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Home My WebLink AboutHIGH HOME BLK 2 LT 1High Home Block 2 Lot I #050-321-57 Municipality of 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-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~]~4:::~P~----~ PID Number:_ ,¢::~:~-O Name: ~;~e-{q~-~ 1---cr¢~ ~, ~¢~ Wastewater System: D New ~ Upgrade Address: I~ ~ ~ ~¢~ ~ ABSORPTION FIELD El Deep Trench hallow Trench D Bed DMound ~Other LEGAL DESCRIPTION soi,.~,i.¢: ~ GPD/Sq. Ft. Tolal Depth from original grade~ / Subdivision: Depth ~o pipe bottom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: ~:/' ~. ~ ~. WELL: ~ew ~ Upgrade 'Gravel width: ~/-~ Ft. Number of lines:~ Distance betwe n lines:/~ ~ FI Classifica~on (Private. A.B C): Total Depth: Cased To: Total absorption area:. ~ Pipe material: Driller: Dale Driged: Stat,cWater LevehFt Installer:ccC ~¢~. Date installed: Yield: GPM Pump Set at: Fl Casing Height Above Ground:Ft. TAN K SEPARATION DISTANCES Cs~,t~ d ~o~d~.~ ~ TO Septic Absorphon Lift Holding Pdblic/Pevate MCRufsctu(er: Capacity m gsIIons: From rank Field Station Tank S ..... Li.es ~~~ ~-~l/~ Well ~ 14~ 1~¢~-- ~ ~¢ % Material~~ Number°fC°mpartments: Surface ~- ~,+ -- -- LIFT STATION Water Lot I O % I¢'~ ~ ~ ~ ~ize in gallons: ~am,facturer: Line evel~ ~ at: High water alarm Foundation /¢ / ~/ ~ _ ~ "Pump on- I Curtain pO~¢ ~1~ ~ Pum~ Model Eleclrical Inspections performed by: Drain ~ -~ _ Remarks: BENCH ~ARK Location and Description: ENGINEER~S~SEAL ..': ~ ' ..., :: .~.,.? , 17034 Eagle ~lvor Loop Roa~, ~ 1st : .... Inspections performed by: ~9;. ~iwr, Alaska 99577 2Rd~/~]~ : : .,~ ,:~. :,,~:, '~' :': ' N,,.,, ~,;'9:-~ ' .::"' ' Department of Hea~ and Human Services approval Reviewed and approved by: __ Date /O-/~-Y} 72-0131Rev 9/91) MOA 25 Permit No. SW950059 Page ~ of ?, _ Municipality of Anchorage DEPAR'I'MENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LegalDescription: HIGH HOME SUBDIVISION: BLOCK ?:~_O_T 1 PIDNo.: 05057!57 C0i C02 I] 99 4 [] / FINAL GRADE MTi C03 SEPTIC I ~ r,~ TANK ]93,2'--'"' SPIL SCALE 1" = 10' MT8 C04 E ~94.5' ~-91.5' · 85.5' BEDROCK ENCOUNTER] NO WATEr{ FOUND 100' WELL t~ADIUS A B FCO 2,5 48.8 CO1 18,5 57,9 C02 24,5 68,0 CO3 48.5 74,8 C04 57,4 89,6 C05 66,5 81.0 MTi 64.5 80.5 C06 79.8 97.8 MT2 78.10 97.2 FOUNDAT[ON NEW 1000 GAL SEPTIC :CO C05 [006 -NEW TRENCHES 72-013 A (Rev 9/91) MOA 25 SUIbLIVAN WtTER .- %' . ~' ~' ' . P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759: · - .... :~.' ,~,j.~',~:..'~'~ CY' LEGAL DESCRI~IO~.[ C~I ~9 ~ ~ DRAW DOWN DATE-: Started ' '::~" Ended q/~,,~ PERMIT NUMBER GALS. PER I!? ..~..~_ KIND OF C,\~;,~C _ ~f~-n~. KIND OF FORMATION:' From__O Ft, to_C~ Ft (~tt'g~ ,.F~'~,t(~() From From' ~" :~Ft. to~' FI,_O ~'~ Vrom. ~ Vt. to~3 V~, O~C ~a7 ~rom~ From~ Ft, to -~Ft From.~_~ Ft. to~ From / ~.i~i. to ,.~3~ Fl. /~!g&CO~ff~/~O ~e_~t~1 From From Ft. to~ Ft. I~TTL d ~/4~ ~ From ' From~ ~ Ft tO 3~O Ft. . From Ft. lo .... _Ft. to .... Fl._ Ft. to ..... Ft._ ri. lo_ Fl. Ir() .... Fl __ FI. to___ Ft. Ft. to_ Ft. ____Ft. to Fl. wt~C'~rom From PAGE 1 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930059 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BROWN CHRISTOPHER W OWNER ADDRESS:18714 UPPER SKYLINE DR EAGLE RIVER, AK 99577 DATE ISSUED: 4/19/93 EXPIRATION DATE: 4/19/94 PARCEL ID:05032157 LEGAL DESCRIPTION: HIGH HOME BLK 2 LT 1 LOT SIZE: 39716 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 (iSAACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE DEPTH TO BEDROCK AT THE WEST END OF THE PROPOSED DRAIN- FIELDS MUST BE CONFIRMED TO BE 12.0 FT. OR DEEPER AT THE ONSET OF EXCAVATING. IF THE DEPTH TO BEDROCK IS LESS THAN 12.0 FT. A DESIGN CHANGE MUET BE APPROVED BY THIS OFFICE PAGE 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PRIOR TO CONSTRUCTION. RECEIVED BY: ~ .-~ [m.~ DATE: April 8, 1993 ROBERTSHAFER PE RQGERSHAFER PE CIVIL ENGINEERS (9071694 2979 FAX 694 HEALTH AUTNORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTtONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: HIGH HOME SUBDIVISION, BLOCK 2, LOT 1 Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. Two test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. The monitoring tubes within the holes have been checked and found to be dry. This property has enough area for a septic upgrade which can be seen on the attached site plan. We do not anticipate any ,adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information ifor your review, please contact us. Sincerely, Robert A. Shafer, P.E. RAS/RLS/LSU/lsu !/~"::,2 / :¢..'E' ! :'(:/" ,, . /, .- 17034 EAGLE RIVER LOOP, SUITE 204. EAGLE RIVER, ALASKA 99577 /" =40' SCALE JSITE PLAN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ,~,.,2'-/ ~/,~',,.~..z.//,~,,~ /¢'~,~,~a.¢ 1 4 5 10 11 12 13 14 15 16 17 18 19 20- ~qMMENTS ~-~'-5 7 /you-/: ~% SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN S L IF YES, AT WHAT O DEPTH? p Depfll l0 Water Alter Monitoring? '~'~ Dale: Z~ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE 1.3' (minutes/inch} PERC HOLE DIAMETER '~ /._.~_/ TEST RUN BETWEEN 5 FT AND ~ _ FT PERFORMED BY: :~:'J" ' ~¢:~~ ' CER!IFYTHATTHISTESTWASPERFORMEDI. ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72'008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~FH ! 1 Townshia. Range, Section: ?"'/q'.,-V /'C;¢,v ,f'~.c (~ ;LOPE SITE PLAN 2 ~ve I 7 ~. s WAS GROUND WATER ENCOUNTERED;' ND 10 11 L IF YES, AT WHAT O DEPTIA? P -- 12 4)~,T /,~,.~,"fz,~-~ E Oeplh Io Waler~. I Gross Net Depth to Net 14 Reading Date Time Time Water Drop '15 ~ /~/~/~ / ,, ~;~. /~,~, ZC 7~'' ~ ~" ~ /' ~ ,'//~ /~.~ 3 ~ 7 ~/~" ~ ~//~" 17 18 19- ,_ 20 P~OOLATION RA]~ TEST ~UN BETWEEN ~'~ FTAND ~ ~FT ._ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: 72-008 (Rev. 4/85) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-3~1-57 Expiration Date: *Complete legal descnp,fi, on.' ' Hloh Home Block 2. Lot 1 Location (s~te address,o.r;'~lr.e..cfic~n.s.)'--*'-18714'Upper Skyline Drive Current Prepertyown.e,r(s),Chrl~ Brown :*'~-~,~' : · Dayphon.e.~:~ Malhngaddress '~:.'-.1,8. 71.4.,. .t~kvllne,Drlve. F~e{3le River.' "AK 99577 Lending agency - . "~- .... /.' · Day:p~o~e *' ' Mailing address .: ~',~R~al Estate Ageht ' Day phone ~',~. . .... :Unless otherwise 'requested,-HAA will be held by DSD for pickup. ' :, . 2.':;.UMBEROFBEDROOMS: · -. ·; -,'. 3.: TYPE 0 SUPPLY: Well , .... c:.,,.:., ,..~n..ua. .... ; ~. · :; Individual Water Storage Community Cla~ Well Public Water S~tem c)'- ..4-- oI [] [] [] TYPE OF WASTE'WATER DISPOSAL: Individual On-site [] Individual Holding tank [] ' Community On-site [] Public Sewer [] The Municipality of Anchorgge Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In Ihe State of Alaska. Certificates of Health Authority Approval are required for the lransfer of title (except between spouses) for properties served by a single family on;site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a pdvata or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage ls not responsible for errors or omissions In the professional engineer's work. ', ., 4. STATEMENT OF INSPECTION BY ENGINEER As certified by' my seal affixed hereto and as of the validation date shown below, I vedfy that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-sRe water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm KND Englneerlng Phone 696-6111 Address 213441 Ptermigen Rival_: F.R.~ AK 99577 Engineer's Printed Name Kenneth M. DUffUs Date 05131101 ............... ,-~[.' '~".~2~. ':'' ENGINEER 8 ' ." ' " '~' vAppmved for B · ..b~r~ms~~o;[<~¢2~ D,sappmv~. ~. . · ~ndi~onal approval for bedrooms, wi~ ~e [ollo~ng s~pulafions: Additional Comments Attachments: HAA Checklist Septic System Advisory . Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other. original Certificaie Date: ~ - .~'". O/ Municipality of Anchorage Development Services Department Building Safety Division On. Site Water & Wastewater Program 4700 South Bragaw St, P.O. Box 196650 Anchorage, AK 995196650 www.ct.anchorage.ak.us (g07) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Hloh Home Block 2. Lot 1 A. WELL DATA Well type_g[LY.~ If A. B. or C provide PWSID # Date completed 0411993 Sanitary seal (Y/N) y Total depth 360 ft. Cased to 20.4 ft. FROM WELL LOG Data of test 0411 993 Static water level ~ :~ fl. Well production 2 ar g.p.h WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi, Nitrate 0.5 rog.Il. Date of sample: 03/27/01 Collected by:. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Parcel ID: 050-321-57 Weli Log (Y/N) y Wires pmpedy protected (Y/N) y Casing height (above ground) 1 2" AT INSPECTION 45 ft. 2 3 g.p.h. Otherbacterte 3 colonies/100ml KND En_alneerlno Water added 450 gal. New depth 2.5 In. Absorption rate >= 450 g.p.d. no If yes, give data Total depth 6.5 ff. Eft. absorpfion area 603 ~ Monitoring tube Y Depression over field II Data of adequacy test_.~.,__,_~sults (Pass/Fall) p~SS For~ bedrooms Fluid depth in absorption field before test.O_ in. Elapsed Time: 10 min. Final fluid depth 0 In. Any rejuvenation treatment (past 12 mo.) (Y/N & type) C. ABSORPTION FIELD DATA Date Installed 06/03/93 Soft rating Length 70 fl. Width ~ (g.p.d./ft~ or ~rodrm) 0.8 System type ft, Grovel below pipe ~ Date Installfi;g,~a[~]~ Tank size 1000 qaL Number of Compartments Cteanouts _y._Foundation cleanout .Y._Deprasslon over tank .j~LHlgh water ala~n NA Date of pumping~ pUmper ~R'~ D. UFT STATION Date installed NA 'Pump on' level at in. Datum. E. SEPARATION DISTANCES Size in gallons 'Pump off' level at Cycles tested Manhole/Access (Y/N) In. High water alarm level at. Meets alarm & drcu~t requirements? 100'+ On adjacent lots 1 0 0 ' + On adjacent lots 1 0 0 ' + Public sewer manhole/cleanout Holding tertk 1 0 0' 1. Absorption field § ' + Surl'ace water 1 0 0 ' + Water main 1 0 ' + D~way. pinking/vehicle storage SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tenk/~lft station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer Iseptlc service line 25% SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation [;'+ Property line ~ ' t' Water main 10'+ Watereewicollne 1 0 '+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 10'+ Building foundation 1 0 ' + Water Sewlce line 10'+ Surface water 1 0 0 ' + Curtain drain *50'+ Wells on adjacent lots 1 00'+ F. COMMENTS *none knc~h'rt G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and rev/ew of Munlc/pel records that the above systems are/n conformance w/th MOA HAA guidelines in effect on this date. ~ Engineer's Printed Name Date 05131101 in. Waiver Fee $ Date of Payment Receipt Number ~ Fee $ ~DO Date of Payment ~)~/n;/2~O I Receipt Number ~/"/~/~ }!b~ICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. o/o26.. During a recent Health Authority Approval 6n-site inspect%on and test of the potable water supply well on Lot look_2._of /C,.14 HO/ ESubdivision, the ell'. productivity was Cetermined to be ~_~u~ga!lpns per minute. The minimum well productivity re.cuire~ by this Depar~ht '(D~IC 15.55) for a ~ bedroom residence is O. ~ / gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing ~ars and watering lawns and gardens may be required. This advisory must be attached to all copies ~f the subject Health Authority Approval. I,~Y-30-01 I 1:22 FROU- .~t~___ CT&E Er~v' ton mental Se rv Ice si nc. T-186 P.02/03 F-696 CT&E Eef. g Client l~anw Project Name/~ Client Sample ID Matrix Ordered By PWSID 0 Shingle RemarkS: 101290500t KND Engineering LI; B2 HieJ~home L1; B2 Highhom~ Drinking Water PQL ~a~.e~o De~a:ct:nent. Ni~e-N 0.500 U CIlenl PO# print ed Date/Time 05/29/2001 16:45 Collected Date/Time 05/25/2001 12:00 Received Date/TIn~ 05/25/2001 14:40 Technical Director Stephen C. £de Umts Me~hod Allowable ~p Analysis Minims Date Date 0.500 mg/t. EPA 300.0 (<10) 05/25/01 SCL Mtcgobt. ologY Total Coliform 3 OD, Ho Coli col/lOOmL SMI8 9222B 05/25/01 KAP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99,519-6650 343-4744 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot I; Block 2; High Home Subdivision Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Scot~qPeppers/PEPPERS CONSTRUCTION Day phone P,0. Box 1064 Eagle River, AK 99577 694-9681 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATFR SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. XXX 72-025 (ROY. 1/91) Front MOA #21 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 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. Phone Name of Firm / Address S & $ ENGIN£EEING 17034 Eagle River Loop Road N~/"~ Engineer's signat~'¢e ~'.",¢--r. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. 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 courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions ir, the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~"-o-F- \ ¢-~'7_,.~ ~ t~ ~r\ '~¢"~¢', Parcel I.D. A, Well Data Well type Log presen~N) Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number ~-~\J>,, Date completed /~- ~'5 Driller ~-~ 0 ~.--~ .~ ,~\ Cased to ~ ~ Casing height FROM WELL LOG Date of test Static water level ~' Well flow Pump level1 ~'~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ l ~ Absorption field on lot \ ~- ~ ~ Public sewer main ~'/'*c- Sewer service line ~ \¢¢ Wires properly protectedL~L~N) AT INSPECTION ; On adjacent lots \ ; On adjacent lots \ Public sewer manhole/cleanout ~,~,/ Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts ~Y~,N) ,~/ High water alarm Date of pumping Collected by: Other bacteria ~ ~"~ ~ \'~ Tank size \ ,c~ c:~ Compartments ~ Foundation cleanout~,~N) '7/ Depression (Y~ ~, Alarm tested (Y/N) / '-'LI '~' ~:- ~-¢.~5S' 'Crkr'~ Pumper ~i~IA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ \ % To property line \d;:>\ Surface water/drainage 72-026 (3/93)' Front ¢(~ On adjacent lots \ ~ o t -~- Foundation Absorption field '~ \ ~ Water main/service line CONTINUED ON BACKPAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) ~:gn~ (wY:~:r alarm level "Pump on" level at _~ Meets MOA electrical codes (Y/N) ~ SEP~FT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Lc:, ~-z~ fc.~ ~ Length '~ ~ ~ Width Soil rating (GPD/Ft2) ~, "~ System type ¢¢¢-~o-¢ ~- ~ Gravel thickness Total depth Cleanout present (~/N) ,,/ Depression over field (Y~ ~1 ~PP~-~ for ~ Bedrooms Total absorption area Date of adequacy ~/,/k~ ~P~ "~\~'~ test ~ ~( ¢-s Results~fail) Water level in absorption field before test ~ Peroxide treatment (past 12 months) (/Y~ ~ After test tf yes, give date '--'~' ~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \~ t To building foundation On adjacent lots '¢-~o \ '~' Surface water Curtain drain On adjacent lots ~ *::>,=:~ k..~ Property line /--~ ~ ~ To x/sting or abandoned system on lot Cutbank '-~ ~k-~ Water main/service line \ ~ c:, ~.4~ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in, Signature $ & $ ENGINEERING ~ , . 17034 Eagle River [.oq//~ No. ~ngineers i~ara~ I~ R'''"", ~'~"=~"" ~.~TZ/' ~ ............ ~//, inspect/on. HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL ~NSPECTION g FLOW TEST SITE Pi ANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P E ROGER SHAFER. P.E WELL RECOVERY TEST DATA CIVIL ENGINEERS (907) 694.2979 FAX 694 ~2~ WELL LOCATION (legal): TEST DATE: lo- WELL DEPTH: ~_~c~~ CASING DEPTH: ~ ~ ~ ~.~, TEST PROCEDU~ 1) Draw water down to pump. 2) Shut pump off 15-60 min. -record time -record meter reading 3) Turn pump on. Drawdown. 4) Shut pump off. -record time -record meter reading 5) Calculate gal./min, recovery. WELL DRILLER: DATE DRILLED: MISC. DATA:. Casing Height: Sanitary Seal?: Wires in Conduit~ Grading O.K.?: Pump Depth: ~ Samples Taken?: Date: ~-'~ TEST DATA: START TIME: \o'~0 /kSTATIC WATER LEVEL: TRIAL PUMP TIME METER GAL./' ~ ¢--, ._ OFF ~P ', '¢;' C:, ~q, ~ ~ ~, 2 ON .------- OFF ~,, ~ ~/%fi.~ ON 4 _ OFF OFF 5 ON OFF RESULTS: WELL CURRENTLY PRODUCES: ~ ~ FLOW RATE NOT GUARANTEED--SUBSEQUENT VARIATIONS CAN OCCUR! 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Chemlab Ref.~ :93.5074-1 Client; Sample ID :L1 B2 HIGH HOME Matrix :WATER REPORT of ANALYSIS 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561 5301 Client Name :S & S ENGINEERING WORK Order :71436 Ordered By :R. SHAFER Report Completed :09/29/93 Project Name : Collected :09/23/93 @ 15:30 hrs. Project~ : Received :09/24/93 @ 15:35 hrs. PWSID :UA TechnicalRelease¢, Director: S.~.EPH~ By / Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate--N 0.10 U mg/L EPA 353.2/300.0 10 09/27 CMR w See Special Instructions Above UA = Hnavailable w'~ See Sample Remarks Above NA = Not Analyzed H = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than Member of the SGS Group (Soci<~t~ Gbnbrale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA