HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 5 LT 10Block 5 Lot 10 #015-091-42  Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825'1.' Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 www.ci.anchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW000412 PID Number: 0'15-091-42 N,,.~ WastewaterSystem: [] New [] Upgrade Mnrk R Lynn Ancl~rRnn 94{3t RtJddv W~rn~_r [3r_ Aneh Al( 99~1~ ABSORPTION FIELD 3464898 4 ~...T,,,~, n$~.r~.,T,.,~. ~ a~,~-,, r~o~: LEGAL DESCRIPTION 1,2 ~,~ 8 n, ~ 10 Proseect Hts #1 3-5 n, 5 ~t 0 Well: [] New [] Upgrade I3 Exlstinq n. r, 500 F~ F81013034PVC F,._ Sco~tt's Svcs .10/6/2000 ~: o.~ ~..s..: n.c..~.~.~o~.o,~.~.. TANK SEPARATION DISTANCES [] Septic I-1 Holding [] S.T.E.P. [] Other: T~ To Septic Absorption Lift Holding Pub~Privat, ~,u, nu*-,c~: cap~c,y: Tank Field Station Tank Sewe~ tJne Existing w. 120 122 t20 s,,~.w*-, t00+ t00+ ~ / LIFT STATION ~,~u. 135 80 ~,, 'Pump ~' ~ at: "Pump OW' level 7 0 c...,. ~,.,. 100+ 100+ "~"~'~' s ~'~ 4" of rigid insulation installed over field. BENCH MARK · ~.,/.~,..%-t-~ ,E,~F~-~c.--~A,,u~- ~J[~Au.,t~' Garage Floor '~-.~,~'P~.c-z-/.~3 'F'~.~_-r,~-~r~c,~. ~"t~om~ I 10o.o Engineer's Stamp Inspections performed by: Pannone Eflq, Svc Dates: 1"10/612000 = ....~..~ .......... .,....,, ="".10/o6/2000 Department of Health and Human Services appro, val and approved b~ Date: J',,~/~-(D! ~e~i~e~w) ed P~RMIT NOI SV000412 AS-BUILT ~/AgTE~ATER A14SDRPTInN SYSTEM LOT 10, ])LOCK 5 PROSPECT HTS P.I.I), NO' 015-091-42 C EXIST'G ~ IN FAILURE BE REMA~ REF SYSTEM-50L EXIST'Gj ~/ELL CO A }] TI 21,7 16.7 T2 15.7 13.0 I}V 14.2 13.0 I~C1 14.1 12.5 *nCP 13.5 13,7 7,9 29,P Ml 9,4 33.1 HP 4P'.4 68,p C3 52.3 78.1 E1 23.1 49.4 E2 39,2 55,8 £3 4O5 22.5 E4 52.3 36.2 GARAGE / INSTAEL~D DIVERTER &. DOUBLE .EXIST'G le500 i SEPTIC ,~ANK EXIST'G 3BR EXlST'G °'~-'-~4ELL / 4 ~E~ROOM HOUSE PERC RATE ~ MIN/IN ~OIL RATING~ 1~5 ~F/~R 5DO ~F ROD ~EEP TRENCH. 5.0' EFF. TOTAL ~EPTH = 9' 50' LUNG,TOTAL AREA=500 ~F PREPARE]) FI]R, Ho.r'k & Lynn Anderson 9401 ]~ucldy ~/erner I)rlve Anchop~ge, AK 99516 346-1698 PANNDNE ENG. SVC,LLC P. D. BDX 102954 ANCHDRAGEo ALASKA 99510 272-8218 Phone & F~x ]ATEi 10-7-00 ~ AS-BUILT ~CALE' 1'=50' I PERMIT NO' ~VO0041:~ AS-BUIL DETAILS WASTEWATER AI)SORPTIDN SYSTEM LOT 10, BLOCK 5 PROSPECT HTS P,I.D, NO' 015-091-4~ CENTER ON IIPE W L ED O_ C,\;/or k\DRAVING\IO-5PRrlSPErtT.DWC, PREPARED FDR, Mc~rk & Lynn Anderson 94{)1 Dudd¥ ~/erner Drive Anchor:ge, AK 99516 346-1898 PANNONE ENG. SVC., LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX J~ATE, 10-7-00 NOT TO SCALE AS-BUILT MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 02, 2000 Expiration Date: Oct 02, 2001 Permit Number: SW000412 Legal Description: PROSPECT HEIGHTS #1 BLK 5 LT 10 Design Engineer: 0062 Pannone Engineering Services Owner Name: MARK & LYNN ANDERSON Owner Address: 9401 BUDDY WERNER DRIVE ANCHORAGE, AK 99516-1048 Parcel ID: 015-091-42 Site Address: 009401 BUDDY WERNER DR Lot Size: 99200 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 AJaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. ENGINEER SHALL VERIFY THE INTEGRITY OF THE EXISTING SEPTIC TANK IF IT IS TO BE REUSED. Received By: Issued By: Pannone Enehleerine Sen'ices. LLC Consulting Engineers (907) 227-3522 P.O. 13~ ICE954 Anchorage, Alaska, 99510 (907)272.-8218 Fax September 17, 2000 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 10, Block 5 Prospect Heights S/D Septic Upgrade Permit Gentlemen: My firm was contacted to investigate the existing septic system at the above referenced property. The system is a bed-type soil absorption system and was found to have 31 to 45 inches of water standing in the field. It is operating in a surcharge mode at this point. The Owners requested I prepare an upgrade design. Two test holes were excavated on ,June 17, 1989 for the installation of the existing system. The data is on file ~vith your Department, and are attached for reference. No water was found at the time of excavation. Bedrock was not encountered in the test holes. The lot is approximately 2.26 acres in size. Lot 10 slopes to the south and west at a rate of approximately one percent where the new field ~vill be placed. The ground slopes off at 20 to 35 percent to the north, west and south. The proposed installation will be located approximately 30 feet from the shoulder of the slope. The proposed location will be greater than 100 feet away from the existing wells serving this property and 25 feet from the water service lines. The surrounding systems are located greater than 200 feet from the proposed installation. The proposed installation will not impact the future development of the surrounding or existing lots. See attached design. The new system will maintain over six feet vertical separation to the bedrock and over four feet vertically to the ground water. Please contact me at 272-8218 or 227-3522 if you have any questions. Sincerely, Attachments: C: \WO R K\ LE-'~r ERS\ I O-SPROSPECT.OO 1 .DOC PE~HiT ND, SWO0 DESIGN WASTEWATER ABSDRPTIDN SYSTEM LOT 10, BLDCK 5 PROSPECT HTS S,D *~-...EXIST'G WELL P.I.D, ND' EFF. EXIST'Oj WELL C,\WorR\DRAWING\IO -SPROSPEOT.D;/G EXIST'G ~IN FAILURE 1ST'G GARAGE ~F~IN~TALL DIVERTER VE & DOUBLE PREPARED FOR, Mark & Lynn Anderson 9401 I~uddy Verner Drive Anchoroge0 AK 99516 346-1B98 EXIST'G 1250 SEPTIC TANK EXIST'G 3BR EXIST'G '-"--WELL DESIGN, 4 ~EDRBDM HOUSE PERC RATE 2 MIN/IN SOIL RATINO~ 125 SF/~R 500 SF ROD DEEP TRENCH, 5.0' EFF. TnTAL DEPTH = 9' 50' LONG TOTAL AREA=50D SF PANNDNE ENG. SVC,LLC P. 0, BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 Phone & F~x DATE, 9-17-00 I DESIGN SCALE, 1'=60' PERMIT NO~ -~V000134 um iUl DETAILS ~/ASTEVATER ABSORPTI[3N SYSTEM LOT 10, ]]LOCK 5 PRDSPECT HTS S,D PJ.9. NO* 5.0 m L.d C=\Vork\DRAVING\10-SPROSPECT,II~/G PREPARED FDR~ H~rk & Lynn Anderson 9401 Buddy ~/epnee Dplve Ancho~'mge~ AK 99516 346-1BgB PANNONE ENG. SVC., LLC P. D. ]]DX I0~954 ANCHORAGE, ALASKA 99510 ~7~-BB1B PHONE & FAX DATE' 9-17-00 NOT TO SCALE DESIGN MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES J.. y~n¢ ~n dct'-x'on ~ SEPTIC ABSORPTION AdOress TANK FIELD WELL Phonets} WELL l 0 f r ~ 130 t LEgaL DESCEIPTION LOT LINE ~ SEPTIC ~ HOLDING / Materim No. of Compa~ments / TYPE OF SYSTEM.~/~ ~TRENCH ~ BED ~ W. DRAIN ~ OTHER ~¢' / Depth to p~pe bottom f,om Total depth from original grade )~ -- Fill 8dded aDo .... iglnaJ grade Gravel depth beneath pipe Gravel length Gravel w,dth / Total ab--~rpt ....... Distance between enes / / NumberoJl .... So,lrahng jP,pematerial F ~fO ~r~ - . ....... Class~hcahon (A.B.C) Total Depth Cased to ~ Insta[le~ Ome Installe& REMARKS: Scale: Itt =ff~ t ~NGINEER'S SEAL' ' ~ rr i~;~l ~ ~o~ ~ [~(V~ ~ v~r a~ 5e~ Inspections Pedormed by: , ~~ r ~ cedi,, ,hat this ,ns,,ai0n was ,eflormefl agg0rflin, 1~ all Heallh DepaHment Approval: C~ & EN~ON~NT~ ENG~EER~G * ENERGY CONSERVA~ON & ~YS~ T~ODORE F. MOORE, P.E. PH: (907) Robbie Robinson M.O.A. DHHS P.O. Box 6650 Anchorage, AK 99519 October 2, 1989 14530 ECHO ST. t'4 UN~ I~I~C)~(~KA 99516 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 5 1989 RECEIVED Dear Mr. Robinson: You have requested a written explanation of the reason why a two foot thick sand filter was not installed under the gravel in the course of the construction of the recent septic system upgrade serving the residence on Lot 10, Block 5, Prospect Heights S/D # 1. The simple answer is that the soil absorption bed was constructed to the specifications shown on the engineer's design, as approved by permit # 890146 issued by yourself on 8/2/89. The reason the engineer's design did not incorporate a sand Hlter should be evident from the log of test hole #1 dug on 7/6/89. This log indicates that the accepting soil itself is predominantly a poorly graded sand, underlain by a silty sand which would have a slower perc rate than the accepting soil. The only reason I conducted the perc test was to confirm the visual soil rating. I then sized the bed on the basis of 125 square feet per bedroom in an attempt to be slightly conservative with respect to the measured perc rate. The soils encountered during construction appeared to conform with the test hole soils. I trust this will alleviate your concerns. Sincerely, Ted Moore, P.E. Pal-c:e]. :lid: '015-091-42 L.e't'. I...ega 1: L. cit Size 992()C l"P:¢.x Bedr'c,o..'ns~ 'Fi-lis F'(r:gpn) J.-h= 4. '~'r{])tat Capa,::::i. ty: 4 F:' E: R M i "1" Day Phone :i1 CE;F;d!' ]: I:::'Y 'THAT i', f'c.,'r"Lh by the Mur-.,i,::::i. pality of' (-:it-tchcmage (I"IOA) arid the Sta't'..e o'[' Alaska, 2,, :1: ~,,i:i.l].:i. nst'..all the sys{.em .i.n acc:c:,r'dar'tce ~/,,~:i.'t.h all I'."tOA c:od~s anti and :i.n compliance ~,,.~:i.!:.h the des:bE]n cr,:i, ter'.:i.a !::'.,~' th:i.s p,'.:...u-m:i.'l:.. :3, I ~vi:[i adher, e 't'..(::) a:l.]. MOA and S't. ate .c.;{ A:l. aska p~:~,~cjL',:i.P(-:~rfler'it':~ {(::ii- the! set bac:k (::!i!;FLal],'.::es {'POrn any ,existing ~,,~e:!.!, ~,,~a. ste~;a't, er disposal, system of se:,wE.:,i-ag,,e system ,'.::in '~:.hJ.s Ol- ar]y ac!.jacer'~t (::m near'by lot, · '%,, Il Ltl]Ct~;.>!r'?..sta!]d '?..ha'h th:i. EB j::h'l.-)Plii:i.'(. J,S.:- va].J.d ~'lDf' a fl],2:U<:i.I¥1L.Uf~ (:1)~' ZI. I:}E, dpc, c)rfiS,, also under's't, and ",:.hat the capac:i, ty ,:.:~¢ '~..i"~8 to'Lal syste, m :i.s 4 I::>edr'ocim~!~ and ariy (.~:,n].ap(.;~l[emel]t w:i.J.:J, r'i~:,qu:i.r'e ar! ach:J:J.'[.iE)F!,.?~.]. .~. ssu.(ed t.'.*'y'n DATE/: :I ,/ 'I'I'-'i :i: 8 SYS'!"E:M I S TO BE :[ N.S'f'AL.L..E),} l t',t ACE;ORDANCE W 1[ 'l'H I"I'..IIE AI:::'I:::'ROVE:D li:i:l',l[:i I h!Eti:R ' S )::)E:S 18t',I ,, DHHS MUST )::)liii: i',I(::I'T :£ F' :I: t!!!:D PR I ,'.:)I';.'. T:{:) AI....L :1: I\ISI:::'ECT'['. .... :[ON,"!!i~ 'N"I]:E:; F'E:I:q"I:!:T ]:[iii l:.:3:~iiUl!'.~t;' i::: (::)1::;; A 4 B!i~:DF-:,'E)ON .S :I: NGI...I!i: F:'AM]:I....Y I:::EEEi:I:.i_)Ei:IqC!!Z ONLY, AND E:XI:::'IF/ES ON i2/::!!;:I./89. A I...iF:T S'!"(¥'FION W]:L.I .... RIE6!LII:I::,'IE THE: AF:'F:'ROF:'R]:ATE EL..E:C'f'!::,']:{:::AL.. Flattop Technical Services 14530 Echo Stzeet ~t=er'xc 7",~at tx OLD ~.THEODORE F. MOORE, CE - 3589 ~,' .~ ITE PLAN L P~ ~ Y ; TFi~ Echo Stree! Lot 10, Block 5, Prospect Heights S/I), Add'n. #1 9401 Buddy Werner DriYe, AnChornge Septic System Upgrade Specifications I. This septic system upgrade for a four bedroom residence consists of a new 1250 gallon septic tank followed by a 22' by 35' soil absorption bed constructed with the bottom of the gravel 6.5 feet below the ground elevation at Test Hole # 1. The configuration shall be as shown on the plans except that minor deviations may be allowed or required by the engineer conducting the insl~ections. 2. All construction practices and material specifications shall conform with M.O.A. regulations. , 3. The existing septic tank shall be pumped, removed and properly disposed of, and replaced with a new 1250 gallon, two compartment steel septic tank. The line leading from the tank to the soil absorption bed shall have a minimum slope of 1% and shall<Be insulated with 4 inches of burial type insulation for the full width of the ditch. 4. In the soil absorption bed special care shall be taken to ensure that the array of perforated pipes is laid level with a minimum of six inches of approved sewer grave] beneath the pipes and another six inches surrounding and covering the pipes. Filter fabric shall be placed over the sewer gravel before backfill. Cleanouts and monitor tubes shall be installed in the locations shown. 5. The final surface shall be graded to drain and appropriate barriers installed to prevent driving or parking vehicles over the soil absorption bed. 6. Three inspections will be required during construction: (I 1 initial stakeout, (2) after the bed is excavated, but before placement of gravel, and (3) after the septic tank is installed, the gravel is placed and the pipes laid and fully connected, but before final backHll. PERFORMED FOR: LEGAL DESCRIPTION:, 2 4 Flattop Techn~caI Services 14530 Echo Street Anchorage, Alaska 9951R Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: 7//'O~'/'¢~ ~ ,~ /~,~'~.~/~c~' /~/'~ Township, Range, Section: SLOPE SITE pLAN 6 7 8 9 10 11 12 13 14, 15 16 17 18 19, 2O OOMMENT$ Oepth to Water Alte[ Monitoring7. o(r'/ Dale: WAS GROUND WATER ENCOUNTERED? ;ri s L ¢, I~y ..~Ot~l~ DEPTH?IF YES. AT WHAT PO Reading Date Gross Net Depth to Net Time Time k~/-l~,.) Water Drop ¢,..~ Pr~/,t 7/6' ~':~ P//' '~o" °. PERCOLATION RATE ~ / (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 7~ O~ FT AND 7,.fi" FT ~' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: _ "~/~:~' ~",~::~ Flattop Technical Services 14530 Echo Street Anchorage, Alaska 9951R Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: 7//0~"//~:~ 1 Township, Range, Section: SLOPE 11 12 13 14 15 16 17, 19 2o COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? p E Depth to Water After AlonitorinD? Dale: Reading Date Gross Net Depth to Net Time Time Water Drop TEST RUN BETWEEN __ PERCOLATION RATE __ (minutes/inch} PERC HOLE DIAMETER FT AND FT PERFORMED BY: .~"~/z~',~ 7~,~JJ';O~l/ S(~..~. I T~ ~ CERTJFY THAT THJS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THiS DATE. DATE: ]~OX ~9, STAR I~OUTE A ANCItORA(~E, ALASKA 9950~ SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DePTh Of DRILLED AT THE RATE OF ~22.o O0 PER FOOT. PROPERTY OWNER ~. /~e ;~J~j. S~/~ ~0~1 ~ ig~o~o~.e 300 9.9507 Sub. LOCATION OF WELL SITE. DRILLER WELL LOG: 0 .... 2..3' S45L4q. q~tre.,L, S¢~e.,~.,L .~m.a.,t.2~ bou~dew~a..30fg 23---68' Sar~&~ cJzuj., /.Sfg q~' 68---92' ~d~. A ce~e~ ~o ~ ~o~ o~ t~i~ ~ot~ u~ 285 200 ,f.¢~ o~ ozaZe, z ,~,tand~¢ ,Ln. ~. ~ 1~6 ~ p~ ~oo~: 320 q~ ~ r~eo MUNICIPALI~ OF ANCHO~GE DEPT. OF HEALTH & C044 o~ ~.~: 922.00 ~ ~. X 250 ~.c~ o~2.: 95500.~VIRONMENTAL PROTECTION no ~¢¢ ~o~ g~ s~. OCT 6 t989 - ECEIVED WRITE CHECK PAYABLE TO RA~ D~LLING WORKS FOR ~NE~U~ OF ~5~0, O0 , ' B .-.~ -- ~, ~O~( ~ ....... : SIX INCH WATER WELL.DRILLED AND CASED OUT TO THE DEPTH OF _ · ..: ., '. . .; .-'.1.., -: ~' ,:.. .. , ..' · " .~1 DRILLED AT THE' RATE'OF: ' 8.00 ' PER FOOT. · ' - · · ...... ,.-.:- ~'~..:~!,~.:~._.~::~ .:~:';..'..,-~,.-,~... .. PROPERTY OWNER".':;'"':~f~;-'Ht-ke. ]~e]-~ SR& ,~ 4gX_ 99507 "' ' -' -'-J.,f.';:; '-' -. :o"l- . '-¢,;.~ · --.:,:... ~ . LOCATION OF WELL'SITE' 'ff;T:t. i0 Blk. 5 _p~ospect Heichts Sub ,~ ~ :~nchora~e 43---92' Silty gravel with th~u stre~s of clay. 92--186, Sedimentary rock~. Bedrock. 186-193' A granu/ar rock Showing some si~ns of water. Pint per m~nute. 193-270' Sedimentary rook. 270-277' ~ore sign~ of water. Possible q,,~t per m~uute. £77-33~' Sea~mentary rock. L...;.~:" . ~ .... ' ' - Total .accmm,l~tton of Yield:. 1500 gnl.~ per 24 h°ur day and should improve to 2000 gals per day after a few' days. use~' Over 200 foet of water stand, in we2D.. bottom. Or~e horse t/d~p should bl~~A'j'~j~O~w,.~__~ Off DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 6 t989 RECEIVED COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING VVORKS FOR THE SUM OF ~HANK YOU VERY MUCH. DAT~E June 26th, 77 $6174. O0 BERNIE CLAUS OF RAMPART DRILLINg WORKS .::UNICIPALITY OF ANCHORAGE Heal, 'and Environmental Protec Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWA©E DISPOSAL SYSTEM LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL_ IN SLIDE LENGTH MAP4UFACTURER ~ INSIDE WIDTH MATE RIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY /E.)OO GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL ....... FOUNDATION # of Lines DISTANCE BETWEEN LINES ABSORPTION AREA ~/G DEPTII: TOP O[- 'TILE TO t'!NI$it GRADE NEAREST LOT LINE__ TOTAL LENGTH OF LINE _TRENCH WIDTH '--~--~IN. TOTAL EFFECTIVE __ SQ. FT. LENGTH OF EACH LINE ©EPTlfi OF FILTER lVIATERIAL BENEATH TILE ABOVE 'FILE .IN. SEEPAGE PI'F: Log Crib Rings BUILDING FOLJNDA-FION r~,,,r--,-H Dh':'.METER OR WIDT/t LL,=',¢, DEPTI-t Crib Size: DIAMETER .... DEPTH__ DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE ABSORPTION AREA (WALL AREA) ___ _SQ. FT. Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~ of Bedrooms: ~ Installer: ~.~ Remarks: i 1 ! 1 Fill:::'i:::'Lill(i::FilNT I"I.1:i<I:?: I<iELI..tii("r' SI:~'.!:::I E',O','< t...Il) Iil]:l:';~! T :il J][ilJ",l j~i!li.j [)[)"r' [.,.jiiiil~!il:;;IJ... I....::I.E~ li~',!:,~i j;:;'j;i]:(])i~i;J;:;'J!~)]][;T HG'l'::ii; 'i'HIE i:.i:1!:~:(;!1...i .1: Iq'.l::;;[:, S .1: ;;i!:E; (i.1F TI.-!IE :E.;;O :i: L.. i::t~I:;.:;I;)i:;i:P"i" 1[ Ol'.il S'-r':E;'I"IF.~]"! I :ii;: it;;::,, E~:E i~:::::" *T If.il ....... ::;;ti .. ;;;;il: I!...... EEl P.,ill !C;i{ii "IF' il--i! ........ ;;~-'~'~t: !551 C:i~ ii::,;:~:: .~:':;~, "",,'¢' !l!~iE II ...... 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E','.r' "t'!...i I;)IE!:::'i:::i!:;:"i"i'filEi'.,l"f' i.,.IiI_L li!i=lili; :iS!...1ii~L.1'liii;C'l" TO i',il:f;l'.,!]:i"1tjhi t;;:, .1: :!ii; T Fl t',l E: I!i!; !i!i',i:iiYl'l.,illii;l:Ei',i I;:1 I.,.!iEI..L F'llXii;)l::illq"r' Elt'4-:iii;t'i"iE SIEI41:::t(ililE 1:)];:SPEd!!;I':iI.-. :i.:;"r'S"f'E] i~'' r::. c:. - - · ' ;::::~ F'lEli:('i' I::'Chq;: i::il I::'l:'"~'h:::ri"iE 1,1[:'1....I.. r'l:;i: 2::':-':1 ..... ~ i; j:::'(;li:;:: I;::t pl_liii! l.. .1' E: I,i!Ei. I. ~.IIE!...I.. !_..(;ill;]:iii; l::ilR[-i: I:;ifiE(iill...i];R!E[)1:~:I1'.4[)t-,ill..l?T' BE: I;:I?'I"I..tI:;i:I'.41ED 'T'O THIE [)IEF:'FiI:;;:"I"i',ltEI'.,IT hl'l'""H/;" '.~:~F~ ...... Df::" THE; I-,ll:::'L..i.... '" '" I"i :::I I::!"" .1: O '., .... ,. .: '::' :' 'I'EI l[ t'.,ISI...IF::IE :::'I:;' '" I:::'I~:' :;' :!ii;l:::'li!i; E: ;[ F ;[ C:t:::I'T' i Ot'.,l:i~; I:::ii'.,1[) '": '" t'-l':::;"i"l:;~' ~. ;';:'" ] i I'., [) ]; I:ilGl:;~:l:::ll"i:i~'; I::llq:IE I I , . I .~_..1~ . :i; 1'-,l:5"i'l:il LI_ F:IT Z t];;11'.,I. ii-:::::" E:E iF;;~:; li"'q~ % '"ii'" ",,,,,," ~l::::fi IL.... :ii;; ii;;;,, IF:::" t(;[])i 8;:;;,]: ~;]]];.1l Ih.,!l EEl ".-~r' IiEE E-::I! li::;;;;: il::::' B::;;ii'.: E:]) th'il :ii;; ::i~E,; :ii~;; Il....~ iii!E:; ]: E:lili]:.:.:'T .1; F:'"¢ THI:::I'i" . ~ .. .:.f ! ....l il l ..... F:'([)F;~: -I'i'""'::;' "1'1~; '::1::::I.,.i1~;:;~:5 I:::I1'.,1!;) I.,.!li-]...i....:i:~; I::IIE; ,'i::'"r' :il.. :i: I:::it"1 Fl:::ll"'i :[ t...1: F:!I:;;: 1.4 ;t; 'il"H 'THE; :;' ii:' ':)i i [ ..... ~:" ' ": ..... ' ........ .::'r;'ll:~"t"i..l I'",' ' THE I',il..1N .1: C .1; I:::' FI I.. . .1; T"r' '"il::' · "' '"'"'""'"',' "i'.i t'"1 ........... I......lfll,,....L.I.,.!l"il'l'4 2 :t; P.I;[I...L. ;[i",!'.STI:::t. Tl-Ilil:; ,'~., ::. .. · ............;, ',i"'::' ... ................. I::.~ !'"11:::!? I:;:".E)]:!I-III::i:t~'[ F't"ii l:::lj:;i:r '"E", .... il;t:: '.1"Hf!'~; ;]i: · ;[ I...ll'.,l[)t!(l:;;:'.:il;'T :: ", ;;:' 'il"Hl:::lT 'THIE '" I'.l,,.'::: "'I"F '::: I:::'1.,.1~ I:,; ......... · ' I:;'E"::: T I;;:,11:;]'., t: ~: I 'mE; i::~'.IEYl "; I':'t.EI..mlZ :' "['E! ]; I'"t :; t I :51; I (iiii'.4 E D: ................................................................................. I:::!i:::;F'I... :1: ::; !:: i,Ff f"l ]; i'::IE LOCATION SKETCH 352' Lot 10, Block 5 . . Prospect Heights~NO. 11 i'. Subdivision -. Not To Scale. Distances shown are approximate and have not been measured by ,-_". · surveying methods. 0.0' SOME 'GRAvEL (SM) )eeasionai Cobbles (sM) ~ Many CObbleS ~ i : -- ! -- --- 6.0' S°~ s~: (s~): ~ Bro~, 0ccasional:;Cobbles ~RavEL (S~)~ subSurfaee, ~0il ~:!i(.: : PERCOLATION TEST Mike Kelley TDC No. 77A-139 May 31, 1977 TI~ ELAPSED TIME INCHES DROP IN INCHES 2:25 0 36,00 2:26 1 36.50 2:27 2 37.00 2:28 3 37.50 2:29 4 38.00 2:30 5 38.25 2:35 10 39.50 2:40 15 40.75 2:45 20 41.75 2:50 25 42.50 ,~_2:55 30 .... ' 4~ 3:00 35 44..2'~ 3: 05 40 45 3:10 45' 46f~ 3:15 50 3:20 55~ 47~75 0 .50 .50 .50 .50 .25 1.25 1.25 1.00 .75 1.00 .75. 1.00 .oo .75 12.5 In£b Total Drop 4~8 Minutes/Iach g=am size fined acco=ding to '~a~' rno'~iEi~rs 'cE the major elements. For cohesive soils other major' soil 'c0nstitue~s .U'~d as ~odif~ are such Ehat theclaydom~ates so~ proper~;,.'Mmor,~bit:~ddhs-~itfi~h~:s:may b~ added ~6 the class~ication: breakdown ~'acco~ahC~ with:~h~ paCk,cie size proportion listed below; i.e. sandy silt w/some gravel, trace clay. no c~l - 0 - 3% trace - 3 - t2% some - 13 - 30% SOIL CONSISTENCY - CRITERIA: Soil consistehcy aS def~ed below and determ~ed by normal field and laboratory methods applies only to n0n~zen mater~l. For these materiaIB, 7the-influence 0f such faC~0ts ~- k62 s~'J.~"~'j'~, i'.e. fissure -systems, shr~kage cracks, slickensides, eec., mus~ be t~n Nfo consideration ~ makNg any correlation wi~h the consisten~)~alueS lis~ed.below; In permafrost zones, ~he consist.ency ~a' strength of frozen'~6~ls, may une~lainablywi~h ice content,~ :the~ai .r~gim,6:andt'~62 Coh'e'sionlass - t;: ...._ ~; .//-: ~.' :_;?'.?.:.;.. _ _~ ;. 7"'-~ 'Cohesive' Loose 0.- lo-.. -'~ 0 to'40%: ~' -:: :;':7 - Ve~ Sof~ 0 - 0.2s ,Medium Dense i0- 30 - '40 ~o-70%: "'": '[.:': : Sof¢: 0.25 - 0.5 Dense " 30- 60 70 ¢'0 90% [2_-. _ct':_( :. Stlff' 0. S - 1.0 Very Dense ' z 60 90'to 100%`7` '-(-; /.?:'u/.(::. Firm ': i. 0 '.- 2.0 *Stand~d Penetration 'N":' Blows ncr fool 0f a I40-pound hammer falling 30 '~ch6% on a. _- [ ~:t.][? ':'../7-. -~ ~2k'~ )~7 2-inch OD split-spoon exceptwhere noted.' . · ' .- ' , . DRILEiNG~M~LS wo: .- · · WL: Water Level' : BCR.J:.;Befo;~:Cas~g Remora WCI: Wet Cave In ,ACR:-!AE~e~'CaB~g k~moval DCI: ~y Cave'~ 'i- : "q :-:-~ABi.~,',.5,After.Bbtihg,-~-' , No~e[ Water levels ~dicated oh the'boring' iog~' a'~:~h~ i~f~'meakured in the boring at the times Ndicaeed.~ ~n pervious dnfk~'aan;~6iil] eh~-indicatea Oleuaeions are 'considered to represent ae'tual g~o5na Wate~'dondiei6~k2' m"~pervious and- · frozen s02s, accurate determinations :0f gfohnd'?~e&f'eieVaeions cannot b'e obtaNed within a l~ited period of observation and o~he~.%kid'efiCe:~a:gtb~d water elevations and conditions aze requiredi _ :. DWN' L.DS. B. E- 3- 1-72 '--:~ C0NGLONERATE':: :~' :: ' MET~ORPH C ,2 ..... ~j SANDY S~L.T ~ SILT ~-SANDY GRAVEL, ~ ~1 "SCATTERED COBBLES  SAND ~ ' INTE~AYERED SAND ~uDsTONE ' - - CE- SILT ' ~ .... ~ '0 SANDY GRAVEL GRAVEL LIBESTONE ORGANIC SILT SILTY CLAY w~R. S~D SABPLER TYPE SYNBOLS '. . St ..... 1.4" SPLIT SPOON WITH 47~ HAB~ER Ts .... SHELBY TUBE Ss ..... L4" SPLIT SPOON WITH 140~ MA~ER Tm,. BODIFIED SHELBY TUBE S~ ..... 25" SPLIT SPOON WITH I~0~ HA~ER - ' ' PN,-.,, PITOHER BARREL Sh ..... 25" SPLIT SPOON WITH ~O~-,HA~NER~: . ...',- . · C~.';, ,.-CORE BARREL WTH SNGLE TUBE SD ..... 2~" SPLI.T SPOON, PUSHED .. -. -'~ ~-'~ "' A,r· .':. AUGER SAMPLE Hs ..... I~" SPLIT SPOON DRIVEN WITH AIR HA~ER :.' .G.,.: , GRAB SANPLE ..... SPLIT SPOON DRIVEN wITH AIR' HABNER "-'. ~-- NOTE' SABDLER TYPES ARE EITHER NOTED ABOVE THE BOflNG LOG OR AD~AOENT TO IT AT THE RES~OTIVE- TYPICAL BORING LOG ' d SW~PLE~ TYPE.Ss st mate 65% V~si~l~ Ice ' .~ ' SANDY SILT ~' CHA~G~ W~TEP TAELEE SANDY GRAVEL. .. ~AMPLE LOCATIO~I-, ' ' ' · ADDITIO~IAL DATA AVAILABL~ O~SUPPL~ENTAL LAB May 25, 1977 ' : R&M No. 751165 Paul Jackson The Drilling Company P.O. Box 8718 Anchorage, Alaska 99508 Attention: Mike Kelley Subject: Soils Investigation for Sanitary Sewer System, Lot 10, Block 5, Prospect Heights No. 1 Subdivision, Anchorage, Alaska Dear Mr. Jackson: ~ At your request of May 19; .1977'i-we'c0~Su~eda subsurfa~e.soilsinvesti- gatio~ at the propose~ locationof the Sanitary sewer system on the subjec~ lot. The investigation complied with those p~ocedures required by the Municipality of Anchorage, Department of Health and Environmental Protection. This investigation~ which was acComplished'on May 20, .1977, consisted of a test hole drilled to a depth of 20 feet below the existing ground surface. The iocation of the test hole is shown in attached Drawing A-01. Drilling took place with a rotary drill rig using continuous- flight, solid-stem auger.with an outside dia~eter Of 6-inches. A sample was taken at the depth shown on the .soils log in attached Drawing A-01. This will be held in storage at 0ur-lab for approximately six months. In addition, all material brought~o the sur'face by the augers was continuously monitored by an experienced engineering geologist. The topography at the drilling site is'generally gently~sloping to.~the west. At the time of the investigation ~he sltehad~origlna~l vegetation and groundcover. The top of the test hole was located in an excavation approximately 1 foot below original ground surface. The soils encountered in the bore hole are shown in the test hole log in Drawing A-01. Groundwater was not'encountered in the test hole while drilling. Bedrock was not encountered. Subsurface conditions may vary in other parts of the lot May 25, 1977 Paul Jackson Page -2- We appreciate this opportunity to be of Service to you. us if you have any questions concerning this letter. Very truly yours, R & M CONSULTANTS, INC. /. ~ ~. /' JMA:LS:gld Attachments: Drawings A-01, B-01, B-02 Please contact Robert L. Schraeder Associate Dept. of Health & Environmental Protec~i0h drilling company, inc. · 8901 toloff, box 8718. anchorage, alaska· 99508 MaY 31, 1977 TDC No. 77A-139 O Mr. Mike Kelley SRA 49X Anchorage, Alaska 99507 RE: Test Hole and Percolation Test for Sanitary System, B.L.M. Lot 167, Section 33, T12N, R3W, S.M., Anchorage, Alaska Dear Mr. Kelley: In accordance with your request, one test hole was drilled at the designated location on your property. A percolation test was con- ducted in the test boring. The results of the percolation test are shown in the attached Table 1. All depths were measured from the ground surface. The resulting percolation rate was 4.8 minutes per inch. Should there be any questions with regard to the enclosed information, please do not hesitate to contact us. Very truly yours, THE DRILLING COMPANY, INC. Paul L. Jackson Senior Geologist PLJ:la Encl. a/s · anohorag e · fairbanks .aloe~?' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY '~/~)1~- 09 ]- ~J~ Application Date 2/ GENERAL INFORMATION (MUST BE COMPLETED PRrOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner ~t~r~ ~- ~y/t¢¢ /z~d~'~ Telephone: Home :~ ~/d'- .~Oo~:~' Business Mailing Address ~ ~"'d.~/ ~,¢~¢,t'p, ~.~"¢¢'4¢f pr. ,,~,4 0~,o,""~¢/ ./~(c ¢'¢5"'/0 (c) Lending Institution (~'/~. Telephone Mailing Address (d) Real Estate Company and Agent Address '~'33 I~e/t~(,' -~1~.., Telephone · ~7~-- (e) Mail the HAA to the followina address: or; Check h~e ~, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family [~ Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conserq~tion attesting to the legality and status. ~' "'. 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 1 of 2 72-025 IRev 8,86~ Fronl ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of 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 ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _ ~'(¢C"/~(P ~'~c.~C~f ffc'¢.~ Telephone Address ~-~¢--'~:~ ~_¢_.~ ,~/~_~_ C~O/"c~z~ ~ Date -~'~'~7~ ~ /~ Engineer's Seal DHHS APPROVAl/' Approved for / Approved Terms of Conditional Approval .bedrooms by/~/¢~/~"~'~/'~;~ ' Date Disapproved Conditional CAUTION 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. 72-025 fRev 8/86~ Back Page 2 of 2 A. WELL DATA Well Classification --~ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) MUNk~/OF ANCHOP'~C~CKLJST - FEBRUARY 1984 ENVIRON/~II~I. ,SERVICES DIVISION 843-4744 SEP 2 7 ]989 RECEIVED Pr~v~ Legal Description: Well Log Present (Y/,N) !_ Date Completed =~ ~/..~ ~, ~t Cz/ ...... Total Depth~-~. $~ Cased to~z !t~' Depth of Grouting Static Water Level ,Ir./. ~' .#~ ~' Casing Height Above Ground #'/- ~' 4f~- '8' · Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM YVELL: ( Or,~ To Septic/Holding Tank on Lot I~l' To Nearest Edge of Absorption Field on Lot 13~' To Nearest Public Sewer Line N,~. To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results .~z~q.~.~c/~r~ - (-¢¢' f Comments Pump Set At ~1 - 5Y/' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date ~ ~ ~/ B. SEPTIC/HOLDING TANK DATA Date Installed ~//Y('~ Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Air-tight Caps (Y/N) No. of Compartments ~ Foundation Cleanout (Y/N) Date Last Pumped I\h R, ; for Temporary Holding Tank Permit (Y/N) TO Water-Supply Well . . To Property Line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field ~0' '+ 72-026 (Rev. 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 9/ /¥/ ~ Width of Field '~ ~' Square Feet of Absortion Area .Depression over Field (Y/N) Results of Last Adequacy Test /'~r~ Type of System Design Length of Field 2'¢' / Depth of Field Gravel Bed Thickness /',~ ' Staj/ndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well 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 Comments To Property Line ~9 ' To Existing or Abandoned System on ; On Adjoining Lots ~ -~ ' To Cutback (if present) D. LIFT STATION bI, A. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guide.~t~br~9.ffect on the date of this inspection. Signed ~"-.,~,~4_- Company r(~ T~a;ca[ ~,~ . ¢......... ........,.... .....~ngineer s Date ~ / E 7/ ~ ~~ .~~ . MOA No. Date of Payment ~ - ~7- ~ ? Waiver Fee: $ Amount: $ 1~' ~ Date of Payment 72-026 (Rev. 7/88)Back Page 2 of 2 NORTHERN TESTING LABORATORIES, INC. 2505 FAIRBANKS ST. ANCHORAGE, ALASKA 99503 907-277-S378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT [] PUBLIC WATER SYSTEM I.D. # [] PRIVATE WATER SYSTEM /¥~'$o ~ c~ F~ Mailing Address State 9~-~ Zip ~o~e SAMPLE DATE: ~' ~ g'~ Phone :~ ~/~--~ 1~,5-~/~' Mo. Day Year Purchase Order No. SAMPLE TYPE: I~ Routine [] Special Purpose [] Check Sample (for original contaminated sample with lab reference no. Sample Time No. Location ColleCted 3 [] Treated Water I~ Untreated Water ) Collected by Laboratory Ref. No. 4 5 6 7 10 Signature of Representative MAIL HOLD FOR PICKUP TO BE COMPLETED B/Y~LABORATORY Received at: [~nch. [] Fbks. Date Received Time Received Next Sample Due COMMENTS: SATISFACTORY ~ UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Count Verification Final LSB BGB Result* - Comments Date /olif~.~ Colonies per 100 mis.  ~0R~HERN .... TEST"NG LABORATOR~ES, 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 INC, 907-479-3115 907-277-8378 Flattop Technical Services 14530 Echo Street Anchorage, AK. 99516 Attn: Ted Moore Source: Lot 10, Block 5 Prospect Heights Sample ID#: A062889-7,8 Date Arrived: Time Arrived: Date Sampled: Time San]pled: Date Completed: 06/28/89 1205 06/28/89 Various 06/28/89 Parameter Unit A062889-7 A062889-8 ADEC MCC* Old Well New Well Nitrate-N mg/1 .09 3.9 10 Reported By: Date: 06/28/89 Francois Rodigari, Anchorage Operations Manager ~ MCC = Maximum Contaminant Concentration CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ANALYSIS REPORT BY SA~PLE fo< Work Orde< ~ 14642 Date Report Printed: JUL 11 89 @ 14:26 Client Sample ID:LIO B5 PROJECT HTS (NEW WELL) PWS!D :UA Colioeted JUL 6 89 ~ 19:30 b~s. ~eceived JUL 7 89 ~ 16:15 hrs. Preserved with :AS REQUIRED Client Hame Client Acct P.O,$ VERBAL Req $ Ozdered By FLATTOP TECHNICAL SRV FLATTOT Analysis Completed :JUL lO 89 Send Reports to: Laboratory SuperT~.~ r~TEPHEN C. EDE IJFLATTOP TECHNICAL SRV Special Instruct: Cher~ab hsf ~: 6153 Lab Smpl ID: 1 ~atrix: WATER Allowable Paramete~ Tested Result/Units Method Limits NiTRATE-N 4.0 mg/1 EPA 353.2 10 Sample SA~,~LE COLLECTED BY 3 F MOORE Remazks: Tests Perfozmed ' See Special Instructions Above UA~Unavailable None Detected '* See Sample Remarks Above Not Analyzed LT~Less Than, GT*Greater Than  .CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. Drinking water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# I I I I I I J [~ PRIVATE WATER SYSTEM Name Phone No. Mailing Address City ~f State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose .) [] Treated Water ~ Untreated Water TO BE COMPLETED BY LABORATORY saSis shows this Water SAMPLE to be: tisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. SAMPLE Time Collected NO. LOCATION Collected By Lab Ref. No. Result* 615.3 ~ Analyst READ INSTRUCTIONS Membrane Filter:, Direct Count (~ BEFORE Verification: LTB BGB COLLECTING SAMPLE Final Membrane Filter Results ~) Reported By~:~,~~~~ Date Time: TNTC = Too Numberous To Count OB - Other Bacteria BACTERIOLOGICAL WATER ANALYSIS RECORD ColiformH00 mi Coliform/100 mi MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date -~/~ /~'7 GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name J~ I,c~, J~,llry Telephone: Home ~ ~/'~'- /~5'¥ Business Applicant Address ~(O/ ~'~c.,(7 64/e~',~¢~' Pri,,~.~ /-/,,~c/te~r'c~vg'~ ~ Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Al~Jf'~r ,.'-t,.<~al ~,~/¢- Telephone Address ~0 I ~. ~ ~ ~ ~c4o~ ~ (e) Real Estate Company and Agent ~. ~. ( ~ ~ q~ ~ ~ Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms -~ Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 5,. , :~NGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of 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. NameofFirm r/~-,//e? '-f'~.J~,t~'~_~/ -.c~"~'~c~'/ Telephone ~?~'/~ Address I ~/~ ~c4~ ..~ .A~~ ~ ~/~ Date ~ ~ 1¢~ ~ DHEP APPROVAL Approved for bedrooms by Approved ~ Disapproved Conditional Date "~ Terms of Conditional Approval 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. MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DI"/I$tON MAR 4 1987 RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Classification Well Log Present (Y/N). Total Depth .-~. _~-..~_~ Static Water Level ~ - Io2' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) If A, B, C, D.E.C. Approved Date Completed ~P~/~/~ ......... Depth of Grouting N.~. Pump Set At ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Y N Separation Distances from Well: -#l- too' ~ C.o. To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot~ - 1~' ; On Adjoining Lots ~ t~' To Nearest Public Sewer Line ~ ~. To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments SEPTIC/HOLDING TANK DATA Size IOOO~cJ No. of Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) N Date Last Pumped /~./~. ; for N.,4. Temporary Holding Tank Permit (Y/N) Date Installed Standpipes (Y/N) ~ Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ! ~?' 4~ ~..*~ttl _~ ~. To Property Line ~ (o' To Water Main/Service Line H, A, Course ~ too' To Building Foundation q ~- ' To Disposal Field I ,¢" ' TO Stream, Pond, Lake, or Major Drainage comments Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed . [o /¥ / 77 Width of Field q~" Square Feet of Absorption Area _,~t ~' Depression over Field (Y/N) ~ Results of Last Adequacy Test /~'¢¢~¢'~f~' Separation Distance from Absorption Field: lO~~ 40 o~,~tf del '/~"¢4'"~ Type of System Design Length of Field Depth of Field to' Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Water-Supply Well I fi3' To Building Foundation Lot N, A. To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~, To Existing or Abandoned System on ; On Adjoining Lots ~ 5'o ' To Cutbank (if present) _ Comments D. LIFT STATION /~,,~. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ¢'~~ ~. '~ Date_ -.~/'~/<~ 7 ~o~- o~ ~ Signed Company -F(4 ~&/~, Receipt No. Date of Payment Amount: $ ¢'/¢ Page 2 of 2 72-026 (11/84) Engineer's Seal MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION ~" Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE ~ ~ '1. PROPERTY OWNER J[~ ~ ~AI~ING ~DDRESS ~ROPERTY R~SiDENT (If different from abc PHONE 2, BUYER MAI LING ADDRESS  PHONE 3, LENDING INSTITUTION ' MAI~ING ~DDRESS / J PHONE 4, REALTOR/AGENT MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION r J 6, TYPE OF RESI~'ENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY UMBER OF BEDROOMS [] One [] Four [] Two [] Five ~]~ Three [] Six [~] Other 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. Awell Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date ~-/~5'--7 7 If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS sIDE FOR OFFICIAL USE ONL. DATE RECEIVED ~ ~ INSPECTION AppOINTMENTS TIME TiME TtME DATE DATE DATE ~PECTOR tNSPECTOR ~NSPECTOR DIRECTIONS: E~ ONE E~TH REE [] FIVE [] OTHER [~--'SI NG LE FAMILY [] MULTIPLE FAMILY [] TWO [~] FOUR [] SIX ~ERMIT NUMBER 2. WATER SUPPLY [~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified_ LOG RECEIVED PERMIT NUMBER 3, SEWAGE DISPOSAL SYSTEM [~ItXIDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified _ -- ~ INSTALLER ~tic Tank or ~Holding Tank Size:_/6 C? O If Tank is homemade SO~LS RATING give dimensions: TYPE~F_ TANK MAN~:ACTURER TOTAL ABSORPTION AREA MATERIAL WELLTO: 1 Absorption Area to nearest Lot Line 5, COMMENTS [~ APPROVED FOR ~.~ , BEDROOMS [] CONDITIONAL APPROVAL (letter must accompa/~t~cate) [] DISAPPROVED ' LEGAL DESCRIPTION