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Home My WebLink AboutFIRE LAKE LT 1 TR JFirelake Tract J Lot 1 #051-332-32 Municipality oi Anchorage Page I of._~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Sile Waslewaler Disposal Syslem and/or Well Inspection Report Permit Number: ~ {~0~0 ~ ~ ~ MID Number: ""~: ~O~ ~[~er ~ Waslewaler Syslem: O New ~Upgrade ~1.¢, ..e ~1< f1572 ABSORPTION FIELD [olal ~pth horn of {gtnal LEGAL DESCRIPTION so,,....~ WELL: ~.ew D Upgrade ,.~ ~.-I o, ,,.I = ... SEPARATION DISTANCES ~.,., lip lis' ~o' ~~F,%S~pN Lol ,~,,.~.,,~. ~'. ~6' ~' Remarks: I.teR--,r,4~r 0~-~,~ O BENCH/MA~K ~ ~,~ ~ [~..m~.,...: I00,,, ,~,s~/ ,....'&D, S & S ENGINEERING . ' . . 170~ Eagle River L~p Road, No.~ ' ' ''v" ~"~' ~ ""~' ' .... Deparlment of Heallh and Human services approval Reviewed and approved by: ate: PERUIT NO. SW000333 PAGE 2 OF 5 MunlciDal. i-t oF Anchorage DEPARTMENT OF HE~THAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 eAnchoroge, Atask~ 9951g-6650eTeler~hone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL iNSPECTION REPORT LEGAL LOT 1, TRACT J, FIRE LAKE S/D P.I.D. NO. 051--532--52 ,PROPOSED P£R~IT NO. SW000333 PAGE ~ OF 3 Municip. oti~c o¢' Anchor'o.ge DEPARTMENT OF HE~_THAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 OAnchoroge, Aask~ 99519-66505Teteohone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL NSPECTION REPORT LEGAL LOT 1, TRACT J, FlEE LAKE S/D 051-332-32 FINAL GRADE--~ ST1[J .~95'7' 2 INSULATION ~ RISER ~ ~ ~,-~ ~ EFFLUENT OUTLET __~ NEW I llJ 1300 GALLON 94,1' POLYETHYLENE ~ ~- 95.8' SEPTIC TANK GRADE - MT2 =88.2' ~ITI MT2 -ORIGINAL GRADE ~ITI =86.1' DIST. LINE= 86.4' A B FCO 21.5' 75.0' ST1 23.0' 79,5' MH 26.0' 81.0' FVl 59.5' 64.0' FV2 61,0' 66,0' rV$ 63.0' 68.0' 'V4 64.5' 70.0' MT1 51.5' 84.0' MT2 58.0' 63.5' YT2=86.2' A GROUNDWATER AT 79.1' B.O.H. BOTTOM OF SAND=84.1' 82.1' Heavenly Lights Electric Inc. 900 S. Gmntham St Wasilla AK 99654 To whom it may concern: The lift station at lot / block "~'=-"f w~c'[-sub division ..~;V'¢ ~ ,~ f;:: e. was wired by a liscensed electrician, in accordance wilh current national Elec~'t code. Under penalty of perjury, I certif7 this information to be true and correct. Sincedy ~ Joh~resldent/Secretary RECEIVED OCT 'l 0 Mumc~p~lity ot Anchorage Oept. Haalth & Human Services FRI3H : PO{. I'ROi'ERTY D~,VNER AGIU~EIHENT FOR 'file lqAiNTENANCE OF AN DN-SITE WASTEWATER DISPOSAL SYSTEI~! This ngteemeld, dMed mt, r~,,u ,~. , ~flnl.$ ix made between lite Mu.icilmlily of A.chor..ge Depadment of lle~llth nnd llllnlalt 8et:vices (DIIII$) and Ihe properly ow.e~(s) Lot 1, Tract J, Fire bake Subdivision 'Fids agreetnent Is made lot lite pt. pose of l..'fintahti.g at! on-site wastewater dispo.~al syslem o, lite st,bj¢ct properly. '|'he I.'operly owtlers nl~t-ee Io tl!e I'ollosi, t.g.~ S.bmlt lo lite Mu,lclpallty ot' A,chorage. mi m~ mmual basis, m~ i.spection mtd q~et,-tlio,! slnlement I'rom d registered ptotesslotml e.gtneer. This Inspectlo. and operatio~l stMement shall verily Ihal Ihe e,glneer Ires Inspected all effluent and ,.ir pttmps. Ilmers, mid al.'trms, a,d that ~lhy deliclencles have bee, repaired and llmt Ihe system ix rtl.clioni~g ~s deslg.ed. (PriMed Nm.e) (Sig,mture) (?tinted Name) MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 2:00 Io:o t ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Aug 25, 2000 Expiration Date: Aug 25, 2001 Permit Number: SW000333 Legal Description: Fire Lake, Lot 1, Tract J Design Engineer: 0003 S & S Engineering Owner Name: Lon Zimmerman Owner Address: PO Box 770906 Eagle River, AK 99577- Parcel ID: 051-332-32 S[ta Address: 18836 Upper Fish Hatchery Rd. Lot Size: 108900 SQ. FT. Total Bedrooms: 2 Permit Bedrooms: 2 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastawatar 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: August 8, 2000 ROBERT C. COWAN, P.E.,, CML ENGINEERS (9O7) 694-2979 FAX (9O7) 694-1211 ROAD DES)GN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 1, Tract .l, Fire Lake S/D It is requested that you issue a permit to install a septic system upgrade (lntermittant Dosing Sand Filter) with u 1300 gallon Premier polyethylene septic tank and an effluent pump to serve the existing 2 bedroom house on tl~e referenced property. Test holes were excavated and percolation tests were performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation on 6/28/00 water was found. After monitoring, ground water was found on 7-3-00 & 7-19-00 at 4 feet on test hole #2 and test hole #1 was found to be dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacen! properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/jhm Enclosure 17034 NORTH EAGLE RNER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577 Z O0 '5'- I I ,09 = .I. '"llV.L'qCI NV'Id PRC WELL DgSlGN CRITERIA: ~ BDRM = 300 GPD SOILS = 50 GPD/SQ.FT. 240 SQ.~. BED CRITgRIA: 2. ~s~p (RS~OVS ORO~N~CS) INTBRMi~ANT DOSING SAND PILTER 20' LONG J, FIRE LAKE S/D R.C.C. 8-14 -00 WILLIAM D, FLEMING ~0. / // / / / / / I I I CONTRACTOR IS REQUIRED TO OBTAIN UTIUTY LOCATES PRIOR TO ANY EXCAVATION WORK. CATCH BASIN POWEI POLE ALL PORTIONS OF SYSTEM WITH LESS THAN .3.5' OF COVER REQUIRE iNSULATION. 12' X 20' DOSING EXISTING FCO PROPOSED INTERMITTANT SAND FILTER \ \ 1500 GALLON POLYETHYLENE SEPTIC TANK WITH S.T.E.P. EXISTING CESS POOL rring F&XL~ (go7)6g4-1211 LOT 1, TRACT J, FIRE LAKE S/D J.H.M. R.C.C. B-9-O0 3 OF 3 NOTE: CO COMPRESSOR TO BE INSTALLED IN HEATED AREA/CRAWL SPACE OR GARAGE. FINAL J-BOX CASKETED MANHOLE COVER MANHOLE RISER 1 - 1/4" FLEX DISCHARGE ASSEMBLY ATION INLET FROM HOUSE 1-1/4' CHECK BAFFLE WALL-- 1300 GALLON POLYETIIYLENEJ SEPTIC TANK --1-1/4' BALL VALVE :FFLUENT OUTLET 1/16' HOLE INSULATION FLOAT TREE (ALARM, ON, OFF) PUMP BLASTER GOULDS TURB)Nr MODEL 20EB05 OR EQUAL -- EFFLUENT FILTERS 1/8', 1/4", FILTER & PUMP ASSEMBLY NOTE: SET ON / OFF FLOAT TO TURN ON WHEN LIOUID LEVEL tS EQUAL TO LEVEL IN TANK. APPROXIMATELY 12 CAL. / PUMP CYCLE Idtmlclpallly bi A/mhotage bEPAhTMENt O1: HEALlll & IIUMAN SERVICES 825 'L" BI,eel, AItcho;age, Alaska 99502-0650 soils LOG -- PERCOLATION TEST t 3 5 6 7 9 IU It t3- ' 20 'Township. Ra,ge, Secllo[t: SLOPE WASGROUND WATER ENCOUNTERED? PthcoLAtlOh hl~t ltst hUHi~EtWEt~l __ Im,nules~mch} I'ErlC |lOlE DIAMETER -- ~t AND ~ 1 · 17034 Eqle River Loop Road No. xu4 --- · ACC:O~t]A/qCi:WiTi~,~i~,i~/O~,,,A~;~i~y/gSI!p/~LOUiDSUNESiklEF~£ctoNll SI)ATE. DATE: ~i i'/'7/'v Muldclpallly OI Attchotage blEPARTMEH? OF I. IEALI'I I & IIIJMAN siEI'WICES I]25 "L" Slreel. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST I 2 3 4 5 6 ? 8 O- to- tl- 12 t4- 10 t9 ~9. SLOPE SITE PLAN Time 1'lee Water D~op / J'thCOLAt lOLl JtXl I: /~' Immules/mch! I't~lC HOLE DIAMEIEI! iES'J hUN iaETW~EEN -'~ Fl AND '~' ~l~rOh~b bm: S & ~ ENGIMI:ItDIU.~ j ~ CEflII~Y lllAI 11115 1EST WAS PERFOIILIED Itl ~le RI~, Alaska )2 ~O I~ev. 4/65) ROBERT C. COWAN, P.E. CMl. ENGINEERS (907) 694-2979 FAX (907) 6944211 INTERMITTANT DOSING SAND FILTER SPECIFICATIONS Lot 1, Tract J, Fire Lake Subdivision August 8, 2000 GENERAL STATEMENT OF WORK The work and plans covered by these specifications consist of furnishing all labor, materials, tools, transportation, and equipment necessary to complete an Intermittent Dosing Sand Filter system as described herein and on the attached drawings. All work under this project shall comply with current Municipality of Anchorage (MOA) Regulations. 2 Bedroom House 300 GPD Use 12' x 20' Bottomless Sand Filter and absorption area (240 S.F. required) Sand filter to be constructed on accepting soil with all organics removed. (bottomless only.) SITE INVESTIGATION The Contractor must carefully examine the project documents, have full knowledge thereof, have investigated the site, and be satisfied with the conditions affecting the work. Conditions include, but are not limited to those bearing upon transportation, disposal, handling and storage of materials, availability of labor, water, electric power, roads, and uncertainties of weather, physical conditions at the site including all underground utilities, the conformation and condition of the ground, the character of equipment and facilities needed preliminary to and during prosecution of the work. The Contractor must be satisfied with the character, quality and quantity of surface and subsurface materials or obstacles to be encountered. Any failure by the Contractor to become acquainted with the available information will not relieve him/her from responsibility of performing the work as stated in these specifications and drawings. Location of utilities will be the contractor's responsibility. 17034 NORTH EAGLE RNER LOOP · SUffE 204 ,, EAGLE FUVER. ALASKA 99577 Page 2 Lotl, Tra~ J, Fire Lake AugustT, 2000 SEPTIC TANK / LIFT STATION / AIR COMPRESSOR General The work under this section consists of the performance of all operations pertaining to furnishing and installing the septic tank/lift station, air compressor and piping to the sand filter. Materials 1. Tank a. Septic tank shall be a two compartment tank ofat least the minimum size indicated on the drawings and MOA approved. b. First compartment shall have a separate 4" pump-out riser. The second compartment shall have a separate 4" pump-out riser. 2. Manhole Riser or Lift Station Tank a. An additional second compartment manhole riser shall be capable ofbeing equipped with the following: 1. A junction (Nema 4x) box or equal, bonded or attached to the pump basin. 2. UL listed electrical cord grips, installed in the J-box. -OR- b. An additional tank (M.O.A. approved) may be provided for the effluent pumping assembly and the items in (a.) above. Effluent Pumping Assembly, Controls, Alarm & Piping a. Effluent pumping assembly shall be of approved materials, including the following: 1. A 110 volt or equal U.L. Listed effluent pump. 2. High.density PVC cylinder housing the pump, with level controls and screen, serving as a baffle to prevent the screen from clogging. Page 3 Lot 1, Tract J, Fire Lake August 7, 2000 3. All piping shall be PVC or other non-corroding material. Pump controls and alarm system shall be an approved system with the following options consisting of: 1. Event counter 2. Elapsed time meter 3. Program timer 4. 10 watt heater Remote alarm panel option with a minimum of 80 DB sound pressure at 24", operating temperature 30AC to 65AC, continuous sound to be located in the home. 6. Oil-tight visual alarm with push-to-silence feature. Automatic audio-alarm reset. 15 amp motor rated toggle switch, double pole, double throw with three positions; manual (man), automatic (auto) and center (off) (H.O.A.). 8. Nema 4x-rated, fiberglass, or equal, enclosure with hinged cover. 9. All controls to be installed as per manufacturer's recommendations. 10. Control panel to be installed on outside wall of home within sight of septic tank/lift station. c. Piping from the septic tank to the sand filter is to be I 1/4" PVC schedule 40 solvent weld piping properly bedded as described in Materials Specifications and sloped to drain back to the lift station. Insulation board 2" thick and 2' wide centered over pipe is to be placed where soil cover is less than 4' depth over pipe. The air line from the house to the filter is to be HDPE arctic insulated pipe 3/4"-2" SDR- 11. The compressor will have a gauge (0-10 psi) and be installed in a heated area, crawl space, or garage. Page 4 Lot 1, Tract J, Fire Lake August 7, 2000 4. Air Compressor a. Air compressor shall be a THOMAS LINEAR SERIES model number 5060-A or 5070V-A or M.O.A. approved equal. CONSTRUCTION SEQUENCE In order to insure proper installation, the system is recommended to be installed in the following order: I. Sewer line from house to tank II. Septic tank/lift station IIL Sand filter IV. Leachfield bed (if required) V. Final grading CONSTRUCTION 1. Construction Instruments Contractor shall provide instruments such as transits, or levels, for establishing proper elevations and levelness of pipe or materials. 2. Pipe Laying All pipe shall be laid with material free of large or sharp rocks and organic matter. Each section of pipe shall be handled carefully and placed accurately. The spigot end shall be fully inserted pointing in the direction of flow and glued in place to make a water tight seal. Each section of pipe shall be properly supported to insure true alignment and an invert which is smooth and free from roughness or irregularity. At all times, when work is not in progress, open ends of pipe and fittings shall be closed so that no undesirable substance will enter the end of the pipe or fittings. Page 5 Lot 1, Tract d, Fire Lake S/D August 7, 2000 3. Bedding of Pipe for Sewer Lines The pipe should be bedded with materials free of large or sharp rocks and organic matter, compacted. Native materials may be used as back fill material above the pipe, provided it is free of large rocks and organic matter. All lift stations shall be installed in accordance with the manufacturer's recommendations and standards. Electrical installation is to be in accordance with the National Electric Code (latest adopted edition) by a licensed electrical contractor, with M.O.A. inspection where required. If MOA inspection is not required, a licensed electrician is to provide a letter to the Engineer stating that the system meets or exceeds all applicable codes. 4. Excavation Excavate to proper depth to allow gravity flow, install tank level, tolerance 0.05 foot, on undisturbed or compacted classified sand fill material. Create a level sand surface over the tank and add 2" burial foam +35 PSI directly over tank. Mound unclassified soil over tank with a minimum of 2 feet ofcover and anti-flotation weights that may be required in areas of shallow ground water. 5. Connections All connections to be as per MOA requirements, PVC 3034 piping with Caulder or equivalent couplings for inlet riser pipes. All tank connections are to be completely water tight. SAND FILTER The work under this section consists of the performance of all operations pertaining to furnishing and installing the sand filter. A. Materials 1. Sand Filter a. Liner (if required - not required for bottomless sand filter) - OSI Model LI or equivalent. 30 mil PVC cut and fabricated to provide water tight enclosure of filter sand volume. Seams to be permanent as per Manufacturer's recommendations. All connections, such as boot flanges, through sand filter to be permanently bonded to the liner. Page 6 Lot 1, Tract J, Fire Lake August 7, 2000 b. The Contractor shall provide a washed sand to meet ASTM C-33 Concrete Sand Specifications with the additional requirement that all but 1% of the materials passing the #100 sieve be removed. All aand shall be approved for use by the Municipality of Anchorage (M.O.A.). If the sample does not meet specifications, all sand will be removed and replaced. c. The Contractor shall be responsible for providing pea gravel that shall be a washed material containing no fines (0% passing the #100 sieve) and a maximum size of 1/4" diameter. d. The Contractor shall provide the manifold assembly. The manifold assembly shall be of approved materials with orifice shields and flushing assembly. All drilled holes to be cleaned of burrs and pipes flushed, prior to assembly. Flushing valve to include riser to finish grade. Lateral distribution piping is to be laid level (@ ~: 0.05'). e. Side walls and top ofthe filter box to be insulated with 2" direct burial polystyrene insulation. f. The Contractor shall be responsible for providing filter fabric. g. Air coil in sand filter to be geoflow WF16-4-24 150 LF placed 6" above bottom of sand. Construction of Sand Filter The sand filter construction is to follow procedures as outlined below, as applicable to this design. Pea gravel and filter sand are to be hand leveled to proper depth (tolerance within 0.05 feet) in filter, taking care not to allow mud or fine soil material into the filter or gravel layer. This would include any soil material picked up by excavation machinery buckets while loading specified material. The ConWactor should estimate filter material volumes such that allowance is made for wastage of material in contact with the ground at site. The area over the sand filter to be finish graded with a minimum of 2 feet of cover and to prevent ponding of surface water mn off. Side slopes shall not exceed 3:1. The Engineer will reject any sand or pea gravel that does not meet specifications or is · contaminated in transit or while handling. If such material is placed in the filter, all soil material may be required to be removed and replaced with new material. CONTRACTOR I INSTALLER Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 'L' Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORI ,TY APPROVA FOR A SINGLE FAMILY:DWELLING~':~ Parcel I.D. 1. GENERAL INFORMATION .Complete legal description :" Location (site address or directior~s) " Current Property owner(s) Mailing address '~',0, Lending agency HAA# H/C) Expiration Date: I Day phone Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked uP bY~ ~ ~ NUMBER OF BEDROOMS: ~. ~/~/~ ~/~, TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: I~ Individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority 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 less than 30 days old. 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 er omissions in the professional engineer's work. 72-025 (Rev. ot/oo)- 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 cf Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S&$ENGiNEERING ' . '. Nameof Firm l?~r.=~. D;..._,.__,,__.~._ .~,,,. Phone ~c~ ~_ ~.o/ -79 Address F..a~e Riv~., Alaska 99577 Engineer's Printed Name DHHS SIGNATURE Approved for Disapproved. ,~ ~ , , . ~ ~ - .-~ , .. ....... ~': WATERAND :ms ~~:-.t .~ ~ ~ PROG~M ; ~ **~-~ c~.ee~}''~'' bedrooms. : ...... Conditional approval for bedrooms, w~)~owing stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: ,.~- ~. '~ '- O/ Reissue Date: 72-025 (Rev, 01/00)' Mnnlcipalit of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewatar Program 470O Sout~ Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 w,,,vw.cLenchoroge.ak.us pO7) 343-7e04 HEALTH AUTHORITY APPROVAL CHECKLIST LogalDescriptlon: ~r~-I' ~ ~r, r '~ ParcellD: {~"'Z'~~°~' WELL DATA Well type~¥~Z.' If A, B, or C provide PWSlD # -- Date completed~/~:~) Sanlta~ seal (Y/N) ~ Total depth ~i~fl. Cased to ~ / lt. FROM WELL LOG Data of test Static water level Well production WATER SAMPLE RESULTS: Coliform O coloniesJ100 mi. Date of sample: '~'/'/(~ ' SEPTIC/HOLDING TANK DATA , g.p.m. Nitrate O, ~ mg.A. Well Log {Y/N) Wires pmpedy pmtectad (Y/N) Casing height (above ground) AT INSPECTION g.p.m. Other bacteria. ~ colonies/100 mi. Depression over tank (Y/N) ~ Pumper "'"- Data installed ~) (~ Cleanouts (Y/N) F~-'"~ High watar alarm (Y/N) ~ Systam type Gravel below pipe Tank Type/Material v~=f:~(-,"/ ~/'"2'~" · Tank size /~ gal. Number of Compartments Foundation ctaanout (Y/N) ~ Date of pumping ~.,'"~ ABSORPTION FIELD DATA Date installed __~Soil rating (g.p.d./ft~ or ~rodrm) ~-- ~ Length ~:~'~'~ It. Width I ~ fl. Eft. absorption area ;~ ~ Monitoring tube ~L~ Results (Pass/Fail) .it. Depression over field ~ For bedrooms in. Total dept~ Date of adequacy tast Fluid depth in absorption field before test~ gal. New depth Any rejuvenation trealm~2 mo.) (Y/N & typo) ,/~/~/V(=,'- ~--~t/,~,'~A,/' If yes, give date g.p.d. LIFT STATION Data installed _ ~/~..~_.?~v-u SizeingaJleAs, 'Pump on" level at ~ in. 'Pump off' level at ~L in. Datum '~-r' Cycles tested ~" E. SEPARATION DISTANCES Manhole/Access (Y/N). High water alarm level at Meets alarm & circuit requirements? Septic tank/tift station on lot Absorption field on let Public sewer main SEPARATION DISTANCES FROM WELL ON LOT TO: On adjacent lots On adjacent lots Public sewer manhole/cleanout ,~/,A- ~/er/septic service line ~--.~' ~" Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~" Water main N/~, Wells on adjacent lots Property line ~'~- Absorption field Water service line /~::) '~- Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line _/(~) "'" Building foundation /~:~ ~'- Water Service line / (~ J'- Surface water ,/0¢2 4- Curtain drain ~/~" ,~/"/~A/Wells on adjacent lots /~ ~'- / Water main Driveway, pafldng/vehicle al~rage F. COMMENTS in. 6. E"6'"EER'S CE~nF,CATIO. ~~. , ce.,,.., t,,a,,,,aw doto,',.,,,,ed th,'ou,,,, ,,e/d /DY review of Municipe/ records that the above systems are in ~.Z/ Ae, c )~.'~ '"."-~ conformance with MOA HAA guidelines in effe' ct on this date ate ~/ I -- · t~ ,, ~.., ........... :.~.~;, .,,. HAA Fee $ ,..~o O. ~' '~ Wawer Fee Date of Payment ~ / "/ /e I Data of Payment Receipt Number O o } ~ ,~ ~' Receipt Number (Rev. 12/00) L~y~2?fll II:OI IRULI* 1-912 PAll/gl I-7~U 200 W. Potter Drive AK ggs111-1806 Tel: {90?) 562-2343 )flaking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTION$ ON REVEillE SIDE J~EFORE COLLECTING SAIffJ'LE Fax: dPLE'[ED BY LABORATORY ~4PLE'IED E SUPPLIER Analysis ahows this Water SAMPLE tO be: tPUBLIC WATER sYSTEM I.IL # PRIVATE WATER sYSTEM Month Day year SAMPLE TYPE: Treated Water ~' Routine r~ Repeat Sample (for routine sample O Untreated Water ~lth lab rtl. no. -) t3 Special Purpose Time Collected SAMPLE LOCATION Collected By · ~ ~/ UnsMisfactoty n Sample over 30 hours old. lesults may be unreliable Sample too long in t~nsit; sample should oD! be ovet~ [~mu~ old at examination tn indicate reliable ~ults. pl~se send new sample ~ia specia?elive~ mail D,te Received ~ ~/~ / ~lme R~elved - AnMyttcat Method: ~ Membrane Filter o MM~MUG · Num~er ~f colonieg 100 mL Telult* Annlyst Client notified o! unsatisfactory relulta: I'~.ned -- Spoke with BACTERIOLOGICAL WATER ANALYSIS RECORD ~'O' MMO-MUGReuR: Tot.ICollform; ~ "~/~ ~ ~.~'~l~ Cotonl./lO0 mi ~ Memb~ne~lte- DIr.tCount ~ ~ 0 -.- - . r~c.r~..~,r.c..-, Fecal Coliform Confirm,tie, ~.. ~ ~' tI' o l . ~,. ~ 09:28 fROU. ~tr~.=~ Cl&E Envl,onmental Sorvlc~ Inc. 1-41Z P.O$/II CT&F. R et'.# 1012250001 Client Hame S & S Engineering Pro]err Hamel# HA Client Sample ID LI T~act "J" Fire Lake Rlattlz Drinking Water Ord~rfl By PWSID 0 Client I'rlnted Date/'fime 05/07/2001 19:47 Colleded Date/Time 05/01/2001 18:4:5 Ilerelved Dote/Time 05/02/200! 12:15 Technical Director Sleptlen C. Ede Ilelea~ed ~ ~, Sample Remarks: Pa.met~' Retultq PQL Units M~lh~l LimilS Date Date Iltlt Nihale-N 0.500 U O.S00 mg/L lIPA 100.O I 0 m,'~x 05/02/01 Microbiology Labozat. o:y T0tnl C01ifon~ 40rl. No Coil col/lOOmL SMI8 9222B 0~/0~01 KAl'