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Home My WebLink AboutMINK LAKE LT BNtink Lo1' 051 - 154 -48 Municipality of Anchorage Page ~ 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 Na~. ~, ¢. ~- ~ ~ ~[ Wastewater System: ~ New ~Upgrade A~ ~. ~ . ~, ~q ~ ABSORPTION FIELD Phone: ~ ~ N~e~s: ~ Deep Trench ~ ShaHowTrench ~ed ~ Mound ~ Other LEGAL DESCRIPTION Soil Rating: ~ Total Depth from original g~de: Subdivision: Depth to pipe bottom from original g~ Gravel depth beneath pipe TOW~ ~ ~ Rang~ [ ¢ Sect~n:~ e Fill added above or gna~l_~,grade Ft. Gravel length: ~' Ft. WELL: ~ New ~ Upgrade Grave~''- Number of lines: Distance between lines: Clas~ion (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~[ Driller:~ [~~ Date Drilled: Itatic Water Level:Ft. ~~lns : ~ Date in~d~ [~ Yield: Pump Set at: Casing Height Above Ground: TAN K GPM Ft. Ft. SEPARATION DISTANCES ~Septic ~ Holding D S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: ~ / Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~[~ ~ ~ I ¢~ I~ Number of CompaAments: Surface Water ~ t~ ~ ~ [~ ~ LIFT STATION Line ~ ~ ~ ~ Size in gallo Foundation ~ ~ 9 ~ ~ ~ "Pump on' level at: "Pump off" le Cu~ain Drain ~ ~ ~ '~~ P~mpMak°&M°d~l 8EIoctricallnspectionspe~ormodby: Remarks: BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL Eagle River, Alaska ~5~ 2nd ~-~-~ / .................. Department of Health and Human Services approval ~ ~~' ~ ...... :~-~'"~'~'~- 72-013 (1/91)MOA25 Permi't No. ~¢~ ~ <~'c~ c;, ~, Page Municipality of Anchorage 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 Legal Description: ~ ~'~ [~/~ [ ~'JY-- ~/~ PID NO.: 72-013 A (2/91) MOA 25 /. MUNICIPALI ANChOrAgE DEPARTMENT OF HEALTH AND HUMAN SERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT Permit Number: SW~tOL~ Permit Type:~:~/f~ ~t£6A/;P~ Date Issued:l-IO-~l , Expiration Date:l-I~.y2 Design Engineer: 5~ 5 ~61~NIm6 Owner Name:~ ~ F f ~7~/ Owner Address:~2~ ~;U ~ ~ Parcel ID: ~;-/~-~H Lot Legal: ~SUbdiVis~n'~'~t~ A~f ~"~R Lot: ~ Block:'-- Section: ~ 'T0wnship:/~ Range: /~ Lot Size:45f77 (~q.ft. ~) Max Bedrooms: This Permit: ~ Total Capacity: ~ Day Phone SEPTIC TANK: Minimum septic tank capacity: /~D gallons. Each septic tank must have at least 2 compartments, insulation is required if depth to top of septic tank(s) is less than 4.0'. Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 days of the well's completion. I CERTIFY THAT: 1. I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality of Anchorage (~OA) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system, or surface water on this or any adjacent or nearby lot. 3. I understand that this permit is valid for a single family dwelling with a maximum of ~ bedrooms. I also understand that any enlargement will require an additional permit. 4. I understand this permit is issued for 365 days and expires one year from the date of issue. 5. I will notify DHHS prior to all inspections by the englnee/ or/~well/~riller. SiONE · DATE: / ' ~0~ner./~design~e5 ~ -- ' / / ISSUED BY: _ ~ · db/ll5 December 3, 1990 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS 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: Lot "B"; Mink Lake Subdivision; PEPJ~IT REQUEST NARRATIFE Request you issue a permit to upgrade the septic system on the referenced property. The existing system was instated on October 17, 1986 for three bedrooms. However, an adequacy test showed the system functional for only one bedroom. As you can see from the site plan the proposed bed system is designed in the only location available without encroaching on any wells or other septic systems. The slope of the property is relativaly flat in the area where the system has been proposed. If you require additional information for your review, please contact /gm This upgrade will effect the development of Lot 211 to the south in that, the we~l location will need to be chosen such that it is 100 ft. from the upgraded l~achfield. However, there is sufficient room on the 2~ acre Lot 211 to do so. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ~..~'~"' ~ 5 6 7 8 9 10 11 12 13- 14- 15- 16- 17- 18- 19- 20- r: ii (EN:GINEER~ SEAL) Township, Range, Section: ~ ~ ~t~ ~ ~. ~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT f DEPTH? ..~ O P E Depth lo Water After ~ MonitorinD? ' L~ Date: ~.~'"~"'~, ~ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE -[ '~/~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~'" FT AND '~ FT PERFORMED~v' , , ~ ' · ~ . /I / ~ /~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDAN~RJX~,9~~NICIPAL GUIDELIN~FF~T ON THIS DATE. DATE: _ / 72-008 (Rev. 4/85) / . MUNICIPALITY OF ANCHORAGE ) iTMENT OF HEALTH AND HUMAN SER~ _..~.:S ~~/ ~'" ~ DEi,..~,.., Environmental Health Division . 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~'..~ d~ ~ ~ ~// ~ SEPTIC ABSORPTION Add .... TANK FIELD WELL Phone(s) PermitNo. No, Bedrooms WELL /~ / /~] / [~2- ~ d ;~ LOT LINE /~ ~ /o / ~5~ / LEGAL DESCRIPTION ~ ~ FOUNDATION ~/ /~ ~/ Township, Range, Section ~ AS-BUILT DIAGRAM (Show Icc ~on of well septic system property hnes ]oundabon, -- '/ /~ ~ ~ / ~ ~ ~ , ~ d ....... y, water hod,es, etc.) ~ ' ' ' TANKS N ~ SEPTIC ~~ ~ HOLDING ~ Manuiacturer Capacity m gallons ~ Material No. of Compadmems TYPE OF SYSTEM ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER j ,, , o,gin~e~ade ~ FT ~ F7 ~ Total absorption area Dimance between lines ¢ ~ / J ~¢ Number o, , .... Pipe material ' ~ ~,,' IJ '/ Installer Date Installed / J , ~ ~, ~ WELLS i.,, ~ PRIVATE ..;~. ~ OTHER fldentilv) .,~ ~ Classlficabon ~,B,C~ Total Depth Cased to Instaae~ Date Installed: REMARKS: ~ ¢/~ 0~¢~ Inspections Pedormed by: J ~ OF 4¢~. Eagle R vet Englneermg ServlcesJ a~. ,~, ~ ,~ ~ [~ ~ ' ~C'~'~'" ~ %~ '~4' ~) P. 0, Box 773294 / ¢~ '0' o" .~'~, % "~' Dale: Eagle ,iver, AK 99577 ..... , I ~/~ ~ cedilylhatlhisJnspectionwaspedormedaccordlngloalJ ~¢r~ Louisa ~ufera ~ ~¢ /~ ~¢ ~ ~ m % CEo/36 o~ ~ Municipal and St~te guidelines in effect 0n Ibis date: ~ ~ ~ ] ~r~.~' % "' ,' x~ 72-073 L.[.~, ,~ B BI...DCK: NA :[DN F'::~NGE: !!4 · ,::e~"L'. i f'y 'Lha'!~: :[,, :[ affl fam:i, l J. ar' v,.,'J.'Ll"~ 'Lhe r'equJ, r'emer'YL~a fc~l- mr'~-.-si'L~.:, :~iewer'~:~ ar"~d w,~.~:i.:[,::~ as; for'+..h by Ch~:~, Mu.n:[Cil:!,~'~].iCy ~:;£ ~n(:hl:l'~£~e-'- (MO(:~) ~.i-id Che L~t,z~'L~ o,c ,~,.I"H:I fi.F:, comp ]. i,m"~c:~:+:, ~>;it..h 'Lh,'a d,.'.~s:i.c..~n c:PiLE.:,pJ.~. ~){ t. hi~.~ :]~,, ]: t,~:i.].:t ~:~dh~.:.d'e '~'..c:, ~t:l.]. l'4, C}(:)i atFb'.:J E[':'L;~'Le (::;f (.~].~:~,I.::~?, r'~.)qL~ir'e:,m(({.?r]'Le:.~ for' Lj"~,:e ~!!i(~!.)'~.. i::)~c:~.:: EAGLE RIVER ENGINEERING SERVIOES P.O. BO)( 775294 EAGLE RIVER, ALASKA 99577 SPEOIFICATIONS FOR ON-SITE SEPTIO SYSTEM LEGAL: Lot B~ Mink Lake GENERAL The well and septic plan are for a single family residence only. The drawing and or site plan shall be a part of this specification. Ali. materials and workmanship shall meet the requirements of the Anchorage Department of Health and State Ail soil tests are advisory to the design and are to be verified or modified in the field by the engineer~ Ail excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet MOA~ D.E.O require-. merits. It is the responsibility of the owner 'to obtain all necessary permits or easements and to locate any adjacent multi-family The excavation is to be exactly in the area shown on the site plan~ any deviation requires engineer approval. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. DRAINFIELD The drainfie],d is to follow the natural land contour to maintain uniform total depth of the bed bottom~ The bottom of the bed shall be ievei~ plus or minus 1.5"~ The total depth of the bed excavation is not to exceed 5.5~ at any point~ ~/ ~,~ ~> ~ The trench gravel is to be covered with typar or fabric material. Soil or combination of soil and extruded board insulation to a depth of 4~ or equivalent is to be placed over the drainfield. The area oven the bed is to be finish graded to prevent ponding of surface water runoff., The septic tank and leachfield must not be closer than 100 feet to any existing private well, 150~ to any Olass "0" well, or 200 feet to any community well. REQOMMENDED LEAOHFIELD DIMENSIONS 5~~ GRAVEL DEPTH= TOTAL DEPTH= Bedroom Oapaoity = 2 Septic tank size= 1000 BED LENGTH= 50~ BED WIDTH=lB~ EAGLE RIVL~.~ ENGINEERING SERVICES INC. P. O, Box 773294 'EAGLE RIVER, ALASKA 99577 Phone 694-5195 JOB SHEET NO. CALCUL^TED CHECKED BY SCALE OF DATE. ./ I 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: LEGAL DESCRIPTION: 1 2 3 4 5- 6 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16- 17 18 19- 20~ COMMENTS WAS GROUND WATER y.,~5 S ENCOUNTERED? L IF YES, AT WHAT DEPTH? ( 7"~'7~- '' \ 7,~-' ~'/"~/-~ Reading Date ~ Net · Depth to Net ~~me Time Water Drop , / PERCOLATION RATE / ~, -~ ] (minutes/inch) TEST RUN BETWEEN ~'~ ET AND ~ ET PERFORMED BY: 72-o08 Eagle River Engineering Services P. ~ Rn¥ 77~04 Eagle River, AK 99577 69~-5195 CERTIFIED BY~~~*~ DATE: i XLA 1 J N 09-53.15-E '2W.86- t 256 ) WELL 8'x40' CO EX 47) 6' 30' ROAD EASEMENT 111 8'x4O'-'., - CONEX 7. 9'X 1 Lot 13 8.2' LEAN–TO Lot 189 49,577 s.f. '3.5'x8.2' 90.2' ut 'PQRH Z .1. 4'x9.9'* 2 STORY RESIDEN E 4� -CANT 01 w/ FULL BSMT 0 2 0' M 14,8' 4. SEPTIC DECK CLEANO CD 28.9' 2.0' A AIN–LINK FE C CIS 89*52' 300.04' UTILI EASEMENT of 212 PLOT PLAN — AS BUILT JL SCALE - 1' = 50' GRID NW 1257 . Protect No. _________17-312/R1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fox "'A OF Professional Land Surveyors ken *langsurvey.corn jonothon6longsurvey.com I hereby certify that I have surveyed the following described property: A� 9 LOT B. MINK LAKE SUED. (PLAT 79-130 Anchorage Recording District, Alaska, and ? 49 hot the Improvements situated thereon are ..... .......... within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed promises and that there are no roadways, transmission lines or other visible KENNETH G 14�6 easements on sold property except as Indicated hereon. –520 Dated this the Day of �S of Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963 I 4:f– 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.cLanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING SAI~ Parcel I.D. 051-1 54-48 e GENERAL INFORMATION Complete legal description Location (site address or directions) Current property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Expiration Date:, ~-- /- ~:) ~ Lot B, Mink Lake Subdivision 19175 Crabtree Street Chugiak, Alaska 99567 Daniel & Michelle Wiggins Dayphone 19175 Crabtree Street Chugiak, 351-9706 Alaska 99567 Day phone Terri Davis/Next Home 3400 Spenard Road, ~5 Dayphone 727-5130 Anchorage, Ak 99503 Un/ess otherwise requested, HAA wi//be held by DSD for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class__ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] E] Individual Holding tank [] ' I-] Community On-site [] I-"1 Public Sewer [] The Municipality of Anchorage 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 the State of Alaska. Cedificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues 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 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 to one year with valid water samples.) Certificates are.valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(am) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pinard Enqineerinq Address PO Box 871347 Wasilla, Alaska Engineers Printed Name Paul E. Pinard 99687 Se DSD SIGNATURE.' ': I//".Appr0ve~d for" "~ bedroOms. Phone 357-3647 Disapproved. Conditional approval for bedrooms, with the following stipulations~.k~. ~\'[ ¥ Or' A~, ."~ . ..... . .' . . '.:%% : WASTEWATER Additional Comments '~/~T ~9~' ~ote: ~he well for this properly mee[s ezisti~g 5tare and Municipal Codes. ~here are ~i~f~e'~~*~''' present. It is su~Aested that periodic testin~ be performed to in~ure' the wells continued ~uit~hili~_ Current nitrate co~ceatratio~ is ?.40 mgA. ~PA maximum concentration is 10.0 ragA. ~ore information ~,, -: .... :~ ' Attachments: HAA CheCklist Septic System Advisory Well Flow Adviso~ X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev, Municipality of Anchorage Development Services Department Building Safety Division On-Sita Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot Bt HJ. nk Lake Subdivision Parcel ID: 051-1 54-48 A. WELL DATA Well type _,E,rj. vate If A, B, or C provide PWSID # NA Dat® completed 1 0/7/76 * Sanitary seal (Y/N) ¥ Well Log (Y/N) N Wires properly protected (Y/N) ¥ Total depth 48 ft. Cased to 45.3ft. Casing height (above ground) I. 7 ' ~lC Date of test Static water level Well production FROM WELL LOG lO/7/7e * 25 (*Est.,from MOA Records) 8.0 g.p.m. AT INSPECTION 9127/01 26,0 5.5 fto g.p.m. WATER SAMPLE RESULTS: Coliform 0 coloniesll00 mi. Nitrate 7.40 mg.~. Other bacteria 0 colonies/100 mi. Date of sample: 9/27/01 Collected by:. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sept:i.c/Steel Pinara Date installed 1 0/8'6 Tank size I 000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 10/19/01 Pumper Sanitary C. ABSORPTION FIELD DATA Cleanouts (Y/N) Y High water alarm (Y/N) P-mpers NA Date installed 10/86 & 4/91 Length 30 & 40 ~ ff. Soil rating (g.p.d./t~ or ftVodrm) 180 sf/b System type Seepaqe Beds -2 & 0.5 cjpd/sf Width 1 8 & 1 5' ft. Gravel below pipe 0. S &0.5 ft. Total depth 3.5 ft. Eft. absorption area 1 1 40 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/27/01 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 6 in. Water added530 gal. New depth 6 in. & 0" " --g- 2" Elapsed Time: 7~; min. Final fluid depth in. Absorption rate >= 450+ g.p.d. See attached Data Scheet. Any rejuvenation treatment (past 12 mo.) (Y/N & type)Nn,,~ _ir~_n..,~_ If yes, give date NA D. LIFT STATION tt~. Date installed "Pump on" level at ~ Datum in. E. SEPARATION DISTANCES Fo Size in gallons 'Pump off" level at Cycles tested in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line 100'+ 100'+ 25 ' + Holding tank Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? JR. On adjacent lots 100 ' + On adjacent lots 1 00 ' + Public sewer manhole/cleanout SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots 10'+ 10'+ 100'+ Property line 1 0 ' + ~I) Water service line ~";. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 ' + Water Service line 10 ' + Curtain drain HA COMMENTS Building foundation 10 ' + Surface water 100 ' + Wells on adjacent lots 100 ' + Absorption field 5 ' + Surface water 113 o ' + Water main 10 ' + Driveway, parking/vehicle storage 5 ' + G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name E~att]. ]~. Date 10/25/01 HAAFee $ ~1:~O(~, Date of Payment Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number FROr.1 : P INARD EHG INEERING FAX NO. : 907-:357-:3647 OCT-~I-20;~I 13:~ ~T&~ ~I A~CHORAGE · GT&E Environmentul Se~ lnG, Oct. 31 2001 02:15Pr.1 Pi 9~75620119 P. 01/01 1.8bommry DMMon ~rinking Water Analysis P,z~port for Total Coliform Bacteria ~ MUST BP. CC,,'MPI~ ~ fd~,~V-W~ Sb~.~i. lY.R -'1'0 gE COMPLEi T~ad Wnm~ Angyt~t ~ IM~ W/~I~,SAI~LI~ lo bo: 8mJiSmmlBIImJ im i Bl~nklq~lJmI. &Cd __ ..... ~LIFIRM__ · M~~ T~C~, Mtmfxmm FUtm DmmrCemm ~ vtrlfletuem LIB .~ ~GB, Fm~:~ Cslffwm Cu~'mafbu. , Comrr~lz: -- D T~TA_ P.E]I CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 1016627001 'Pinard Engineering Lot B Mink Subd Kitchen Sink Lot B Mink Subd Kitchen Sink Drinking Water Client PO# Printed Date/Time 10/03/2001 11:14 Collected Date/Time 09/27/2001 16:40 Received Date/Time 09/28/2001 14:00 Technical Director Stephen C. Ede Released ~ ~ Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Waters Department Nitrate-N 7.40 0.500 mg/L EPA 300.0 (<10} 09/25/01 ,' 10/01/2011 08: 3S cJB7-373-2157 ERDMAN ASSOC PAGE 03 RDMAN & ASSOCIATES N~INEErlNG/WATER TESTING DRINKING WATER ANALYSIS COLIFORM BACTERIA SECTION 1. PINARD ENGINEERING Box {311847 ~h:nc/fax 1357,2~47 Prciec~, Legsl De;¢:i~:i~n: Lc:: 'L~,., Bl=ck: Repeat; ~ample Lsb ref # SECTION II. COMPLETL~D bY TEST j' READING * DATE J TIME: INTL I PRE ,~EN'I'/ AI3~ENT , MMO MUG Te~l ~llfo~ ~ ~J3 In 2C · 2B hcum I Bacteria Present In or Absent/rom Water Sample ! RESULTE. ; / I~ SATISFACTDRY ~ [] UNSA'rlSFAOTORYI [] INC0NCLU~IVE Ple~_,~e .tubmh ~noth'~r .t."mF,'¢ ! SECTION III. -I NOTIFICATION /DISTRIBUTION Numeric £itt Wa~:ll~a, Alaska S9~54 Te~: fsx:'$07-373-~157 ,~ ', PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) WELL FLOW TEST LOCATION: Lot B, Mink Lake JOB NUMBER: 01-185 DRILLER: Unknown DATE OF TEST: 9/27/01 DATE WELL COMPLETED: 10/07/76 FIELD STAFF: P.J. Pinard WELL DEPTH: 48' STATIC WATER LEVEL (top of casing): 26.0' Elapsed Static Flow Cumulative Time Time Water Rate Gallons Remarks (Minutes) Level (gpm) Pumped 12:20 PM - 26.0' 3.3 - 'Start Flow- Meter 236340 12:35 15 31.9' 6.7 50 236390 12:50 30 30.3' 5.3 150 236490 1:05 45 31.1' 5.3 230 236570 1:20 60 30.8' 4.0 310 236650 1:35 75 31.1' 4.0 370 236710 1:50 90 29.9' 1.3 430 236770 2:05 105 29.2' 4.0 450 236790 2:20 120 29.2' 5.3 510 236850 2:35 135 33.9' 6.7 590 236930 2:50 150 33.8' 6.7 690 237030 3:05 165 33.2' 7.3 790 237130 3:20 180 33.1' 7.3 900 237240 3:35 195 33.0' 7.3 1010 237350 3:50 210 33.1' 6.7 1120 237460 4:05 225 33.1' 6.7 1220 237560 4:20 240 33.3' - 1320 Stop Flow - 237660 RECOVERY No need for recovery measurements. Average Flow Rate: 5.8 gpm Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF PRODUCING 6.7 GPM. THIS TEST DOES NOT CONSTITUTE A WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE. Reviewed by: Paul Pinard Date: 9129/01 PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) .ADEQUACY TEST LOCATION: Lot B, Mink Lake APPLICANT: Daniel Wiggins III 19715 Crabtree Streot Chugiak, Alaska 99567 SEPTIC TANK TYPE/SIZE: Steel/1000 gallons, per MOA Records ABSORPTION SYSTEM: Seepage Beds (2), per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GAI_/BR = 450 gallons TEST DATA JOB NUMBER: 01-186 DATE OF TEST: 09/27101 FIELD STAFF: P.J. Pinard NUMBER OF BEDROOMS: 3 SCUM: 0.1' (felt solids) SLUDGE: 0.2' NEEDS TO BE PUMPED: Yes XX No CURRENTLY IN USE: Yes XX No Time Flow Volume Cumulative Septic Tank Septic Soil Absorption System Comments Rate Volume Tank ])]V[ (GPM) (GALs) (GALs) Uquid Level * A Level Monitor Monitor Monitor Monitor Tube 1' Tube 2* Tube 3* Tube 4* 2:40 6.0 4.0' 0.5' 0.4' 0.0' 0.0' Start Test- Meter 2369(;0 2:55 6.0 100 100 4.1' 0. l' 0.5' 0.4' 0.0 0.0 237060 3:10 6.7 100 200 4.1' 0.0' 0.5' 0.4' 0.1 0.0 237160 3:25 6.7 110 310 4.1' 0.0' 0.5' 0.4' 0.1 0.0 237270 3:40 6.7 110 420 4.1' 0.0' 0.5' 0.4' 0.2 0.0 237380 3:55 110 530 4.1' 0.0' 0.5' 0.4' 0.2 0.0 Stop Test 237490 RECOVERY *ALL MEASUREMENTS IN FT. Date Time ST MT1 SAS MT1 TEST: PASSED XXX FAILED COMMENTS: Monitor Tubes #1 & #2 were those in the older seepage bed, located close to the house. Monitor Tubes #3 & #4 were those in the newer seepage bed that was installed in 1991. Reviewed by: Paul Pinard 1¢~~) Date: 9/29/01 DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services - .On-Site Services Section P.O. Box 196650 - Anchorage, Alaska 99519-6650 343-4744 CERTIFI CATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O~,1-154-48 '~ 1. GENERAL INFORMATION Complete legal description Lot B, Mink Lake S/D Location (site address or directions) P.ro pe rty.owner"-srer~t Drummond, .-.~ . ;';.- '< '- Mailing address....-.. '- Lending agency '- --~. Mailing address ~,gent Address 19175 Crabtree St.,'Chuqiak, AK 99567 Shirley Ronnigen Day phone Rema× of Eagle River Day 16600 Centerfield Dr, Eagle River, AK 99577 Sharon Minseh Day phone 694-4200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well x×x Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding tank Community on-site Publicsewer 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, verify that my investigation of this Health Authority Approval application shows that the on-site water supply an d/or wastewater dis posal 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. S & S ENGINEERING ,=~.,,. m,,~ ,,,,,~ ~.,,~ ~. 204 Phone E c~ ~./_ ~'~1 '7 ~ Name of Firm 17o~4 .~= ....... ,~L__. Address Eagle River, Alaska 9~577 Engineer's signature ~/~} ~'/~--- Date ,S'/,, / ~7¢ DHHS SIGNATURE ~ Approved for '7't~/~ E E bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. -T4re-~a~cc~nitr~a-be~ present. T+=~ is ~---*=~ that ~=~4~4¢~ .......... testing ~¢ performed to insure the wells continued suitability. Current nitrate -co~c~rt6r-gt-i-olt--i-~--7-.~52 rog/1. ER~A .,~x~mu,~entrat~on ~o ~o.0 rog/1. More information on nitrates is available from the On-site Services Program, ~43-4744. 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 in the professional engineer's work. 72~'25 (Rev. 1t91) Back MOA #21 ' Municipality of Anchorage AU6 ',.,~ ~DEPARTMENT'OF HEALTH & HUMAN SERVICES .... '~r Environmental Services Division MUNICIPALITY OF AN~ 825 L Street, Room 502 ' Anchorage, Alaska 99501 · (907)'g~-~t~-~ Health Authority Approval Checklist Legal Description: A. WELL DATA Well type gC-~[~"C'-- Log presel)t ~l) x¢ Total depth q ~ ~ Sanitary seal CH) If A, B, or C, attach ADEC letter. ADEC water system number {~z~ Date completed '~o--l-')~ ~----~--r Cased to ~ 5' ~' Casing height (above ground) FROM WELL LOG Wires properly protected (~N) AT INSPECTION Date of test Nitrate 7, ~ ~ ~, ~ r Other bacteria ~ ~.~ ~ -D Z Collected by: Static water level Well production ' WATER SAMPLE RESULTS: Coliform ~ Date of sample: '~-~-~ -5¥ B. SEPTIC/HOEDING TANK DATA g.p.m. Date installed Foundation cleano~N) Dat,e of pdi~Pi~'~. 'i'~..~? ~% Pumper ABSORi~TION, FIELD DATA ? ', ?' ~,:;' .,~ , . - . ; ?;. ';"" ......... Y ..... --- · -/~:~i"~ rating (g.p.d./fForfF/bdrm) Date-~ nst~_'l ed I,o - ~ Soil System type ,:: ...... : .................. : .... / ken'lb..:'~'~ ¢'¢';¢' .i' ~" Wi~l'(i~''" ~'~'//C/d-' Gravel thickness below pipe ~ ~..'.; / ..... .,.;.:..(. . . Effectiv6::a?sOrption area·: !/¢~/'~r;~Monltorlng Tube present~N) '"" ";' ~ ~Z ~ ~-~ ~ Result,~Fail) Date of adequady test~ Tanksize I~>~> Number of Compartments ~ ~ Cleanouts~/N)._/V_~ y Depression (Y~ ,--) High water alarm (Y/N) ,'¢ ~ Total depth · Depression over field (Y~ For '~ bedrooms Fluid depth in absorption field before test (in.);'~ ~; '~ Immediately after~s''¢ gal. water added (in.): 4,] 5 ] 3, r :~" - ~ ~ ~s~DA' Fluid depth ~/~ ~ ~ (ins) Minutes later: ~ F Absorption rate = _g.p.d. Peroxide treatment (past 12 months) ~ ~o ~ ~ If yes, give date ~]~ 72-026 (Rev, 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* ..~-----------'--'q~t u m E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot Io ~ Public sewer main ~\ ,~. Sewer/septic service line On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation \~ \'¥ "Property line ~ c, \~- Water main/service line \ o Surface wateddrainage \ c~t, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Absorption .field ~" ~ '~ Wells on adjacent lots \ ~ ~ tV Property line \ o ~'~- Building foundation \ o t~- Water main/serv ce line Surface water \ c~ o \ ~ Driveway, parking/vehicle storage area Curtain drain ~/~:,, Wells on adjacent lots 1 ~ ~ ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal record~ ['W~l~ms are in conformance with MOA HAA guid~elines in effect on this date. _,~,4~1'~,,~'-'"'~, ~..~_,~ ' Date HAAFee $. ;'~ ' ~ ReoeiptNumber Z'-/f/O~/ _(~/-.-flbTLL'/[ 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number JUL-29-1998 16~14 CT~E ESI ~NCHOR~GE ~075615~01 P.02×02 TF.. CT&E Environmenxa[ Services Inc. Laboratory Division ~ara'l~-a'~a~/~la'a'a'~'l/a'~as :inking Water Analysis Report for Total Coliform Bacteria :oow. ,o.,, o,~. A.eherlge. AK 9951 4D hvSTRE~[ONE ON REFE~E SIDE BEFORE CO~E~I~YG ~MPLE TEl: ~7) 562-Z343 F.: (~7) 561 4301 &lUST BE COMPLETED BY WAT~[ SUPPLLEK PUBLXC WA~R SY~[M l.D.t PRIVATE WATER SY~bl SAMP[,E DATE: ~Y Routiee '0 Treated Wa(er ~t Sample (f~ ~uflae with lab ~C a~ ) ~me Coil~t~ SABLE L~ATION ~ .'~ CoH~ ee co~-~e're~ sv Analysi! ~ho~ ~is ~ater SA~IPLE to ~ U~~ .. , S~ple ~ 30 ho~ ~l~ ~ulU may S~;le t~ long in z~sic; ~ple should not be ever 48 hou~ old at e~i~lion m ifl~ ~li~le ~lU, PI~ ~nd .... .~ O~~ , ~ Receiv~ Aaals~lteal [~htbod: ,'ill' Membnme FII~' blMOJ, IIJG Client notified oi' unfld,1 flttor/f'~uitg ri ...... D Spas,- wl~ BACIT, RIOLOGICAL WATlgR ANALYSIS RECORD ~lembnaa Filt*fi Oir~'t CouNt ... ,. ~ o g Vfflfl~dom* LIB ~ BGB' Fmal Cofl~nm Coaflrmel#o - . Coil COlonic/. lOG mi :omm~ntl: TE1TflL P. 02 AUG-O?-i998 i6:53 CT~E ESI ANCHORAGE 9~75615301 P.01/01 ~m~_ _ CT&E Envlronment~d Sewice. Inc. Sample Remarks: Client PD~ Prl.t~ l)ateXTbae 08/07/98 16:42 Collected Date/Time 08/06/98 11:45 R~ceived Date/Time 05/05/98 12:40 Teehufeal Dir~otor.: Stephen C. Ede Method Llmitg {)ate Date Init NItPA~-M 7.62 0,100 ~/k APA 300,0 10 ~a~ 08/C6/98 RMV TOTAL P, 01 CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 983862001 S & S Engineering LB Mink Lk S/D LB Mink Lk S/D Drinking Water Sample Remarks: Client PO# Printed Date/Time 07/29/98 15:07 Collected Date/Time 07/23/98 12:45 Received Date/Time 07/24/98 08:20 Technical Director: Stephen C. Ede Released By~ ~y~ ~ _~/.~ Parameter Results PQL Units Method Allowable Prep Anatyr'z Limits Date Date Init Total Coliform 1 OB NO COLI SM18 9222B 07/24/98 RMV Nitrate-N 6.25 0.100 mg/L EPA 300.0 10 max 07/26/98 07/26/98 GCP 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 - ~ ,,_~ut- L~ ~ NAA# 1. GENERAL INFORMATION Complete legal description Lot B; Mink Lake Subdivision Location ~site address or directions) 19715 Crabtree Street Property owner AHFC :~79081 Mailing address Day phone Lending agency NORTHLAND MORTGAGE Day phone Mailing address ATmRNTTON: S~]e Simmons Agent RE/MAX OF EAGLE RIVER - Sharon Minsch Day phone Address 16600 Centerfield Drive, Suite 201, Eaqle River, Alaska 694-4200 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: X-~ TYPE OF WATER SUPPLY: Individual well × 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. 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 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. Name of Firm ..... ~,,,.~:~ Address :~ ~'0:~4 E~g[,~ River Loop Road No. 204 ~a~le River, Alaska 9~5]~ Engineer's signature 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 in the professior~'al engineer's work. 72~25 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~.-,c:~-¢ ~,~ ~"~-- ~_a,v._~__ _ Parcel I.D. A. WELL DATA Well type~ If A, B, or C, attach ADEC letter. Log present ,~/N) Total depth Sanitary seal ON) ADEC water system number ( % . \ Date completed \O-"{- "J l~ ~'~'~' Driller 0~,~-,~, Cased to ~ ~ ~ Casing height Wires properly protected (~/N) ~ FROM WELL LOG AT INSPECTION Date of test . Static water level Well flow 'Pufnp Ibvel SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line ; On adjacent lots On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: ~"7-~-~ ~ / Nitrate D, L~,~'~ ~'~/,JL. '¢~ ~ -'~ ~ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts ~)'N) High water alarm (Y~ Date of pumping Other bacteria 17034 Eagle River L~p Road No. 204 Eagle River, Alaska 99577 Tank size I c~ c:,o Compartments '2. Foundation cleanout ~/N) ~ Depression (Y/~ Alarm tested (Y~) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ~> ~ ~'"' On adjacent lots To property line \ ~,~ t ~ Absorption field '~ ~'~" Surface water/drainage ~ c~ ~ ~- Foundation Water main/service line 72~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer ~ .Manhole/Access (Y/N) Vent (Y/N) ~ _ "Pump on" level at "Pump__oJCz4evel-E~. High water alarm level ~ ~ ........ Meets MOA electric~ ~-- ~on lot On adjacent Jots Surface water D. ABSORPTION FIELD DATA Date installed Length '~o' / ,~¢-/:)' Width Total absorption area Gravelthickness ~' / Cc". Totaldepth ~',~5' )~'-ff'5~, , / ~,O~ Cleanoutspresen.t(~)'N) 7 Depression over field (Y/~ /kJ Results (pass/fail) ~/,~.- Peroxide treatment (past 12 months) (Y,~ Date of adequacy test for ~'J/A- ' bedrooms If yes. give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~-c~ ~'~ On adjacent lots ~ t4-- Property line To building foundation ~ c~ ~ ~ To existing or abandoned system on lot On adjacent lots ~ ~ Cutbank Water main/service line Surface water ~ o c, ~ ~ Driveway, parking/¥ehicle storage area Curtain drain I-~/~. ; E, ENGINEER'S CERTIFICATION ' ::: I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eff.¢~ th'e~]~(~, of this inspection. Signature 5 2, :5 ~:~.~¢~.~F,{i:;:, NG ~ ';'." ,." ,;' ~ ~" '* ~ ;'" ,~ Date ~/' ~-¢ ~ ~',~ '~ ~';' HAA Fee $ ~O,~ Waiver Fee: $ Date of Payment ~ ~ [ ~ % ~ Date of Payment Receipt Number ~ ~/ ~ [ ~ Receipt Number 72-028 (Rev. 3/91) Back MOA 21 ¸-% CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Client Sample ID:L B MINK LAKE PWSID :UA Collected APR 9 91 @ IT:30 hrs. Received APR 10 91 @ 13:00 h~s. Preserved with :AS REQUIRED ANALYSIS REPORT BY SAMPLE for WORKozde=~ 33190 Date Report Printed: APR 15 91 @ 10:07 Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO $ PO ~ NONE RECEIVED Req ~ Ordered By :B. SHAFER Analysis Completed :APR 12 91 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)S & S ENGINEERING Released By: ~~.~../ 2) Chemlab Kef ~: 911349 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 0.63 mg/1 EPA 353.2 10 Sample SAMPLE COLLECTED BY: RAY. Remarks: 1 Tests Performed * See Special Instructions Above UA~Unavailahle 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 Colifor~n Bacteria TO BE COMPLETED BY WATER SUPPLIER '~ PRIVATE WATER SYSTEM Name Phone No. Mailing Address City State Mo. Day Year SAMPLE TYPE: [] Routine ~. Check Sample (for routine ~ample with lab ref. no, ~11,\'5'~, ~7.-- ) [] Special Purpose SAMPLE NO. ~ I 2 I LOCATION Zip Cede [] Treated Water [] Untreated Water I I Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: isfactory [] UnSatisfactory [] Sarhple 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 /00(--~ Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. I I I Result* Analyst READ INSTRUCTIONS BEFORE ' COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count A.D.E.C. ~Coliform/100 mi Verification: LTB Final Membrane Filter Results Reported By , ~'~~ · BGB TNTC = Too Numerous To Count OB = Other Bacteria Coliformtl00 mi PART ONE OF TWO REMAINDER TO FOLLOW ~--~-; 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 November 6, 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot B Mink Lake T15N R1W, Sec.8 Location (address or directions) Eagle River (b) Applicant Name Rodger Powell Telephone: Home 688-2635 Business Applicant Address P.O. Box 771226 Eagle River~ Alaska 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); . (d) Lending Institution First Interstate Telephone 276-7000 Address P.O. BOX 871725 Wasilla, Alaska 99687 (e) Real Estate Company and Agent N/A Address N/A (f) Telephone N/A Mail the HAA to the following address: pickup by engineer TYPE OF RESIDENCE Single-Family [] Multi-Family [] Other Number of Bedrooms ~ 2 j0£/~ Z. ou. f~u T~/~,~ %. [~'/I 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. 4, 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 I of 2 72-025 (11/84) ENGINEERING FIRM PROVlDI~'~ INSPECTIONS, TESTS, FILE SEARCH, DA~A AND INFORMATION r, 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 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. Name of Firm Address EAGLE RIVER ENGINEERi,N. F. AGLE RIVER, AK P. O, BOX 772 694-5195 Telephone DHEP APPROVAL Approved for' ~ ~' Approved X Disapproved Terms of Conditional App[o, val bedroomsby ,~'~/ ~ Date Conditional 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 DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of 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 72-02s (11/84) MUNICIPALITY OF ANCHORAGE (MO~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: 7~/~-~ WELL DATA Well Classification · ~)...O/~ t U'.~' T/,.~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) y Date Completed Jk2-- ?-~'~ ~.~.z.. Yield Total Depth ~/"~' Cased to /~;--'"~ Static Water Level ~'~ / Casing Height Above Ground Electrica! Wiring in Conduit (Y/N) Separation Distances from Well: To Sep~ic/Holding Tank on Lot Depth of Grouting Pump 8et At Sanitary Seal on Oasing (Y/N) Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /~/,"~' Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots /¢/ / ; On Adjoining Lots w/¢'~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~'~ ; Date !// B. SEPTIC/HOLDING TANK DATA Date Installed /¢/'¢¢ Size J¢¢~'5'~'/ No. of Compartments ~' Standpipes (Y/N) ~' Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) /v Depression over Tank (Y/N) /~' Date Last Pumped ,'~/~-" ~-'"~,~ ~-'~ '~"--~ Pumping/Maintenance Contract on File (Y/N) "~//~ ' for ~ Holding Tank High-Water Alarm (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) ~,~ Separation 'Distances from Septic/Holding Tank: TO Water-SuPply Well To Property Line /~ / To Water Main/Service Line "~'-/~ / Course To Building Foundation ,~ / To Disposal Field -~ / To Stream. Pond, Lake, or Major Drainage Comments MUNICt~'ALH ¥ OF ANCHORAGE DEPT. OF HEALTH & Page 1 of 2 ENVIRONMENTAL PROTECTION 2 RECEIVED 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / Width of Field Square Feet of Absorption Area Depression over Field (Y/N) A// Results of Last Adequacy Test /I,,,'/~ Separation Distance from Absorption Field: To Water-Supply Well /D / / 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 ,~ r~'~ / Gravel Bed Thickness ~" '~ Standpipes Present (Y/N) Date of Last Adequacy Test /- To Property Line / ~' To Existing or Abandoned System on ; On Adjoining Lots ~'---~¢ / To Cutbank (if present) .h-LC, D ' Comments 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 MOA and HAA guidelines in effect on the date of this inspection. Signed ~'"~~~ Date MOA No. Company Receipt No. 2_~ <:Z~/ Date of Payment Amount:* ¢'¢-, Page 2 of 2 72-026 (1 ~/84) Eagle River Engineering Services P. 0. Box 773294 Eagle River, AK 99577 694-5195 ' t 4.1 9~67 within thirty (38) days after drilling t~ co~?l~t~d. Prl~cfpal ~viro~en~al Control Officer DE:F'FIF~:'ff'IE:N"f' OF' HEALTH AN[::, ENVZRONMEN'f'AL. F'F~]OTECTION 25J. O E, TUDE'IF~:! RD.., RNCHORF:IGE., RI<: ¢9~95E;1'? 2'76--222Z FE. F4.fI:i; I NO. r..iAF~:'.r' F(CIGEF4b, .......... c,,.~,.:¢.£."~'='"'" B];RCHL,.IOO[;:, LC:IOF' N 27~9444.4 ~iF~ ~ OFF .~r R~'HRL4K [,1iNit,JUl,1 [::,IE;"I'RNCE FRO[,1 ~,IELL "f'O RN'¢ SEPTIC IHN[., F R...KRL~E F'LRN'f ,..;, ,~ ......., ......... , ..,,. ~,, ............ 2E~¢Z~ FOR F'UE~L. IC L4ELL. =¢..IEF1 I=, :t. OEI FT F.)k R F-~.I,HIbL4ELL I..P ~._ OF THE L4ELL. L.)~.~_, [1U=,I BE RE'f'UF'.NE[:) TO THE I:;)EPRR'.1'f,IENT L,IITHIN ]~8 '~""~; ~4EL. L ..... = ' " ....... COl,IF'LET I ON. SPEC]:F:I;CF:I]"IOf.~:~; RNE:, "2';;NSTR'JCT(])N [:,][RE, RRb12; RRE R',~'R:[LFIE:LE TO :[N~;LIRE F'REF'ER I N'.~FI" FILLR T I ON. I CER"f'IF~' "t'HRT :[ Rf4 F;'Rf,1;[I_IR~: ~4ITH THE; RE6!I..II~:E~IEN'I"~; F_R ON-S]:TE _EI.4ER.. RNB, L4EI_LE; FI_, :SE'f'FOI~'.TH E:'¢ THE fllJtJ).iFRL..I~ OF RNCHORR~]E RNB, L4ILL IN2;TFILL IN RCCOR[':,RNCE ~41 TH THE; CO[:,E.