HomeMy WebLinkAboutEAGLE CREST #2 BLK J LT 2AEagl
t/ 2
Block
Lot 2A
#0§0-293-96
'J ' · GreA'--r ANCHORAGE AREA Bor IIGH /' . .~.~__¢-/.~' i
I _~ ..... //.,-7"T Y~'I '~::.',,o-
~ S~AGE ~ISPOSAL SYSTEM i APPLICATION AND
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
FINANCED THROUGH
/~/
COMPLETION DATE ANTICIPATED
SEEPAGE PIT DRAIN FIELD
TO BE INSTALLED ElY ~.~Z~
OTHER
NOT£z THIS PERMIT I$ NOT VALID WITHOUT SOIL, 'TE:ST
/~ ~ ar /o/
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION,
/~/~k~.~~'
MINIMUM DISTANCE:S, REQUIREMENTS
...~- /
FOUNDATION TO SEEPAGE PIT
DRAIN FIELD
/O ·
DIAGRAM OF SYSTEM
SEPTIC TANK ~ / SEEPAGE PiT .
WELL TO 'EPTIC TANK / ~ /
DRAIN FIELD ~/ ~ ~ /
SEEPAGE PIT ~
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
CONFORM TO ~OROUGH REGULATIONS REG,~RDINRDING INSTALLATION.
-"} " o.~... '- ~ · ' /'
~. .-~ ,~ '~.-~ ........ ... '.:... . .
O a- E GEOTECHNICAL 6'- DEVELOPMENT CO.
Box 90, Davis St.. Eagle River. Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Soils Et Foundations
Earl EZl/s
688-2280
Land Development
SOIL LOG
Perfomed for: Hame:,
Legal Description:
Depth (feet)
0
1
2
3
4
5
Hatllng Address:
$otl Characteristics
7
8
g
10
11
12
Ground Water Encountered:
Proposed Installation:
Comments: ~ .. c
Perfomed by:
Yes ~/ No ]f .yes, what depth
Seepage Ptt Oretn Fte~d v~
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION /' ~ tot
DATE-Started ~;'/
PERMIT NUMBER
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
ST.~IC LEVEL OF WATER Fr.
Ended (;A~. PEr ItR ~O O
. KIND OF FORMATION:
From O Ft. to ~ Ft.
From ,~. Ft. to q Ft.
From /~ Ft. to/.~_._FI.
From I ~:' Ft. to_._lA.g~Ft.
From fOO Fi. to/$~ Ft
From Ft. to.__,Ft.
From /2~' n. to/</? Ft.
From //'] 5 Ft. to 1o-~'~ Ft.
From/-~".~ Ft. to /.~"~,
From FI. to Ft,
From FI. to Ft.
From Ft. lo Fl.
r,o,o F,.,,, F,
Fro,. ~t~~.
DEPT. OF HEAL~ &
From
no m
"Ft. t~ Ft.
From/.~"4 FI. to/61 Ft. ~"4"d'0 ~'~fiu~,-,~
From Ft. to Ft. ~
From Ft. lo Ft.'
From Ft. to Ft
From Ft. to__--Ft.
From ~ Ft. to ' Ft.
From ~Ft. to Ft.
From.~Ft. to FI.
From
From R E _C _~._V, .1~
From ; ~ FI. lo FI
From__.Ft. to FI.
From~.Fl. to FI.
From Ft. to Ft
MISCL. INFORMATION:
DRILLER'S NAME p--'-'~J ~'?~'~"'
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Eimore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.or9/onsite
(907) 343-7904
CERTIFICATE
FOR A
OF 0N-SITE SYSTEHS APPROVAL
SINGLE FAHILY DWELLING
Parcel I.D. 050-29~- 96
COSA# C r lll/ D--
1. GENERALINFORMATION
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
EAGLE CREST ¢2; BLOCK J, LOT 2A
18636 CITATION ROAD *EAGLE RIVER, AK
JENNIFER DONNELL
Day phone
18656 CITATION ROAD *EAGLE RIVER, AK
207-287-5295
Day phone
CRAIG BENNETI' W/ KELLER WILLIAMS Day phone 24-2-5251
101 W. BENSON BLVD. SUITE 503 *ANCHORAGE, AK 99505
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well ·
Individual Water Storage []
Community Class Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site []
Public Sewer ·
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems
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 samples. (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 !NSPECT!ON _Y ENG!NEE~
As certified by my sea/affixed herefo and as of the validation date shown below, / vedfy t~at my
investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guideiines for this appiication,
sho~;s that the on-site water supply and/or wasC, ewater di~osa! ~ystem is (are) safe, functional and ~dequate
for the number of bedrooms and type of structure indicsted herein. I further verify that based on the
on-site water supply and/or wastewater disposal system is(are) in compliance with afl appficable Municipal
and State codes, ordinances, and regulations in effect at the time of installation,
Name of Firm GARNESS ENGINEERING GROUP, Ltd,
Phone 337-6179
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis 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
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being 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 guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA 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
other person or party is not author/zed, nor will it confer any legal right w,~atsoever.
DSD SIGNATURE
v/ Approved for ~
Disapproved.
Conditional approval for
bedrooms.
, ' " ..
bedrooms, with the following:~:~'iations: · ~
Attachments: ~OS,~, ~,heck,~t
Septic System Advisory
Well F/ow Advisory
m r~ ~ ^ ~' ': .....
(Rev. 11/05)
.~.Fsen!c ~,.d v!~o~ y
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:_
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.rnuni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
CHECKLIST
Legal Description: EAGLE CREST #2; BLOCK J, LOT 2A
Parcel ID: 050-29-396
WELL DATA
Well type PRIVATE
Date completed
Total depth 161
9/,86
ff.
If A, B, or C provide PWSID# N/,A
Sanitary seal (Y/N)YES
Cased to 160.66.ft.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+
in.
Date of test
FROM WELL LOG
9/86
AT INSPECTION
Static water level 133 .ft.
130 ft.
Well production 15 g.p.m.
5.24 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi. Nitrate 4,72 mg./L. Collected by:
Arsenic: ND ug./L. Date of sample: 4./11./11
GE(;. Ltd.
B. SEPTIC/HOLDING TANK DATA
PUBLIC SEWER
Tank Type/Material Date installed
Tank size gal. Number of Compartments Clean~
Foundation cleanout (Y/N) ~ Dep~ High water alarm (Y/N)
. Pumper.
ABSORPTION FIELD DATA
Date installed
Length ft.
Soil rating (g.p.d./ft2or ft2/bdrm)__ System type
Width .ft. Gravel below
Total depth .ft. Eft. absorption area__ ft~ Monitoring tube ~~epression over field
Date of adequacy test Results (P~ss/Pa~"'"'~ For bedrooms
Fluid depth in absorption fie~ in. Water added __ gal. New depth in.
Elapsed Ti~ Final fluid depth in.. .... .A_b. ~.orption rate >= g.p.d.
An ' enation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at__
,in.
Eo
Size in gallons Manhole/Access (Y__(_(_(_(_(_(_(_(~ ~
"Pump off" level_..a~. High water alarm level at,
Cycles tested Meets alarm & circuit requirements~
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main 75'+
Sewer/septic service line 25'+
Animal containment areas 50'+
in.
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
100'+
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
PUBLIC SEWER
Building foundation Property line Absorption field
Water main Water service line. Surface water ~
Wells on adjacent lots ~
SEPARATION DISTANCE FROM ABSORPTION FIELD ,O~ TO:
Property line Buildi~tion Water main
Water service line ......-.~Su~ace water Driveway, parking/vehicle storage
Wells on adjacent lots.
COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. (:;ARNESS
Date
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SGS Ref.# i il 1359001
r'~i~n*~ ...... No-,~...~ Garness EngiT~eering Group, Ltd Printed Date/Time '~v-,/l' a/~a~y/~vi ] .... lo.D2
Project Name/# Eagle Crest 2 BJ L2A Collected Date/Time 04/11/201 l 17:45
Client Sample [D Eagle Crest 2 BJ L2A Received Date/Time 04/12/2011 14:55
Matrix Drinking Water Technical Director Stephen C. Efle
PWSID 0
Saml~le Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5~00 ug/L EP200.8 C (<10) 04/18/11 04/19/11 NRB
Waters Department
Total Nitrate/Nitrite-N 4.72 0.100 mg/L SM20 4500NO3-F B (<10) 04/12/11 AYC
Microbiology Laboratory
Colony Count 0 col/100mL SM20 9222B A (<200) 04/12/11 DLC
Fecal Coliform 0 col/100mL SM20 9222B A (<1) 04/12/11 DLC
Total Coliform 0 col/100mL SM20 9222B A (<I) 04/12/11 DLC
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P,O. Box 196650 Anchorage, AK 99519-6650
www, ci.anchorage,ak, us
(907) 343-7904
0
CERTIFICATE Of HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ~)~'~--:~.q3-Q/o
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Expiration Date:
Current Property owner(s)
Mailing address
Lending agency
Day phone
Day phone
Mailing address
Real Estate Agent
Mailing Address
Un/ess otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY: '
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site []
Public Sewer ~
The Municipality of Anchorage Development Services Department (DSO) Issues Certificates of Health Authority
Approval (HAA) based only upon the represent~tinns 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 sewed by a single-family on-site wastewater disposal and/or water
supply system. DSD atso issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for g0 days from the date of issue for prel:erties se,wed by a private or Class C we!l and may be reissued with
new water sample results. (Certificates may be reissued for a pedod of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells cra 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 vedfy that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this appfication, shows that the on-
site water supply and/or wastewatar 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 flies and from my investigation and inspe~on, the on-site water supply and/or
wastewater disposal system is(are) in compliance w~th all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of instaJlation.
Address L~.~_~ I..V../,c~ L~ r'llo ~_.
Engineer's Printed Name
DSD SIGNATURE
~ Approved for
Disapproved.
Conditional approval for
Phone ~
...--.., :: ~ - .....;-:.~;,.~
--~,~,.0-.=.'~ ,v ...
¢,~.;... ..... /. .... - .......
bedrooms. { ?,.~,,. ?..~,...,~::..:)q~,,, .
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev, 01,~2)
if/.
Original Certificate Date: ~ . ~..~.0-
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Sbe Water & VVastewatar Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage, ak. us
(9O7) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~' L :~-- # I.o'~' ~.~. E' . .' Parcel ID: 030 --~.q~- q~,
A. WEll DATA ' I ' ~
Well b/pe ~- IfA, B, or C provide PWSlD# H~ Well Leg (Y/N) ~/
Date completed ~/8g Sanita~/seal (Y/N) ~/ Wires property protected (Y/N)
Total depth I (o ~/ ff. Cased to J~ I ff. Casing height (above ground)
FROM WELL LOG
Date of test
Static water level
Well production /-~
WATER SAMPLE RESUL'r~:
Coliform ..~colonies/100 mi.
Arsenic: mg./I.
ft.
g.p.m.
Data of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size gal.
Foundation cleanout (Y/N)
Date of pumping
C. ABSORPTION FIELD DATA
Number of Comments
DepraSSp~m~=r tank (Y/N) .
AT INSPECTION
/::~ ~' g.p.m.
Other bacteda ~ colonies/100 mi.
Collected by: ~'~ ~t o~' V- [~
nouta (Y/N)
water alarm (Y/N)
Date installed Soil rating (g.p.d.~/~ ~/bdy
Length ff. . Width/ / ff.
Total depth ff. Eft. absorption a~l~ y Mo_ni~dng tube
Dete of adeduacy tast / Resu/(P,.~.Fail) -- --
Fluid depth in absorption field befo~-'~est i~ Water added
Elapsed Time: min. Final fluid depth in.
Any rejuvenation treatment (pest 12 mo.) (Y/N & b/pe)
System type
Gravel below pipe ff.
Depression over field --
For bedrooms
gal. New depth in.
Absorption rata >= g.p.d.
If yes. give date
D. UFT STATION
Date installed
'Pump on" level at tn.
Datum
E. SEPARATION DISTANCES
.S, ize in gallons / ,/'~Manhole/Access (Y/N)
Pump o~vel at n/. High water alarm level at
cy~.~.~/.'/ M.~.,... & ~r~, ~,,ir. mo.~?
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Sepl~c\ ....
tank/ll/t:~fation on lot
Absorption field on lot ~/,~-
' /~o' -
Public sewer main
On edjacentlots t~_
On adjacent lots
Public sewer manhole/cteanout
Sewer Isoptic se~ce line ~~ ~
Holding tank
SEPARATION DISTANCES FROM SEPTI~IOLDING~;~ANK ON LOT TO:
Building foundation .~,rty Iln,.~ Absorption field
Water main "Water serv..jg'e line Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM~SORPT1ON FIELD ON/~T TO:
P...,,.e /..,d,ng foundatio.___/___ W. tar ma,n
!
Curtain drain i/ Wells on adjacent 116'ts
F. COMMENTS
G, ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance wfth MOA HAA guidelines in effect on this date.
Engineer's Pdnted Name ~~
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/O1)
Waiver Fee $
Date of Payment
Receipt Number
~j~'l~__ CT&E Environmental Se~ices Ina.
CT&E Ref.~ 1023314002
Client l~ame Tobben Spurkland P.E.
P rojecl Nimrda
C]~eat Samplt ~D L~I 2a, ])lc ~' £age] Crest
IH a,rtx D rL',king W&t~r
Ordcred By
PWSID 0
Sample Rcm~:
pa:'emtte~ Res~.lu PQL
UnIU Method
All Detes/Tlmes are Ale~i SteodenI Time
l'rlnled D~tetTIme 06/13~002 16;1~
Collected Date/Time ~/! 1/2002 9:30
Received D~te/Tlme 06~11/2002 12:35
Technlcl] Director Stephev/e~Ede
AlIo~,~le Prep Amlxsh.
Limh~ D~te Date l~it
Ni~a:c-N
3.~3
0.200 m~L EPA 300.0 (¢101
l~i e z~ob:1.o ~ og'y
Total Colifon~
I OB, No C~li
col/100r~ $M18 9222D
¢<1~,
06~11/02 SBH
~OOl
~o=~
P,,OI
ASBUILT-NO CORNZRI SET T~I$ DATE.'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION ' l
Complete legal description . Lot 2A=~'B].Ock'~.L' P"lagle Crest Subdivision'~Z..
Location (site address or directions)
Property owner
Mailing address
Robert Parks
18636 Citation
Eaqle River, AK
Day phone
c/o Eva Loken/REMAx EAGLE RIVER, AK
e
Lending agency
Mailing address
Agent Eva Loken/ REMAX EAGLE RIVER
Address 16600 Centerfield Dr. Eagle River,
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
Day phone
Dayphone 694-4200
AK 99577
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm .~', ;;,~;,,'l-'l:RlN~ -'"""7 Phone ~/~/2/_~.r_~'~ ~'
I ~'~34 Eagle River Loop Road Ne. 20~
Address Eagle River. AI.,I,, ~,~'~ / / -
Engineer's signature
DHHS SIGNATURE
~x~ Approved-for'~-~'° (2.~)
~ Disapproved.
~ Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: ,,~--'-<-- ~
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 indu~,endent
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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~
A. Well Data
Well type '~,.,/~
Log presen[~l)
Total depth ~o'
Sanita~ seal'N)
If A, B, or C, attach ADEC letter, ADEC water system number
Date completed c~ ~ ~:,t.. Driller
Cased to ~ t.~o' q5'~ Casing height
Wires properly protected (~TN)
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main ~ ~°t ~
Sewer service line "~"5~
; On adjacent lots
adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform 4~)
Date of sample: G- ~o.-~'.~
Nitrate '~..~ ~
...c~ '~ Collected by:
B. SEPTIC/HOLDING TANK DATA
Other bacteria
S & $ ENGINEERING
17034 Eagle EIv~' Loop Road No. 204
Eagle River, Alaska 9~$77
Date Installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
SEPARATION DISTANCES FROM ~G TANK TO:
Well(s) on lot ...-"/On adjacent lots
To p~ Absorption field
St~'~ce water/drainage
.Tank size Compartments
Foundation cleanout (Y/N) Depr~..ession~ _
.Foundation
Water main/service line
72-m~ (3~3)- F.x,t CONTINUED ON BACK PAGE
C. UFT STATION
Date installed
Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) 'Pump on' level at 'P~
High water alarm level ~
Meets MOA electrical codes (Y/N)
SEDATION TO:
~ On adjacent lots Surface water.
D. ABSORPTION FIELD DATA
· Date installed
Length
Total absorption area
Date of adequacy test
Soil rating (GPD/FF)
.Width .Gravel thickness
.Cleanout present (Y/N)
Results (pass/fail)
Wa~er lev'el In absorption field before te~t
.System type
.Total depth
Dep~/N)
Peroxide treatment (past 12 months) (Y/N) Jif yes, give date
SEPARATION DISTANCE FROM ABSORPTI~ '
TWoe~u;l~in( tg foundati°n J To existin g or abandoned sy'On'adjacent I°ts ~stPer(:mP;n irtY~e
On adjacent lots
Curtain drain
Cutbank
Water main/Service line
Driveway, parking/vehicle storage area
Date of Payment
Receipt.umbar-
'/2-~28 (3~3)* Back
Date of Payment
Receipt Number.
E. ENGINEER'S CERTIFICATION
I cer~[y ~at I have checked, vedfied, or confon-ned to all MOA and HAA guidelines in effect on the date of this inspecEon.
-- ¢ O,"~A'?*'-~. .-.
Signature $ & S ENGINEERING ~~, ,,:~.. ~'~
17034 Eagle RI~ Leop~Roa~
Engineer's Naq~l. m~.~ ~1.~ ~77 /
HAA Fee $ / '~0 Waiver Foe $
, .MMERCIAL TESTING & ENGINEERING CO.
ONMENTAL LABORATORY SERVICES
· ,.c, ,~. REPORT of ANALYSIS
Chemlab Ref.~ :93.3038-I
Client Sample ID :L2A B J EAGLE CREST ~2
~atrix
5633 B STREET
ANCHORAGE. AK 99518
TEL: (907) 562-2343
FAX: (907) 561-5301
Client Name :S & S ENGIN~_~ING WORK Order :67623
Ordered By :R. SHA~ Report Completed :06/29/93
Project Name : Collected :06/24/93 @ i2:00 hrs.
ProJect~ : Received :06/25/93 @ i7:15 hrs.
PWSID :UA Technical Dlrector.'ST~.~J~. EDE
Released By'----.~. ~//~
Sample Remarks: ROUTINE SAt~PLE COr~cl'~D BY: RAY.
QC Allowable Ext. Anal
Parameter Results Qual Units Hethod Limits Date Date Init
Nitrate-N 2.46 mg/L EPA 353.2/300.0 10 06/28 LLH
* See Special Instructions Above UA = Unavailable
** See Sample Remarks Above NA = Not Analyzed
U = Undetected, Reported value is the practical quantification limit. LT = Less Than
D = Secondary dilution. GT = Greater Than
~S~S Member of the SGS Group (Soci6t§ G~n6rale de Surveillance)
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