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SPRING HILLS ESTATES BLK 1 LT 1
Spring Hill Estates Block 1 Lot 1 #015-051-39 Municipality of Anchorage Development Services Department Building Safety DbAsion Onsite Water S Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage sk us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL , FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-051-39 HAA# "H P O / , o A'3 '4 1. GENERAL INFORMATION Expiration Date: Complete legal description SPRING HILL ESTATES S/D: LOT 1. BLOCK 1 Location (site address or directions) 9201 SPRING HILL DRIVE ANCHORAGE, AK. 99507 Current Property owner(s) MARCEYLYN LaPIGUE do ROB RAWLS Day phone (907) 344-6267 Mailing address 9201 SPRING HILL DRIVE ANCHORAGE, AK. 99507 Lending agency Day phone Matting address Real Estate Agent LARRY SURER w/PRUDENTIAL VISTA Day phone _ (907) 273-7766 Mailing address 4242 08" STREET ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well S Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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. Certificates of Health Authority Approval are required for the transfer of UUe (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. (Certificates 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 omisslons in the professional engineer's work Note: Alaska Water and Wastewater Consultants, Inc. shall be pald $400.00 at or prfor to dosing for the engineering services provided. • . 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my Investigation, based on procedures outlined in the Health AuthodtyApproval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and" 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 Mun/cipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Finn ALASKA WATER do WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 28 • ANCHORAGE, AK 99504 Engineers Printed Name JEFFREY A GARNESS, P.E. Engineers Comments: In conducting this evaluation, AWWi;. ina attempted to provide a thorough, conscientious englneodng ana ysls of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation dislancos measured to readilytdendflable loa lures. The operational Eta of all wells and septic systems depend on Me local sous condition, groundwater levels that may fluctuate during the year, and the water usage of the famDybeing served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guaran too that there are no hldden defects or encroachments. AW=, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meof the operational requirements of the ADEC or hf0A DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any othorperson orparryis notauthorfzed, nor Y411t confer any legal tight whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date Zz or Manitenance Agreements Supplemental Engineers Reort Other ONSITE • WATER AND WASTEWATER •. PROGRAM ;A By: tlfil� U�j Original Certificate Date:_ S- 2. S 0 (rw. WDO) Municipality of Anchorage ° • Development Services Department Safety OMSIM on b Water a Wastswa Program .... . 4700 South Sragaw SL P.O. Box 198850 Anchorage. AK 995198850 www.dAnchaage.ak.us (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SPRING HILL S/D: LOT 1, BLOCK 1 Parcel ID: 015-051-39 A. WELL DATA Well type PRVATE If A. B, or C provide PWSID# N/A Data completed 7/17/84 Sanitary seal (YM)_)M Total depth 237 R Cased to 237 R FROM WELL LOG Date of test 7/17/84 Static water level 212 R Well productlon 5 g.p.rr WATER SAMPLE RESULTS: Well Log (YM) YES Wires properly protected (YM) YES Casing height (above ground) 12"+ in. AT INSPECTION 8/15/00 207 4. 6.1 9 - p.m - Conform 0 colonles/100 ml. Nitrate o. 5 mgR. Other bacteria 0 coloNes/1oo ml. Date of sample: 5/14/01 Collected by; AWWC, INC. B. SEPTIWHOLDING TANK DATA Tank Type/Material GREER/STEEL Date installed 7/84 Tank size 1000 gal. Number of Compartments 2 Cleancuts (YM) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Data of pumping 8/15/00 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA N0 RE WHICH TRENCH IS THE [NORTH/SOUTH) DEEPER OF THE 1w0. Data installed 9/20/99 Son rating g.pA fl'/bdrm) 0_6 System type TRENCH Length 49.8/51 R Width 2 fL Gravel below pipe "4.7/5.3 & Total depth 9: 0.1 fL Eff. absorption area 1007 R' Monitoring tube `SES Depression over field NO Data of adequacy teat 8/15/00 Results (Pass/Fall) PASS For—!—bedrooms Fluid depth in absorption field before test32/6 In. Water addedm caul. New depth��1n. Elapsed Tlmeaa=min. Final fluid deptheawIn. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN B yes, give date — Date installed Size in gallons •Pump on• level at_Jn. E. SEPARATION DISTANCES High water alarm level at in. Cycles Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/iift station on lot 100'+ Absorption geld on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhola/deanout N/A Sewer /septic service line 25'+ Folding tank N/A SEPARATION DISTANCES FROM SEPTIVHOLDING TANK ON LOT TO: Building foundation 50+ Property One 5'+ Absorption field 5'+ Water main 10'+ Water service Ona t 0'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT M. Property One 109+ Building foundation 10'+ Water main 10'+ Water service One 10'+ Surface water 100'+ Driveway, parldng/vehide storage 50'+ Curtain drain NONE KNOWN Web on adjacent kmt9 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I cer* that I have determined through field brspecdons and ! 1 review of Munidpel records that the above systems are /n ...... . cm mmence with MOA HAAgu/dellnes /n effect on this date. e A. Gayness;• Englneeea Pti N JEFFREY A. GARNESS —7953 Data S L//ar ��i�e�••........••''�oo P�ore�do�d HAAFee$ 3c�a.o0 Date of Payment Receipt Number pw- IZM Waiver Fee$ Date of Payment Receipt Number SETT BY TAC I F I C NF TITLE -AK 8- 7- 0 : 1:47PN PINT ALASKA -title 907 338 3246;# 2/ 2 N �2 �o iLu m uou q 1PTZUL a SUHLILS 7. r- - - -• '- - - - - -. . I I 1 I I I 1 I I I I I I I IIII AOOD FITMNLL An PAELYAYS I I G I I I I I I d� I � A• TROVORY 1 1 t I I I I. I I I I I I I I � uwATDErs I 1 1 �• 1 AS.BUILTSORVEY NERESY CIATRY TNAI I NAVt iIMOIMEO A ORTGA"I'S INSPECTION Of THE IOULOKNO 6CRISED AIOrem. T 1. NOCK 1, 6M1N6 MLS ESTATES Sto . / I ` NCHOMGE RECORDING D16TRICT. ALASKA AND THAT ON TIONS YTO I THE tINGSTR ESEREINGAS ..._m TT UNES ANO MO VILNE MB171yW NDTEp, STRUON CTURES AND PLATTED LINESEASEMENTS AND ANO PUTTED LOT LINE6 OR FASEIEHT9 AND 6 NOT 70 BeK! USW;OR POSff10NW0 AOOITONAL NOT 10 W;ORPANTGNING AcS,pON4L STRUCTURES d1 fENLBNES STRUCTURES OR FENS GATED AT ARhgAAGC, ALASKA EASEMENTS Of RECORD. OTHER THAN THOSE S/qRM ON TNERECOROm PUT, ARE N07 SNOYm NCAEON, OAYOF OCTOBER HOLT LATIO SVIIV[Ylli jj�J,R NOTE ANY IENCEIHES 3HOVM ARE LOCATED APPRCIX N LT AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES TSL. 34"s 13 OR LOCATE STRUCTURE& !UY-18-01 15:12 FRW- CG CT&E Environmental Services Inc. CT&EReLN 1012604001 Client Name AK Water & Wastewater Consultants Inc. Project Nanta# Lt 1 Bk 1 Spring Hill Est Client Sample ID 9201 Spring Hill sDr Matrix Drinking Water Ordered By PWSID 0 Sample Remarks: T-820 P.01/03 F-151 Client PON Printed Date/Time Collected DalcMn* Received Datef[ime Technical Director Released By --74i 05/18/2001 9:02 05/14/2001 12:07 05/1412001 12:45 Stephen C. E Allowable Ptep Analysis Parameter Results PQL Units Maw Limits Date Date Init Waters Department Nitrate•N 0.586 0.500 mg/L PPA300.0 Microbiology Laboratory Total Coliform 0 0 col/100mL SM19922211 0 t (<10) 05/14/01 SCL 05/14/01 KAP lUY-18-01 15:13 FROl1- T-820 P.03/03 F-151 LTE ME Environmental Services Inc. Laboratory Division P------/fir//W --- - 200 W. Porter Drive Drinking Water Analysis Report for Total Coliform Bacteria Anchorage. AK 99618.1606 Tel: 19071562-2343 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTINGSAMPLE Fax: (907) 561.5301 MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ® Analysis shows this Water SAMPLE to be: O PUBLIC WATER SYSTEM 1.D. R Satisfactory PRIVATE WATER SYSTEM p Unsatisfactory ( tufts D Send lnwice , »•mem...�����r! r.. v..o... lLas N-5X;r— a— p Sample over 30 hours old. results may be unreliable o Sample too long in transit; sample should not be oveT3lChours old at examination to indicate reliable results. Please send new sample via specia/l d live mail. Date Received S �'/ 6 Time Received S edR re +g _ Send Invoice Analvslc BRtan L ion1 44x_ 20 U Analyticcl Method: D. Memo rane MUG Iter e Numbe_r_of_eoloni_es/10001. Result* Analyst SAMPLE DATE: F431 WE FZF71 1012604 Month Day Year SAMPLE TYPE: XRoutine O Treated Water O Repeat Sample (for routine sample Untreated Water with lab ref. no. O Special Purpose Time Collected SAMPLE LOCA 1� ON C011eeted BY E `Lti7 Cf7.0/ S� lY�' Tj rl..wn.t ED ,ch Fbks Jun ❑ Fazed Date: Time: Client notified of unsatisfactory remlts: ❑ ❑ Phoee4 Spoke with Faxed Dae: Time BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Raaltt Total Coltrane E. Cali Membrane niter. Direct Count C J Coloalesl100 ml Verification: LTB BCD COLIFIRM Fecal Coliform COnfirmalian Find Membrane Filter Results Q CollferaY100 ml Reported BY ^X— �ate OL Time 030 bra Comments: LvrC- r.. N� T. C . n OR -Ou..a..m. 4DEMM Member of the sos Group (Soeieta GanMale do Sutv«llaneel ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA. FLORIDA, ILLINOIS. MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO' WEST VIRGINIA p a n L*l I�Q +\ 1) vs�- 0:! ) --,, 3 Municipality of Anchorage Page I of -3— DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW c?!PO364- PID Number: cn!5"~ c5 -,S-1 — 31 Name: LemeApk( I R Wastewater System: EJ New Vupgrade Address: 9 2.01 S`�►Za,uc, I�tG wcs 9g /b ABSORPTION FIELD Phone: � ! S3 3 U (aa No. of Bedrooms: )'Deep Trench ❑ Shallow Trench ❑ Bed []Mound ❑ Other LEGAL DESCRIPTION S'loiilRating: Total Depth from original grade: d. GPD/Sq. Ft. ' .6 4.2 Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe % 'I-pR t.0 6101 11, S Z. Q 3 • ct Ft. Q- 7 / S`• 3 Ft. Township: Range: Section: Fill added above original grade: Gravel length: CT Ft. Ft. • WELL: ❑New 1:1 Upgrad Gravel width: Number of lines: Distance between lines: 2— / FL > Ft. Classification (Private, A,B,C): Tot the Cased To: Total absorption area: Pipe Ft. Ft. I CJd SQ. Ft. _+material, / lii /30 Driller: ' Date Drilled: Static Water Level: Installer: Date installed: S Ft. CJWt-4& gI26/4 Yield:Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic O Holding T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Well -Number l2�j /6�� ln3l of Compartments: Surfac Watere 6e>oIT eoe" — LIFT STATION Lot // — Size in gallons: Manufacturer: Line Foundation ..Pump on" level at: m vel at: High water alarm at: Curtain ` Pump Mak el Electrical Inspections performed by: Drain Remarks:12 V_ LZ 2 u Co-ret,vB Atm BENCH MARK Location and Description: �•�C` Acont -r. Le, -rG 11, S°eonvO-�&r– Q n11 t 'CW c9 S A) 9A d:?IN CMNVL (2S Assumed Elevation: ENGIN SEAL > i hj d Inspections performed by: S Dates: 1st 4/23/4P3^�•'• 49th ......w�..•,1,° ° 2nd,.� Steven R. Pannone ' y. Department of Heal and Human Services approval CE -0149 11111, na Reviewed and approved by: Date: /D- q -9B414 . �,e 72-013 (Rev. 9/91) MOA 25 P.11. NO, 015-051-39 AS -BUILT PERMIT NO, SW9B0366 WASTEWATER ABSORPTION SYSTEM ro'. LOT 1, BLOCK 1 SPRINCHILLS S/D Clr ............ && ABBOTT LOOP ROAD 'CO A B C ............ T! ..... FP -,5 T2 30.4 28.7 C1 29.2 3013 EXIST'G 10009 C2 26,4 24.0 103.1 ti'FINTEGRITY FS 41.4 18.4 1 If C3 42.0 19.3 '.N T MI 59,2 33.8 SOO I. c �f 1! C4 693 68.6 C5 26.0 20.9 M2 48,5 52.4 0 EVENLY SPLIT EFF C6 623 69.1 EXIST'G DRAIN. FIELD IN FAILURE, ABANDONED: IN PLACE D NEW UPGRADE, Clr ............ && ABBOTT LOOP ROAD C,\Work\l-ISPRNG,DWG PREPARED FOR, Lee & Markle Caseloler 9201 Spring Hilt Drive Anchorage, AK 99516 (907) 346-1533 DESIGN PERC RATEi 30 MIN/INCL SOIL RATEi 250 SF/BR i 3BR HOUSE 750 SF REQUIRED 2 DEEP TRENCHES 5' EFFECTIVE, 50' ZONG: i1000 SF TOTAL 19' TOTAL DEPTH{ PANNONF.,,ENG. SVC P. I ..... D. -AIX• 142025 ANCHORAGE, ALASKA 99514 272-8218 Phone & Fax 1TE1 9-27-98 AS -BUILT -ALEi 11=60' d 5 ............ EXIST'G WELL, "IS- 'G 3 BR EXIST'G 10009 HOU E SEPTIC TANK 103.1 ti'FINTEGRITY II ER E1 V 9/1 110 .2 A i/BM F100.0 '.N T B T2 SOO I. c �f 1! 6,9 7,5 V) INSTALL FLOW SPLITTf 0 EVENLY SPLIT EFF bETWEE,N BOTH FIELDS EXIST'G DRAIN. FIELD IN FAILURE, ABANDONED: IN PLACE C,\Work\l-ISPRNG,DWG PREPARED FOR, Lee & Markle Caseloler 9201 Spring Hilt Drive Anchorage, AK 99516 (907) 346-1533 DESIGN PERC RATEi 30 MIN/INCL SOIL RATEi 250 SF/BR i 3BR HOUSE 750 SF REQUIRED 2 DEEP TRENCHES 5' EFFECTIVE, 50' ZONG: i1000 SF TOTAL 19' TOTAL DEPTH{ PANNONF.,,ENG. SVC P. I ..... D. -AIX• 142025 ANCHORAGE, ALASKA 99514 272-8218 Phone & Fax 1TE1 9-27-98 AS -BUILT -ALEi 11=60' d P,I,D, NO, 015-051-39 4, 0i a a u c o d q O Ll Lcl� �$ L Ll p 3.9'-1 ' 5,3 LD Li. O O I 1~ AS -BUILT DETAILS WASTEWATER ABS❑RPTI❑N SYSTEM LOT 1, BLOCK 1 SPRINGHILLS S/D m M m Cl\Work\1-1SPRNG.DW6 PREPARED FOR: Lee & Markle Casebier 9201 Spring Hill Drive Anchorage, AK 99516 (907) 346-1533 InoN 3Hnl NOlINOW 1nON PERMIT NO. SW980366 -36 ti 2 U Z U Ld L3Z 1- ❑ J W OD o Ld phi] U H LL ry n m s aj U U C N z ri l L _Y 4 w Ly 1nONV313 r � -N d N s r p4 p 1nONV3'10 4 o� a 0 rn 4, 0i a a u c o d q O Ll Lcl� �$ L Ll p 3.9'-1 ' 5,3 LD Li. O O I 1~ AS -BUILT DETAILS WASTEWATER ABS❑RPTI❑N SYSTEM LOT 1, BLOCK 1 SPRINGHILLS S/D m M m Cl\Work\1-1SPRNG.DW6 PREPARED FOR: Lee & Markle Casebier 9201 Spring Hill Drive Anchorage, AK 99516 (907) 346-1533 InoN 3Hnl NOlINOW 1nON PERMIT NO. SW980366 -36 ti 2 U Z U Ld L3Z 1- ❑ J W OD o Ld phi] U H LL ry n 1nONV3l0 NOUVQNnOj U N _C G FW-U� ❑ p Z i' PANN❑NE ENG, SVC. P. ❑, BOX 142025 ANCHORAGE, ALASKA 99514 274-0308 272-8218 FAX �TEI 9-27-98 ❑ TO SCA E AS -BUILT aj U ln0-NV310 C N im-NV2110 ri l L _Y 4 c S 1nONV313 Y -N d N as r�fL p4 p 1nONV3'10 4 o� a 1nONV3l0 NOUVQNnOj U N _C G FW-U� ❑ p Z i' PANN❑NE ENG, SVC. P. ❑, BOX 142025 ANCHORAGE, ALASKA 99514 274-0308 272-8218 FAX �TEI 9-27-98 ❑ TO SCA E AS -BUILT Municipality of Anchorage Department of Health and Human Services 825 "l_" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor http://www.ci.anchorage.ak.us October 13, 1998 Steven R. Pannone, P.E. Pannone Eng. Svc. P.O. Box 142025 Anchorage, Alaska 99514 Subject: Waiver Request for Lot 1 Block 1 Spring Hills Estates Waiver Request #WR980067 Parcel ID 401504139 Health Authority Number HA980324 Dear Mr. Pannone: Your request for a waiver of the required 10 feet horizontal separation from the west property line to two(2) wastewater disposal absorption trenches has been approved. The approved separation distances are 6.9 and 7.5 feet. This waiver approval applies to the existing wastewater disposal system to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On -Site Water Quality Program WR# WR980067 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet PID # 015-041-39 HA# HA980324 Date Received: Sept 28, 1998 Legal Description: Lot 1 Block 1 Spring Hills Estates Engineer: Steven R. Pannone, P.E. Permit # PO Box 142025, Anchorage, Alaska 99514 Applicant: Lee/Markie Casabier Waiver Requested: Lot line waiver of 6.9 and 7.5 from the trench to the west property line/ Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: X Waiver is NOT Granted: List Conditions or Reasons for above: &12S a;* AW,X PA -CH uPOW M1 tor-- Ll,vk- Fefty 6 *4- RI& Date: I "'y—yo BY: PKA/ Name of Reviewer Rec #: 04210/5667 Amount: $ 115.00 Date Paid: Sept 28, 1998 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 C'em ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT ❑❑❑ �� _c1� Upgrade `(� ,❑ Date Issued: Sep 17, 1998 Expiration Date: Sep 17, 1999 Permit Number: SW980366 Parcel ID: 015-051-39 Legal Description: SPRING HILLS ESTATES BLK 1 LT 1 Design Engineer: 0062 Steven R. Pannone Site Address: 009201 SPRING HILL DR Owner Name: Lee & Markie Casebier Lot Size: 36680 SQ. FT. Owner Address: 9201 Spring Hill Drive Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , AK 99507-4370 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 Alaska 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. Received BDate: n Issued By: / > �,_� Date: %' Steven R. Pannone, P.E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska, 99514 (907)272-8218 (907)272-8218 Fax September 14, 1998 Municipality of Anchorage Dept, of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot ll, Block 1 Springhills Subdivision, Emergency Septic upgrade System Permit Gentlemen: My firm was contacted to test the existing septic system for the referenced lot. The liquid level was found to be 4 inches deep in the foundation clean-out, and above the lateral pipe of the field. We conducted one test hole on September 10, 1998 for a the upgrade system design. The soils report and a percolation test results are attached. Ground water was encountered at 17 feet. No bedrock was encountered in the test hole. The lot is approximately 0.96 acres in size. Lot 1 slopes to the west at a rate of approximately 1-3 percent. The north eastern portion of the lot rises approximately 5 feet and then levels off. The proposed installation will be located on the western portion of the lot. The existing septic tank was inspected and found competent, and will be reused. The existing field will be reused. A diverter valve will be installed after the tank to control the direction of the effluent flow. Double clean -outs will be installed after the tank and diverter valve. The proposed location is greater than 100 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. Please contact me at 272-8218 or 227-3522 if you have any questions about the proposed installation. Sincerely, Steven fP nnone, P.E. Attachments: C:\WORK\l-1 Spruighills.001."pd 44th Steven R. Pannone 10,, C�E•8149 'mak P,LD. NO. 015-051-39 DESIGN PERMIT NO, SW98 WASTEWATER ABSORPTION SYSTEM LOT 1, BLOCK 1 SPRINGHILLS S/D . .............. .......... . ........... — — ---- ----- ABBOTT LOOP ROAD . ........ . .......... N891 c)'00gE ........ .. 3.9 2 Z' XIST'G WELL. �oo EXIST'G 10 Jt iST'G 3 BR .... HOUSE SEPTIC TA E0 co INTEGRITY� PROPOSED UPGRADE VERIFIED . L --,,DEEP TRENCHES l�.5.',EFFx501-Fx2'—� INSTALL DI VALVE ........... ... —10 AIV -1 Nw .. . ....... Alp 69 49RJ ............... ...... ......... C,\Work\l-lSPRNG.DWG ....... PREPARED FORT Lee & Markle Casebler G) AN CE 8149a of 9201 Spring HILL Drive ............ Anchorage, AK 99516 (907) 346-1533 ,.\PSTALL FLOW SPLITTE 0 EVENLY :NLY SPLIT EFF1 BETWEEN BOTH FIELDS EXIST'G DRAIN\FIELD IN FAILURE. TO"BE REUSE DESIGN PERC RATE, 30 MIN/INCH SOIL RATE, 250 SF/BR 3DR HOUSE 750 SF REQUIRED 2 DEEP TRENCHES �5' EFFECTIVE, 50'/LONG�E CH, '11000 SF TOTAL 19' TOTAL DEPTH PANNONE,ENU Svc P;.....0; BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 Phone & Fax aTF, 9-13-98 DESIGN PS.D, NO. 015-051-39 DESIGN DETAILS PERMIT NO, SW98 WASTEWATER ABS❑RPTI❑N SYSTEM LOT 1, BLOCK 1 SPRINGHILLS S/D U Z W (Y i 2 � } inONv310fL ,- 4• 5 d �. m ; l UL ..,... Z V W W d 0 3au HGENOW _ .� I-- �- J �l I�<.r't:•'>: W (L In I LJ fy 1 LL- inONe310 _ C3 z 4 5 wn w' J � 6 " 3m C Cs J r� Cr W NO _ !n0-NV313 3'1maa J -F d S Y o o >+ .InONV3n3 Z tls +• e m ¢ +, N -p ; L+ Lndi LONo ~ U1 O > 1nONV313 c a 9 0) �����•rr���, CF u 1 ° C + ..•.1•� N i' LTJ O.p C+�a r NOIlvQNnEu p O N rr : 492i i_ ...............................................% C•\Work\21-5TAL,DWG ;• .... .............I.......... r j R. Pannone; is PREPARED F❑Ri PANN❑NE ENG, SVC, .Steven ♦Icy `., No. CE 8149: Lee & Markle Caseloler P. ❑, BOX 142025 ♦j •. ¢�©q/�f ,.•° '++� ♦j��,D;a,�p1o�+� 9201 Spring HU Drive ANCHORAGE, ALASKA Anchorage, AK 99514 FAX (907) 99516 274-0308, 272-8218 �N►rr������ 346-1533 ➢ATEi 9-13-9d DESIGN ❑T T❑ SC L Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: l a -a * I%(uxli�. C A'SLl-r'[� l 1p-4- DATE P LEGAL DESCRIPTION:i2�.t%ftiiilLLS Township, Range, Section: DEPTH SLOPE SITE PLAN (FEET) I I I 1— j 1 1 1 1 1 1 1 1 . 1 2 +LL a2rgdwtcs 3 4 5 G(1Aww'%' S A�j7 6 '1G,M N 0 10 WAS GROUND WATER v ENCOUNTERED? r%S 11 S l IF YES, AT WHAT L � 0 12 DEPTH?_ P E Depth to Water Aft e t 13 Monitoring? f' Data: �� 1 } 14 A Ml- I S& -r oSr L—CS 51617 15- 16-- 17 18 19 =h ==Mmm ra .. � fiffw T 20 $iu a lul PERCOLATION RATE �j� (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND '� FT COMMENTS —T-t�.5'T HOL t3 -M51 -SC Fes- 612SOAV4M PERFORMED BY: �'�—���NN�N� 1 1 CERTIFY THAT /THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: �` ��C eg 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW 1- F� 1)\,✓1{1" 1' i �(/� JJ}`--�(r� j E] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION c( r LOCATION NO. OF BEDROOMS DISTANCE TO: Wellry�^ NU'�- Absorption ar a `� Dwelling,, / PERMIT NO. "2-f0 Vy .k-Vl �`lj h z W Manufacturer �j�� �/ � � �G" Mat r'Iyal No. of compartments I- 1 ee, N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth I t, 1, 0 ,�._ 4 Y DISTANCE TO: Well Dwelling PERMIT NO. _1Z = z h Manufacturer Material Liquid capacity in gallons O -j DISTANCE TO: Well I �� 1V0•' Foundation / Nearest-•ot�ine PERMIT NO, L 0 J LL Z No. of as Length of each line Y J"i'rJ'- Total length of lines Trench width Distance between lines F- z w a U7 inches cch Top of tile to finish grade 44 Material beneath tile / Total effective ab orptionj�rea e ,; - kxA 6o inches oo r/ Length Width Depth PERMIT NO. U-1 U a H Type of crib Crib diameter Crib depth Total effective absorption area wa W DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. ur 3: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 'I C.:L SOIL TEST RATING n �7 ' U INSTALLER l--)+, un ir��i �eC� Ir X Fro a OCA 6 REMARKS D 7 _ In, . e APPROVED DATE LEGAL Lo� 1 C31is 5'pr�ny H-1 k; 5(A6V 7 )�o 72-013 (Rev. 3/78) PERMIT NO: DHTE ISSUED HPPLICHvjT HDDRESS: CONTHCT PHONE LEGHL DESCRIP LOT SIZE� MR� BEDROOMS -1 1: Q X oil Q L. X W �B..;::: g.,,5 C.- � 11 S F91 IEH DEPHRTMENT OF HEHLTH HAD EMIRONMENTHL PI:;::OTECTION 825 L STREET/ HNCHORHGE/ HK 99501 264^4720 X Q-TH "T EE: r., '. 5 .51 W M L. Q 101 EE IT: I w I X 7' 7800 �EBHRR HNCHORHGE, �K 99504 ]]7676] SUBDIVISlON� SPRING HILLS LOT� 1 SECTION: i5 TOWNSHIPi2N RHNGE]W ]6680 (SQFTOR RCRES) ] BLO[K� 1 � �* GRHVE� L���T� } 75 FTREQUIRES |4ULTIPL� R�NS ** THNK MUST HHVE HT LEHST TWO CUMP8RTMENTS (NOT EXCEE[::1INf3 75 F'T. EI'l[[ 1) I CERTIFY THHT: 1 I HM FRMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HND WELL.S HS SET FORTH BY THE MUNICIPALITY OF RNCHORHGE (MOH) HND THE STHTE OF HLHSKH 2I WI'L INSTALL THE SYSTEM IN HCCORDHNCE WITH HLL MCIH HND REGULHTIONS/ HNDIN COMPLIHNCE WITH CRITERIR OF THIS PERMIT. I I WILL HDHERE TO HLL MOH HND STHTE OF FOR THE SET BHCK DI�THNCES FROM HNY EXISTlNG WELi/ WHSTEWHTER DISPOSHL SYSTEM OR PUBLiC SEWERHGE SYSTEM ON TH1S OR RNY HDJACENT OR NEHRBY L.OT. 4. I UNDERSTHND TH8T THIS PERMIT IS VALID FOR H MAXIMUM OF ] BEDROOMS HND HNY !ENLHRGEMENT WILL REQUIRE HH HDDITIONHL PERMIT. IF H LIFT STHTION IS INSTHLLED 114 HN BRER COVERED BY MOH BUILDING CODES/ THEN (1) RN ELECTRICHL PERMIT RND INSPECTION MUST BE OBTHINED/ LTS WILL NOT BE HPPROVED WITHOUT HN ELECTRICAL lNSPECTION THE ELECTR1:CHL WORK MUST BE DONE BY 8 LICENSED ELECTRICIfill, r 8 1< SOILS LOG MUNICIPALITY OF ANCHORAGE • +.c" DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR:�/ti DATE PERFORMED: LEGAL DESCRIPTION: L. Ci -41, //S' I SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS 6r5c3Ntc 5W, dvr (04 S�H� 5:'��y Crravz� dr 5; ley �ravt� dry scl"a fury (6M /SM) WAS GROUND WATER S X10 ENCOUNTERED? - N0 L p O l� P IF YES, AT WHAT E DEPTH? 11 11 •-- 6fln .4 ReadingDate Gross Time Net Time Depth to Water Net Drop ¢ a Lu 1 13 -g VA /W 4121 0 0,50,501 n. j8 0.1L v •L u'.4 yl: S3 :l0 0,so oqz 0.01; 11:54. 6.5L +WL()3 Wo 4- 'lo 0544 6.08 105, �v.1 :Iv v.44 6,ot Iz"16 u. it 0,56 o.4- O!oL Iz' I2'.37 : )u o.44-- 050E PERCOLATION RATE %. YJ (minutes/inch) TEST RUN BETWEEN _7,5 FT AND FT A r4rd e d !7 ¢ `Z 3 (l .F'±'L 1 �7dron i+, 3 LI MA PERFORMED BY: b6vAy1eY' / (r(k[-eS CERTIFIED BY: /v%0 4 72-008 (6/79) DATE: M -W DRILLING, Inc. P.O. Box 10.378 • 10300 Old Seward Highway (907) 3498535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner Location (address of: Township, Range, Section, if known; or distance main Loi; 1 ?3:Loc : 1 CnrinF: 114-.11s, W Ancl orvt_e Size of casing Depth of Hole " feet Cased to feet ??u of Well ,o Static water level -) ft. (above) (below) land surface. Finish of well (check one) open end ( ) Screen ( ); Perforated ( ). Describe screen or perforation- Well erforation Well pumping test at 5 gallons per (hour) (minute) for I hours with of drawdown from static level. Date of completion WELL LOG �.I i, Ci 1d, Depth in feet from ground surface Give details of formations penetrated, size of matgrJi al, ,cojgl &r{d h� •dness -4 c I y (} TO —TO TO C iC TO L 1 1 TO TO TO —TO— O TO- TO TO— TO TO— TO TO TO "as%111' i;t1 ckir, Erwin :;,.ltr Brawn SiUv Gray Gray i V 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 015-051-39 1. GENERAL INFORMATION HAA # V �( Complete legal description Spring Hill Estates, Lot 1, Block 1 Location (site address or directions) 9201 Spring Hill Drive, Anchorage Property owner Robert A Barbara Fiddes Day phone 346-8202 Mailing address 9201 Spring Hill Drive, Anchorage, AK 99507 Lending agency N/A Mailing address Agent N/A Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 N 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water Day phone Day phone 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 X 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 421 6 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 Eagle River Engineering Services Phone 694-5195 Address P_0_ Rnx 773294, Faglp Rivpr Ax 9 577 Engineer's signature /�'`�V�11— Date�a �A5 6. DHHS SIGNATURE Approved for_r�°� _ bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: By: c'`ti`` `' "-�2 Date &? _ / ' y;Z- 111Ttc 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 theirlending 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 (Rev. 1/91) Back MOA U21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Ips Legal Description: 5&,QIN&) N/t L 4S % Z07-113141 Parcel I.D. to/ 5 __ y J/ " 3 ! A. WELL DATA Well type / el(1,47'k If A, B, or C, attach ADEC letter. ADEC water system number 1,//A Log present (Y/N) Y`S Date completed 6)')/Z M?11 Driller M - k) Total depth Z J ? , Cased to Z 3 2 Casing height /J Sanitary seal (Y/N) Y&S Wires properly protected (Y/N) yC 5 FROM WELL LOG AT INSPECTIOf4UNICIPALITY OF ANCHORAGE Date of test �') I �{ 4 OV// /�rij(IRONMENTALSERVICES DIVISION Static water level Z/Z / /// %2j''G `' ' 2 G 1992 Well flow Pump level (//&/K/(Dw/1/ SEPARATION DISTANCES FROM WELL TO: Septic/halding tank on lot 7� 106 g.p.m. 6''P R ECnE I V E V /sIIY {T N/iN rJ ; On adjacent lots f /00 / Absorption field on lot / 33/ ; On adjacent lots /-/()0 Public sewer main Public sewer manhole/cleanout /VSA Sewer service line Petroleum tank N°j,J e x.,g2. ti WATER SAMPLE RESULTS: Coliform '` Nitrate 0''/ 12nG / /— Other bacteria Date of sample: def //��2- Collected by: C/V62/N6ee B. SEPTIC/H1DLM tG TANK DATA Date installed 0'1/ 2Z/ Tank size /000 Compartments Z_ Cleanouts (Y/N) yds Foundation cleanout (Y/N) y/5 AS Depression (Y/N) Ali High water alarm (Y/N) IVIA Date of pumping Alarm tested (Y/N) / `/) / Pumper SEPARATION DISTANCES FROM SEPTIC/HOL-QtUG TANK TO: Well(s) on lot On adjacent lots Foundation 2.5 i pj! 5W P - D i To property line /0 Absorption field /Z' Wateraitahl/service line ;4- 50 Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y. Manufa ManhoWA'ccess (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lo y' On adjacent lots D. ABSORPTION FIELD DATA "Pump off' level at Cycles tested Surface water _ Date installed 0,)// g�l Soil rating %,5 System type t / Length U Width 0 Gravel thickness 5 y Total absorption area )ao o Cleanouts present (Y/N) Ti -e "/ c 1. Total depth VES 1-Y, 3/ Depression over field (Y/N) /Ufa Date of adequacy test 0? 12 2 - Results Results (pass/fail)y4SS for bedrooms Peroxide treatment (Past 12 months) (Y/N) A//A If yes, give date 1(/1A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1,33 On adjacent lots )1 /00 Property line r / 11,4)yEecU oy//? i To building foundation /I To existing or abandoned system on lot LV/� '�O/) On adjacent lots .� d Cutbank Al/y�/>t Water n�a+�r/service line Surface water �/OD r Driveway, parking/vehicle storage area f ( v Curtain drain MNI E. ENGINEER'S CERTIFICATION o 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name 1e Date 1f r� 0� HAA Fee $ Waiver Fee: $ Date of Payment -y:z--� Date of Payment Receipt Number ;237X4� � •`�3 ,� Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Eagle River Engineering Services 11940 Business Blvd, Suite x}205 P.O. Box 773294 694-5195 Eagle River, Ak. 99577 Fax 694-3297 Legal: SP19/I)I 1Mon eor Level �L r'` !07,/ GPM Owner: fob;.Arr,7 //"1?- �� a�R� �lb�s Date: 7//5z Type of test: ❑ Well Flow Test ❑ Septic Test Only I�AWell & Septic Test ❑ Other: Time Meter Reading 1Mon eor Level Well Level Tank Level GPM PSI Remarks //"1?- 7 s 6 ° _ / 9 ' 73. 7�-' `, Y b /b .ver frti� Mrd - 41;0 �'7G F5-87�r � 73.5" .7 vvirc /06 yd/, 2 1 `I ' ? 3• G , S' 13sfil or Id . 'y3 97710 '(,5- sIf:sCI I G-CI 87666 59.7x' LI 7,16 / 73,S 6, Z: 6 97960'c sp, iS Y'o,o — )3. a! LB 8806040, ",a rl.Lsr m ( 7 12; v3 gSjbo300 — /i 73. 6 6 Hoeg 3Zb0 s-6 sz,zr /S5 73- 6,7 coo A- 5/O04- 23E6iv 5z 4',. CvvEIP _ s a:2ti:0 D YU,7s /Ss 6'r 3: 12- ;a) I �,vv v WEL4 %1 Sl 3 zS.,on ss2.5 Y8,r 3: 5a: 30 H/au,- no 4uar I — MoNnoe 1080 L — CnST NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 • FAX 274-9645 Eagle River Engineering Report Date: 08/14/92 P.O. Box 773294 Eagle River AK 99577 Date Arrived: 08/11/92 Attn: Louis Butera Our Lab #: A119634 Location/Project: - Your Sample ID: Springhill Sample Matrix: Water Comments: Method Parameter EPA 353.3 Nitrate -N LeU4/1-cj Reported By: Susan C. T'fental Microbiology Supervisor Date Sampled: 08/11/92 Time Sampled: 1540 Collected By: MD MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Units Result Flag MDL Analyzed -------------------------------------------- mg/l 0.4 0.1 08/13/92 NOR rHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE SPECIAL INSTRUCTIONS FAIRBANKS, ALASKA 99701 907-456-3116 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT ❑ PUBLIC WATER SYSTEM I.D. # PRIVATE WATER SYSTEM 1� 12 ES NAME P/, 6OY- 2 1:3 2-9!�� Mailing Address nk 9 9,512 1 ,„ City State •/ Zip Code IM (P914 31--9 . SAMPLE DATE: ©y 92- Phone 5/95 Mo. Day Year Purchase Order No SAMPLE TYPE: XRoutine ❑ Special Purpose ❑ Check Sample (for original contaminated ❑ Treated Water XUntreated Water n sample with lab reference no. ) "`Semple Time No. Location Collected Collected by Laboratory Ref. No. 1 /ZINC r _ 3- Yo /1.0 A15 + FALL. 2 3 4 5 6 7 8 9 10 Signature of Representative FOR LABORATORY USE ONLY CASN CHARGE PREPAIDTRAN ITTAL SPECIAL INSTRUCTIONS MAIL HOLD FOR PICKUP TO BE COMPLETED BY LABORATORY Received at: X Anch. / ❑ Fbks. Date Received D� 1 Time Received J Next Sample Due . -. COMMENTS: SATISFACTORY CS) UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT DATE AND TIME ANALYZED 8/11/92 16:30 MEMB, ANE FITLER Direct Verification Final Count LSB BGB Result* Comments 0 T *No. of Total Coliform C to s per 0 mis. i L--t—� Re ! by Date � /� /�V/)o Time OF P1,,GN0o'q ON 0 /f ~ N\CPj-S`5�g��CEs MUNICIPALITY OF ANCHORAGE M� eN ";t,tM PDEPARTMENT OF HEALTH & HUMAN SERVICES JU�2� DIVISION CERTIFICATE OFNOPECTION OR HEALTH AUTHORITY APPROVAL k J qg _CZDQ OF ON-SITE SEWER AND WATER FACILITY R V 4• 264-4744 Application Date 7-29—Fl? 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) / 916 C_K / S PRIN6 ///,C 4s FSTATF� s Location (address or directions) G fl//_L /J/. (b) Property Owner Ji i 4 y 6e'A /V C/t Telephone: Home Business Mailing Address 7201 SP#?1k6 N/41 OR Abt/`t. Ak i%s-47 If.? 7.0 (c) Lending Institution Telephone Mailing Address // n (d) Real Estate Company and Agent ReMAX %—�1 e4 ,(7 Arr,'e r (e) Address Telephone Mail the HAA to the following address: or: Check here if hold for pick up. List contact person and day phone number below. &dX Pojgf 3 y9 -6W 2. TYPE OF RESIDENCE Single -Family A Number of Bedrooms 13 3. 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 x Public ❑ Community ❑ Holding Tank ❑ Note: If communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front NUS 19818 Aael Seo-& Z 10 Z abed -�JoM s,iaaul6ua leuolssajoid ay) ul suolsslwo ao saaaa aoj alglsuodsaa jou sl abeaogouy jo A111edlolunlnj ayl panssl sl ajeoljljaao a aaolaq elep az/leue jo suolloadsul jonpuoo lou op SHHO jo sea/\oldw3 'sjuawajlnbai ajels pup 1paapaj uleljao Alsiles 01 aapao ul suoljnjljsul 6ulpual alayl pup sawoy jo saasegojnd of (salanoo e se slyl saop SHHO N -L e�sely jo a1elS 8y1 ul paaajsl68a aaaulbua leuolssajoid juapuedepul up Aq anogp 9 ydeibeied ul uanl6 suoijejuasajdaa ay1 uodn Aluo paseq sojeoipjAeo lenoaddy /jlaoyjny ylleaH sanss! (SHHO) saolAaaS uewnH pup ylleaH to juawljedap a6eaoyouy 10 Ajlledlolunlnl ayl NOunvo lenoaddy leuoljlpuoo jo swaal leuoll!puoo panoiddesla >0 panoaddy alga � �j' ,(q swooapaq Ic ao1 panoaddy IVAOdddV SHHO • �,� �'� S.�y-f �O .S -{i ,S-woa✓OJ7 � J � �T bn6,p(/ B c4 8 Z—L oleo OS �/ 17 an yf 8 0 2'� ssaaPPV S9 _ 6 euoydalal 44, U —P S a g Wald 10 aweN -uoljoadsui s!Ul jo alpp eqj uo joalle ul suoljeInbei puu'seoupulpio'sapoo 91e1S pup 1pololunlnl ilia y1!m aouelldwoo ul sl walsAs lesodslp AelpMalseM Ao/pue Rlddns jelpM ails-uo aul 'uoljoadsul pup uolle6llsanul AW woaj pup sallj abeaogouy jo tliledlolunVq ayj woaj paulelgo uoljewaojul aU1 uo paseq jeyl (juaA jayUnj I •ulaaay pajeolpul ainjonils jo adAl pup swoapaq jo aagwnu ay) aoj ejenbape pup leuoljounj'ajes sl wags (s lesodslp AeleMalseM ao/pue (lddns jalim alis-uo aUl jeUl sMoys lenoaddy Allaoglny ylleaH sly) jo uolle6lls8nul Aw legj Ajuan I 'anolaq UM04S ajep uolleplleA ay) jo se pue ojaaaq paxilju leas Aw Aq paljllaao sy 9 NOIIVWHOdNI ONV V1VO `HOHV3S 3l1d `S.LS31 `SN01103dSNl JNIOIAOHd WHIj ONIH33NIJN3 '9 MUNICIPALITY OF '�;;CHORALE DEPT. OF HEN PIVCIPALITY OF ANCHORAGE (MOA) ENVIRONMENTALFk"CHIT" THORIFEBRUARY ITY AHAA) CHECKLIST84 291988 264-4744 Legal Description: /oT � / 106k RECEIVED 5'PR/N6 /sI-4r�s- A. WELL DATA Well Classification 5iNgle 17�4t)"- Y If A, B, C, D.E.C. Approved (Y/N) —��/✓% Well Log Present (Y/N) _ Y — Date Completed4- 7._1? 7`y 1;1 Yield�+~ �r+� (.trA SrC*j'r) Total Depth Cased to 4- -2 3 Depth of Grouting MLI Static Water Level I // s Pumo Set At UNKMO Casing Height Above Ground Sanitary Seal on Casing (Y/N) X Electrical Wiring in Conduit (Y/N) % Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot �UU 'F On Adjoining Lots /CIO To Nearest Edge of Absorption Field on Lot On Adjoining Lots © y' To Nearest Public Sewer Line N/W To Nearest Public Sewer Cleanout/Manhole N To Nearest Sewer Service Line on Lot yid Water Sample Collected by Nay IP90 Date 7-2 2 S— Y* Water Sample Test Results Comments 600 'W#4eole) f""loc� fes f- 4- IAL. B. SEPTIC/HOLDING TANK DATA Date Installed * 7-16 `Y y Sized� 0 b 0. ,1A No. of Compartments ;1 I -L, Standpipes (Y/N) y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) Date Last Pumped 7 ",2 Pumping/Maintenance Contract on File (Y/N) ;for Holding Tank High -Water Alarm (Y/N) —NIS Temporary Holding Tank Permit (Y/N) Nv—.4 Separation Distances from Septic/Holding Tank: To Water -Supply Well 100 i"- To Building Foundation 13 To Property Line �2 CJ To Disposal Field /a To Water--Main/Service Line .h To Stream, Pond, Lake, or Major Drainage Course NoN Comments Morn 014113' records Page 1 of 2 72-026 fRev 81861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata `f% 2 %s ZldfAr. Type of System Design Date Installed 7._ ��'- y Length of Field /1 qo Width of Field 3 Depth of Field )E- p Gravel Bed Thickness *- 6 - Square Feet of Absorption Area 1 00 Standpipes Present (Y/N) Depression over Field (Y/N) /AU Date of Last Adequacy Test 7 -.ZS �-Y? Results of Last Adequacy Test r7 d 2q uA �c tCy � 3 i5 ed f -o el S Separation Distance from Absorption Field: / To Water -Supply Well X00 f To Property Line iM14a-_)J To Building Foundation �Z To Existing or Abandoned System on Lot N �ffi On Adjoining Lots To Water hkaiti/Service Line �r To Cutbank (if present) Na To Stream/Pond/Lake/or Major Drainage Course /v,/117, To Driveway, Parking Area, or Vehicle Storage Area SIC Comments L' �7 k 'ri d M /7/. f Q � /S C� GO d J' D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments — Dimensions Manhole/Access (Y/N) "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** 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 Company MOA No. Receipt No. '� r Date of Payment Amount: $ Page 2 of 2 o`l 72-026 fRev 8/86) Rack e 0044 Municipality of .Anchorage K Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 10, 1988 Besse Epps & Potts 2220 East 88th Avenue Anchorage, Alaska 99507 Attention: David Grenier, P.E. Subject: Waiver Request for Lot 1 Block 1 Spring Hills Estates Subdivision Waiver Request #WR88-044, #H88-0302 Dear Mr. Grenier: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 5 feet at the eastern end of the trench and 7 feet at the western end of the trench. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, tpa'y�/�" AP --?Z Daniel J. Roth Civil Engineer On-site Serivices DJR/ljw#7 July 26, 1988 Municipality of Anchorage Department of Health and Human Services Enviromental Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Waiver Request, Lot Line Separation Distance Lot 1, Block 1 - Spring Hills Estates Gentlemen: This is a request for a waiver from the lot line separation distances specified in AMC 15.65.040. This section of the code specifies a ten foot separation between any portion of a wastewater disposal system and any property line. The separation distances found on subject property are 5 feet at the Eastern end of the trench and 7 feet at the Western end of the trench (see attached As -Built Survey). The system is the same as it was when installed and approved in 1984. Also attached is a copy of the As -Built of the neighboring lot to show that granting this waiver will have no siginificant impact_ on this lot. There is sufficient room for replacement systems on Lot 21 should they be required. The owners of this lot are out of town until late September and we are therefore unable to obtain a letter of non -objection. The closing on subject property is scheduled for late August. Thank you for your cooperation on this matter. Sin re y, David Grenier, P.E. jmm Enclosures ENGINEERING, PLANNING, SURVEYING 2220 P. 88th Ave. / Anchorage, Alaska 99507 / Telephone 907-349,645-11344-1352 "Providing a quality personalized service to those building Alaska's future" BESSE, EPPS & POTTS 2220 EAST 88 AVENUE ANC"iORAGE, AK 99507 (907) 349-6451 WATER WELL TEST Date: 7- Subdivision: ,Vr,'nia - Lot: / Block: / C:ienc8s Name: it .4�� Address: S✓e L=;tial Reading on Meter: 3 o F o DRA;i DGIN 'IME GPM GALLONS A VOLUME G.e11 o HS y-arA t F;•e/ d Mo � ; {o�,(c�e(` METER READING 21 Q '`/v -7 5.3 3 o b'S Z ,/" G:-5-5 S'� (2 2 .2- ' 1 /1: os p e7 S, d 39' 2/l' ;% S `/S S. 1 tj 09vZ �,2S l/ 3D S& S 5' -Z t ! 7 NI( NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479.3115 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-271.8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT ❑ PUBLIC WATER SYSTEM I.D. # PRIVATE WATER SYSTEM i Ise, NAME Melling Address Clry State Zip Code SAMPLE DATE: _ 2S -eff Phone 1�91' 399-69sl Mo. Day Year Purchase Order No. SAMPLE TYPE: Routine ❑ Special Purpose ❑ Check Sample (for original contaminated sample with lab reference no. ❑ Treated Water ❑ Untreated Water Semple Time No. Location Collected Collected by Laboratory Ref. No. 1 e1 42"o0 , 1zq- 2 3 4 5 6 7 8 9 10 Signature of Representative FOR LABORATORY USE ONLY CASH CHARGE PREPAIDMNSM L SPECIAL INSTRUCTIONS MAIL HOLD FOR PICKUP TO BE COMPLETED BY LABORATORY Received at;, rCJ Anch. ❑ Fbks. Date Received /' 2S -V Time Received /Iy/' Next Sample Due _ COMMENTS: SATISFACTORY UNSATISFACTORY RESAMPLE OTHER BACTERIA TOO NUMEROUS TO COUNT Direct Verification Count LSBBI GB so U R OB TNTC Final Result- Comments d I "No. of TotalColiformColonies per 100 mis. Reported by Date ^np Time NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 9074793115 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907277.8378 Besse, Epps, & Potts 2220 East 88th Avenue Anchorage, Alaska 99507 Attn: Andy Potts Date Arrived: 07/25/88 Time Arrived: 1346 Date Sampled: 07/05/88 Time Sampled: 1200 Date Completed: 07/29/88 Source: L.1/B1-Spring Hills Sample ID#: A072588-30 -------------- Parameter Unit Nitrate -N mg/1 Result 0.31/0.31 ADEC MCC* 10 Reported By: C�--`----------------------Date-----07/29/88 Francois Rodigari, Anchorage Operations Manager ---------------------------------------------------------------------------------- * MCC = Maxinnnn Contaminant Concentration NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS. ALASKA 99709 907-4793115 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907 277 8378 Quality Control Report Client: Besse, Epps, & Potts Ill#: A072588-30 Listed below are quality control assurance reference samples with a known concentration prior to analysis. The acceptable limits represent a 95% confidence interval established by the Environmental Protection Agency or by our laboratory through repetitive analyses of the reference sample. The reference samples indicated below were analyzed at the same time as your sample, ensuring the accuracy of your results. Sample # Parameter Unit Result Acceptable Limit EPA WP 284-3 Nitrate -N i / k mg/1 0.14 0.10 - 0.18 ISAACS PUMPING SERVICE (Norm Tibbetts, Owner) 6218 Quinhagak Street ANCHORAGE, ALASKA 99507 Phone 563.3300 348 48 o accompanied by [his bill. 'Aank'i'ou PAOCOC1609 M,ve Inc. Ov".11mu 01471 /O l \ cy V A•l1o.a0 t X35, 6•' 1 � ^..-- /��''I \� /77 eDlptr, LEGEND O LOT CORNERS, . \\ ` FOUNDATION �-- DRAINAGE ARROWS OF A4R; T ;*,d I. IT SHALL BE THE RESPONSIBILITY OF THE BUILDER OR OWNER TO VERIFY THAT I• •• ••. .•• •••••••` BUILDING LOCATION SHOWN MEETS ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES. • ••u••• •r• •• •••••rr•r•••u® 2. Il' IS THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATIONS WITH Andrew r'. Potts TO ALLI1T11_ITIF.S. 1V!�'.No. 3514-S :• �� 3. THIS PLAT REPRESENTS THE PARCEL. OF PROPERTY DESCRIBED BELOW TAKEN •.�� •. S`V FROM THE RECORDED PLAT DESCRIBING THAT PARCEL. INSTRUMENTS RECORDED 11`� •,•�••••••�••'4 �,• PRIOR TO OR AFTER THE FILING OF THE RECORDED PLAT ARE NOT SHOWN ON THIS PLAT. E33JUNA I60 -mW 4. THE INFORMATION ON THIS PLAT IS FOR THE USE OF LENDING INSTITUTIONS A �\���►0�` /�� ///� SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS ,THE PLAT IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCEB, Y� SURVEYORS CERTIFICATION I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DESCRIBED ON THIS PLAT AND THE IMPROVEMENTS SITUATED THEREON ARE LOCATED AS SHOWN ON THIS PLAT. pp yy DATED THIS 21 DAY OF-46K—II0 .., 349-6452 ,(�/A //Sf+,//' !�%�d IT • 7- 26 8 9C.� �i Gs*CHK. DY ,A5 6U/.LT �a7 d6K / VV VVI.-, V I I V VII V I I V 2220 E. 88th. AVE. ANCHORAGE, ALASKA 99507 349-6454 SCALE, /', a-, I C-CDWO.NO. DATE I y -2f -6'fI FLO. OK. 1 v�d�ae 7-2G^$�d It) 30 I I r / , ago t77.8 3 1� y.tGEND 3 12/Ik/ 0 LOT CORNERS FOUNDATION (�L DRAINAGE ARROWS �" ••/,� NOTES: .>• r/ -� :• I. IT SHALL BE THE RESPONSIBILITY OF THE BUILDER OR OWNER TO VERIFY THAT BUILDING LOCATION OW (aT SHOWN MEETS ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES. .•. ..� y.•... �,�,�•�,� ;14 ,` ,�" P V. IT IS THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATIONS WITH RESPECT TO ALL UTILITIES. • ,,,••,,,,,.,C .................. FA YI-� Andrew F. Potts �C`r,A; 3. THIS PLAT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW TAKEN oe' 4, � FROM THE RECORDED PLAT DESCRIBING THAT PARCEL. INSTRUMENTS RECORDED c- , ISO. 3J14 -S PRIOR TO OR AFTER THE ,•'.�D,'"d �tY�^,y •e� �j� a/ FILING OF THE RECORDED PLAT ARE NOT SHOWN ON THIS PLAT. �e• � v��> X✓ 1'4�°j' r 4. THE INFORMATION ON THIS PLAT IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLYCONFLICTS EXISTING STRUCTURES AND �✓'A nf ��"q, .0.y �J,/ljY�,,�►•-��.. y' PLATLOT LINESS OR EASEMENTS THE PLAT'I IS TTO BE USED POSITIONING ADDITIONAL STRUCTURES OR FENCES. v/ - SURVEYOR S CERTIF CATION I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DESCRIBED ON THIS PIAT AND THE IMPROVEMENTS SITUATED THEREON ARE LOCATED AS SHOWN ON THIS PLAT. O �� DATED THIS '�j'0 DAY OF ��_.,191L.._. AS- P�UILT' /_07' 2� , /.3,4DG/K / ,5 PRiVr, /-/i,,4 s 17-5 ra 7-,L S BESSE, EPPS 81 POTTS 2220 E. 88th. AVE. ANCHORAGE, ALASKA 99507 DRAWN BYSCALE- /"-.j01 C -C CHK. BY: DATE, —,b -9'V FLD. BK. DWO. NO. 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING e n - J,A Parcel I.D. # ®fes = 051-3 HAA # 1. GENERAL INFORMATION 3. 4 Complete legal description L 2 T ( t MLocL I i4/LCL aszq—c? S Location (site address or directions) `Z?C) t % Q tum Property owner GtrE 111AROIR CLiSc3tt/e'vA— Day phone Mailing address 2_?I G Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water Y Day phone Day phone 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 X 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 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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'�-AvNo,.�tx gNc,, S\lCPhone z�z—}32IR Address 7-�'0k I ANC`l_ A 6 161�S7(-/ Engineer's signature Date Ql2r�/4Pi 6. DHHS SIGNATURE -X Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: St*ven R. Pannone I,^,- CE-8149 ,CCE-8149 ,K::' 1. �'n�'Tt i �Jviti�{-abt 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 courtesyto 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 (Rev. 1/91) Back MOA #21 Municipality of Anchorage R E C t V DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division pp� 19 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-944 Municipality o norar�e Health Authority Approval Checklist Dept. Health & I-turnan Services Legal Description: 4 1 IMI.5 1�2tA); 01 LlS Parcel I.D.: ®/`S — 0,S_/—Z `? A. WELL DATA Well type'2kyA-rt--t If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed �7-Z?--- S L( Total depth Z Sanitary seal (Y/N) Date of test Static water level Well production Cased to Z3? FROM WELL LOG `:? /2-,18 If WATER SAMPLE RESULTS: Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION WZ6 % 48 z© 7- g. p. m. 60 Coliform O Nitrate Other bacteria Date of sample: 4Collected by: S,V�AAM1o.0 cC- B. SEPTIC/HOLDING TANK DATA zYa Date installed 74h.119c/ _ Tank size 1 ne7ca 2 Number of Compartments Z Cleanouts (Y/N)__j-� Foundation cleanout (Y/N) Y Depression (Y/N) (✓J High water alarm (Y/N) Date of Pumping c►/I k/4e Pumper 420'c-o'TP-u t&;Y2_ C. ABSORPTION FIELD DATA Date installed q%6 19 0 Soil rating (g.p.d./ft2 or ft2/bdrm) b. 6 System type 'D T l Length Width Gravel thickness below pipe 'q• ?%S3 Total depth 8-6 ! 4•'2- Effective absorption area Monitoring Tube present (Y/N) i Depression over field (Y/N) X1.7 Date of adequacy test A W Results (Pass/Fail) 00,LQ For bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES Size in on" level at* *Datum "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic/holding tank on lot On adjacent lots Absorption field on lot a3 On adjacent lots Public sewer main t.) /A loo "F Public sewer manhole/cleanout Sewer /septic service line Lift station / (,c,+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 41 i Property line Z2` Absorption field qS= Water main/service line 410 Surface water/drainage loo's- Wells on adjacent lots 141(74. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: W A%v4Z2 _;ix Property line 6•c?' Building foundation / q Water main/service line Surface water /rsoi- Driveway, parking/vehicle storage area Curtain drain / Oo 4 Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that t have determined thru field inspections and review of Municipal in conformance with MDA HAA guidelines in effect on this date. Signatur Engineer's Name �t�ti�Aunlo.uc3�� 4a, Date `t12-,-z�4�p) HAA Fee $ _SL)a nr) Waiver Fee $ j � cc) q n /o r �tems are ti «.«..... Date of Payment Oli cg -0) Date of Payment O�, Receipt Number C)LAQ 1t� `� �'�� ) Receipt Number c) L( "A\0 72-026 (Rev. 3/96)* OCT -02-99 16:07 FROM -CTE ENVIRONMENTAL CT&E Envlmonmental Services Inc. •ceuorrr� 6918301 T-899 P.02/03 P-776 CT&E ReP.a 985597001 Client 1?0# Client Name Pannone Eng, Srv. Printed Date/Time 10/02/98 09:59 Project Name/i! Front Hose Collected Date/Time 09/28/98 09:00 Client Sample 11) 1-1 Spnng Hilis Received Date/rnme 09/28/98 10;13 Matrix Dnnkin8 Water Technical Director: Stephen C. Ede Ordered By PWSiD Released By n n I I n Samp a Remarks: AILowElple Prep Analysis Parameter .4esut rs PDL units molnod Limits Date Date Init Tota! Coliform 0 cot/100mL WS 92229 09/26/98 KAP Nitrate -N 0.535 0.100 mg/L EPA 30n.0 10 max 3v/28/98 09/28/98 ccp OCT -02-98 16:08 FROM. -CTE ENVIRONNi:NTAL 5615301 T-698 P. 09/08 F-778 �1ME Environmental Services Inc, WW Laboratory division �v,+4rw�v����rns�►s��irrrirrsi.#as n%ing Water Analysis Report for Total Coliform Bacteria A0 a► alt. r drive,a.,aos 7 14VS7RUt."ilONS ON REV£RSESIDE BEFORE COLLECTING SARPU Tel: (907) 552.2343 Pall: 15071 551.5301 MUST BE COMPLETED BY WATER SUPPLIER 0 PUBLIC WATERSYSTIMI.P.0 k PRIVATE WATER SYSTEM M IN Rause ca sad r,Mae I s;t�t1i 16L I FROW YID w t • Cl S4iad Rsrxlrr 0 SAINO10 rmt4 Yr 3A`1PLE DAM Mdstit Ray Year WIAPLE TYPE; 3 Raurine i Ropers Sample (for routine sampler with lab ref, oo.�) 1 Special Purpose ;AMPLE LOCATION , — Q Treated Water Cr LIKIM d Water Time Collected colleaallil or ze rAW hW ,tmenu: .analysis Shows thio Westar SAMPLE IA ba - PL Suisfaotory C3 Unusisfactory 0 sampte over 30 hours old, mulls may be 4rimlitble 0 Sample too long in trtinsil; sample should not ba ovar 48 hours old at examination to indiaaa reiiabie rp"llsy Please send new samplo ria1 a q v mail. Dare Reeeived Time Received Analysis Ressm I LP ✓ Analytical Method: �¢-�Vjambtanp Piitu O hlMd�ivI1JG • NtunheroftrolaniesllOpmt. - — - Routs* Aaalytt 985597 -. nelt MR ,1118 Fstsd Duo: T11ns: � MOM notified ofunsstisfaetory results. Q 13 Pitaaeo $pow wills Faxed 04M rune BACTEMOLOGICAL WA'V'ER ANALYSIS RECORD MNICHMUG Reaalk Total coliferet cou mamorspa lriiltar. mi Verifiterloer LTA „ 5GIb COLIF1R1N� r='rwAW� Tow Irl ai couro mCallflrosoew QQ rat eawti• Ffasa NIMisrarve Piltee Resales G� g ) coliferwl10a nil Reperscii B7 ��� `�+� s Date +.t-�++-.� T .w..- bra ue 5t+rvamancet 8 AONMONTAL FACILITIES IN ALASKA. CAUFoaNW FLORIO& ILLINCea. MAAyLANO, Mtt:FOGArr, MISSOURI. NEW a4Rti4Y, ONTO, w%$T VIRGINIA MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL IiEAI.TH DEPARTMENT Of HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name} > //u._L._ -Telephone -- Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder Buyer 1:�—j ; Other F—I (explain); (d) Lending Institution —.------------Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence S Ingle -•Family ,,i1 - Number of Bedrooms 3. WaterKSup )I - Individual Well Multi. -•Family F- 1 Community Other. (describe- Public describe Public L1 Notre: 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 'f/- Public GCommunity = Holding Tank Note: If community well system, must have written confirmation from the Stot.e Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] S. Engineering Firm Providing Inspections Tests, File Search Data and Information izp 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 onsite water supply and/or wastewater disposal. system is in compliance with all. Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm 97 S Telephone Address'-"? ":>C> I f i£s F=� �}�, 1 i;.- 1L ��t�_._ '9P, Date -- — - -- - ��� `J 1 _�— _ do �_ _ _ _ ;'car e• rig oF y u IX (ENGINEER SEAL) ` oe� u�occ;,c uJo .c UJucrau - far7777 S. Mey t 6. DEEP Approval��� s�°�Je 635 f Approved for 5 bedrooms B i Da Le r-� j: Approved Disapproved Conditionalu Terms of Conditional. Approval. CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMEN'T'AL PROTECTION (DEEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH S ABOVE BY. AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED _IN THE STATE OF ALASKA. THE DEEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR IENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DEEP DO NOT CONDUCT INSPECTIONS OR ANALY7.E DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DEEP SEAL) RR4/ej/Dl8 [Page 2 of 2] 7-1.9.84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA MUNICIPALITY OF ANCI_Ir,;,,,_L DEPT. OF HcFtLf;; GNVIRONMENFAL P1,uj;C1 ,)N ±SSP 1 �I 1984 RECE1vrm Well Classification Siiv�Lr Irvi. If A, B. or C, D.E.C. Approved(Y/N) ':Cl__v Well Log Present (Y/N) Y Date Completed -7/a7/oV Yield 2 GOM Total Depth Z37' Cased to Z:� 7 Depth of Grouting Static Water Level 2/?/ Pump Set At Casing Height Above Ground 2 Sanitary Seal on Casing (Y ) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)A' Separation Distances from Well: To Septic/Held-ing- Tank on Lot /Dal- ; On Adjoining Lots 16()",- To b()tTo Nearest Edge of Absorption Field on Lot loo) - On Adjoining Lots I od-r- To Nearest Public Sewer Line 0& To Nearest Public Sewer Cleanout/Manhole_ /N. To Nearest Sewer Service Line on Lot y®�� Water Sample Collected By k?,? Date®o_ ��o%✓� Water Sample Test Results S�}rj.S�Acrc�ym Caments W,4RE12 WL- rLow a B. SEPTIC/H8EDI-NG TANK DATA Date Installed 74/0 Z/ Size __ZobLL. No. of Compartments 12 - Standpipes (Y/N) Y Air -tight Caps (Y ) Foundation Cleanout (Y/NL_ Depression over, Tank (Y/N) Al Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Al ® Temporary Holding Tank Permit (Y ) Separation Distances from Septic/Holding Tank: To Water -Supply X11 >bo To 'Building Foundation_^ 1 3 To Property Line 2-5 ' To Disposal Field To Water Main/Service Line N To Stream, Pond, Lake, or Major Drainage Course -_----- Comments es P Items 2 9 [Page 1 of 21 2-15m84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed `��61011 Length of Field 901 Width of Field 3 Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (YM) y Depression over Field (YM) /V Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Fb11 )Uc+ To Property Line 8� To Building Foundation b n To Existing or/ Abandoned System cn Lot N� On Adjoining Lots Nl4 To Water Main/Service Line NIA To Cutbank(if present) ^1 To Stream/Pond/Lake/or Major Drainage Course 111A To Driveway, Parking Area, cr Vehicle Storage Area ti e s� Comm nts Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** T row+ifv +hat- T hava ehackad. verified, or, conformed to all MOA HAA on the date of this inspection. Signed LV Date 9 /y� v � r� Company C c' �r� S MOA No. d c� °d KBl /d5/s (Page 2 of 21 in effect U �oaoro�o a p V `s CiMCbt`77i�{'d� cooaeo uo e l S� " _ Carlo S. May®.' 'e 6353 °dap _ 2-15-84 i CHEMICAL &c GPOLOGICAL LABORATORIES OFLASKA, INC. `r TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER ..a.•.o.., 5633 B Street Drinking Aater Analysis Report for Total Coliforr i Bacteria TO BE COM 1 - WATER SYSTEM: WATER SUPPLIER (') See h on back k I.D. Nn. 3e-19-64 1 Water System Name Phone No. Lo I c c` Mailing Address 2220 j�;7- 064-L tdE City i� /UGH • State A K. Zip Code SAMPLE DATE: F07 --b 2 Dj Mo. Day Year SAMPLE TYPE: Zr outine ❑ Check Sample (for routine sarriple with lab ref. no. ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 2 3 I _ 4 I II 5 TO BE COMPLETED BY LABORATORY Ar4lysjs shows this Water SAMPLE to be Satisfactory ❑ Uns&j�sfactory ❑ 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 J �� Analytical Method: ❑ Fermentation Tube ;.I Membrane Filter Lab Ref. No. Result' [Analyst i I •Noof colonies/ 100 ml or No of Povnve poruom. 06.1220 (e) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1993 MEAD INSTRUCTIONS Membrane Filter. Direct Count Coilforml100ml Verification: LTB BOB t — Final Membrane Filter Results Q Coll ormlt00ml BEFORE Reported By r�h-�c, +— vllin . Date Time: /'77 -)CC, a.m. COLLECTING SAMPLEP.m. � TNTC = Too Numerous To Count 1 Municipality of Anchorage ot Development Services Department y Building Safety Division s . On-Site Water and Wastewater Program 4700 South Bragaw St. s. :.r P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL i FOR A SINGLE FAMILY DWELLING kI!)Parcell.D. 0-051-39 HAA# u3032�l Expiration Date: /0 1. GENERAL INFORMATION Location (site address or directions) 9201 SPRINGHILL ANCORAGE, AK Current Property owner(s) PETER STOKES Day phone Mailing address same as above Lending agency Day phone Mailing address Real Estate Agent SHAYLENE ERNISE - _Prudential Vista Dayphone 273-7311 Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: _3_ 3. TYPE OF WATER SUPPLY. TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) 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. (Certificates 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(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-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 KND ENGINEERING- Ine- Phone (907) Rgs Ll Engineer's Printed Name Kenneth M. Duffus Date 7/11/9no3 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE OF .44 All '• 9 CE 7116 - ... ».. PROFESSION Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: O r� TE G� WATER AND • rn WASTEWATER Attachments: PROGRAM ' HAA Checklist x Maintenance Agreements Septic System Advisory Supplemental Engineer's Report ►>> Well Flow Advisory Otherr377yllll By: Original Certificate Date: %' �� D Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchomge.ak.us (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SPRINQHILL EST, 87. L7 Parcel ID:_061-051-39 A. WELL DATA Well type private if A. B. or C provide PWSID # Date completed JULY 27, 1984 Sanitary seal (Y/N1 Y Total depth—_23Z—jt. Cased to 237 ft. FROM WELL LOG Date of test Z/2 7/10114 Static water level 212 ft. Well production 5 g.p.m WATER SAMPLE RESULTS: Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 1 8 " AT INSPECTION 71212003 204 f. 5.5 9— p.m- Coliform __Q__golonles/100 ml.Nitrate 0.676 mgA.Other bacteria __I__colonles/100 ml. Arsenic: _KA mg.A. Date of sample: 7/7/2003 Collected by: KND Engineering B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7119 8 4 Tank size 1000 gal. Number of Compartments Cleanouts (Y/N) i Foundation cleanout (Y/N) -Y—Depression over tank (Y/N)JJ—High water alarm (YIN) JWA Date of pumping 7/2/2003 Pumper OLD MCDONALD'S C. ABSORPTION FIELD DATA 9/2(0/1-79$ Date Installed 9/4%2= SpIl rating (g.p.d.& or felbdrm) JLJ System type TRENCH Length 1Q0 -110 51'. 10 49,811'_ _$ Width 6 ft. Gravel below pipe _4.7' /5.3' ft. Total depth ' ft. Eff. absorption area 1007.2 fe Monitoring tube Y Depression over field H Date of adequacy test 712/03 Results (Pass/Fall) PASS For 3_bedrooms Fluid depth in absorption field before teq 37.9/DRY in. Water added Oso gal. New depth34.6111.5 in. Elapsed Time: 1440 min. Final fluid depth 27.9/DRY in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump oW level at in. "Pump off level at In.High water alarm level at in. Datum Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ On adjacent lots 10 0 ' + On adjacent lots 10 0 + Public sewer manhole/cleanout 100'+ Holding tank 10 0 ' + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line -5-Lt + Absorption field 5 ' + Water main * 10'+ Water service line 10'+ Surface water -100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10 + Water Service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain 50'+ Wells on adjacent lots 10 0'+ F. COMMENTS 1: sl2litter may not be diverting the flow evenly •:U=%1 the two trenches. 11 equal amount water - : • to the 1w• trenches, T1 % 1 • 1 1 = 11 tren 1 - • % [t 1 • / Pie too half of 1 % syste 11 CERTIFICATIONG. ENGINEERS I certify that / have determined through field inspections and ANY 4- review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. t3e..!• , • • Engineer's Printed Name Kenneth M. Duffus y N ' 'Q Kenneth Date 7/11/2008 % Cf. 7t ib •S'���, HAA Fee $375.00 Date of Payment Receipt Number �! (Rev. 12101) J Waiver Fee $ Date of Payment Receipt Number 7-10-03; 6:62PM; ;907 6616301 # 3/ 3 • CT&E Environmental Services Inc. 200 W. Potter Drive Anchorage, AK 99518-1605 0./ll_/ Telephone: (907) 562-2343 Facsimile: (907) 561-5301 200 W. Potter Drive )rinking Water Analysis Report for Total -Coliform Bacteria Anehbrage, AK sss18-1605 Tel: (107) 07) 562-2343 READ..INKS'T�ZULTILjNSOJYRL' BIS•Sk,S1P $ I�ORECOLLEt'TINCSAMI�LE Fax: ($07)561.6301 MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. # JV PRI VATE WATER SYSTEM )k_SendA.esulu '}�. Sendlnvofce {a,4irt altl SyfleN P.—Aa LM esc � CY•4 Pron 3?�tt : tlm3793 COW wo Zip O SendResufts O Sendlnvoice Yr•Y :vM Abe,11N Lube{ • (y zip ode SAMPLE DATE: Month SAMPLE TYPE: )S. Routine ltewt 4*06(46 ❑ Repeat Sample (for rottfine satri'ple withlab reL•tio. O Special Purpose SAMPLE LQCATIOPT Comments: FA0 7 aU Day Year n MMtraueG ❑ Treated Water O Untreated Water Tlme Collected Collecteil By MAU rent Analysis shows this WAter SAMPLE to be: Satisfactory ❑ Unsatisfactoy O Sample.over 30 hours old, results may be unreliable ❑• Satirjilti too lift iii.transit; sample should not be,ovet,�{VItoilrs old'at examination tb indicate reliabttr results. Please send netv_.sample via special delivery.mail Date Received �� ��✓ Time Received,2:[� Analysis Began Began 18(S Analytical Method: 'OT'1Vlcmbrane Filtu - n MMtraueG 00 ml. 1034004 Result* Analyst fSentto A O.E.C. Anrh Fbks Jun Q . Faxed t Date: Time: Client notified of tinsatlsfactory• results: Pha d Spokewitb Faxed Date: Timm BACTERIOLOGICAL WATER ANALYSIS UC RD MidiO-MUG Result: Total Coliform_ e ,,11 4 1w Coli Membrane Filter: Direct Count We, 4 -col; Colonles(300ml Verification: LTB BGB Fecal Coliform Confirmation Final Membrane Bitter Results Reported By Date COLIFIRM Coliform/100 ml Time lO. �y� firs �����embero1heSGS Group isocidt6GEtndraledoSurveillancoi TNTC -Tao Nt,,,.w ro Ceunr OB - other Beerrle 7-10-03; 5:52PM; ;907 5815301 # 2/ 3 a SG9 SCS Ref.# 1034004001 Client Name KND Engineering Project Name/# Spring Hill Est B 1, Ll Client Sample ID Spring Hill Est B1, LI blatrix Drinking Water All Dates/Times are Alaska Standard Time Printed DateMme 07/10/2003 14:55 Collected DateMme 07/07/2003 8:45 Received Date/Time 07/07/2003 9:20 Technical Director Stephen C. de Released Sample Remarks: Parameter AILonatbsle Prep Analysis !nit Qualifiers Results PQL Units Method ContainsID Date Date Waters Department Nitrate -N 0.676 0.100 mg/l. EPA 300.0 B (<=10) 07/07/03 JJB Microbiology Laboratory Total Coliform 1 OB, No Coli coVI00mL SM19 9222D A (<=1) 07/07/03 JS SEM BY:PACIFIC AB TITLE -AK ; 8- 7- 0 : 1:47PY : Wr ALASKA-tititfl� 907 338 3246:9 2/ 2 N S4*10 00115 TE WCO WTION HEREON R FOA TMC Lm Of LEMDNO NSTRUEIOW A►i OCAUYTO SNOW UNMHTLCTS tETTVEBI ENSTIN0 STAUCTUMS Aro RATTEO LOT LKS OR EASENItIM AND 0 HOT TO K Ipm 8011 POUrK"w AOOITIOMAL SMULi{RGS OR FCNMINES CASCHCHTC Of RECAMI OTHEri TAA THOU AHDwa ON THE RECAROCD PVT. RRC NOT SNOWM "CRCON. NOTE AHI PfMCMP43 mrWMIN ARE LOCATED APPAWANTELYWO ARE NOT TO Of MOM OMANINC PROKMLMES ON LOCATE FO.r+CNnGC uuc{ INSPECTION OP lois FOLLOWING em E, vms+ro AG sus MATES we. )0 f MACE AECOAOHO OICTIOCT. to ANO MAY nOv4rtM($ INTWTEO THMEON AMC WITNN THE aT LINES AND NO VASrIIL 6NGROA00ANTS W6T oe le R. errell � °v No. 2055•C � . e Location. 2'.2.20 Le4:i:4 88 ill Ei.'AUL .e.Ica sacaAGa e AK 99507 ( 907) 349--G451 WATER MLL 'iF.:i`i' Date: /ZI�t Subdivision.��I� Lot: 1 Block: Client': Name: WoDL Addcess: Tester: P Initial Reading on Meter: 'q TIME GPM GALLONS _ A VOLUU11 QkLLONS ` CY!Ai:, VOLUME 2,51 7. 7 to _211 617 SUE _ ! t a , NC12ES: 6o r AQ _ 7, - 3 (5 M Production Rate: '7.2- GPM 24-hour Capacity Gallons