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Home My WebLink AboutELMORE #2 BLK 10 LT 12 ~-~NICIPALITY OF ANCIIORAGE ~ }leal~ ~and Environmental Protect Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 , / INSPECTIO_N_ REPORT ON-SITE~SEWAGE DISPOSAL SYSTEM LOBATION SEPTIC TANK: DISTANCE . FROM W~.LL INSIDE LENGTH NUMBER OF MANUFACTURER MATERIAL _~--~'(:~--- L COMPARTMENTS INSIDE WIDTH ~ LIQUID DEPTtt -"'"'- LIQUID CAPACITM/~GALLON~ TILE DRAIN FIELD: DISTANCE FROM WELL # of Lines ABSORPTION AREA DEPTIh TOP or TILE TO FINISH GRADE FOU,'IDATION DISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE DEPTII OF FILTER k~,ATERIAL BENEATH TILE NEAREST LOT LINE T RE~'ICIt WIDTI4 TOTAL LENGTH OF LINE IN. TOTAL EFFECTIVE IN. ABOVE TILE IN. SEEPAGE PIT: Log Crib BUILDING FOUNDATION .---.--~, i DEPTH ~ / Rings__~ Crib Size: DIAMETER - . DISTANCE FROM: WELL TOTAL EFFFCTIVE NEAREST LOT LINE "~) /. ABSORPTION AREA (WALL ARE . FT. Well Class: ~,~ Depth: ~-~ Well Distance To: Lot Line B1. dg: Sewe~ Line: . P~pe Materials: ~ ~ of Bedro. oms: Instal ler. ~9~3~ ~_ " Remarks: /~.~ 77~~ // D A~---~ff_~..~' AP P R 0 V DAILY DRILLING LOG PENN JERSEY DRILLING CO. Anchorz~:e. Al~sk,x ~ ' ~ DEI'Tll ,)r WELl ...................... ~0~ ........................................................... STATIC LI?,'EL OF WATEI~ F'T,.......~,~.I~. .................................................... U~A~'.' I)mv;~ r'T .................................................................................................. GALS. pER {IR ....................... G i~c~ ~oetct~d ......................... KIND OF CASING .............. ~ ' I~.IND OF FOItMATION: '~ ---- { |/~'~- FT TO ~'r...~'~.~lt~ ....... ~' -. TO ~ rT .1.2(~tzl~_qt~v~/ rno.,,....~ .......................... ~ ~&.r~ 0t:lmo bf:'...c~.nP ~ , t'no.~, ........... rt. To.. .................. ~! .................... t"P.o.s~ ......... .'.1. ........... Fr. TO ....../ ............ I~'" '" ~ [-'~f,'~l l--t" ..... ..,:o,, ~ ~ ,,, ~..,.,..&.~..~c~ ~,,,,, ................ ,-,.T,, .............................................. ~ ....~ ,..6c'~S¢.~ 6'~ ~,..,',:,,,, "' "" FROM..~,c~ ....... r ~.s~, ............... -- " ~ 15)'1 ' ' ................... ~n/ ,~. TO ~q ,-,&~..~.~c~,~ ~ ,.,o,, ........... ~.T,, .............. "~' ............ '"'"" 7;~ ..... T,, ~'~ .......... ,',i~"~ ~6~1 ~,=,,.,, .... ..T,, ............ '"' .... FItOM. *-/..7'/ ......... ~ ............ , 93 ~.T,, g~ ,_,~r~,~.~a~tc/~.~y,~, ............. ,-,.T,, ....... "' ..... ...... ,,.,o ......... ......... ,-'" ~. qo 6c.C~. 6~'¢~el ,-,.,,,, ................ ,'~-'" ................. "' ............ FI~.II,M ....... IT. TO { ~l .. F'T. ,,,,.,,.......~.~ ...... ,-,. T,, 0.~...?....~....b~.C ........ ""'"" ............ ,-,. T,, ........... '" '°"'I" To ~'7. ~-~.~...50,~?~¢~1 ~',:o:., .............. "~.~° .......... '-~'' rn O.'U .....~..(Z) ............. r~ ................. ' .... oO ./,n~ ,,.r~e~,,~..~.{:~eI Ft,,.,, ......................... ~r. To .......................... rr ............................... F B 0 M ......Z ./...,./.. ......... Fr. TO...L~-~...~ MISCL, iNFORMATION: PERM ~-T NO.' I"IUI'-I 'r C DEPRRTMENT 825 q~- ( 77~i0 ) APPLICA[4T LOCATION LEGAL ~?OHt.~ 'y'AUGHT 14?TH & TETOH Ll2 BiO ELMORE SUBD #2 LOT SIZE 40280 SQUARE FEET TYPE OF SOIL RBSORBTION SYSTEM IS: PIT MAXIMUM NUMBER OF BEDROOMS SOIL RRTI[~G THE REQUIRED SIZE OF THE SOIL ABSORPTIOt-~ SYSTEM IS: DEPTH= 8 LENGTH= ~L6 GRAVEL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF EACH SIDE FOR A SEEPAGE PIT. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATIOt'I (IN FEET). THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE A~D THE BOTTOM OF THE EXCAVATIOt~ (I~ FEET). REQU I RED SEPt I C TRP'.II< S I ZE= :LOOO GRLLOP~--q T~O < 2 > INSPECT IONS ARE REQU I RED BRCKFILLIt'~G OF ANY SYSTEM WITHOUT FI~IAL INSPECTIOt-; AND APPROVAL BY THIS DEPARTMEHT WILL BE SUBJECT TO PROSECUTIO[I. MINIMUM DISTANCE BETWEBl R WELL AND Rt'~Y ON-SITE SEWAGE DISPO5RL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A.PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETIOH. SPECIFICATIONS A~D CONSTRUCTION DIAGRAMS ARE RVRILRBLE TO INSURE PROPER I NSTRLLRT I PER~I I T VRL I D FOR Ot~E ~ERR FRO~I ISSUE I CERTIFY THRT l: I RM FRMILIRR WITH THE REQUIREMENTS FOR Ot.4-SITE SEWERS R~,4D WELLS AS SET FORTH BY THE MU~ICIPRLITY OF R~CHORRGE. 2: I WILL D4STRLL THE SYSTEM IN RCCORDRHCE WITH THE CODES, ~: I U~DERSTRND THAT/THE ON-SITE SE~ER SYSTEM MRY REQUIRE ENLARGEMENT IF THE RESIDA'~CE IS REMODE~D ~UDE MORE THRt~ ' . i/ SIGNED: .... - GARY PLA"-/'ER VENTURES- CONSULTING GEOLOGIST I9OX 476-M, STAR ROUTE A · ANCHORAGE° ALASKA 99507 * PHONE 344-707I SOILS LOG Performed for '"'~'-~ D?pth (f~et) --0- --~-¢~-~0 --I6- -10,- -12- -16-- -18- Soil Description 6.0- q. ~' ¼L -20- Total Depth, IL Was gro~Lud.water encountered. ~ Depth to bed. rock ~ '2--0 f~et in ~'~ . How determined ~ ~e~ ? ? Respectfully submitted, Gary F. Player Consulting Geologist ALASKA ENVIRONMENTAL CONTROL SERVI(~', INC. · 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, AI.aska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # t'-')\O~"' \-'1,-~- 1. GENERAL INFORMATION Complete legal description HAA # ,( Location (site address or directions) ! -~'~ : :";~:.~'~ Property owner ~',~,~f~- 4-7'~,,, /-c~,c, ha/~ ,' Day phone Mailingaddress I~/~'0/ '7'~/~,~ P/,~cg~ r~.~,.~o~ Lending agency ~. ~. Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. phone NUMBER OF BEDROOMS: 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 WA'STEWATER DISPOSAL: Individual on-site HOlding tank Community on-site Public sewer NOTE: If com~nunity wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 ' ~nd/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 /~"/~/--'/-c,? Address Engineer's signature ~'r-~ ~. ~-o-~.~ Phone Date DHHS SIGNATURE .- Approved for t~ Disapproved. ~ Conditional approval for bedrooms. ~ .... .. C .... 7 . ~ ~ bedrooms, with the following stipulations: 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. Tom Fink. Mayor /V unicipality o 'Anchorage Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 October 22, 1991 Ted Moore, P. E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Lot 12 Block 10 Elmore Subdivision PID #018-173-18, HAA #HA910452 Dear Mr. Moore: The attached request for Health Authority Approval has been disapproved by DHHS. This disapproval is based on insufficient evidence to prove that the absorption field is not in the underlying groundwater. In view of the fact that an evaluative study was made by DHHS and the HAA was processed, the $170.00 fee charged by DHHS cannot be refunded. If there are any further questions, please call our office at 343-4744. ~hn Smit~, P. E. ~_rog.r.am M_anager On-sate Services CC: Robert W. Robinson, Civil Engineer On-site Services Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: Lc,{' I~.. B'/'c,c~ t'~ ~:lmo,~'#gParcelI.D. A. WELL DATA Well type />r~,cJ-~- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~' Date completed Total depth I o ~ ' Cased to Sanitary seal (Y/N) ~ FROM WELL LOG Date of test "~ / ,~'~ ! '? ~ Static water level ~' .Well flow '7 3/,~o/'77 Driller i o ~-' Casing height. Wires properly protected (Y/N) AT INSPECTION ? / ~ t~/' ' ' 5-l' g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public Se~e~ mair~ ' ~ Public sewer service line ' WATER SAMPLE RESULTS: Coliform ,~ot ~too ~.~ Date of sample: ~) t~ ICl /9! ; On adjacent lots ¢.o, ; On adjacent lots · ' ~ublic sewer manhole/cleanou~ Petroleum tank Nitrate O. ~omj't/-~ Ot.he.r bacteria . ~. , .¢¢'f bc.'o ~.~ Collected by: ~/~/-~',~ T'e~ ..C~.¢ B. SEPTIC/HOLDING TANK DATA Date Installed ~/'Z)/"/? oCleanouts (Y/N) High water alarm (Y/N) /V, ~, Dateofpumping ~ /.70 Tank size iooo ~.a! Compartments Foundation cleanout (Y/N) *r' Depression (Y/N) Alarm tested (Y/N) N' ~ b? ..~'~'"0' ' ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I/Y' On adjacent lots *~' lc, o' Topropertyline 'f~' ~..o,.¢.~. Absorption field Surface water/drainage ~. Foundation l¥~ .,~C,~ c.~. Watermaln/serviceline -.~ to, ~2-o~ (a~,.~) r~o~t aOA~ CONTINUED ON BACK PAGE C. LIFT STATION J~,~. Date installed Size in gallons Vent (WN) High water alarm level Well on lot D. ABSORPTION FIELD DATA Date Installed ~/~P/'77 "Pump on" level al Manufacturer Manhole/Acce,ss (Y/N) "Pump off" level at Cycles tested Meets MOA eleCtrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: On adjacent lots e th ~'2" Total absorption area Depr,es. sion over field (Y/N) Results (pass/fail) Width. Surface water. /o,-/- F/'. HAA Fee $ Date of Payment Receipt Number 72-~2~ (Rev. 3,/91) Back MOA 21 Peroxide treatment (past 12 months) (Y/N) ./~ooe I. co~,~.,n o,,'F' If yes, give date. /4.,4, SEPARATION DISTANCE FROM ABSORPTION FIELD TO:., , , , , ~ Wellonlot I1~' ~ro~ ¢,c,'. On adjacent lots ~ (oo' Prope~y.line~' ~ ~,~ To building foundation ~ ~' ~ ~.o. To existing or abandoned sys[em on lot ~,~. On adjacent lots ~ ~oo' Cutbank N.~. Watermain/se~iceline ~ to~ Sudacewater ~ too ~ Driveway, parki~g/vehicle storage area > ~o' Cu~aindrain ~lone o~o~ :" ' ''" E. ENGINEER'S CERTIFICATION I cedi~ that I have checked, verified, or conformed to all MOA and H~ guidelines in effect on the date of this inspection. Signature ,~ EngineefsName ~ o~ ~. ~oo e ~~ ~ Gravelthickness_ ~ ' Totaldepth Cleanouts present (YIN) Y ~e p~ ~av ~e been Date 0f adequacy test for '~ bedrooms Waiver Fee: $ Date of Payment Receipt Number Soil rating. I ~ 0 ~/~'¢~¥',,~ Sy?tem type .... ' '" . MUNICIPALITY OF ANCHORAGE .'* ." DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~.,' ' ;',:~' ,' · ~. DIVISION OF ENVIRONMENTAL HEALTH ,. ~ . · ';.- . ~,.CERT F CATE OF. INSPECTION'FOR HEALTH AUTHORITY APPROVAL ~:'",.?' , :.,:': *. , ' d, *,'.': ~. :. FI'~.;',~',"~:. : ~ . '*P~264-4720 . " ..... ~... . , · , '.. "- '. App cat on Date ' 1. GENERAL INFORMATION '"* . . (a) Legal Description (include lot. block, subdiv sion, section, townsh p, range) 'BIO Lo~:ation (address or d~rechons) ~. , , i". A~plica;lt Ua~e' ''''°'' ~ C~! ~)/~ ~/~ I~D~-~-..Telephono: Home ~//~r- Business (b) AppIi c a n ~ *~cjc~ r'e'~s; .......... n i-i ;;. ~ {c) Apphcsn! Is (c.,h. eck one~: [.ehdLng Insbtubo Owner/builderJ~ Buyer [] ~ Other I-I (explain); · (d) Lending Institution. · "' Telephone Address :' (e) Real Estate Company and Agent M I~ PI ~/I t~ ~-~.. ~ ~) J~ (f) Mail the HAA'to the following ac~dress: ~ ; ' T~PE OF RESIDENCE " · "' ' 'F ' Single-FamilyJ~" Multi-Family I'1 Other. ' ". ' Number of Bedro0m~ ':' ,,~ WATER SUPPLY [ 'o · ' Individual Well,J~[' Community r'l Public r'l 'i' '~, ' ' , Note: If community well system, must have written conhrmat~on from the State Department of Enwronmental Conservabon attesting to the legality and status. ' , , ~.. ~, .~ . ! . , . ~, ,. 4. , SEWAGE DISPOSALt,,." .~ ,.,:.;',,~'~ ~ . . ..~ ,~,~,. ,,!.. ~,**,~..-: · ,. - - '., :OnsteJi~,.'PubhcI'1 · Communtyl-I".HodmgTankl-I . , ..... , Note: If community well system, must have written conflrmahon from the State Department of Environmental Conservabon · : . , atteshng to the legahty end status, ,,,, '." .":-',~',,.[' ,, ;~',;'--.'~'. ~ " ~-;;'.,'.,~,.,,-,'.-,, *~,:"~.,~. :. .'; , ,.~,..~. :,,.... ~. ,*.r ~.--..-, .:..,...~t..~:,: ~;:,,,'?' ,i.~,.~..~..~ f,;',..~. ~-'~ '.'.,: '.~,~,,.~.','~-;.' :,..'.,/-, t ,,7.:.;,-','.-., ENGINEER NG F RM PROVIDINg. INSPECTIONS. TESTS'TILE SEARCH, DAI~ AND INFORMATION f '' ;' As c~rtified by my seal affixed he~et(~ and as of the v~lidation 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 el Firm Address· ~.00 Date ' · · I.' "o,, ~J..- .~, ,,.: -~ o~ '. ' ~ -., .',.,', ~, .. ,~% , . l.,., ,.' .-" ;', · ' ",:,, , .' ." ' ~ ' '', .;",' ',",' .".,-:'~ ~.: ' 6 · DHEP APPROVAL . ....... , ....... ., ', , Approved for. ,'~A__...edrooms by ~~L~'''''' ~ t~ Date,:: '~-'~.~"~. '" ' .. --, :.. · , Approved ....... D~sapproved Conditional ....... '/,; ' · ' ~, ' · ' :' :'; · , .-'L,' . ,, ?,;, I, ! ' '~ .... :.~ - . ~ .- :- 'r, erm, s of Conditional Approval ,..~. , : .,: ::,. ~,,... ~[.-......, . , , , .,. ~ , ,...., ..,. ..,,, ,,: -,, ,,.. ; :, :, .,., . ,. , ...... : *' '.. ' ..;,. ,'' ..'..:; ',)t . ., - ;: .... ;. · ~, · · ' 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 :r. analyze data before a cerlificate Is issued. The Municipality of Anchorage is not responsible for error~ or ?missions In the -; ~r,..,,eso,,.,,,.,, ,.n:~,nee,s , . ... ,., ,. ..... . ,~ . .,, .-: ',"' .' ", ., ' . ,, ": , ,... :~i ~"', ,.. . i:'::..',*;~" -?'..., , · . Page2of2' . . ..'. " ~ i '" ' .' · ~ - '' ~' ' ' · "' '~, '" MUNICIPAUTY OF ANCHORAGE (MO~/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 I~UN1CIPALIW OF ANCHOP. AOE DEPT. OF HEALTH & EHVIRON/~ENTAL I~ROTECTION 031986: Legal Description: WELL DATA Well Classification I/~/DI ~J/D~t~Z/_ If A, B. C, D.E.C. Approved (Y/N) Well Log Present 6N) Date Completed Total Depth lO,~- Static Water Level Casing Height Above Ground Electrical Wiring in Conduit ~1) Separation Distances from Well: To Septic/Holding Tank on Lot Depth of Grouting /V'/~L Pump Set At Sanitary Seal on Casing {~N) Depression Around Wellhead (Y~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot I O0/'1['' ; On Adjoining Lots To Nearest Public Sewer Line ,~_/~ To Nearest Public Sewer Cleanout/Manhole I~'~/3~ To Nearest Sewer Service Line on Lot ~'~'/A- water Sample Collected by ..~ '~'~ ~ I '~C_,,~ ~/C..~' · Date - ~'/--'~0/~'~/~ ' Water Sample Test Results ',~ ~'rl-~ FI~(~ Comments "~ ~'1~ F/_.OLU ~._~ ~;//-.~/~' B. SEPTIC/HOLDINGTANK DATA Date Installed Standpipes (~N) Air-tight Caps ({~N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~V//_.~- Separation Distances from Septic/Holding Tank: To Water-Supply Well ifO~/"~ To Property Line ifO / ~ '~To W*ater Main/Se,rvice Line Course ' comments · : . ~ Size ~0~ No, of Compartments Z . Foundation Cleanout (Y.~. Date Last Pumped 7/,~/~~' Temporary Holding Tank Permit (Y/N) To Building Foundation ..~/ To Disposal Field ~.~" / To Stream, Pond. Lake, or Major Drainage Pagelof2. -' 72-026( 1 t/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ ~-,~' Date Installed ,~//~_~/;77 Width of Field ~' ]~GX ]~.~- / Square Feet of Absorption Area Depression over Field (Y(~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well [ O~ /'"/~'" TO Building Foundation 2 Lot ~//~1' Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present {~)N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutbank (if present) D. LIFT STATION Date Installed Size in Gatlons "Pump On" Level at High Water Alarm Level at __ Tested for Electrical Codes (WN) Comments Dimensions Manhole/Access (Y/N) __ "Pump Off" Level a Pumping Cycles during Adequacy Test. Meets MOA "Check Permitted Bedroom Rating Against HAA Request °* I certify t h~..~ h ~/,e~k,.~,e r i f ie~l, or conformed to all M(~ ,A ajld HAA guidelines in eflect on the date of this inspection. Receipt No. "~ ~q _'"~'"~ Date of Payment "~ Amount: $ SYSTEH ADDRESS C~Y " .. Sllrr[ ZIP CODE· LOCATION MERI: ~ 'COLLECTED BY OF (CHECK ONLY Of~ THIS COLUI~) ~DRINKING WATER" /CHECK I'1 RAW SOURCE WATER I-] H£W CONSTRUCTION OR REPAIRS [] OTHER(SpectCy) []-1 CXLORIKATEIL~ I-I FILTERED /~NTREATED OR OTHER IS TXIS SAIqPL£ A CHECK SAMPLE TO A PREV]OUS HON-CONFORMING:SAI~LE? I-I YES ~ PREVIOUS COLLECTION DATE ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFOI~) SEND REPORT TO:(PRINT FULL FlAngE.ADDRESS AND ZIP CODE ADORESS rg~x~ cd~a~L//~/F_ -~U/~*~ ~ I~lgot tn proper container r'iLeaked out I-1 Insufficient Information provided. Please read Instructions on form. [] Other (Specify) RECEIVED FROM RECEIVEO ~Y DATE TI~E AN~CAL HETHOD: 1~4M~MBRANE FILTER ~RTION TUBE Date & TI~ Started' l--I RESUBMIT SAHPLE Test unsuitable because: [] Confluent Growth D TNTC ~ SATZS~ACTO~Y UmSATISFACTO~Y [] BACTERZOLOGXCAL MATER RNAL¥S]S RECORD FOR LAB USE ONLY [~TOTAL COLZ FORHS FECAL COLI FOR~S OTHER 14embrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By Col tform/lO0~l · BGB Col tform/lO0~l Date Time READ SAHPLE COLLECTION INSTRUCTIONS ON BACK OF FOR~q ALASKA NARY REARDON 3628 A WEST 40TH ANCHORAGE ALASKA 99517 SELLER-ALLISON MENDEL NARY REARDON 3628 A WEST 40Tll ANCHORAGE ALASKA 99517 ?/3/86 60328 LEGAL:ELMORE SUBDIVISION BLOCK 10 LOT 12 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-6/30/86 THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN AREA OF 648 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 6?6 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE POR A 3 BEDROON HOME. SEPTIC TANK ADEQUACY TIlE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON ?/2/86 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE-6/30/86 A FLOW TEST WAS PERFOEMED ON THE WELL. 6?6 PUMPED AT A RATE OF 6.145 GPM OVER A DURATION OF TIlE DRAWl)OWN WAS 30 ' WITH A RECOVERY TINE OF 10 AND THE STATIC WATER LEVEL WAS 67.2 FEET. TIlE WELL IS ADEQUATE FOR THIS 3 BEDROOM ltOME. GALLONS OF WATER WAS 2 HOURS. MINUTES /l tD-'lq MUNICIPALITY OF ANCHORAGE DEPT. OF H~ALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~U~[~ONMENTAL PROTE~ION ~ LS~-~,~ ~1 ENVIRONMENTAL ENGINEERING DIVISION NOV 2 8 1979 Tde~.e ~7~ RECEIVED DIRECTIONS: Complete all parts on page 1, I~omplm .qmtz will not be pr~. Please allow ten (10) days for processing. 1. PROPERTY .~NER MAILING ADDRESS PHONE PROPERTY RESIDENT (If dif fere.~ from a/~ove) 2. BUYER MAILING ADDRESS PHONE PHONE 3. LENDING INSTITUTION IPHONE PHONE 5. LEGAL DESCRIPTION ~. TYPE OF R~IDENCE NUMeER OF BEOROO~ ~ One ~ Four ~ SINGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Thr~ D Six I--~ Other 7. WATER SUPPLY [~' INDIVIDUAL* ° ATTACH WELL LOG. A well log is required for all wells drilled i--~ COMMUNITY since June 1975. For wells drilled prior to that date, give well I'-] PUBLIC UTILITY depth (attach log if available.) 8, SEWAGE DISPOSAL SY~I'EM [~ INDIVIDUAL/ON-SITE*' I--1 PUBLIC UTILITY '"If individual/on-site, give installation date ~ °---- NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR : INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] /THREE ' ~ ~1'-I FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] 'FOUR ' 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED r-I PUBLIC UTII~ITY Connection Verified LOG RECEIVED , 3. SEWAGE DISPOSAL SYSTEM ' PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUB.C UTILITY Connection Verified INSTALLER []SepticT~nk or []Holding Tank Size: l~,00 If Tank is homemade SOILS RATING , give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL1 4. DISTANOESwELL TO: S~p'ic/R°'ding Tank IAb'°rpti°n Area Absorption Area to nearest Lot Line 5. COMMENTS I~'~'APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~z/~ DATE B~,~itle) LEGAL DESCRIPTION 724)10 IRev. 3/78) / unicipality of Anchorage 825 '*L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 G(ORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION November 30, 1979 Toni Brown % Jack White Company 3201 C Street Anchorage, Alaska 99503 Subject: Lot 12 Block 10 Elmore Subdivision ]2 Approval for your individual sewer and water facilities can not be granted until the following items have been completed: {1) A well log submitted to this department. The water analysis report be delivered to this office from Chem Lab, 5633 B Street, for our review. ~,~)' The septic tank pumped with a receipt submitted to this office. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: National Bank of Alaska Mortgage Loan Department Pouch 7-025 99510 ~ Dou~'s E×c~aling 8-2 Trave Time 2hrs. TOTA!.. $1287. ,, '! '~ATT 'AGGREGATE, IN' '~ ' ' 2326 ST. ELIAS DRIVE * ' ANCHORAGE, ALASKA 99503 " PHONE: 344-8710 or 277-8865 INVOICE 190 WASHED SAND & GRAVEL · CUSTOM PROCESSING SERVICE CHARGE II