capacity in gallons / ~ ~ IF HOME~DE~ Wetl Dwelling PERMIT NO. 9~ DISTANCE TO; O Z ~ Manufacturer Material Liquid capacity n gallons ~-- ~ PERMI'~ NO. Well Foundation ~/ ~ Nearest lot line -~ To~I effective ~hsorptlon area ~ ~ ~ ~op Of tile to finish gra ~ I ~ ~aterial beneath tile ~ ~ inches ~ PERMIT NO. Length Nidth Depth ~ ~rib depth ' Total eRoctive absorption area ~ ~ Type of crib Crib diameter m ~elJ Building foundation Nearest lot line ~ DISTANCE TO'. , ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Abso~ ption area(si ~ Building foundation Sewer line Septic tank ~ DISTANCE TO: OTHER PIPE MATERIALS Fr, ., REMARKS .-- .ce~ xO / ' -- APP ' (~ DATE LEGAL ' ~> ..... MUN C PAL TY 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 [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS DISTANCE TO: 0~<~ I I Absorption area Dwelling Iwe'l// / // Manufacturer 4~/~=~__,~ Material -~ 7-~ Liq. capacity in gallons I ,c un~c,~^ nc Inside length / ~)~ ~ .............. : W dth DISTANCE TO: Well Dwelling Manufacturer Foundation DISTANCE TO: ~ / No. of lines Length of each line / Top of tile to finish grade~ Length Type of crib DISTANCE TO: DISTANCE TO: 01ass Width ;rib diameter Well Depth Building foundation Total length of lines /~ ~_~ Material beneath tile Depth Crib depth Building foundation Driller Sewer line Material Nearest)otli~/~ ! T[ench wi.~ inches inches PERMIT NO. No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance b et.~7,~es Total effective ~bsorption area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Absorpt on area(s) Septic tank OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE LEGAL 825 "L" STREE! ABICi--I(] R!',GE, A LASKi', 99501 (907) 264-41 I I GEO.qGr{ M. SULLIVAN', t,.i.AYOR December 31, 1979 Howard Erickson Star Route Box 9030 Chugiak, Alaska 99567 Permit ~ 790545 Subject: T15N R1W Section 8 Lot 190 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-bui!ts for our files. If there are any further questions, please contact this office at 264-4'720. Sincerely, Les N. Buchho!z, R.S. .,,.,,.?-.7L~ Senior Environmental Speci%Jz~±st LNB/ljw enc: Copy of Permit I:::IF'F't. t C I:::IN ]' L. El C: FI"t- I 0 N I ~ [ IF!. ElF '.ii~;[:) ! t.... F:IE:SC]F::E:-F I ON E;"r'STE]"I T ':::: [:,I;i:F:I ! i",!!'::' ! ELD THE RE~:!U I F.'.ED S I ZE OF '['H[!!~ 111!~1]1 ]: L. FIBS()[q:F'T :1: ON S'.,.'s"rEH :[ S: E:::" E: F" ""r IF--fl ..... E,,.~ E: ~'-4 C~ ~"~'" ~.~-~ ..... ~,~'::~.,_, ~r:':",~., ,.~r:::~,, '.~...." ~......~::" ~ ........ ~....~ '"',, ,,..._~::=' ,,~:::::~ 'i., .,L ,,~ ........ ........... ,,~=::.. THE L ENEH'H D I !"IENE; ]~ 01'.,! I S "FHE: LEi'.,iG"I]...I ( I N F'E:E:T ) Cfi:' THE TI:~:ENCH 01:;?. E:,I:;~'.I:::i )~ Ni::;' ! EI..D. "r'HE [)E:F'TH OF' FI TF:ENCFI OFJ: F'ZT ZS 'THE~ D]:STFINC:E: BET['I.,!E:I~]q 'Fi..!I~: E;I...II:;~'.Fi:::ICE: OF' GF;:CC.!N[:, FIN[:~ THE:J BO'T'TOH OF:' THE: E~',~.:;C:FI',,,'FITIOI'.,! ,:~ IN F'EET). 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I"t! f'-,I I I'"ILIP1 E:, I STFII'.,!CE E,'ETNEE:i'-,I FI t.,.IE:!.J.... FIND FIi',I'~.' ON'""S I '!"E SENI::IGE D :i.C"~.;;:) F'EET FOFi: !::1 Pf;:I',/Fi'I"E !.,.!ELL.~ !.E!i~:J 't"O :.:213e~ [::'[~:111['t" FF.:OH. I;:1 PLI[3L..IC !4EI....L. DE:F'E:N[)!I",!G t..t!:::'ON THE: T'.,.'F'iE O1::' I:::'IJEE...!C: 1.,]1~:[..[ .... OTl"]['ii:[;: I~:EI]:!I..I :[ !;.'.'E:I"tE:NTS I'"IFI'~.' FIF'F'L"r'. SF'EC ! I::'! OFi."T'!' ONS FiI'.,tD C(]I",ISTF;:LICT t O1",! [:, !' t~[!i[;i:I::!1"I~i!; FIlE:E: FI';,'Fi I L.I:::IE;LI!~ "I'O I i",IE;IJ[iiE: F'I:;.'.'OPE:[~: ]: N~'".':TFILLFITI O!",1. :[ C:Et'E:TZ F"/ THI::fT' :!.: I FII'4 FRFIILIF!F.': I.,IZ'I"H THE: f~:EQLt:I:F;:E:HEI'.,!T:!~; FOR ON'-'SITE :51'~I.,iE:!:;~:S I::~!",ID 14E:!...L.S I:::!S :~E;E:-i" FOF[:'I-H E?'F THE I"ILtt'-,I Z C I F'F:IL Z T"r' OF FINE::I'"IC~F;~FIGE:. :F:: i 14:[L.L ZI",tSTFII...L THE: S"r':E;TEH tN F~CCO[;:DFINC:E: !.,.IZTH THE: CODES. s :[ ,::~NE:[::,: ....................... ~~~ ............... Performed For Robert Johnson Leaal qescrintion: Lot Block This Form Renort$ Soils Loq 2204 Cleveland Anchorage, Alaska 99503 Date Per fora, ed Subdivision Mink Lake Yes Percolati on LEGAL: Govt. Lot 190 sect 8, T15N, R1W, S.M. Penth Feet ~,,% .... Soil Characteristics Brown Silty Sandy Gravel- Bottom of Test Hole 4 6 8 10 14 16 18 20 Test Hple #1 6-9-78 Test iEE MA Was Ground Water Encountered? Water I~ Yes, At what Depth? seepage @8' ..% jReadinq Date Grnss Time Net Depth H20 Time to Net Dron Percolatinn Rate Hinute -'-:. Prnposed I.nstallation: Seenaae Pit- Drain Field Deoth of Inlet Depth To Bottom Of Pit Or Cn~,.~ENTS: 150 Sq. Ft. drJ~nage area required per h~nl'rrw',m' ;..:.. Date: Trench 0 0 0 0 0 0 0 LL LL ii ii ii LL Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program ~,700 Sou~h Bragaw St. P.O. Box t96650 Anchorage, AK 99519-6650 wv~,.ct.anchorage.ok.us {907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D. 051-154-47 1. GENERAL INFORMATION Co'~plete, legal des~:dp~ro.n ~o~ation (~ite address' or directions) 21_01_4 Tenada Ave 'Current Propedyowner(~);£aY & Carolyn Tomory · .._M~.i.{ingaddress2lO'l'4 Tenada Ave Chugiak, AK Lendrng._ag e.ncy Mailing address Real Estale Agent Mailing Address Expiration Date: Lot A: Mink L~ke Subdivision Unless otherwise requesfed, HAA will be held by DSO fer pickup, 2. NUMBER OF BEDROOMS: 3 Day phone 841-1659 99567 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 Health Aulhority Approval (HAA) based only upon the representafions given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Aulhority Approval are required for the transfer of title (except between spouses) for propedles served by a single family on-site wastewater disposal and/or water supply system, DSD also Issues HAAs upon request to homeowners. Certificates of Heallh Authority Approval are valid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. {Cedificates may be reissued for a period of up 1o 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 o~' the validation da~e shown below. I veri~y Ihat my Invesllga~ion, based on procedures outlined In Ihe Health Au~horiiy ^pproval Guldellnes for this application, shows tha~ Ihe on-site water supply and/or wastewa~er disposal sy~lem Is(are) safe, functional and adequate for the number of bedrooms and type of struclure Indicated herein. I fu~er ~eriry Iha~ based on the Information obtained from Ihe Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance wilh all applicable Municipal and Sta~e codes, ordinances. and regulations in effect at the time of tnstallalion. NameofFirm S & S EnKineerins Phone 69/4-2979 Address 17034 N. EaRle River Looe Ste 204 Ea~le River, AK 99577 Engineer's Printed Name Robert C. Cowan Dale 5. DSD SIGNATURE '1,~ ~ Approved for . ..~ bedrooms. '~ Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certit'icate Date: ~ . ~ c-'} _ O..Q_. Mnnicipality of Anchorage Development Services Department Building Safety DIv~ion On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 1966,50 Anchorage, ~ gg519-6650 www.ci.anch0rage.alcus (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well htpe ~ IfA, B, orC provide PWSID #-"'" FROM WELL ~OG Stehc water ~1 Well p~on ~ g.p.m Well Log Cf/N) ~res propedy protect~ (Y/N)_ "~ C, as~g height (al:x3ve ground) ./'_,~ AT INSPECTIOI~I ~Z.~" .. WATER SAMPLE RESULTS: Coliform /~) colonies/t00 mi. Amenic: rng./I. B. SEPTIC/HOLDING TANK DATA Tank e~z ~al.- ' ~ .4d. umber of Cempa~ments Nltmted~mgJL . / Date of sample.-~/f~/O ~ Other bacteria ~ colonies/100 mi. / Ck, anou~ (Y/N) Tote, d..h F' ¢". E,. ,~o~,o,.=~ ~_~/.e Mon~ ~ y Flu~ dep~ ~ a~o~ field ~m ~t ~ ~. ~r add~l gal ~ ~: ~ min. Final fluid dep~ ~ in. ~rp~n ra~ >= ~ ~ju~nafion ~a~nt (~t 12 ~.) ~tN & ~) ~ Depression over field For ~ bedrooms If yes, give date D. UFT STAT]ON 'Pump on level at// i . / Datum E. SEPARATION DISTANCES Size in gallons "Pump off level at Cycles tested Manhole/Access (Y/N), High water alarm level at Meels alarm & cb,a,,tt requirements? irt. SEPARATION DISTANCES FROM WELL ON LOT TO: Absorption field on lot /~) Public sewer main On adjacent Iota /4:7~::) /'.+- On adjacent lots Public sewer manhole/cieanout Holding tenk SEPARATION DISTANCES FROM SEPTIC/H..O~G TANK ON LOT TO: Building foundation ~' ~ Properly line ~' ~' Absorption field / · Watermain ~J ,~ ' Water service line ,/t"~ I~. Surtecewater Wells on adjacent lots '/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / O I,p_ Building foundation / ~) /~- Water main Water Service ~[ne J(~::) I.}.. Surface water i/,~L,~ I',f,-- Dfiveway, parkingNehideltorage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined thmugt~ field inspections and review of Municipal recorcls that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date HAA Fee $ 3 Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc; .. 'Laboratory Division r~rJ'w'J~'~:o:a'~lr~,)',w, ir,,~Jar, ar, ep, eM,j~.,e,,~j~,~:a,j~,jr~s~~~ 200 W. Poller DriVe Drinking Water Analysis Report for Total Colifom, Bacteria A. cho,..o. ^K 99S~8-~606 Tel: Jg071 562-1~343 READ ZNSTR UCTION$ oN'.P. EI/EREE ,SIDE BEFOICE COLLECTING SAMPLE Fax: (907} 561-5301 II MUST BE COMPL.ETED BY WATER SUPPLIER CI ?UBLICWATERSYSTEMI.D-# ' J J { { J · ,~ {'RIVAT~; WATER SYSTEM S & S ENGINC~I'RING .' Day S'AMPLE T~E: ~1~ Routine D Treated Water Cl Repeat Sample (for routine eample Cl . Untreated Water with lab ref. no. ' ' ) . I:1' SpeciaIPurpose ' ' Time Collected · SAMPLE LOCATION Colhcte,~ . By TO BE COMPLETED BY LABORATORY · Analysis shows this Water SAMPLE to .,,)~' Satlsfac~or~/ , . .* ~ Unsafi~hcto~ , a' ~le o~ 30 houri old. ~ul~ ~y " oe un,liable ' ' not ~ ~:~o~ old at examinad~ to indi~tc ~liable ~I~. ?I~ Date ~ecelved * TlmeReeelv~ ' ' [ ~.' lnal~lcal ~ethod: ~Mmb~n~ Filter · ~umb~ ofcoIonie~l~ ~1. Lab Ref. ~o. Result* . Analyst Seat to A.D.E.C. lnJh Fbke Jun [] BACTERIOLOGICAL WATER ANALYSIS RECOI~ · MMO-MUG Result: Total C~ilifom ' Membrane Filter: Direct Count ~) Verification: LTB ~GB Fecal Coliform Confirmation Final Membrane l~ilt~r Results ~) .-£, Cell. Colonies/tOO mi. ' cOLIFIRM Coliform/100 mi Time ~/~-''* hr, AUG-IS-02 IZ:'~SPtl FROI~CT&E ENVIRONMENTAL SRV ~1~_- C:T&E £nvtmnment,l Sen, lee, Inc. T-856 P.04/09 F~285 CT&£ Ref.~ 1025208003 ~lient Name S & S En~g P~J~t Nam~ NA ~ent Sample ~ ~ ~ ~ Lot ~x D~g Water O~e~ By PWS~ O Sample P,.emaltts: All Datts/'rlmts art Alaska St-ndard Time Printed Date/~me 01]/16/2002 8;49 Colle~ed Datefflme 08/13/2002 16:10 Received Daterrlme 08/13/2002 17:40 Technical Director ~ephen ~. £de Units Mc'Jmd Liners Date Date Init Nitrate-N 4.44 0.200 m;/L EPA 300,0 (<'-I0) 0~/14/02 JDT M:Lc~:ob:l. olo~y' Total Coliform cal/100rttL SMI8 9222B 08~t3/02 SBH Z "1 As --IP31LT (-II0-c0,",tl=Ks ,~I::T-Tri[$-DATE )-~'"---,,'o' ' -- I h~rc~y'certify that I have performed a Hortgagee s ind~tcl:ion o! the foiJ. o~t~.g described proper~y MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # (~[- 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT A: MINK LAKE SUBDIVISION Location (address or directions) NHN @UAKEN DRIVE (b) Property owner Mailing Address 6910 North Chateaux, (c) Lending Institution Mailing Address Telephone:(ho~8)772-7169 Business Co~ur'D Alen¢, Idaho 83814 Telephone (d) Real Estate Company and Agent Address 16600 ~'~+~/;~'~ ~;"~ o,,;-~ Telephone 694-,~ (e) Mail the HAA to the following address: (or check herex6~, if hold for pick up.) List contact person and day phone number below: R~/Max. of Eagl~ Riu~.~ ATTN~ V~hgi~J~ Ko~blf~d ENGINEERING 1703e Ea~le River Leap Read River, Alaska t9577~. 2. TYPE OF RESIDENCE Single-Family ~X Number of bedrooms 3. WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must .have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site E~.z Public [] Community [] Holding Tank [] Notei If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codeS, ordinances, and regulations in effect onthe date of this inspection. Name of Firm 17034 Eagle Ri~er Loop Road Address Date 6. DHHS APPROVAL. Approved for ,.~ .bedrooms by Approved ~/~"J~' - Disapproved Terms of Conditional Approval Conditional The MunicipalityofAnchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions inordertosatisfycertain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification ~ MUNICIPALITY OF ANCHORAGE (MOA) ~L~'~ ©? Al~L'~-~' '~'CA~th°rity, 343-4744Approval (HAA) .... ~N-~ AL S~-~'V~'-rc;~'~K'~IST ' FEBRUARY 1984 ' '~U J..?J~'t'~ Legal Description: Well Log Present ¢Z~) ~ Total Depth ~2~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit td~N) If A, B, C, D.E.C. Approved (Y/N) /44 Date Completed t4~-'7_.~r~'i~ Yield I.p, ~ ~¢'t-,t -~ /. , Depth of Grouting Pump Set At .~. Sanitary Seal on Casing ¢;~)'N) ~ Depression Around Wellhead (Y/~j~: ~ _ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot I ¢~-'~ To Nearest Edge of Absorption Fie~..~/)~ Lot I To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ..~ Water Sample Cbliected by ~¢¢~ ~:~_-~ II''~::)'?~'~''T ; Date ; On AdjOining Lots \ ~ ; On Adjoining Lots Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~1'~1'"/'~ Size Standpipes ~/N) ~ Depression over Tank (Y/~:~' Pumpi0g/Maintenance Contact on File (Y/N)~/. Holding Tank High-Water Alarm (Y/N) , SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line Air-tight Caps ~d~/N) ~ c:>t-P No. of Compartments ~ Foundation Cleanout ¢~N) ~ i~D/~&te Last Pumped (~,-7~t~ - 'i~'¢/ ; for Temporary Holding Tank Permit (Y/N) I'~/A To Building Foundation To Disposal Field 1.4- To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments "~-'~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata \ ~-t~ Type of System Design Date Installed ,c~ ~ t'~ - l~ Length of Field ~ c=,-7---I Width of Field ~' ~ ! Depth of Field '~'-,5~' I Gravel Bed Thickness 7..-) Square Feet of Absortion Area L¢~ '3... ~/~ Statndpipes Present ¢:f~'N) y Depression over Field (Y/.~ ~ Date of Last Adequacy Test Results of Last Adequacy Test ~. r__..~¢.~~ _ -'~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ "?---~" ~ To Property Line ~ c: To Building Foundation ' ~ ~ ~ To Existing or Abandoned System on Lot ~//& ; On Adjoining Lots "~c=. t +- To Water Main/Service Line ~. ~ t Jr To Cutback (if present) r~//~ To Stream, Pond, Lake, or Major Drainage Course \ o,-~ I,..~ To Driveway, Parking Area, or Vehicle Storage Area ~ ~c Comments / LIFT STATION I~/~ ,~ Date Installed Size~ in "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~e,~_/N~ Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA gu~dehnes m eff~5%,ep~,C-~te of this inspection. -~.~ Signed S & S ENGINEERING -,'- .. 17034 Eagle Rive~ L~p Road No, 204 Receipt No. -~/:~'--'~ ~ ~ Receipt No. Date of Payment ~ '- ~'~ ~ Waiver Fee: $ Amount: $ "~'~:~, (~¢~ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 ~z,-c?'~ CHEMICAL & GEOLOGICAL LAB.ORATORIES OF ALASKA, INC. /,A~'~ ' "~----~E'~P~ ' -- -- '~-'-"~"~ S-'~r e e ~"-"~ / ~X Anchorage, Alaska 99518 ~ ....... ~ Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER XPRIVATE WATER SYSTEM Name S & S ENGINEERING Phone No. 17034 Eagle River Leop Read Ne. 2~ Mailing Ac~ River, Alaska ~957Z City State Mo. Day Year SAMPLE TYPE: ~- Routine [] Check Sample (for routine sample with lab ref, no. [] Special Purpose SAMPLE NO. LOCATION 2 I 31 Zip Code Treated Water Untreated Water Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: J~ 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 Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* I I Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD ~ · Membrane Filter: Direct ecu nt G Collf o?n~/1~ Verification: LTB· BGB. Final Membrane lit r R ults,.,-- ~ Collform/100ml Time: f ~ ~ a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria pART I OF 2 REMAINDER TO FOLLOW · . CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. / -~" X 5633 B STREET ANCHORAGE, ALASKA 09518 TELEPHONE (007) 562-2343 ~.-"L;~'o~.;~',;;'% FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 16154 Date Report Printed: AUG 31 89 @ 10:06 Client Sample ID:LOT A MINK LAKE PWSID :UA Collected AUG 24 89 @ hrs. Received AUG 24 89 8 15:15 hrs, PreserYed with :AS REQUIRED Client Name : S & S ENGR Client Acct: SNSENGP P.O.~ NONE RECEIVED Req ~ Ordered By : Analysis Completed :AUG 25 89 Send Reports to: Laboratory Supervi§or /~EPHEN C. EDE 1)S & S ENGR Special Instruct: Chemlab Roi ~: 7178 Lab Smpl ID: 3 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 0.18 mE/1 EPA 353.2 lO Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RP 1 Tests Performed ND~ None Detected NA= Not Analyzed See Special Instructions Above UA=Unavailable See Sample Remarks Above LT=Less Than, GT=Greater Than [%,;/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date _r~- GENERAL INFORIVlATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~(~'~¢., ,¢ ~: ~ ¢~J¢ Telephone: Home ~¢~¢ % ~ ~ % Business Applicant is (check one): Lending Institution ~; Owner/builder ~'; Buyer ~; Other ~ (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) .4vk~i+the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms ~ Other 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 T~nk [] 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 72l°25 (11/841 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ~ As certified by my seal affixed hereto and as of the validation date shown below, r verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Address '. ~ ~ Date Telephone Approved for //¢:'/'&2~ . bedrooms by Approved 7:~ ', Disapproved Terms of Conditional Approval Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DNEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHOI~AOE DEPT. OF HEALTH & ENVIRONMFNTAL PROTECT/ON .RECEIVED A. WELL DATA Well Classification Well Log Present. N) Total Depth t,O.¢~t Cased to Static Water Level '~;:;~ Casing Height Above Ground Electrical Wiring in ConduitS/N) If A, B, C, D.E.C. Approved (Y/N) Date Completed t.~- ~_~--~ Yield ~[~)~ Depth of Grouting Pump Set At ¢2"~~' Sanitary Seal on Casing(~N) Depression Around Wellhead (Y~ Separation Distances from Well: To Septic/~-d~rcJ Tank on Lot I "~ ~'~ - ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ], "~--~ ; On Adjoining Lots To Nearest Public Sewer Line ~ //~ To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments *- To Nearest Sewer Service Line on Lot ~ t .~ SEPTIC/~;GLDING TANK DATA Date Installed 4:~ [¢~t ¢~-~ Size I ~...¢~ ''~ No. of Compartments Standpipes~/N) ~ Air-tight Cap'C/N) --4 Foundation Cleanout Depression over Tank (Y~ ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/l?~I ~'~ / (/~' ;for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic,4&-N~:3 Tank: To Water-Supply Well \ '2~-,~" ~ To Property Line 1 (~ t jo To Water Main/Service Line JE:~ t'~,' Course ~.5 ~ Temporary Holding Tank Permit (Y/N) To Building Foundation ~ \ To Disposal Field ~'- ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~:~ Width of Field Square Feet of Absorption Area Depression over Field ('~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well 1 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 "'"T-'f~-~:~.,,~.~' .._IA Length of Field ~_¢O'%.~j Depth of Field ~-"~ Gravel Bed Thickness ~ ~ Standpipes Present<~N) Date of Last Adequacy Test ¥~ ~'7~,~ ~ "~ ~ ~ I I To Property Line ~ o ~ To Existing or Abandoned System on ; On Adjoining Lots ~ .2¢- To Cutbank (if present) ~ ] ¢~' Comments D. LIFT STATION Date Installed 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) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all ,~_ A anC/,~HAA,._guidelines in effect on the date of this inspection. Signed ~,~g4 ~-'.. ~.~!.r'!E--,~l~ Date ~/~- ~"~ ~'~ · Date of Payment ~" ~O ~ :~~,, ~'~ P age2of2 ~~¢~ 72-026 (1~/84) HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 552-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street ' Drin.king Water. Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Water System Name (*) See h on back I.D. NO. Phone No. Mailing Address ~ C~ State Zip Code SAMPLE TYPE: : (~Routlne [::] Check Sample (for routine sample with lab ref. no. ) [] Treated Water I~ Untreated Water n Special Purpose SAMPLE Time Collected NO. LOCATION Collected By 3 I I , I I 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 Time Received Analytical Method: [] Fermentation Tube li~ Membrane Filter Lab Ref. No. Result* Analyst I I-r-I i I-1-] I FT~ I r-~ 06-1220 (b) Rev. 1983 BACTERIOLOGICAL. WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Collfo~nll00ml Verification: LTB BGB Final Membrane Filter .Results::, ' ~(~"~ CollformllOOml a.m. D,m. TNTC-- Too Numerous To Count